Proprioception is significantly impaired in knee osteoarthritis (KOA), contributing to reduced functionality. Strength training (ST) is essential in KOA by improving muscle strength, although it may also be effective in improving proprioception. The purpose was to determine the effect of ST on knee proprioception in KOA patients. Pubmed, CINAHL, Scopus, WOS, and PEDro were searched for randomized controlled trials (RCTs) (inception to March 2023). Comparisons for ST were physical exercise different from ST, non-exercise-based interventions, and no intervention. Methodological quality was assessed using the PEDro scale, and risk of bias (RoB) using the Cochrane tool. Meta-analyses were performed by comparison groups using the standardized mean difference (SMD) (Hedge's g) with random effects models, also considering subgroups by proprioception tests. Finally, six RCTs were included. The mean PEDro score was 6.3, and the highest proportion of biases corresponds to performance, selection, and detection. The meta-analysis indicated that only when compared with non-intervention, ST significantly improved knee proprioception for the joint position sense (JPS) (active + passive), JPS (passive), and threshold to detect passive motion (TTDPM) subgroups (g ​= ​−1.33 [-2.33, −0.32], g = ​−2.29 [-2.82, −1.75] and g ​= ​−2.40 [-4.23, −0.58], respectively). However, in the knee JPS (active) subgroup, ST was not significant (g ​= ​−0.72 [-1.84, 0.40]). In conclusion, ST improves knee proprioception compared to non-intervention. However, due to the paucity of studies and diversity of interventions, more evidence is needed to support the effectiveness of ST. Future RCTs may address the limitations of this review to advance knowledge about proprioceptive responses to ST and contribute to clinical practice.

To analyze the effects of exergames on rehabilitation outcomes in osteoarthritis (OA) patients. A systematic review was reported according to the PRISMA statement. Randomized controlled trials (RCTs) were searched in Pubmed, Scopus, WoS, CINAHL, and PEDro (inception to November 2023). Studies that applied non-immersive exergames and assessed physical, functional, cognitive, pain, and psychosocial outcomes were included. Comparisons were other exercise modalities and non-intervention. Methodological quality was assessed with PEDro scale, and risk of bias (RoB) was assessed with Cochrane RoB-2 tool. Eight studies were included (total of participants = 401). The mean PEDro score was 6.1, and seven studies had high RoB. Seven studies involved knee OA and one cervical OA. The most frequent duration for interventions was four weeks. Exergames were more effective than controls in at least one outcome in all studies. The outcomes for which exergames were most effective were functional disability, postural balance, muscle strength, proprioception, gait, range of motion, pain, quality of life, depression, and kinesiophobia. Non-immersive exergames constitute an effective strategy for optimizing several relevant outcomes in rehabilitation. However, more RCTs with high methodological quality are required to deepen the knowledge about the multidimensional effects of exergames in OA patients.

Objective: This systematic review and meta-analysis aimed to (I) evaluate the evidence on the effects of high-intensity interval training (HIIT) on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in hypertensive patients; (II) determine whether HIIT impacts SBP and DBP differently; and (III) assess the clinical relevance of these effects. Methods: A comprehensive search was conducted across multiple electronic databases, resulting in the inclusion of seven randomized clinical trials in the meta-analysis. The outcomes were analyzed using random-effects models to compute mean differences (MD) and standardized mean differences (SMD) for SBP and DBP. Results: A small reduction in SBP was observed with HIIT interventions (MD −3.00; 95% CI −4.61 to −1.39; p < 0.0001; SMD −0.28; 95% CI −0.42 to −0.13; p = 0.0003). However, no statistically significant reductions were detected for DBP (MD −0.70; 95% CI −1.80 to 0.39; p = 0.21; SMD −0.07; 95% CI −0.22 to 0.08; p = 0.35). Despite demonstrating statistical significance for SBP, the effects did not reach clinical relevance. Conclusions: HIIT interventions yield small reductions in SBP, with minimal impact on DBP. These findings suggest limited clinical relevance in the management of hypertension. Further randomized controlled trials are necessary to standardize HIIT protocols, with specific emphasis on intensity control and manipulation, to better understand their potential role in hypertensive populations.

Background: Chronic pain affects millions worldwide, influenced by biological, psychological, and social factors. Catastrophizing predicts chronic pain outcomes, increased pain intensity, and worsening recovery. Virtual reality (VR) interventions offer innovative pain management strategies, but their effects on catastrophizing remain unclear. Methods: This systematic review and meta-analysis followed the PRISMA guidelines. Studies involving adults with chronic musculoskeletal pain, VR-based interventions, and randomized controlled trials were included. The primary outcome was pain catastrophizing. Searches were conducted in PubMed, CINAHL, Scopus, WoS, and PEDro until May 2025. The risk of bias was assessed using Cochrane RoB-2. Meta-analysis calculated effect sizes using mean differences (MD) and standardized mean differences (SMD) with fixed and randomized-effects models. Results: Of 306 records, 244 were screened, 19 underwent full-text review, and two additional studies were identified via Google Scholar. Nine studies were included, eight of which were meta-analyzed. The interventions included eight immersive and one non-immersive VR studies, lasting 3 to 12 weeks. A small but statistically significant effect was found when comparing VR-based interventions with controls (SMD = −0.26 [−0.48; −0.04]). Psycho-cognitive VR-based interventions had a significant effect (SMD = −0.32 [−0.56; −0.09]), while exercise-based VR did not (MD = −0.11 [−4.36; 4.14]). Immersive VR showed a small but significant effect when compared to non-intervention or sham controls (SMD = −0.37 [−0.75; −0.00]). However, when compared to all types of comparators, the effect was not statistically significant (SMD = −0.25 [−0.51 to −0.00]). Heterogeneity was moderate and not significant (p > 0.05). Conclusions: VR-based interventions, particularly immersive with psycho-cognitive approaches, show potential in reducing pain catastrophizing. Future randomized trials are needed to elucidate VR’s efficacy in managing pain catastrophizing.

Chronic neck pain (CNP) is a worldwide health problem with several risk factors. One of the most widely used treatments for managing this condition is therapeutic exercise, which could generate a response called exercise-induced hypoalgesia (EIH). There is no consensus on the best exercise modality to induce hypoalgesia. Therefore, this review aims to analyze and synthesize the state-of-the-art about the hypoalgesic effect of exercise in subjects with CNP. We included articles on EIH and CNP in patients older than 18 years, with pain for more than three months, where the EIH response was measured. Articles that studied CNP associated with comorbidities or measured the response to treatments other than exercise were excluded. The studies reviewed reported variable results. Exercise in healthy subjects has been shown to reduce indicators of pain sensitivity; however, in people with chronic pain, the response is variable. Some investigations reported adverse effects with increased pain intensity and decreased pain sensitivity, others found no clinical response, and some even reported EIH with decreased pain and increased sensitivity. EIH is an identifiable, stimulable, and helpful therapeutic response in people with pain. More research is still needed on subjects with CNP to clarify the protocols and therapeutic variables that facilitate the EIH phenomenon. In addition, it is necessary to deepen the knowledge of the intrinsic and extrinsic factors that influence EIH in people with CNP.

Key words: Cognitive Dysfunction; Executive Function; Fibromyalgia