2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T7f2,The aim of this study was to compare clinical, performance-based, and patient-reported outcomes between patients with moderate-to-severe hip osteoarthritis (OA) who were treated with total hip arthroplasty (THA) or conservative treatment with a self-directed exercise programme. We conducted a single-centre, randomized controlled trial including 120 participants with radiologically confirmed moderate-to-severe hip OA (Kellgren-Lawrence grades 2 to 4). Participants were randomly allocated (1:1) to receive either THA combined with postoperative rehabilitation or a self-directed exercise programme. The primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Harris Hip Score (HHS) at 12 months. Minimal clinically important differences (MCIDs) were predefined as 11 points for WOMAC and 15.9 points for HHS. Secondary outcomes included WOMAC at six months, as well as WOMAC subscales, health-related quality of life (HRQoL) RAND 36-Item Health Survey 1.0 (RAND-36) domains, and physical performance tests (chair stand, 40 m walk, and stair climb). At 12 months, the THA group demonstrated significantly greater improvements than the conservative group in WOMAC total score (-30.9 (95% CI -34.9 to -27.0) vs -3.7 (95% CI -8.2 to 0.9; between-group difference -27.1 points (95% CI -32.4 to -21.8)) and HHS (29.8 (95% CI 25.8 to 33.9) vs 5.7 (95% CI 2.4 to 9.0); difference 24.1 (95% CI 19.6 to 28.7)), both exceeding MCID thresholds. Overall, 23 participants (38%) in the conservative group underwent THA during the study; two participants in the THA group declined surgery. The THA group also showed superior gains across all performance-based tests and most RAND-36 domains. In patients with moderate-to-severe hip OA, THA combined with postoperative rehabilitation provides clinically meaningful improvements in pain, function, and HRQoL compared with a self-directed exercise programme alone. These findings reinforce THA as the preferred option for eligible patients.31:Tb07, Aims The aim of this study was to compare clinical, performance-based, and patient-reported outcomes between patients with moderate-to-severe hip osteoarthritis (OA) who were treated with total hip arthroplasty (THA) or conservative treatment with a self-directed exercise programme. Methods We conducted a single-centre, randomized controlled trial including 120 participants with radiologically confirmed moderate-to-severe hip OA (Kellgren-Lawrence grades 2 to 4). Participants were randomly allocated (1:1) to receive either THA combined with postoperative rehabilitation or a self-directed exercise programme. The primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Harris Hip Score (HHS) at 12 months. Minimal clinically important differences (MCIDs) were predefined as 11 points for WOMAC and 15.9 points for HHS. Secondary outcomes included WOMAC at six months, as well as WOMAC subscales, health-related quality of life (HRQoL) RAND 36-Item Health Survey 1.0 (RAND-36) domains, and physical performance tests (chair stand, 40 m walk, and stair climb). Results At 12 months, the THA group demonstrated significantly greater improvements than the conservative group in WOMAC total score (-30.9 (95% CI -34.9 to -27.0) vs -3.7 (95% CI -8.2 to 0.9; between-group difference -27.1 points (95% CI -32.4 to -21.8)) and HHS (29.8 (95% CI 25.8 to 33.9) vs 5.7 (95% CI 2.4 to 9.0); difference 24.1 (95% CI 19.6 to 28.7)), both exceeding MCID thresholds. Overall, 23 participants (38%) in the conservative group underwent THA during the study; two participants in the THA group declined surgery. The THA group also showed superior gains across all performance-based tests and most RAND-36 domains. Conclusion In patients with moderate-to-severe hip OA, THA combined with postoperative rehabilitation provides clinically meaningful improvements in pain, function, and HRQoL compared with a self-directed exercise programme alone. These findings reinforce THA as the preferred option for eligible patients. Cite this article: Bone Joint J 2026;108-B(5):588–596. 32:T502,Eighty-six participants were randomized (mean age, 53.60; 88.37% female). Between-group analyses showed that participants in the EXCAP-placebo group demonstrated significantly better attention performance on the Trail Making Test compared to the placebo group (-21.57 seconds, p < .001; Cohen's d = -1.31; 95% CI, -2.18 to -0.44; lower times indicate better performance). The ibuprofen only group showed greater improvements than the placebo group (-11.27-second difference, p = 0.05; Cohen's d = -0.73; 95% CI, -1.57 to 0.11). Both EXCAP-ibuprofen and EXCAP-placebo participants exhibited improvements on the FACT-Cog "comments from others" compared to placebo (Cohen's d = 1.00; 95% CI, 0.35 to 1.65 and Cohen's d = 0.65; 95% CI, -0.01 to 1.31). On Rapid Visual Processing mean latency, participants in the EXCAP-placebo group had a significant improvement compared to placebo (Cohen's d = -1.10; 95% CI, -1.97 to -0.23); those receiving ibuprofen had an improvement compared to placebo, which revealed a trend after adjusting for reading score (Cohen's d = -1.04; 95% CI, -2.06 to -0.01). The ibuprofen group performed less well on the Hopkins Verbal Learning Test-Revised delayed compared to those not receiving ibuprofen (Cohen's d = -0.64; 95% CI, -1.21 to -0.07).33:T80d,Interventions for cancer-related cognitive impairment are understudied, particularly during therapy. Patients with cancer receiving chemotherapy reporting cognitive problems were randomized to one of four study arms for 6 weeks in this phase 2 randomized controlled trial with a 2 × 2 factorial design. Study arms included: Exercise for Cancer Patients©® (EXCAP)-ibuprofen, EXCAP-placebo, ibuprofen only, and placebo only. EXCAP is a home-based, low to moderate-intensity, progressive walking and resistance exercise prescription. Cognitive and biologic assessments were conducted at baseline and post-intervention. Eighty-six participants were randomized (mean age, 53.60; 88.37% female). Between-group analyses showed that participants in the EXCAP-placebo group demonstrated significantly better attention performance on the Trail Making Test compared to the placebo group (-21.57 seconds, p < .001; Cohen's d = -1.31; 95% CI, -2.18 to -0.44; lower times indicate better performance). The ibuprofen only group showed greater improvements than the placebo group (-11.27-second difference, p = 0.05; Cohen's d = -0.73; 95% CI, -1.57 to 0.11). Both EXCAP-ibuprofen and EXCAP-placebo participants exhibited improvements on the FACT-Cog "comments from others" compared to placebo (Cohen's d = 1.00; 95% CI, 0.35 to 1.65 and Cohen's d = 0.65; 95% CI, -0.01 to 1.31). On Rapid Visual Processing mean latency, participants in the EXCAP-placebo group had a significant improvement compared to placebo (Cohen's d = -1.10; 95% CI, -1.97 to -0.23); those receiving ibuprofen had an improvement compared to placebo, which revealed a trend after adjusting for reading score (Cohen's d = -1.04; 95% CI, -2.06 to -0.01). The ibuprofen group performed less well on the Hopkins Verbal Learning Test-Revised delayed compared to those not receiving ibuprofen (Cohen's d = -0.64; 95% CI, -1.21 to -0.07). Exercise and low-dose ibuprofen improved some domains of cognitive function, although effects were not observed across all measures. Phase 3 trials are needed.34:Td8d,Abstract Background Interventions for cancer‐related cognitive impairment are understudied, particularly during therapy. Methods Patients with cancer receiving