Patients in both groups received their program three times/week for 3 months. Pain, cardiorespiratory fitness, functional ability, and quality of life were assessed through the visual analogue scale, cardiopulmonary exercise test, 6 min walk test, and PedsQL scale, respectively, just before and after treatment. Results: Pain (p = 0.001), cardiorespiratory markers , functional ability (p = 0.002), and overall quality of life (p = 0.007) improved significantly in the experimental groups compared to the control group. Conclusion: Incorporating Pilates exercises into CPT is likely more effective for decreasing pain intensity, improving cardiorespiratory fitness, augmenting functional ability, and promoting quality of life in children with JIA than CPT alone.Objective: This study intended to examine the effects of Pilates exercise on pain, cardiorespiratory fitness, functional ability, and quality of life in children with polyarticular juvenile idiopathic arthritis. Methods: Forty children with polyarticular JIA aged 10–14 years old were randomly allocated into two groups: the control group ( Juvenile idiopathic arthritis (JIA) is one of the most common chronic childhood inflammatory diseases and is characterized by permanent joint inflammation attributable to immune system disturbance . The infChildren with JIA often present with pain, morning stiffness, and swelling in the involved joints. They also experience muscle weakness and atrophy around the inflamed joints and activity limitations . MoreoveImpaired aerobic fitness and lower levels of physical function during the active stage of the disease lead to functional declines among children with JIA . FurtherTherapeutic exercises play an essential role as a non-pharmacologic treatment for children with JIA. They have been effectively used to reduce pain, improve muscular function, increase physical activity, and promote quality of life in children with chronic musculoskeletal disorders . PilatesAlthough evidence is mounting for the beneficial effects of Pilates exercises on the cardiorespiratory fitness and physical activity level in healthy people and different patients  ,16,17, sThis randomized, controlled clinical trial was conducted between August 2020 and July 2021 in the physical therapy outpatient clinic at the College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University (PSAU), Saudi Arabia. PSAU’s Physical Therapy Research Ethics Committee (No: RHPT/0020/0035) provided ethical approval. Study measures were performed in agreement with the Declaration of Helsinki 1975 ethical standards for medical research. Before enrollment, all procedures were fully demonstrated to all patients and their caregivers. They were then requested to sign a consent form. A researcher who was not aware of treatment assignment evaluated pain severity, cardiorespiratory fitness, physical activity level, and quality of life before and after the intervention. This trial was registered at ClinicalTrials.gov (ID: NCT05231057).Patients were enrolled from the Maternity and Children’s Hospital and King Khalid Hospital (Pediatric Rheumatology Department) in Al-Kharj, Saudi Arabia. Inclusion criteria were as follows: polyarticular JIA according to the classification of International League of Associations for Rheumatology , age rann = 20), while Pilates exercises plus the conventional physical therapy program were administered to the experimental group (n = 20). An independent researcher used a simple randomization approach in which sealed non-transparent envelopes included a code for one of the two experimental sets . These were drawn to determine intervention assignment for each participant. Forty patients met the criteria. Following the baseline examination, they were divided into two equal-sized groups at random. Conventional physical therapy (CPT) was administered to the control group , with 0 demonstrating no pain or discomfort and 10 indicating the strongest pain experience. Participants were instructed to cut the line at a point that represented how much pain they felt at rest and/or during activity .2), maximum heart rate (HRmax), and breath-by-breath minute ventilation (VE) according to the McMaster incremental cycle protocol [A graded cardiopulmonary exercise test was used to assess cardiopulmonary fitness. An electromagnetic cycle ergometer with electronic braking  was used to assess the peak oxygen uptake . It assesses nine domains: dressing, grooming, getting out of bed, eating, ambulation, self-hygiene, grip reach, activities, and extra-curricular events. The results were transformed to a CHAQ disability score ranging from 0 to 3 (a higher mark indicates a higher level of disability) .The self-reported Pediatric Quality of Life Inventory was used to assess quality of life (PedsQL). PedsQL is a 23-item multidimensional measure of health-related quality of life (HRQL) in children and adolescents and is divided into 4 areas . This questionnaire has been approved for usage with kids and adolescents aged 2 to 18 years old . On a 5-All children in the two groups underwent the conventional PT program , which was delivered by a pediatric physical therapist. The key priorities were reliving pain, increasing flexibility and mobility, improving muscle strength, and promoting proprioceptive awareness as well as increasing aerobic fitness. In general, the program consists of pain reliving modalities, stretching exercises, active range of motion activities, weight bearing activities, aerobic exercises on a treadmill or a bicycle, and isometric exercises ,24,25.Pilates exercises  were administered to patients in the experimental group by a pediatric physical therapist. Mats, Pilates bands or elastic bands, and Pilates ball are some of the several types of equipment used in Pilates exercises to attain various goals ,27. Detad = 1.04; as calculated in a pilot study of eight children who received similar interventions). The significance level was 0.05 using a two-sided independent t-test. To account for a potential dropout rate of 20%, the sample