Physical activity, sedentary behaviour, sleep quality, and anxiety are interrelated factors that play a critical role in physical and mental health. However, limited evidence exists on their associations within the Saudi Arabian context. This study aimed to investigate the relationships between physical activity, sedentary behaviour, sleep quality, and anxiety symptoms among healthy, pain-free adults in Saudi Arabia. A cross-sectional online survey was conducted between December 2024 and April 2025 using validated Arabic versions of the Global Physical Activity Questionnaire (GPAQ), the Brief Pittsburgh Sleep Quality Index (B-PSQI), and the Generalised Anxiety Disorder-7 (GAD-7). The data were analysed using descriptive statistics and multivariable linear regression models. A total of 185 participants (mean age = 33.99 ± 12.57 years; 69.73% female) were included. The average total physical activity was 1730.02 ± 2109.24 MET min/week, and the mean sedentary time was 6.77 ± 4.69 h/day. No significant associations were found between physical activity and either sleep quality or anxiety symptoms. Similarly, sedentary behaviour time was not significantly associated with sleep quality or anxiety symptoms. However, poorer sleep quality was significantly associated with higher anxiety levels. These findings highlight the importance of sleep quality in mental health strategies for healthy adults in Saudi Arabia.

Objective: the aim of this systematic review and meta-analysis was to evaluate the effectiveness of photobiomodulation therapy (PBM) on perineal pain and wound healing following episiotomy. Methods: Electronic databases were searched for randomized controlled trials (RCTs) and non-RCTs investigating PBM after episiotomy. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-RCTs. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analyses were performed using random-effects models. Results: Eight studies were included in the systematic review, and six studies were included in the meta-analysis. According to RoB 2, one trial was judged at low risk of bias, two trials raised some concerns, and three trials were at high risk of bias. ROBINS-I showed the serious risk of bias of two non-RCTs. GRADE for both pain and wound-healing outcomes was rated as very low. Meta-analysis of pain showed no significant difference between PBM and control groups (SMD = 0.04; 95% CI −0.60 to 0.68; p = 0.89), with considerable heterogeneity (I² = 91%). For wound-healing outcomes, meta-analysis showed no significant difference (MD = 0.94; 95% CI −0.69 to 2.56; p = 0.26), with substantial heterogeneity (I² = 94%). Conclusions: PBM therapy did not demonstrate a significant benefit for reducing perineal pain or improving wound healing after episiotomy compared with control interventions. Interpretation of these findings should be made cautiously due to small study numbers, substantial heterogeneity, and the inability to perform sensitivity or subgroup analyses, highlighting the need for high-quality RCT with standardized PBM protocols before clinical recommendations can be made.

Objectives: The aim of this systematic review was to evaluate the effectiveness of photobiomodulation (PBM) on pain and function in individuals with Patellofemoral Pain Syndrome (PFPS). Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Search was performed across PubMed/Midline, Scopus, Web of Science, EBSCO, ScienceDirect, Wiley Online Library, Springer, Cochrane CENTRAL, PEDro, ResearchGate, and Google Scholar from inception to January 2025. Randomized controlled trials (RCT) examining PBM in individuals with PFPS were included. Data extraction, risk-of-bias assessment (RoB 2), and quality of evidence evaluation (GRADE) were performed independently by multiple reviewers. Primary and secondary outcomes were pain and function, respectively. A random effect meta-analysis was performed to estimate the standardized mean difference (SMD) at 95% confidence interval (CI) and overall effect size. Results: Eight trials (340 participants) met the inclusion criteria. PBM significantly reduced pain compared with the control (SMD = −0.83; 95% CI −1.40 to −0.27). Functional outcomes demonstrated a significant improvement favoring PBM (SMD = 0.68; 95% CI 0.08 to 1.27), although substantial heterogeneity was present (I² = 83%). RoB2 showed five high-risk studies. GRADE showed a very low quality of evidence due to study limitations, imprecision, and inconsistency which limit the confidence to the effect estimate. Conclusions: PBM, combined with exercise, provides improvements in pain and knee function in individuals with PFPS. While findings support PBM as an effective adjunct modality, standardized dosing protocols and larger, high-quality RCTs are needed to strengthen future clinical recommendations.