chemotherapy reporting cognitive problems were randomized to one of four study arms for 6 weeks in this phase 2 randomized controlled trial with a 2 × 2 factorial design. Study arms included: Exercise for Cancer Patients©® (EXCAP)–ibuprofen, EXCAP–placebo, ibuprofen only, and placebo only. EXCAP is a home‐based, low to moderate‐intensity, progressive walking and resistance exercise prescription. Cognitive and biologic assessments were conducted at baseline and post‐intervention. Results Eighty‐six participants were randomized (mean age, 53.60; 88.37% female). Between‐group analyses showed that participants in the EXCAP–placebo group demonstrated significantly better attention performance on the Trail Making Test compared to the placebo group (−21.57 seconds, p < .001; Cohen’s d = –1.31; 95% CI, –2.18 to –0.44; lower times indicate better performance). The ibuprofen only group showed greater improvements than the placebo group (−11.27‐second difference, p = 0.05; Cohen’s d = –0.73; 95% CI, –1.57 to 0.11). Both EXCAP–ibuprofen and EXCAP–placebo participants exhibited improvements on the FACT‐Cog “comments from others” compared to placebo (Cohen’s d = 1.00; 95% CI, 0.35 to 1.65 and Cohen’s d = 0.65; 95% CI, –0.01 to 1.31). On Rapid Visual Processing mean latency, participants in the EXCAP‐placebo group had a significant improvement compared to placebo (Cohen's d = −1.10; 95% CI, −1.97 to −0.23); those receiving ibuprofen had an improvement compared to placebo, which revealed a trend after adjusting for reading score (Cohen's d = −1.04; 95% CI, −2.06 to −0.01). The ibuprofen group performed less well on the Hopkins Verbal Learning Test‐Revised delayed compared to those not receiving ibuprofen (Cohen’s d = –0.64; 95% CI, –1.21 to –0.07). Conclusions Exercise and low‐dose ibuprofen improved some domains of cognitive function, although effects were not observed across all measures. Phase 3 trials are needed. 35:T5ee,The primary aim of the study was to investigate the long-term symptom progression of long COVID. The secondary objective was to assess whether any treatment had an impact on symptom evolution. Longitudinal, prospective, observational, uncontrolled study. Internal Medicine Department, Río Hortega University Hospital (Valladolid). 40 patients with long COVID (cases) and 40 volunteers (controls) of the same age and sex as the cases, who had experienced acute COVID-19 without developing long COVID. Scales, indices, and questionnaires were sent by post to evaluate the main symptoms of long COVID. The following were assessed: fatigue (MFIS), emotional disorders (HADS), sleep disturbances (PSQI), cognitive impairments (MFE-30), dyspnea (mMRC), physical exercise (GPAQ), quality of life (SF-36), and pain (CPGS). The cases were reassessed after three years. After three years, cases showed an improvement in dyspnea (mMRC), which decreased from 1.38 to 1.10 (p=0.014). Ten cases reported having followed aerobic and/or anaerobic physical exercise as treatment, and it was observed that their pain severity (CPGS) improved from 2.7 to 1.3 (p=0.039). In the remaining measurements, variations among cases did not reach statistical significance. After three years of follow-up, patients with long COVID continued to have similar symptom scores to their initial assessments, and worse than those of the control group. Aerobic and/or anaerobic physical exercise may contribute to partially improving symptom evolution. .36:T73e,This year in review (1) narratively synthesises the effect of, or patient experience with, non-pharmacological or non-surgical rehabilitation treatments for osteoarthritis at any joint; and (2) describes how sex and/or gender are defined, reported, and analysed. We searched three databases (Medline, Embase, CINAHL) for studies that met predefined criteria and selected those of perceived moderate-to-high quality and importance published between 12th March 2024 and 1st March 2025. Studies were grouped according to predominant treatment topic areas (e.g. core [exercise, diet]; adjunct [electrotherapy, manual therapy]; multimodal [different rehabilitation treatments]). Two authors independently screened records. One author extracted data, and another checked 10% of the accuracy. Full-text screening identified 158 eligible studies, reduced to 39 for synthesis. We identified eight themes: i) Exercise is effective for knee osteoarthritis and comorbidities, but has varied effects for hip osteoarthritis; ii) Diet plus exercise is effective for weight loss, but may not reduce pain; iii) Digital rehabilitation is a viable alternative to in-person care; iv) No added benefit of mind/behavioural treatments; v) Effects of electrotherapy modalities on pain were inconsistent and region-specific; vi) Orthoses may relieve pain, but should be individualised to patient preferences; vii) Acupuncture and blood flow restriction treatment show effectiveness in single clinical trials; viii) Treatment packages for osteoarthritis have varied benefits. Sex and gender were reported in 23 and 11 studies, respectively. For gender, most studies used female/male/woman/man interchangeably. No study defined sex or gender, 5% reported results disaggregated by sex or gender, no study justified why results were not, and 5% summarised key sex or gender findings.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Exercise Therapy: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Exercise Therapy (modality). Clinician-written summaries and actionable practice insights. 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evidence for several recommendations is extrapolated from the general population, and CKD-specific RCT data are limited.","value_numeric":null}],"summaries":{"what_studied":"This narrative review evaluates ten non-pharmacological interventions to reduce fragility fracture risk in patients with CKD-associated osteoporosis, covering strategies from nutrition and exercise to fall prevention and fracture liaison services.","key_result":"CKD-associated osteoporosis affects ~25% of all CKD patients and up to 75% of elderly dialysis patients; the review identifies ten actionable non-pharmacological strategies — including calcium/vitamin D optimization, adequate protein intake, smoking and alcohol cessation, medication review, exercise, home hazard reduction, orthostatic hypotension prevention, neuropathy management, fall risk assessment, and fracture liaison services — as applicable across CKD stages with specific considerations in end-stage kidney disease.","limitations":"This is a narrative review without systematic search methodology or meta-analytic pooling, limiting the strength of evidence; most cited interventions are extrapolated from the general osteoporosis population rather than CKD-specific RCTs.","practice_takeaway":"Screen all CKD patients for osteoporosis and apply non-pharmacological interventions first — especially fall prevention, exercise, and nutrition — before or alongside pharmacotherapy, with tailored adjustments for end-stage kidney disease."