Objective: This work aimed to determine the relationship between the autonomic nervous system and reactive hyperemia (RH) in type 2 diabetes patients with and without cardiovascular autonomic neuropathy (CAN). Methodology: A systematic review of randomized and nonrandomized clinical studies characterizing reactive hyperemia and autonomic activity in type 2 diabetes patients with and without CAN was performed. Results: Five articles showed differences in RH between healthy subjects and diabetic patients with and/or without neuropathy, while one study did not show such differences between healthy subjects and diabetic patients, but patients with diabetic ulcers had lower RH index values compared to healthy controls. Another study found no significant difference in blood flow after a muscle strain that induced reactive hyperemia between normal subjects and non-smoking diabetic patients. Four studies measured reactive hyperemia using peripheral arterial tonometry (PAT); only two found a significantly lower endothelial-function-derived measure of PAT in diabetic patients than in those without CAN. Four studies measured reactive hyperemia using flow-mediated dilation (FMD), but no significant differences were reported between diabetic patients with and without CAN. Two studies measured RH using laser Doppler techniques; one of them found significant differences in the blood flow of calf skin after stretching between diabetic non-smokers and smokers. The diabetic smokers had neurogenic activity at baseline that was significantly lower than that of the normal subjects. The greatest evidence revealed that the differences in RH between diabetic patients with and without CAN may depend on both the method used to measure hyperemia and that applied for the ANS examination as well as the type of autonomic deficit present in the patients. Conclusions: In diabetic patients, there is a deterioration in the vasodilator response to the reactive hyperemia maneuver compared to healthy subjects, which depends in part on endothelial and autonomic dysfunction. Blood flow alterations in diabetic patients during RH are mainly mediated by sympathetic dysfunction. The greatest evidence suggests a relationship between ANS and RH; however, there are no significant differences in RH between diabetic patients with and without CAN, as measured using FMD. When the flow of the microvascular territory is measured, the differences between diabetics with and without CAN become evident. Therefore, RH measured using PAT may reflect diabetic neuropathic changes with greater sensitivity compared to FMD.

Background: Breast cancer-related lymphedema (BCRL) is a common complication that impairs function and quality of life (QoL). The comparative effectiveness of physical therapy interventions (PTIs) remains unclear. This systematic review and network meta-analysis (NMA) was conducted to identify the most effective PTIs for BCRL management. Methods: A systematic search of Medline/PubMed, LILACS, CENTRAL, PEDro, and CINAHL was conducted up to July 2024. Eligible studies were randomized controlled trials (RCTs) involving women with BCRL, evaluating PTIs delivered alone or in combination. Primary outcomes were lymphedema volume, volume reduction, percentage reduction, QoL, and pain. Secondary outcomes included range of motion (ROM), grip strength, and adverse events. A frequentist NMA was performed, and certainty of evidence (CoE) was assessed using the GRADE approach. Results: Eighty-three RCTs were identified, of which twenty-six (1203 participants) were included in the NMA, assessing 23 PTIs. Based on moderate CoE, yoga was among the most effective interventions for improving QoL within 6 months compared to usual standard care (USC). The multimodal approach, with or without a home exercise program, showed intermediate benefits for external rotation and may also improve shoulder abduction (low to moderate CoE). No intervention demonstrated clear superiority over USC for other outcomes. Adverse events were reported with kinesiotaping and compression measures. Conclusions: The evidence supports yoga and multimodal programs as potential short-term strategies for improving QoL and shoulder mobility in women with BCRL. However, the predominance of low-to-very-low CoE underscores the need for individualized clinical decisions and future high-quality RCTs with standardized comparators, larger samples, and longer follow-up. The consistent use of standardized comparators will be crucial in improving network connectivity and enabling more robust and comprehensive comparisons across multiple interventions.

Introduction: Post-Coronavirus disease 2019 (Post-COVID-19) syndrome has neurological symptoms related to the dysfunction of the autonomous nerve system. However, a pathogenic relationship between post-COVID-19 syndrome and dysautonomia still remains to be demonstrated. Establishing a pathogenic relationship between paresthesia and the presence of cardiac dysautonomia in patients with post-COVID-19 syndrome is the objective of this study. Participants and Methods: This observational study was carried out in the neurophysiology service wing of the Juan Bruno Zayas Hospital, Santiago de Cuba, in Cuba. The patients were recruited through a post-COVID-19 clinic at the same hospital. A variability study of cardiac frequency and a test of autonomic cardiovascular reflexes was carried out, which is composed of deep breathing, orthostatism, and the Valsalva maneuver. Results: The variability parameters of the cardiac frequency, the expiration–inspiration ratio between deep breaths, and the Valsalva Index showed no statistically significant differences between healthy participants and those with post-COVID-19 syndrome. During the Valsalva maneuver, there was a greater cardiac frequency response in participants with post-COVID-19 syndrome than in healthy subjects. The difference in supine and standing blood pressure was significantly minor in patients with post-COVID-19 syndrome. The logarithm of high frequency (log HF) increased significantly in patients with paresthesia when compared to patients without paresthesia. Conclusions: In the autonomic function tests, no signs of dysautonomia were found in patients with post-COVID-19 syndrome. The presence of paresthesias is associated with differences in cardiac vagal activity, which may suggest that damage to peripheral sensory nerve fibers could be associated with an affectation to autonomic fibres.