Background/Objectives: Disability in chronic low back pain (CLBP) is multifactorial, yet the independent associations of pain, fear-avoidance beliefs, and comorbidity burden with self-reported disability and performance-based walking capacity remain unclear, particularly in Saudi Arabia. This study examined factors independently associated with functional disability and walking capacity in adults with CLBP and explored whether disability was independently associated with walking capacity after accounting for demographic and clinical factors. Methods: This cross-sectional study included 339 adults with CLBP. Functional disability was assessed using the Oswestry Disability Index (ODI), walking capacity using the 6-Minute Walk Test (6MWT), and fear-avoidance beliefs using the physical activity (FABQ-PA) and work (FABQ-Work) subscales of the Fear-Avoidance Beliefs Questionnaire. Comorbidity burden was quantified as an unweighted count of previously diagnosed chronic conditions reported by participants and BMI-defined obesity. Multiple linear regression was used to examine factors independently associated with disability and walking capacity. The disability model included age, sex, pain intensity, FABQ-PA, FABQ-Work, and comorbidity burden. Walking capacity was examined using two models: the first included the same factors, whereas the second exploratory model additionally included ODI to examine whether disability was independently associated with 6MWT distance. Results: Bivariate analyses showed that pain intensity was positively correlated with FABQ-PA and FABQ-Work (r = 0.303–0.355), while ODI was positively correlated with comorbidity burden (r = 0.170). The 6MWT was negatively correlated with pain intensity, FABQ-PA, and FABQ-Work (r = −0.162 to −0.170) and more strongly with ODI (r = −0.550). In the adjusted disability model, comorbidity burden was the only factor independently associated with ODI score, with each additional comorbid condition associated with a 2.30-point higher ODI score (B = 2.296, 95% CI 0.834 to 3.759, p = 0.002). In the first adjusted walking-capacity model, higher pain intensity was independently associated with shorter 6MWT distance (B = −5.108, 95% CI −10.05 to −0.17, p = 0.044), while the other factors were not significantly associated with walking capacity. In the second adjusted walking-capacity model, greater disability was independently associated with shorter 6MWT distance (B = −3.996, 95% CI −4.655 to −3.337, p < 0.001). None of the other factors remained significantly associated with walking capacity in this model. Conclusions: Greater comorbidity burden was independently associated with greater disability in adults with CLBP, while greater disability was strongly associated with poorer walking capacity, highlighting the relevance of comorbidity burden and disability to functional limitations in CLBP.

Background/Objectives: Foot arch status and muscular strength may influence balance and physical performance. However, evidence regarding their associations with unilateral balance performance, walking performance, and lower limb functional capacity in healthy young adults, particularly in Saudi Arabia, remains limited. This study investigated the associations of foot arch status and handgrip strength with these outcomes in healthy young Saudi adults. Methods: In this cross-sectional study, 104 healthy young adults (mean age: 21.1 ± 1.2 years; 52.9% female) underwent assessment of foot arch status using the sit-to-stand navicular drop test (SSNDT) and of muscular strength using a digital hand dynamometer. Unilateral balance performance was assessed using the single-leg stance test (SLST) under eyes open and eyes closed conditions. Walking performance and lower limb functional capacity were assessed using the 10 m walk test (10-MWT) and the 30 s chair stand test (30 s-CST), respectively. Generalised estimating equations and multivariable linear regression models were used to examine adjusted associations. Results: Greater SSNDT scores were independently associated with shorter SLST duration for both the right (β = −0.46, p = 0.003) and left feet (β = −0.25, p = 0.048). Greater handgrip strength was independently associated with longer SLST duration for the right foot only (β = 0.17, p = 0.019). Neither SSNDT score nor handgrip strength was independently associated with 10-MWT or 30 s-CST outcomes after adjustment. Athletic participants demonstrated superior balance and chair-stand performance, while the male sex was associated with longer SLST duration. Conclusions: Greater functional lowering of the medial longitudinal arch was independently associated with poorer unilateral balance performance, whereas handgrip strength demonstrated a more limited association. These findings suggest that foot arch behaviour is more strongly related to balance performance than to walking performance or lower limb functional capacity.

Background/Objectives: Knee osteoarthritis (OA) is a prevalent degenerative joint disorder associated with pain, impaired proprioception, and reduced physical function. While closed kinetic chain exercises (CKCEs) are commonly prescribed to enhance joint stability, their weight-bearing nature may exacerbate symptoms. Graded weight-bearing exercises (GWBEs) using anti-gravity treadmill training provide a novel approach to reduce joint loading while maintaining functional mobility. This study aimed to evaluate the effectiveness of GWBEs compared with CKCEs and open kinetic chain exercises (OKCEs) on pain, function, proprioception, and quadricep strength in patients with knee OA. Methods: Forty-five adults aged 40–60 years with radiographically confirmed knee OA were randomized into three groups: (1) GWBE + OKCE, (2) CKCE + OKCE, or (3) OKCE alone. Interventions were conducted three times per week for six-weeks. Outcomes included pain (Visual Analogue Scale), physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 6-Minute Walk Test), proprioception (joint repositioning error at 45°), and quadriceps strength (isokinetic peak torque at 60°, 120°, and 180°/s). Results: All groups demonstrated significant improvements in pain and function (p < 0.05). Proprioception improved in the GWBE + OKCE and CKCE + OKCE groups but not in the OKCE group. No significant changes were observed in quadriceps strength across groups. The GWBE + OKCE group showed significantly greater improvements in pain, function, and proprioception compared to both comparator groups (p < 0.05). Conclusions: GWBE combined with OKCE is more effective than CKCE + OKCE and OKCE alone in improving pain, function, and proprioception in patients with knee OA.