}},{"doi":"10.1093/jbmr/zjag127","pmid":"42631701","title":"Osteosarcopenia Revisited: From Mechanisms to Management","journal_title":"Journal of Bone and Mineral Research","journal_issn":"0884-0431","published_at":"2026-08-22T00:00:00.000Z","url":"https://doi.org/10.1093/jbmr/zjag127","source_score":14,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-29T06:19:16.901Z","updated_at":"2026-08-29T06:19:16.901Z","tags":[{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"condition","value":"Osteoporosis","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"condition","value":"Osteosarcopenia","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"condition","value":"Sarcopenia","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"modality","value":"Nutritional Supplementation","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"modality","value":"Pharmacotherapy","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"warning","value":"Genetic and molecular findings (GWAS, animal models) cited are mechanistic and may not yet translate directly to clinical decision-making.","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"warning","value":"No original data or patient-level outcomes are reported; this is a narrative review and effect estimates are not quantified within the abstract.","value_numeric":null},{"paper_doi":"10.1093/jbmr/zjag127","tag_type":"warning","value":"Study design classification as 'Narrative Review' is inferred from the abstract; the full text was not available to confirm scope or systematic methodology.","value_numeric":null}],"summaries":{"what_studied":"This narrative review examines osteosarcopenia — the co-occurrence of osteoporosis and sarcopenia in older adults — covering its mechanisms (hallmarks of aging, mitochondrial/nuclear pathways, osteokines, myokines, GWAS findings), clinical consequences, diagnostic approaches, and multimodal treatment strategies.","key_result":"Osteosarcopenia is associated with increased risk of falls, fractures, depression, frailty, and mortality compared to either condition alone; diagnosis requires combined imaging of bone mineral density and skeletal muscle mass plus physical performance assessment, with management requiring exercise, nutritional supplementation, and pharmacotherapy.","limitations":"As a review article, it synthesizes existing evidence without original data, so effect sizes and outcome numbers are not directly reported. The clinical translation of emerging AI-based tools and multi-omics biomarkers remains unproven. Causality between identified genetic/molecular mechanisms and osteosarcopenia phenotypes is not yet firmly established.","practice_takeaway":"Older adults should be screened for both bone and muscle deficits together, not in isolation, as osteosarcopenia carries additive risks beyond each condition alone. A multimodal plan — combining resistance exercise, protein/nutritional support, and appropriate pharmacotherapy — is the current standard of care."}},{"doi":"10.1111/aogs.70336","pmid":null,"title":"Strength training during pregnancy for the prevention of gestational diabetes: A randomized trial in women with overweight or obesity","journal_title":"Acta Obstetricia et Gynecologica Scandinavica","journal_issn":"0001-6349","published_at":"2026-08-19T00:00:00.000Z","url":"https://doi.org/10.1111/aogs.70336","source_score":81,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-08-22T06:53:33.664Z","updated_at":"2026-08-22T06:53:33.664Z","tags":[{"paper_doi":"10.1111/aogs.70336","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"condition","value":"Gestational Diabetes Mellitus","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"condition","value":"Obesity","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"condition","value":"Overweight","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"modality","value":"Strength Training","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"sample_size","value":"n=209","value_numeric":209},{"paper_doi":"10.1111/aogs.70336","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"warning","value":"Adherence was only 48%, which may have substantially diluted the intervention effect and contributed to the trial being underpowered.","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"warning","value":"The primary outcome (GDM incidence) did not reach statistical significance in the intention-to-treat analysis; per-protocol findings showing 0% GDM in adherent participants should be interpreted cautiously due to potential selection bias.","value_numeric":null},{"paper_doi":"10.1111/aogs.70336","tag_type":"warning","value":"The trial was registered prospectively (NCT05840497), but the published date is listed as August 19, 2026—results are very recent and have not yet undergone broad post-publication scrutiny.","value_numeric":null}],"summaries":{"what_studied":"A randomized trial evaluated a strength training program (gestational weeks 12–14 to 36 or delivery) versus standard care in 209 pregnant women with BMI ≥25 kg/m², examining incidence of gestational diabetes mellitus (GDM) as the primary outcome, plus gestational weight gain, macrosomia, and quality of life.","key_result":"GDM incidence was not significantly reduced in the intention-to-treat analysis (absolute risk difference −5.3%, 95% CI: −12.5 to 0.5; p=0.07); however, in adherent women (48% of intervention group), GDM was 0% vs. 7.3% in controls and macrosomia was 0% vs. 6.3%. Quality of life improved significantly (mean difference 8.4, 95% CI: 4.9–11.9; p<0.001). No increase in adverse events, including preterm birth.","limitations":"Only 48% of participants met the adherence target, limiting intervention efficacy; the trial was likely underpowered to detect statistically significant GDM differences; per-protocol results are subject to selection bias.","practice_takeaway":"Strength training in pregnancy appears safe and improves quality of life in women with overweight or obesity, but current evidence is insufficient to recommend it specifically for GDM prevention—larger, adequately powered trials are needed. Clinicians can still offer it as a safe adjunct to standard prenatal care."}},{"doi":"10.1002/dmrr.70218","pmid":"42619215","title":"Skeletal Muscle Function in Type 1 Diabetes: A Complementary Outcome for Clinical Care and Research","journal_title":"Diabetes/Metabolism Research and Reviews","journal_issn":"1520-7552","published_at":"2026-08-19T00:00:00.000Z","url":"https://doi.org/10.1002/dmrr.70218","source_score":9,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-26T06:19:55.260Z","updated_at":"2026-08-26T06:19:55.260Z","tags":[{"paper_doi":"10.1002/dmrr.70218","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"condition","value":"Diabetic Myopathy","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"condition","value":"Sarcopenia","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"condition","value":"Type 1 Diabetes","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"modality","value":"Resistance Training","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"study_design","value":"Expert Commentary","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"warning","value":"Biological mechanisms discussed (cGAS–STING, AMPK/SIRT1/PGC-1α, Piezo1) are largely preclinical and not yet validated specifically in human T1D skeletal muscle.","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"warning","value":"No sample size is applicable as no primary data were collected for this article.","value_numeric":null},{"paper_doi":"10.1002/dmrr.70218","tag_type":"warning","value":"This is an opinion/commentary piece with no original dataset; all cited evidence is drawn from referenced primary studies. Clinical recommendations should be weighed accordingly.","value_numeric":null}],"summaries":{"what_studied":"This commentary argues that skeletal muscle strength, physical function, and exercise capacity should be treated as formal clinical and research outcomes in type 1 diabetes (T1D) care — complementing, not replacing, glycaemic metrics.","key_result":"Evidence suggests people with T1D show reduced muscle strength, impaired mitochondrial function, altered muscle morphology, and lower exercise capacity — consistent with accelerated neuromuscular ageing even without major overt complications. Resistance training trials in both adults and youth with T1D show strength gains without increasing adverse glycaemic events.","limitations":"- This is an expert commentary, not a systematic review; no new primary data are presented.