size was increased to 40 .The analysis was conducted using G*Power program version 3.0.10 . A group sample size of 16  was needed to achieve 81.23% power to reject the null hypothesis of zero effect size on pain intensity when the population effect size is too small (Cohen’s t-test (for continuous data) and a Chi-square test  were used to assess baseline differences between the IMT and control groups. The analysis of covariance (ANCOVA) test was used to calculate the post-treatment differences between the two groups (for primary and secondary outcome variables). To compare the two groups, the pre-treatment values of the dependent outcome variables were employed as covariates. The partial eta-squared equation was used to calculate the effect size (ES) for the significant ANCOVA. For all statistical tests, the level of significance was set at p < 0.05.Data analyses were conducted with SPSS version 21 . The Kolmogorov–Smirnov test was used to determine data normality. An independent The children involved in the current study were screened for eligibility. Out of 61 possibly eligible children, 40 participants met the criteria for inclusion and were randomly assigned to either the control or the experimental group. Three children did not complete the study . The CONSORT flow chart is explained in p = 0.001, ES = 0.92), which were in favor of the experimental group. In addition, there were large significant differences in the cardiopulmonary fitness between the two groups, as measured by the peak VO2  = 8.45, p = 0.008, ES = 0.81), VE  = 11.16, p = 0.002, ES = 0.90), and HRmax  = 6.39, p = 0.004, ES = 0.84), where the experimental group showed better cardiopulmonary fitness than the control group.p = 0.002, ES = 0.89), as the mean CHAQ score was lower in the experimental group in comparison to the control group. Still, there were significant differences in the quality-of-life domains between both groups: the physical dimension  = 7.21, p = 0.011, ES = 0.74), psychosocial dimension  = 5.17, p = 0.029, ES = 0.59), and total scores  = 8.20, p = 0.007, ES = 0.79) were all in favor of the experimental group.Further, there was a large significant difference between the two groups concerning their functional status  = 10.75, The current study was designed to evaluate the influence of Pilates exercises besides conventional physical therapy on pain, cardiorespiratory fitness, physical activity level, and quality of life in children with polyarticular JIA. Our results revealed that combining Pilates exercises with a conventional physical therapy program yielded favorable outcomes regarding the reduction in pain perception, the improvement of cardiorespiratory fitness, increasing the physical activity level, and the enhancement of quality of life.The role of Pilates exercises in relieving pain may be attributed to the breathing exercises, which are a main component of Pilates, as breathing exercises improve lung capacity, blood oxygenation, and circulation. Pilates also encourages the brain to release normal endorphins and opiates, which reduces pain and stress . IncreasOne possible explanation for the constructive effect of our results is the weekly exposure to the exercises, as the two interventions (Pilates + CPT) were delivered to improve cardiorespiratory fitness. The strengthening of the lumbopelvic region and core muscles that occurred during the exercises may have led to a better movement pattern in the limbs and better strength in the expiratory muscles . Another2 max and ventilatory thresholds in sedentary women with decreased respiratory capacity levels [The results of our study are also in line with the study conducted by Souza et al. to investigate the effect of cardiorespiratory adaptation to Pilates training. They concluded that 15 successive weeks of Pilates training has a positive impact on cardiorespiratory factors such as VOy levels . Our resy levels .Our results also showed that 3 months of clinical Pilates exercises in adolescents with JIA improved their functional status. This improvement may be associated with reduced pain intensity and improved aerobic capacity. We verified this claim through a finding of a study by Limenis et al., who studied the association between physical activity levels and functional status with pain in JIA children and concluded that there was an inverse relationship between pain severity and functional activity level . A studyThe results of our current study revealed that there was enhancement in the HRQOL in children with JIA, and these results are consistent with the results of Calik et al., who stated that clinical Pilates exercises increase mobility in children and adolescents with JIA, making them more active in daily activities. This has enables them to improve their overall quality of life . Our resAlthough the results of this study are mostly positive, there are some limitations that affect the generalizability of the results. First, the lack of long-term follow-up means further research is required to study the effects of Pilates exercises after 6–12 months. Second, a small sample size and relatively low power mean further studies are required to examine the influence of Pilates exercises on a large sample, thus resulting in more solid conclusions. Special consideration should be given when generalizing these findings, as this study was conducted on patients with only one specific type of polyarticular JIA and in one specific age group. As such, more research is desirable to explore the impact of Pilates exercises combined with a conventional physical therapy program on other types of JIA and on different age groups of children with JIA.Notwithstanding the relatively limited sample, this work suggests that the incorporation of Pilates exercises into physical therapy programs is likely an effective strategy for decreasing pain intensity, improving cardiorespiratory fitness, augmenting the physical activity level, and promoting HRQOL in children with JIA. However, large randomized controlled trials could provide more definitive evidence.