The aim of this study was to compare the effectiveness of exercise combined with educational strategies to exercise alone or educational strategies alone in patients with WAD on pain or disability. Systematic Review and Meta-Analysis. The MEDLINE, Cochrane, Scopus, PEDro, and Web of Science databases were searched. Clinical trials investigating the effects of education and exercise combined on pain and disability in adults diagnosed with WAD. PEDro, RoB2 and GRADE were used to assess methodological quality, risk of bias and certainty of evidence, respectively. Random-effects models were applied for meta-analysis. Six trials were included in the final review. Education and exercise compared to education alone showed a statistically significant change in pain (MD = -1.00; 95%CI -1.29, -0.71; 2 studies, 212 patients) in the post-treatment period . There was no statistically significant change in pain during the follow-up period. Likewise, education and exercise compared to exercise alone showed a statistically significant change in pain (MD = -0.61; 95%CI -1.00, -0.23; 6 studies, 386 patients), obtained from mid-long follow-up . There was no statistically significant change in pain in the post-treatment period. The resulting significant changes in the pain variable are not clinically relevant. The results show no significant change in disability over any time period. The certainty of the evidence was downgraded to very low for all comparisons. There are no important clinical differences between a combined exercise and education treatment and an education alone or exercise alone treatment in terms of pain and disability in patients with WAD.

Background and Objectives: Comprehensive physical profiling is important for monitoring athletic development in youth soccer players (YSP), yet integrated data from competitive South American players remain limited. This study aimed to characterize the anthropometric profile, neuromuscular performance, and cardiorespiratory fitness of competitive Chilean YSP and explore associations among these components. Methods: This cross-sectional study included 24 male YSP from a Chilean professional club academy. Participants underwent anthropometric assessment, bilateral quadriceps isometric strength testing, vertical jump testing (Squat Jump [SJ], Countermovement Jump [CMJ], and Abalakov Jump [ABK]), and maximal cardiopulmonary exercise testing. The primary analysis was an integrated characterization of anthropometric, neuromuscular performance, and cardiorespiratory fitness. Secondary exploratory analyses included correlations with false discovery rate adjustment and multiple linear regression. Results: Participants had a median age of 13.5 years (IQR: 13.0–14.0) and a BMI of 21.1 ± 1.6 kg·m⁻². Mean bilateral quadriceps strength was 406.1 ± 70.0 N, while mean jump heights were 24.6 ± 4.2 cm for SJ, 28.4 ± 3.7 cm for CMJ, and 33.4 ± 5.3 cm for ABK. The average relative VO₂peak was 55.0 ± 4.7 mL·kg⁻¹·min⁻¹, while absolute VO₂peak was slightly higher than predicted. Bilateral quadriceps strength was positively associated with all three jumps before FDR adjustment; after FDR correction, the associations with CMJ and ABK remained statistically significant, whereas the association with SJ did not. Relative VO₂peak was not associated with CMJ performance. Conclusions: This study provides an integrated characterization of physical performance within this cohort of youth soccer players. Quadriceps strength was associated with vertical jump performance, whereas relative VO₂peak was not associated with CMJ, supporting assessment of neuromuscular and cardiorespiratory capacities.

Introduction: Patients with type 2 diabetes mellitus tend to have insulin resistance, a condition that is evaluated using expensive methods that are not easily accessible in routine clinical practice. Objective: To determine the anthropometric, clinical, and metabolic parameters that allow for the discrimination of type 2 diabetic patients who have insulin resistance from those who do not. Methods: A cross-sectional analytical observational study was carried out in 92 type 2 diabetic patients. A discriminant analysis was applied using the SPSS statistical package to establish the characteristics that differentiate type 2 diabetic patients with insulin resistance from those without it. Results: Most of the variables analyzed in this study have a statistically significant association with the HOMA-IR. However, only HDL-c, LDL-c, glycemia, BMI, and tobacco exposure time allow for the discrimination of type 2 diabetic patients who have insulin resistance from those who do not, considering the interaction between them. According to the absolute value of the structure matrix, the variable that contributes most to the discriminant model is HDL-c (−0.69). Conclusions: The association between HDL-c, LDL-c, glycemia, BMI, and tobacco exposure time allows for the discrimination of type 2 diabetic patients who have insulin resistance from those who do not. This constitutes a simple model that can be used in routine clinical practice.