\n- Proposed biological mechanisms (cGAS–STING, AMPK/SIRT1/PGC-1α, Piezo1) remain largely preclinical and unproven specifically in T1D.\n- Whether improvements in muscle outcomes translate to long-term cardiometabolic or glycaemic benefit has not been established.","practice_takeaway":"Consider adding simple muscle function assessments — such as handgrip dynamometry and sit-to-stand tests — to routine T1D care, especially in older adults, those with neuropathy, or patients with poor body composition despite acceptable HbA1c.\nResistance training is already guideline-recommended; the gap is that muscle strength and physical function are rarely *measured* or *treated* as therapeutic targets."}},{"doi":"10.1016/j.breast.2026.104905","pmid":"42648243","title":"Breast cancer-related fatigue: Mechanisms, biomarkers, risk factors, and intervention strategies","journal_title":"The Breast","journal_issn":"0960-9776","published_at":"2026-08-18T00:00:00.000Z","url":"https://doi.org/10.1016/j.breast.2026.104905","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-28T06:25:19.190Z","updated_at":"2026-08-28T06:25:19.190Z","tags":[{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"condition","value":"Breast Cancer","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"condition","value":"Breast Cancer-Related Fatigue","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"modality","value":"Acupuncture","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"modality","value":"Microbiota Modulation","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"modality","value":"Nutritional Support","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"modality","value":"Pharmacotherapy","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"modality","value":"Psychotherapy","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"warning","value":"No sample size is applicable as this is a review article, not a primary study.","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"warning","value":"The paper is dated August 2026 and was processed close to its publication date — some cited evidence may be very recent and not yet widely validated.","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104905","tag_type":"warning","value":"This is a narrative review without a registered protocol or systematic search strategy; risk of selection bias in the evidence synthesized cannot be excluded.","value_numeric":null}],"summaries":{"what_studied":"This narrative review synthesizes current evidence on breast cancer-related fatigue (BCRF), covering its mechanisms (inflammation, HPA axis dysregulation, mitochondrial dysfunction, neuromuscular impairment, psychosocial factors), biomarkers, risk factors, and intervention strategies in patients during and after breast cancer treatment.","key_result":"Multiple intervention categories — including acupuncture, exercise, psychotherapy, pharmacotherapy, nutritional support, and microbiota modulation — show varying degrees of efficacy for BCRF; no single strategy is universally superior. Biomarkers such as cytokines, cortisol, leptin, and mitochondrial DNA show diagnostic and prognostic potential.","limitations":"As a narrative review, it does not perform a systematic search or meta-analysis, limiting quantitative conclusions. No head-to-head comparison of intervention efficacy with pooled effect sizes is provided. Generalizability may be constrained by the heterogeneity of included studies.","practice_takeaway":"Clinicians should consider BCRF a multimechanistic syndrome and tailor interventions — particularly exercise and psychotherapy — to individual patient risk profiles. Emerging biomarkers (cytokines, cortisol, mitochondrial DNA) may eventually guide more personalized management, but are not yet standard of care."}},{"doi":"10.1002/cns.71035","pmid":"42605248","title":"Exercise and Circadian Rhythm Regulation: Mechanisms, Resilience, and Therapeutic Potential for Neurological Diseases","journal_title":"CNS Neuroscience & Therapeutics","journal_issn":"1755-5930","published_at":"2026-08-17T00:00:00.000Z","url":"https://doi.org/10.1002/cns.71035","source_score":21,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-22T06:53:22.093Z","updated_at":"2026-08-22T06:53:22.093Z","tags":[{"paper_doi":"10.1002/cns.71035","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"category","value":"Neurosciences","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Alzheimer's Disease","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Circadian Rhythm Disruption","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Intracerebral Hemorrhage","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Ischemic Stroke","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Stroke","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"condition","value":"Subarachnoid Hemorrhage","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"modality","value":"Behavioral Chronotherapy","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"warning","value":"Most mechanistic evidence is from rodent models; direct translation to human clinical practice should be interpreted cautiously.","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"warning","value":"No sample size tag applied — this is a review with no original patient cohort. The ICH mortality statistic (3.6× odds, 70% mortality reduction) is cited from a single prospective observational study, not from a trial conducted by these authors.","value_numeric":null},{"paper_doi":"10.1002/cns.71035","tag_type":"warning","value":"The study design is a narrative (not systematic) review; risk of selection bias in included studies cannot be excluded.","value_numeric":null}],"summaries":{"what_studied":"This narrative review examines the molecular and systemic mechanisms by which exercise — acting as a non-photic zeitgeber — modulates circadian rhythms, and evaluates the therapeutic implications for two neurological diseases: stroke (ischemic, ICH, SAH) and Alzheimer's disease (AD).","key_result":"Exercise enhances circadian amplitude, stability, and phase alignment via AMPK-SIRT1-BMAL1 signaling, PGC-1α-dependent mitochondrial regulation, and immune-clock coupling. In stroke, pre-stroke physical activity was associated with ~3.6× higher odds of mild neurological deficits at ICH onset and ~70% lower 30-day mortality. In AD, regular exercise reduces Aβ burden, shifts microglia toward anti-inflammatory states, and normalizes sleep-wake cycles in preclinical and observational data.","limitations":"- Almost entirely based on preclinical (rodent) models and observational data; randomized controlled trials on circadian-targeted exercise in stroke or AD are lacking.\n- Optimal exercise timing, intensity, and duration for circadian benefit in neurological disease have not been established.\n- Individual variation by age, sex, chronotype, and disease stage is acknowledged but uncharacterized.","practice_takeaway":"Appropriately timed, regular moderate exercise may improve circadian alignment and support neurological recovery in stroke and AD — consider it a behavioral chronotherapy adjunct, not just a fitness tool. Until optimal timing protocols are defined, encouraging habitual physical activity remains a low-risk, evidence-supported recommendation for patients with or at risk for these conditions."