Helicobacter pylori (HP) is known to be involved in intestinal carcinogenesis. As regards hepatobiliary cancers, there are few and inconsistent reports. We investigated HP infection and its association with the incidence of hepatobiliary cancers in a large cohort study. The cohort's appropriateness for the purpose was gauged by its ability to identify the established risk relation to gastric cancer.This historical study was performed in the Central Denmark Region. Patients were included from primary healthcare after being tested for HP infection with a urea breath test. Patients’ diagnoses, age, gender, and country of birth were obtained from Danish national administrative registries. Cox regression was used to compare incidences of hepatobiliary and gastric cancer between HP-positive and HP-negative persons, adjusting for confounding variables.A total of 53,633 persons were included and 10,553 were tested HP-positive. They were followed for a median of 4.6 years . We found 64 hepatobiliary cancers, with a markedly lower incidence in HP-positive persons; HR = 0.27 (95% CI 0.11–0.68). A higher incidence of gastric cancer in HP-positive persons was confirmed (HR = 1.99 (95% CI 1.35–2.94)).The incidence of hepatobiliary cancers was remarkably lower in HP-infected persons after adjusting for age, gender, cirrhosis, alcohol-related diagnoses, chronic viral hepatitis, and country of origin. We found no methodological cause for this unexpected finding, and the pathogenic links between the infection and cancer remain to be identified. Our results must be confirmed in a similar cohort. Helicobacter pylori (HP) is a gram-negative bacterium colonising the gastric mucosa. HP infection is very common worldwide, and the prevalence increases with age.,,Hepatobiliary cancer covers primary cancers of the liver, the biliary tree, and the gallbladder. Primary liver cancer is the fifth most common cancer and one of the leading causes of cancer-related death worldwide.H. pylori proteins was associated with an increased risk of biliary tract cancers.H. pylori protein, CagA, and a higher risk in seronegative individuals.Any association between such prevalent diseases is of obvious pathophysiological and public health interest. Recently, as well a higher prevalence and a lower prevalence of HP DNA in liver tissue with HCC and chronic liver disease are reported, and the findings are of unclear significance.HP is a recognised carcinogen of the gastrointestinal tract, and it remains unsettled if and how HP relates to hepatobiliary cancer. We had access to a dataset of people tested for the presence or absence of HP with long-term follow-up. On this background, we investigated the association of HP infection and the incidence of hepatobiliary cancer in a population-based cohort.The study was approved by the National Board of Health and by the Danish Data Protection Agency .According to Danish law, approval from the Danish Committee on Health Research Ethics was not necessary. As this is a register-based study, written consent from participants was not required.The current historical cohort study includes a total of 53,633 persons who underwent a urea breath test (UBT) from November 2002 until 31 December 2012, employing a system developed to diagnose and treat HP infections in general practice.The test results from the UBT (negative or positive) were extracted from a local laboratory information system. The UBT data were linked to the patients' Danish Central Personal Identification Registry Number . Via the CPR, the individual records were linked to the Civil Registration System to establish each patient's country of birth and to the National Patient Registry to identify patients with a diagnosis of cancer in the gastrointestinal tract, cirrhosis, chronic hepatitis B and C, and alcohol-related diagnoses .The National Patient Registry records dates of hospital admission and discharge, surgical procedures performed, and discharge diagnoses  coded by doctors according to the International Classification of Diseases . The primary ICD code covers the primary symptom or cause of the patient's health system contact. Any additional ICD code covers other diseases of importance for this specific health system contact.The main outcome was diagnoses of hepatobiliary cancers in the National Patient Registry at the time of UBT and during follow-up. Follow-up ended at diagnosis of hepatobiliary cancer, death, or in censoring on 31 December 2012.Characteristics of the study population and by HP positivity were tabulated, and data were displayed as median values with interquartile range if relevant . Cox regThe cohort is characterised in Ten persons had a diagnosis of hepatobiliary cancer at the time of UBT  and were excluded.The median follow-up time was 4.6 years after UBT . During follow-up, a total of 5 HP-positive compared with 59 HP-negative patients were diagnosed with hepatobiliary cancer (see HP infection was associated with a higher incidence of gastric cancer (19 cases), yielding an adjusted HR of 1.99 (95% CI 1.35–2.94).With this large population-based cohort study, we find a markedly lower incidence of hepatobiliary cancer in HP-positive persons compared with HP-negative persons. The association holds true when adjusting for gender, age, alcohol-related diagnoses, cirrhosis, chronic viral hepatitis, and country of birth. This is the first study to date to compare a population defined by HP positivity versus HP negativity for hepatobiliary cancer development.The role of HP in hepatobiliary