Pre-stroke frailty, often reflecting the cumulative consequences of lifestyle behaviors like physical inactivity and poor nutrition, is a known predictor of poor outcomes in acute ischemic stroke (AIS), but its role in Vietnamese patients undergoing endovascular thrombectomy remains unexplored. This study evaluates the association between pre-stroke Clinical Frailty Scale (CFS) scores and functional outcomes at 1 and 3 months post-endovascular thrombectomy in Vietnam.
In this prospective cohort study (2023–2024), consecutive AIS patients receiving EVT at a tertiary hospital in Vietnam were assessed for pre-stroke frailty using the CFS. The primary endpoint was a favorable functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score of 0–2. Multivariable logistic regression identified independent predictors, and receiver operating characteristic (ROC) analysis evaluated prognostic performance.
Of 125 patients with a mean age 68 years, 70.4% achieved favorable outcomes (mRS 0–2). Frailty (CFS ≥ 5) present in only 2.3% of patients in the favorable outcome group compared to 27.0% in the poor outcome group (p < 0.001). Median CFS was lower in the favorable outcome group (3 vs. 4, p < 0.001). CFS showed strong predictive accuracy, with areas under the curve (AUC) of 0.78 and 0.84 for favorable and excellent outcomes, respectively.
Pre-stroke frailty, assessed via the CFS, is a simple yet powerful predictor of post-EVT outcomes in AIS patients. Screening and addressing pre-stroke frailty through lifestyle optimization may improve recovery. Therefore, routine frailty screening can enhance patient selection, inform prognostic discussions, and optimize the use of advanced healthcare in resource-constrained settings.
Athletes face multifaceted challenges across physical, psychological, and social domains that impact both performance and well-being. Although a healthy lifestyle is a key factor in athletic success and recovery, current lifestyle assessment tools fall short in capturing the complete scope of interconnected domains of an athlete's health.
This study aimed to develop and validate the Athletes’ Healthy Lifestyle Index (AHLI) as a multidimensional toolkit integrating lifestyle medicine and athlete well-being frameworks to assess and enhance athlete lifestyle behaviors comprehensively.
The AHLI was developed through a rigorous five-stage process: theoretical model development, module selection via Delphi rounds, precise definition of toolkit components, design and structural planning, and comprehensive user evaluation. Additionally, both the external and concurrent validity of the toolkit were confirmed through comprehensive expert reviews and a pilot study involving 95 female taekwondo athletes.
The tool exhibited robust content validity, as indicated by strong content validity ratio/content validity index metrics, alongside moderate external validity (r = 0.368, p = 0.007). Moreover, a significant inverse correlation with stress (r = –0.249, p = 0.015) reinforces its empirical soundness. In pilot testing, 74.7% of participants scored in the moderate lifestyle range, and the tool was deemed comprehensive, intuitive, and actionable.
The AHLI provides a holistic, validated framework for evaluating lifestyle behaviors. It might support performance optimization, injury prevention, and mental well-being through structured assessment and feedback.
Physical inactivity remains widespread, including in Lebanon, with significant health consequences. The Physical Activity Index (PAI) is a practical and cost-effective tool for large-scale population studies. However, the PAI has not been validated in Arabic-speaking populations. This study intended to evaluate the psychometric properties of an Arabic translation of the PAI, with the aim of providing an adapted tool to assess physical activity and support public health initiatives and research efforts in Arab-speaking regions.
The forward-backward translation method was adopted. Data were collected through a one-time online survey from a sample of Lebanese adults (N = 462; mean age = 25.85 ± 9.69 years).
Exploratory factor analysis revealed a single-factor structure for the Arabic PAI. A Cronbach's alpha of 0.71 indicated acceptable internal consistency. The factor structure was invariant across gender. In the total sample, the mean PAI was 23.15 ± 18.81, indicating poor physical activity, with no significant gender differences. Convergent validity was supported by a significant positive correlation between PAI and Exercise scores (r = 0.50; p < 0.001). Concurrent validity was confirmed through positive correlations between PAI scores and general physical condition, general well-being, and emotional intelligence scores.