}},{"doi":"10.1016/j.jacc.2026.07.009","pmid":"42573541","title":"Cognitive Impairment and Frailty in Older Adults With Cardiovascular Disease: 2026 ACC Scientific Statement","journal_title":"JACC","journal_issn":"0735-1097","published_at":"2026-08-10T00:00:00.000Z","url":"https://doi.org/10.1016/j.jacc.2026.07.009","source_score":33,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-13T13:22:50.293Z","updated_at":"2026-08-13T13:22:50.293Z","tags":[{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"condition","value":"Cognitive Impairment","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"condition","value":"Frailty","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"condition","value":"Sarcopenia","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"modality","value":"Nutritional Intervention","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"modality","value":"Polypharmacy Reduction","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"study_design","value":"Scientific Statement / Consensus Document","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"warning","value":"No sample size is applicable as this is a narrative/consensus statement, not an original study.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"warning","value":"The impact flag 'practice_changing' reflects the ACC endorsement and breadth of clinical recommendations, but the underlying evidence strength is low.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.07.009","tag_type":"warning","value":"This is a consensus/expert opinion document (ACC Scientific Statement), not a systematic review or meta-analysis; the authors explicitly note the evidence base is limited and fragmented. Level of evidence assigned accordingly.","value_numeric":null}],"summaries":{"what_studied":"This ACC Scientific Statement reviews the intersections among cardiovascular disease (CVD), cognitive impairment, and frailty in older adults, including shared biological aging mechanisms (vascular dysfunction, chronic inflammation, sarcopenia) and consensus-based approaches for prevention, assessment, and management.","key_result":"Key recommendations include treating CVD, cognitive impairment, and frailty as manifestations of shared biological aging; targeting common modifiable risk factors; ensuring appropriate diagnostic evaluation and referral; and promoting resilience through structured exercise, nutrition, medications, and reducing polypharmacy.","limitations":"Authors acknowledge recommendations rest on a 'limited and fragmented evidence base'; the statement is consensus-based rather than derived from dedicated clinical trials in this population.","practice_takeaway":"Cardiologists caring for older adults should routinely screen for cognitive impairment and frailty, as these conditions share biological roots with CVD and directly affect treatment decisions. Structured exercise, nutrition optimization, and polypharmacy reduction should be integrated into cardiovascular care plans for this population."}},{"doi":"10.1016/j.knee.2026.104565","pmid":"42476040","title":"The effect of hip abductor or external rotator strength on dynamic knee valgus in healthy subjects-a systematic review with partial meta-analysis","journal_title":"The Knee","journal_issn":"0968-0160","published_at":"2026-07-20T00:00:00.000Z","url":"https://doi.org/10.1016/j.knee.2026.104565","source_score":15,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-28T14:02:22.470Z","updated_at":"2026-07-28T14:02:22.470Z","tags":[{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"condition","value":"Dynamic Knee Valgus","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"sample_size","value":"n=22","value_numeric":22},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"study_design","value":"Systematic Review with Meta-Analysis","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"warning","value":"'Practice-changing' flag applied with caution: the finding challenges a widely held clinical assumption, but the authors note continued research is needed and discuss alternative explanations without fully resolving the question.","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"warning","value":"Results apply only to healthy/asymptomatic subjects; findings may not generalize to patients with knee pain, ACL injury history, or other musculoskeletal conditions.","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"warning","value":"Sample size tag reflects number of included studies (n=22), not individual participants — total participant N is not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1016/j.knee.2026.104565","tag_type":"warning","value":"The paper is dated July 2026, which is ahead of today's date (July 28, 2026) — content has been treated as published and available.","value_numeric":null}],"summaries":{"what_studied":"Systematic review with partial meta-analysis of 22 studies examining whether hip abductor or external rotator (ER) weakness is associated with increased dynamic knee valgus in healthy (asymptomatic) subjects, using dynamometric strength measures and kinematic analysis.","key_result":"No significant association was found in the majority of studies: 12/16 hip abductor correlation studies and 8/12 hip ER correlation studies found no significant link to dynamic knee valgus. None of the partial meta-analyses reached statistical significance.","limitations":"- Restricted to healthy/asymptomatic subjects, limiting generalizability to clinical populations with pain or injury.\n- Heterogeneity across studies likely precluded full meta-analysis (only partial meta-analysis feasible).\n- Cannot establish causality from correlation-based and cross-sectional designs.","practice_takeaway":"Routinely prescribing hip abductor or ER strengthening to reduce dynamic knee valgus in healthy individuals may lack strong biomechanical justification. Clinicians should consider alternative mechanisms when designing knee injury prevention programs."}},{"doi":"10.1007/s11154-026-10069-y","pmid":"42400735","title":"Exercise remodels the skeletal muscle immune microenvironment to ameliorate type 2 diabetes mellitus-induced muscle atrophy: From immunometabolism to organ crosstalk","journal_title":"Reviews in Endocrine and Metabolic Disorders","journal_issn":"1389-9155","published_at":"2026-07-04T00:00:00.000Z","url":"https://doi.org/10.1007/s11154-026-10069-y","source_score":11,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-07T13:26:07.995Z","updated_at":"2026-07-07T13:26:07.995Z","tags":[{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"condition","value":"Muscle Atrophy","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"condition","value":"Sarcopenia","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"condition","value":"Type 2 Diabetes Mellitus","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"modality","value":"Aerobic Exercise","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"modality","value":"Resistance Exercise","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"warning","value":"Most mechanistic evidence cited is from preclinical (animal/in vitro) studies; direct human clinical evidence for several proposed pathways is limited.","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"warning","value":"No sample size tag applied — this is a