cancer has been a hot topic in the last decade, and it is highly debated whether it is a silent bystander or a direct liver carcinogen. Our data, while not contributing clarification of this issue, may be put in perspective by biological findings.Helicobacter hepaticus, is able to colonise livers of mice and cause hepatitis that may lead to HCC.,,,Animal studies show that another Helicobacter species, Our study holds several strengths. Healthcare data were available both before and after UBT. The validity of cancer diagnoses including hepatobiliary cancer in The Danish National Patient Registry is very high.Nonetheless, our study has limitations. Overall, the total number of cases of hepatobiliary cancers, although not trivial, is small, particularly so for HP-positive persons. Still, to result in non-different HRs, we should have found 14 cancers; that is nine overlooked cases. Considering that such cancers are symptomatic and the tightly woven and free Danish healthcare system, a loss-of-diagnosis of that magnitude is hardly possible. Most diagnoses were HCCs followed by cholangiocarcinoma, and despite the low case numbers resulting from this subdivision, the incidence estimates were similar for both cancers. The same may be said for the very low numbers of gallbladder cancer and other primary liver malignancies . This unHP infection is associated with lower socioeconomic standards, and hepatobiliary cancer is associated with both low and higher socioeconomic standards, depending on the cause of the underlying chronic liver disease. In our cohort, any socioeconomic difference was not expressed as a difference in harmful alcohol use. Anyway, direct adjustment for socioeconomics would have strengthened our analysis.Possible biases must be addressed as well. Persons with abdominal discomfort and a negative UBT are more likely to be tested for other causes of their symptoms, including hepatobiliary cancer. Another reason could be that persons with undiagnosed hepatobiliary cancer are more likely to be tested for HP, testing negative, and subsequently being diagnosed with hepatobiliary cancer. A bias towards underestimating hepatobiliary cancer in the HP-positive group is theoretically also present. Additional testing may be halted in a person with a positive UBT that might be taken to cause the symptoms. Furthermore, treatment with antibiotics as part of the HP eradication could clear a mild episode of cholangitis as an early sign of biliary cancer. These biases may affect incidence analyses in short term but should practically be abolished by our long follow-up time, as hepatobiliary cancer eventually will cause symptoms and lead to diagnostic work-up. On the other hand, our results could be biased towards the lower prevalence of HP in patients with hepatobiliary cancer, as patients with frequent healthcare contact are more likely to receive antibiotics for several reasons including cancer, which in theory could eradicate possible HP infection. This was examined in a study of HP infection in patients with Crohn's disease and a control group consisting of patients with chronic obstructive lung disease.Overall, the low number of cancer cases and effects of unknown confounders should be kept in mind. However, as We present incidences of cancers occurring after the UBT, and it might be argued that our findings to a degree result from the HP diagnosis and its subsequent eradication. However, the HP exposure time of our positive cohort was about 40 years and the post UBT follow-up 4.6 years and so the post UBT time was likely insignificant – even when being HP eradicated. As previously described for our cohort, HP was successfully eradicated in 82% of HP-positive patients just after the UBT.a priori expectations were open but if anything, we expected HP infection to be associated with a higher incidence of hepatobiliary cancer, which would have been in better synchrony with the studies reporting a higher prevalence of HP DNA in HCC liver tissue. Our results turned out to refute any such expectations and add a new angle to the discussion of the consequences of HP infection. We hope for confirmation of our results in a similar, suitable cohort. Additionally, animal models could prove helpful in further investigation of the association between H. pylori and HCC. An effective mouse model for H. pylori infection has been describedOur study showed a remarkably lower risk of hepatobiliary cancers in HP-positive persons. We evaluated our results very carefully in search of a methodological cause for the finding and did not find any. As mentioned, our The incidence of hepatobiliary cancers was lower in HP-infected persons after adjusting for age, gender, alcohol-related diagnoses, cirrhosis, chronic viral hepatitis, and country of origin. This large historical cohort study is the first to suggest that HP infection may play a protective role against hepatobiliary cancer. However, this is an observational study, and our data offer no mechanistic explanation to our findings.Linda S. Kornerup: Conceptualisation, Methodology, Writing – original draft, Writing – review and editing; Peter Jepsen: Conceptualisation, Methodology, Formal analysis, Investigation, Data curation, Writing – review and editing, Supervision; Lars E. Bartels: Conceptualisation, Writing – review and editing; Jens F Dahlerup: Conceptualisation, Writing – review and editing; Hendrik Vilstrup: Conceptualisation, Methodology, Writing – review and editing, Supervision.The authors have none to declare.None.