These preliminary findings indicate that the Arabic version of the PAI has acceptable psychometric properties and holds potential for use in large-scale population studies due to its low cost, easy scoring, quick completion time, and suitability for the Lebanese young adult population. Further research is needed to confirm its validity and expand its applicability across different age groups and Arab countries.
Extended sitting time negatively affects physical and mental health. The objective of this study was to determine the relationships among sitting time, cardiovascular disease (CVD) risk and health-related quality of life (HRQoL) among desk-based employees at a tertiary academic institution in South Africa (SA).
This cross-sectional survey was conducted among desk-based employees at a tertiary academic institution in SA through an online questionnaire. Demographic information, CVD health risk (using the heart disease risk score [HDRS]), HRQoL (using RAND 36-Item Health Survey) and workday sitting time (Workforce Sitting Questionnaire [WSQ]) were collected. Partial correlations, adjusted for age, sex and ethnicity, were conducted to explore the relationships between total daily sitting time, CVD risk and HRQoL.
The study included 295 university employees (39.24 ± 9.76 years; 72% females and 28% males). During a typical weekday, employees spent 12.90 ± 2.66 h/day seated, primarily performing 7.09 ± 1.45 h seated during the expected 8-h workday. More than half (56%) of the employees reported increased CVD risk. The results indicate that prolonged sitting was associated with reduced energy (r = −0.12, p = 0.004), greater fatigue, poorer social functioning (r = −0.104, p = 0.012) and increased pain (r = −0.083, p = 0.044). In addition, a small yet significant positive relationship with CVD risk (r = 0.101, p < 0.05).
Desk-based employees at a South African tertiary institution exhibit high sitting time, particularly during their workday, with more than half at moderate to high risk of CVD. Prolonged sitting negatively influences energy, social functioning and pain. Further studies should focus on increasing the frequency of breaks during a workday to limit sitting time.
Digital health technologies promise a future of efficient, empowered patients and improved clinical outcomes. However, real-world clinical experience reveals a more nuanced picture. Through encounters with tools like myCOPD, the NHS App and Oviva, it becomes clear that these systems hold a dual potential: they can either strengthen the therapeutic alliance or subtly erode it. On the one hand, rigid digital pathways risk excluding older adults, and strict app adherence can sometimes mask dangerous clinical deterioration, prioritising algorithmic convenience over lived expertise. On the other hand, when applied flexibly and aligned with patient preferences, technology powerfully enhances health literacy and fosters meaningful engagement.
This dichotomy highlights that the success of digital healthcare cannot be measured by adoption rates or technical sophistication alone. True effectiveness is found in a tool's capacity to honour patient autonomy, preserve personal identity and ultimately deepen human connection. Therefore, integrating digital health requires more than deploying software; it demands a deliberate fusion of technology with clinical judgement, compassionate communication and co-designed choices. As healthcare becomes increasingly digitised, our ultimate metric must be whether these systems amplify patient voices and support care that is guided by one essential question: ‘What works best for you?’
The neurogenic and neuroplastic capability of the brain plays a crucial role in mitigating responses to internal and external environmental stimuli. However, this process is inhibited in obesity, neurodegenerative and psychological disorders, the prevalence of which has increased on a global scale. To date, there is no real effective way to ameliorate these conditions except for lifestyle and behavioural interventions. Lifestyle interventions, such as dietary regulation, nutrient supplementation, physical activity and environmental enrichment, can positively modulate neurogenic capacity.
This review describes various lifestyle modifications and how these impact the neurogenesis of adult brains.
Ideally, multimodal approaches incorporating several of these interventions could be employed to enhance neurogenesis and facilitate constructive neuroplastic remodelling. This has promising potential in supporting brain health and contributing to the management of various neurological conditions, including brain injuries and can promote healthy ageing, although its impact on longevity remains to be fully understood.