review with no study population of its own.","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"warning","value":"Sex of populations in cited studies is not consistently reported across the review.","value_numeric":null},{"paper_doi":"10.1007/s11154-026-10069-y","tag_type":"warning","value":"This is a narrative review without systematic search methods or PRISMA reporting; conclusions reflect author interpretation rather than pooled evidence.","value_numeric":null}],"summaries":{"what_studied":"This narrative review examines how T2DM drives skeletal muscle atrophy (diabetic sarcopenia) through immune-myocyte crosstalk — including macrophage M1/M2 imbalance, mast cell dysregulation, NLRP3 inflammasome-mediated pyroptosis, T-cell immunosenescence, and chemokine storms — and how exercise reverses these processes both locally and via multi-organ axes (adipose tissue, gut microbiota, liver, brain).","key_result":"Exercise shifts the skeletal muscle immune microenvironment from pro-inflammatory/destructive to reparative/regenerative by: downregulating TRIB3/AKT to promote M2 macrophage polarization, inhibiting the NLRP3/caspase-1/GSDMD pyroptosis pathway, increasing Treg infiltration, restoring mast cell function, and reducing chemokine signaling; systemic effects operate through adipokines, gut-derived SCFAs, hepatic SIRT1/FGF21 signaling, and brain-derived myokines (BDNF, CTSB).","limitations":"- Narrative review only; no primary data, meta-analysis, or risk-of-bias assessment.\n- Most cited mechanistic evidence comes from animal models or in vitro studies, limiting direct clinical translation.\n- Optimal exercise type, intensity, and duration for each immune pathway are not defined.","practice_takeaway":"Exercise interventions should be considered a core strategy for patients with T2DM at risk of sarcopenia, as they target multiple immune and metabolic pathways simultaneously. Clinicians can use this mechanistic framework to support prescribing structured exercise — combining aerobic and resistance modalities — while awaiting more precise dosing trials."}},{"doi":"10.1038/s41574-026-01276-3","pmid":"42380503","title":"Strengthening the metabolic alliance: exercise as an essential partner of obesity pharmacotherapy","journal_title":"Nature Reviews Endocrinology","journal_issn":"1759-5029","published_at":"2026-06-30T00:00:00.000Z","url":"https://doi.org/10.1038/s41574-026-01276-3","source_score":42,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-07T13:26:16.051Z","updated_at":"2026-07-08T13:26:32.748Z","tags":[{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"condition","value":"Obesity","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"modality","value":"Anti-Obesity Pharmacotherapy","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"modality","value":"GLP-1 Receptor Agonist","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"warning","value":"No sample size, population details, or quantitative results are available from the provided source.","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"warning","value":"Study design and level of evidence cannot be determined from the available content; this appears to be a review article based on the journal and title, but this is inferred, not confirmed from text.","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"warning","value":"Study design labeled as 'Narrative Review' based on journal type and title framing; the actual methodology could not be confirmed from the text.","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"warning","value":"The full article body was not available — only PDF metadata and blank page placeholders were extracted. All structured fields reflect only what could be inferred from the title and journal; no specific findings, populations, sample sizes, or conclusions were verifiable. Tags and summaries should be treated as provisional.","value_numeric":null},{"paper_doi":"10.1038/s41574-026-01276-3","tag_type":"warning","value":"The full text of this paper was not extractable — only metadata and font information were present in the provided content. Summaries, results, limitations, and detailed tags cannot be populated without access to the actual article body.","value_numeric":null}],"summaries":{"limitations":"The full text of the article was not available for extraction — only metadata and page placeholders were provided. No specific data, findings, or conclusions could be verified from the source.","what_studied":"This review examines the role of exercise as a complementary intervention alongside obesity pharmacotherapy (e.g., GLP-1 receptor agonists and related agents), evaluating how physical activity may enhance, preserve, or modify the metabolic effects of weight-loss medications."}},{"doi":"10.1016/j.diabres.2026.113326","pmid":"42191026","title":"Sarcopenia in Diabetes: A proposal on integrating muscle assessment and nutritional intervention in people living with diabetes","journal_title":"Diabetes Research and Clinical Practice","journal_issn":"0168-8227","published_at":"2026-05-25T00:00:00.000Z","url":"https://doi.org/10.1016/j.diabres.2026.113326","source_score":3,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-05T13:26:38.951Z","updated_at":"2026-06-05T13:26:38.951Z","tags":[{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"condition","value":"Sarcopenia","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"condition","value":"Type 2 Diabetes Mellitus","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"modality","value":"Muscle Assessment","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"modality","value":"Nutritional Intervention","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"study_design","value":"Expert Consensus / Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"warning","value":"No patient sample size is reported — this is a consensus/review paper, not a clinical trial. Level of evidence reflects expert opinion.","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"warning","value":"Study design label 'Expert Consensus / Narrative Review' reflects a hybrid methodology described in the abstract; the authors describe both a structured consensus process and a literature review.","value_numeric":null},{"paper_doi":"10.1016/j.diabres.2026.113326","tag_type":"warning","value":"The DOI and publication date (2026) are future-dated relative to typical indexing; content should be verified upon formal publication.","value_numeric":null}],"summaries":{"what_studied":"This expert consensus paper evaluated screening, diagnosis, staging, and management of sarcopenia in people with Type 2 diabetes mellitus (T2DM), using a structured two-phase consensus process informed by a PubMed literature review and an international multidisciplinary panel.","key_result":"The consensus produced a clinically applicable algorithm that integrates functional, nutritional, and metabolic evaluation — covering muscle assessment methods, exercise, and muscle-targeted nutritional interventions — to guide personalised sarcopenia management in people with diabetes.","limitations":"Consensus-based methodology rather than primary clinical trial data; no sample size for the patient population studied; applicability may be limited in people with high BMI or excess adiposity where standard muscle assessment tools are less sensitive.","practice_takeaway":"Systematically screen all people with T2DM for sarcopenia, especially those with high BMI where adiposity can mask muscle loss. Use the proposed integrated algorithm combining functional tests, nutritional assessment, and metabolic evaluation to guide individualised treatment."}},{"doi":"10.1007/s10067-026-08184-x","pmid":"42183918","title":"Fibromyalgia in men: beyond invisibility—a biopsychosocial and clinical perspective in rheumatology","journal_title":"Clinical Rheumatology","journal_issn":"0770-3198","published_at":"2026-05-25T00:00:00.000Z","url":"https://doi.org/10.1007/s10067-026-08184-x","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-05T13:26:35.554Z","updated_at":"2026-06-05T13:26:35.554Z","tags":[{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"category","value":"Rheumatology","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"condition","value":"Chronic Pain","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"condition","value":"Fibromyalgia","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"modality","value":"Biopsychosocial Rehabilitation","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"study_design","value":"Narrative Review / Perspective","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"warning","value":"No primary data were collected; all conclusions are derived from a targeted literature review with acknowledged selection bias.","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"warning","value":"Study design label 'Narrative Review / Perspective' is used because the paper is explicitly framed as a perspective/opinion piece with a non-systematic literature search—not a standard study design category.","value_numeric":null},{"paper_doi":"10.1007/s10067-026-08184-x","tag_type":"warning","value":"This is a single-author, non-systematic perspective article; the framework is hypothesis-generating and not based on a formal systematic review or meta-analysis.","value_numeric":null}],"summaries":{"what_studied":"This perspective critically examines fibromyalgia in men as an underrecognized clinical entity, proposing an integrative conceptual framework that covers epidemiological, sociocultural, biological, and clinical dimensions of the condition in male patients.","key_result":"The authors argue that underdiagnosis of fibromyalgia in men results from three interacting factors: sociocultural barriers to care-seeking (driven by masculinity norms), clinician diagnostic bias, and heterogeneous symptom expression. Emerging evidence points to small fiber pathology, reduced handgrip strength, gait impairments (slower speed, reduced stride/cadence), and psychological comorbidities in male patients—but current evidence is limited by small samples and methodological heterogeneity.","limitations":"- Non-systematic, narrative review with targeted literature selection; susceptible to selection bias.\n- Most underlying studies have small samples, cross-sectional designs, and lack sex-balanced comparison groups.\n- Male-focused primary research is scarce; much inference relies on mixed-sex or female-dominant cohorts.","practice_takeaway":"Rheumatologists should actively screen men with persistent diffuse musculoskeletal pain, fatigue, and non-restorative sleep for fibromyalgia—even without inflammatory or structural findings—and consider simple functional measures (handgrip strength, gait assessment) alongside explicit symptom validation to reduce diagnostic delay.\n\nA biopsychosocial, gender-sensitive approach that integrates pain education, exercise-based rehabilitation, and shared decision-making may improve engagement and adherence in male patients."}},{"doi":"10.1001/jamasurg.2026.1519","pmid":"42160080","title":"Nationwide Implementation of Multimodal Prehabilitation and Complications After Colorectal Cancer Surgery","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-05-20T00:00:00.000Z","url":"https://doi.org/10.1001/jamasurg.2026.1519","source_score":26,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-26T13:34:50.387Z","updated_at":"2026-05-26T13:34:50.387Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"condition","value":"Colorectal Cancer","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"modality","value":"Nutritional Support","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"modality","value":"Prehabilitation","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"sample_size","value":"n=2384","value_numeric":2384},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"study_design","value":"Multicenter Cohort Study","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"warning","value":"Historical controls span a longer period (2014–2023) than the prehabilitation group (2020–2023), raising concern that improvements in surgical care over time may partly explain the outcome differences — not prehabilitation alone.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"warning","value":"Mean patient age was 70 years, so findings may be most generalizable to older adults; applicability to younger colorectal cancer patients is less certain.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1519","tag_type":"warning","value":"The surgical complication OR (0.82, 95% CI 0.68–1.00) just reaches the boundary of statistical significance; this finding should be interpreted cautiously.","value_numeric":null}],"summaries":{"what_studied":"A multicenter cohort study across 18 Dutch hospitals evaluated a uniform multimodal prehabilitation program (high-intensity exercise 3×/week, nutritional support, psychological counseling, comorbidity optimization) vs. historical controls in unselected adults undergoing elective colorectal cancer resection (prehab group: April 2020–June 2023; control group: June 2014–June 2023), with propensity score matching on age, sex, BMI, ASA class, procedure, and operative approach.","key_result":"Overall complications were lower in the prehabilitation group (30.1% vs 37.8%; OR 0.71, 95% CI 0.60–0.84), driven largely by fewer medical complications (15.4% vs 24.6%; OR 0.56, 95% CI 0.46–0.69); median hospital stay was 1 day shorter (4 vs 5 days; P<.001), with reduced readmission and ICU admission rates — benefits held across all age and ASA score subgroups.","limitations":"- Retrospective cohort with historical controls introduces risk of secular trends (e.g., enhanced recovery protocols evolving over time) confounding results.\n- Propensity score matching cannot fully account for unmeasured confounders such as baseline fitness or patient motivation.\n- Prehabilitation program adherence and completion rates are not reported, which limits dose-response interpretation.","practice_takeaway":"Consider integrating structured multimodal prehabilitation — combining exercise, nutrition, and comorbidity optimization — into standard preoperative care for all elective colorectal cancer surgery patients, regardless of age or ASA class. A roughly 8-percentage-point absolute reduction in overall complications and a 1-day shorter hospital stay suggest clinically meaningful benefit at scale."