The observed improvement in the measured outcomes elicited through these interventions cannot be ignored. Thus, further efforts should be made to investigate this topic and research field to identify more evidence-based impacts of lifestyle modifications on neuroplasticity and related processes.
Cold water immersion (CWI) has gained attention as a potential strategy for improving mental health. Although studies demonstrate consistent mood-enhancing effects following sea swimming and controlled CWI, the role of environmental context remains unclear. No previous studies have directly compared natural and artificial immersion settings using a within-subjects design. This study aimed to isolate the influence of immersion environment on acute mood outcomes.
Twenty-seven healthy university students (16 males, 11 females; age 20 ± 4 years, height 1.71 ± 0.08 m, mass 70.4 ± 9.2 kg) completed a within-subject crossover design comparing two CWIs: one in the sea and one in a laboratory tank, 1 week apart. Mood was assessed using the Profile of Mood States—Short Form (POMS-SF) before and after a 5-min chest-deep immersion. Immersions were completed individually to minimise social facilitation. One- and two-way repeated measures ANOVAs analysed total mood disturbance (TMD) and subscales, with Bonferroni-corrected post hoc t-tests.
Mood improved significantly following both immersions and across all subscales. Paired-sample t-tests showed greater reductions in TMD (t(26) = −2.69, p = 0.012, d = −0.52) and larger increases in esteem-related affect (t(26) = 2.41, p = 0.023, d = 0.46) after sea immersion compared to laboratory immersion. A trend in favour of sea immersion was also observed for vigour (t(26) = −1.998, p = 0.056, d = −0.38). Although all negative subscales improved over time, no significant between-condition differences were found. Analysis of TMD change scores showed that 13 participants (48%) responded similarly across both conditions, 10 (37%) improved more in the sea, and 4 (15%) improved more in the laboratory.
CWI significantly improved mood across both conditions. Sea immersion produced slightly greater benefits, suggesting that natural environments may modestly enhance the psychological effects of cold exposure.
Social connectivity and interpersonal relationships underpin all aspects of lifestyle. As part of a broader research collaboration on the Mediterranean lifestyle, we examined existing evidence on social connectivity patterns in Mediterranean regions and how they differed from those in non-Mediterranean regions to explore the role of social connectedness in health and well-being across two settings.
We conducted a comparative narrative umbrella review of systematic, scoping and narrative reviews with no time limit, identifying papers using PICOS criteria (participants: adults; interventions: social connectivity and interpersonal relationships in Mediterranean countries; comparators: social connectivity and interpersonal relationships in non-Mediterranean countries; outcomes: well-being/lifespan, morbidity and mortality; studies: systematic review, meta-analysis, scoping review, evidence synthesis and narrative reviews). The umbrella review was prospectively registered with PROSPERO and followed PRISMA guidelines with a double-blind selection process and multi-researcher data extraction. AMSTAR2 criteria and ROBIS were used for quality and bias assessment. Studies with high risk of bias were excluded.
A total of 49 reviews were included (systematic n = 44, scoping n = 4 and narrative n = 1). Overall, 75% of reviews were high quality (AMSTAR2), and 71% of the studies had a low risk of bias (ROBIS). A positive association between social connectivity or healthy relationships and health outcomes was found in both Mediterranean and non-Mediterranean countries, especially in the elderly population. Conviviality and interdependence and family orientation were common features of Mediterranean relationships, and important social structures within families and local communities. Research on Mediterranean relationships explored various contexts, including protective effect of social support, loneliness and social isolation, family dynamics, gender norms, mental health and chronic disease-associated stigma.
Social connectivity and healthy relationships, defined by both quality and presence, are positively associated with well-being and healthy aging and reduced mortality in all regions. Future studies should include measures of social connectivity and explore how enabling and strengthening interpersonal relationships can enhance health outcomes.
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