}},{"doi":"10.1302/0301-620x.108b5.bjj-2025-0858.r2","pmid":"42061873","title":"Total hip arthroplasty compared with conservative treatment with a self-directed exercise programme in moderate-to-severe hip osteoarthritis: a randomized controlled trial","journal_title":"The Bone & Joint Journal","journal_issn":"2049-4408","published_at":"2026-05-01T00:00:00.000Z","url":"https://doi.org/10.1302/0301-620x.108b5.bjj-2025-0858.r2","source_score":37,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-05","doi":"10.1302/0301-620x.108b5.bjj-2025-0858.r2","days":"14","issn":"2049-4394","rank":"4","field":"Clinical Medicine","score":"37","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1302/0301-620X.108B5.BJJ-2025-0858.R2","title":"Total hip arthroplasty compared with conservative treatment with a self-directed exercise programme in moderate-to-severe hip osteoarthritis: a randomized controlled trial.","journal":"The bone & joint journal","methods":"","results":"At 12 months, the THA group demonstrated significantly greater improvements than the conservative group in WOMAC total score (-30.9 (95% CI -34.9 to -27.0) vs -3.7 (95% CI -8.2 to 0.9; between-group difference -27.1 points (95% CI -32.4 to -21.8)) and HHS (29.8 (95% CI 25.8 to 33.9) vs 5.7 (95% CI 2.4 to 9.0); difference 24.1 (95% CI 19.6 to 28.7)), both exceeding MCID thresholds. Overall, 23 participants (38%) in the conservative group underwent THA during the study; two participants in the THA group declined surgery. The THA group also showed superior gains across all performance-based tests and most RAND-36 domains.","abstract":"$30","keywords":[],"pubmed_id":"42061873","conclusions":"In patients with moderate-to-severe hip OA, THA combined with postoperative rehabilitation provides clinically meaningful improvements in pain, function, and HRQoL compared with a self-directed exercise programme alone. 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phase 2 RCT (2×2 factorial, n=86, mean age 53.6, 88% female) tested 6 weeks of home-based progressive exercise (EXCAP) and/or low-dose ibuprofen (400 mg/day) versus placebo on cancer-related cognitive impairment in patients actively receiving chemotherapy.","key_result":"EXCAP alone improved Trail Making Test (TMT) attention scores by −21.57 s vs. placebo (p<.001; d=−1.31) and rapid visual processing latency (d=−1.10). Ibuprofen alone showed a trend on TMT (−11.27 s, p=0.05; d=−0.73). Both EXCAP arms improved patient-reported 'comments from others' on FACT-Cog vs. placebo (d=1.00 and d=0.65). Ibuprofen was associated with worse delayed verbal memory (HVLT-R delayed; d=−0.64, p=.03). No significant interaction between EXCAP and ibuprofen was found, and no study-related adverse events occurred.","limitations":"- Small per-arm sample size (n≈21–22) limits power for interaction and subgroup effects.\n- Population was 76% breast cancer and 92% White, reducing generalizability.\n- Outcomes assessed only at 6 weeks post-intervention; durability of effects is unknown.","practice_takeaway":"A structured home-based progressive exercise program (EXCAP) during chemotherapy can meaningfully improve attention and perceived cognitive function with no safety concerns — making it a feasible, low-risk option to offer patients reporting cognitive difficulties. 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Med.","doi-asserted-by":"crossref"}],"short-title":[],"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"update-policy":"https://doi.org/10.1016/elsevier_cm_policy","alternative-id":["S1063458425011914"],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","oarsijournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"original-title":[],"container-title":["Osteoarthritis and Cartilage"],"published-print":{"date-parts":[[2026,1]]},"reference-count":92,"published-online":null,"references-count":92,"short-container-title":["Osteoarthritis and Cartilage"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1016/j.joca.2025.10.008","is_oa":true,"title":"Osteoarthritis year in review 2025: Rehabilitation and outcomes including sex and gender reporting","updated":"2026-01-10T04:46:20+00:00","published_date":"2025-10-30","best_oa_location":{"url":"https://doi.org/10.1016/j.joca.2025.10.008","pmh_id":null,"url_for_pdf":null,"url_for_landing_page":"https://doi.org/10.1016/j.joca.2025.10.008"}}},"created_at":"2026-01-14T18:30:49.575Z","updated_at":"2026-01-21T12:05:26.220Z","tags":[{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"category","value":"Rheumatology","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"condition","value":"Osteoarthritis","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"modality","value":"Acupuncture","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"modality","value":"Behavioral Therapy","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"modality","value":"Blood Flow Restriction","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"modality","value":"Dietary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"modality","value":"Digital Rehabilitation","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"modality","value":"Electrotherapy","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"modality","value":"Exercise Therapy","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"modality","value":"Orthoses","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"warning","value":"Design classification may be ambiguous: comprehensive database search with narrative selection rather than a formal systematic review or meta-analysis.","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"warning","value":"Findings on acupuncture and blood flow restriction derive from single trials.","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"warning","value":"Sex and gender terms were used interchangeably across included studies, and none defined these constructs.","value_numeric":null},{"paper_doi":"10.1016/j.joca.2025.10.008","tag_type":"warning","value":"The review reports numbers of studies, not participant counts, and spans multiple joints and modalities.","value_numeric":null}],"summaries":{"what_studied":"A narrative synthesis of non-pharmacological and non-surgical rehabilitation for osteoarthritis across any joint, plus how sex and gender were defined, reported, and analyzed. Searches of Medline, Embase, and CINAHL (12 Mar 2024–1 Mar 2025) found 158 eligible studies; 39 were selected for synthesis across core, adjunct, and multimodal treatments.","key_result":"Eight themes emerged: exercise helps knee osteoarthritis and comorbidities but shows mixed effects in hip osteoarthritis; diet plus exercise reduces weight but may not reduce pain; digital rehab is a viable alternative to in‑person care; mind/behavioral add‑ons showed no added benefit; electrotherapy pain effects were inconsistent and region‑specific; orthoses can relieve pain but should reflect patient preferences; acupuncture and blood flow restriction each showed effectiveness in single trials; multimodal packages had varied benefits. Sex was reported in 23 studies and gender in 11; no study defined sex or gender, 5% disaggregated results by sex/gender, no study justified the lack of disaggregation, and 5% summarized key sex/gender findings.","limitations":"Narrative selection of a subset (39/158) judged moderate-to-high quality may introduce selection bias; conclusions span heterogeneous joints, interventions, and outcomes with region‑specific and inconsistent effects; some signals rely on single clinical trials.","practice_takeaway":"Prioritize exercise for knee osteoarthritis and consider digital rehab as a practical alternative; use diet plus exercise for weight loss without promising pain relief. Reserve mind/behavioral add‑ons and electrotherapy given uncertain benefit, individualize orthoses to patient preference, and treat acupuncture and blood flow restriction as preliminary signals; expect little sex- or gender‑specific guidance due to poor reporting."}}],"initialOffset":18,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Exercise Therapy"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Exercise Therapy"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Exercise Therapy"}}}]]

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