Methods: Age, gender, BMI and atopy, forced expiratory volume in 1 s (FEV1), maximum mid-expiratory flow (MMEF), and maximum expiratory flow at 25% of lung filling (MEF25) were assessed via a Boolean selection process from the institutional database at recruitment, as well as after 6 and 12 months, together with the incidence of exacerbation, school days that were taken off, GP and specialist visits, and systemic steroid and/or antibiotic courses. Adherence was checked monthly via a direct telephone call. Statistics were calculated with an ANOVA trend analysis, assuming p < 0.05. Results: Two well-matched sample groups of 54 subjects each were obtained. The mean annual adherence to treatment ranged from 48.2% doses ± 10.9 sd to 79.3% doses ± 8.8 sd (p < 0.001), regardless of age and gender. Only adolescents that adhered to the o.d. ICS/LABA inhalation regimen progressively achieved complete control of all lung function parameters , minimized their bronchial hyperreactivity (p < 0.001), and optimized all health outcomes (p < 0.001—p < 0.002) over the survey duration. Discussion: A good adherence to treatment is essential for asthma management, particularly in young patients. Factors that are totally independent of the complexity of the therapeutic regimen adopted  probably represent the major reasons limiting the adolescents’ adherence. Cultural, educational, behavioral, and psychological factors are frequently involved, are difficult to control, and can present barriers to adolescents’ asthma management. Further studies aiming to deeply understand and possibly remove the reasons for such adolescents’ attitudes are needed, in cooperation with actions oriented in this direction by families, educators, and health professionals.Adolescents with asthma are usually insufficiently adherent to regular inhalation treatments, thus limiting their effectiveness. The aim of this study is to investigate the role of adherence to single-inhaler long-acting LABA/ICS dry-powder combination o.d. in affecting lung function, bronchial hyperreactivity, and health outcomes over a twelve-month survey of a group of non-smoking adolescents with mild to moderate asthma.  Inhaled medications are as crucial in asthma management as adherence to the therapeutic strategy adopted. Adolescents with asthma commonly have suboptimal adherence to inhaled treatments, thus limiting the effectiveness of whatever therapeutic strategy they are following ,2. TodayIt has been reported that inappropriate adherence to both preventer and reliever drugs via inhalation represents a major factor that is able to affect asthma control, particularly in children and teenagers ,16. On tThe study was an observational, retrospective analysis of asthmatic adolescents referred to the Lung Unit of the Specialist Medical Centre (CEMS), Verona, Italy, over the period from February 2018 to September 2019. Data were obtained from the institutional, UNI EN ISO 9001-2008 validated database, and classic Boolean algebraic formulas were used for subject selection . The datThe basic selection criteria were adolescents: with mild to moderate asthma, of both genders; ranging from 12 to 18 years of age; non-smokers; with normal cognitive function and without any relevant comorbidity; who have been prescribed (and then presumably taking) fluticasone fumarate/vilanterol 90/22 mcg dry powder o.d., via Ellipta. This combination was chosen because the drug is suitable for prescribing to adolescents within the age range of 12–18 years in our own country. Exclusion criteria were: the presence of comorbidities that make inhalation difficult; the refusal of parents’ informed consent; an incomplete set of clinical and lung function data; prescriptions of ICS/LABA o.d. that were different from fluticasone fumarate/vilanterol. 1), maximum mid-expiratory flow (MMEF), and maximum expiratory flow at 25% of lung capacity (MEF25) were assessed at recruitment (the index date), and after 6 and 12 months, their values being reported as a percentage of predicted value. At the same time, the extent of bronchial reactivity to methacholine (MCh) was also assessed in all subjects and was reported as the MCh dose (in mcg) inducing a 20% drop from their FEV1 baseline value (PD20 FEV1). At each time point of the survey, the number of exacerbations, school days taken off, GP and specialist visits, and systemic steroid and/or antibiotic courses were also recorded from the database. At the index date, these health outcomes were calculated over the previous six months and were compared to those measured over the two semesters of the study . The variables of sex, age, BMI, and atopy, forced expiratory volume in 1 s . Even though the selection of subjects was conducted by automatic procedures run from the database, informed consent was requested from the adolescents’ parents because monthly direct telephone contact had been planned for during the survey.As the inhaler device used is provided with a clearly visible dose counter and the device contains enough doses of the drugs for exactly thirty days of treatment, the adolescents’ adherence to the inhalation regimen was calculated at the end of every month via telephone calls, during which each adolescent (or one of the adolescent’s parents) had to communicate the number of remaining doses visible in his/her device to the interviewer. The compliance was then calculated as the percentage of skipped inhalation doses/month, which corresponded to skipping days of treatment over each period of the survey. As established some time ago, subjects who took <70% of the prescribed inhalation doses were considered “non-compliant” . StemminAccording to the inclusion and exclusion criteria, a sample of 108 adolescents with mild to moderate atopic asthma was selected , without significant differences according to age and gender. Their corresponding trends of lung function variables are reported in 1 p < 0.002; MMEF p < 0.002; MEF25 p < 0.001, respectively) and minimized the degree of their bronchial hyperreactivity (p < 0.001) over the survey duration. Conversely, all lung function parameters, and bronchial reactivity did not change significantly over the study in non-adherent adolescents, such as in those taking <70% of the prescribed doses .The sample consisted of two subgroups, comprising 54 adherent and 54 non-adherent subjects. The mean annual adherence in the adherent group of adolescents was 79.3% doses ± 8.8 sd, while the adherence was 48.2% doses ± 10.9 sd in the non-adherent group (p < 0.002) over the survey duration, together with that of school absenteeism (p < 0.001), of GP and specialist visits , and of systemic steroid and antibiotic courses (both p < 0.001) in the sub-group of subjects with good adherence, while it remained unchanged in those with low adherence .Moreover, all health outcomes considered in the study proved the same trends . In otheLung function, bronchial reactivity and health outcomes showed a progressive trend of improvement on a semester-by-semester basis, but this was only in those adolescents with good adherence to treatment.The effectiveness of therapeutic strategies against bronchial asthma is usually mainly investigated in terms of the drugs’ efficacy and tolerability. Nevertheless, even if contributing substantially to asthma morbidity per se, the role of non-adherence to treatment is much less frequently investigated, particularly in young patients, as in those subjects who are known to be less prone to coping with their persistent respiratory disorder and to compliance with the therapeutic strategies prescribed ,27,28.Several factors can contribute to the low adherence of asthmatic adolescents: cultural, educational, behavioral, and psychological variables are very difficult to control in many cases and frequently act as barriers to asthma management. Adherence has been generally reported to be very poor in adolescents, ranging from 25 to 35% in various studies, resulting in poor health outcomes ,30,31. SThe strategy based on the once-daily administration of long-acting inhalation drugs has been supposed to further foster the patients’ adherence during long-term therapeutic strategies; several studies tend to confirm this hypothesis ,34,35,36Although not aimed at calculating the prevalence of non-compliance in young asthmatics, data from the present study confirm that adherence is generally poor in adolescents with mild to moderate asthma and that all long-term outcome results are unchanged over the survey duration in these cases. Conversely, a good level of long-term adherence to the prescribed regimen proved to be quite effective and enabled the progressive improvement of lung function, bronchial hyperreactivity, and health outcomes. It should be emphasized that the significant poor adherence observed in the present study was recorded even though the therapeutic regimen prescribed to the adolescents was very simple (once daily), probably not interfering significantly with their daily activities. As is different from the results of some previous studies ,38, the The main message emerging from the study seems to be that factors completely independent of the complexity of the therapeutic regimen adopted  can represent the major reasons affecting the adolescents’ levels of adherence to inhalation treatments. As mentioned above, too low an awareness of asthma ,6,7, a pObviously, the role of health professionals, families, and schools would be of great value in supporting these fragile personalities . OtherwiAs non-adherence for at least two times/week has still proven to be intentional in around 25% of subjects , variousThe present study has several weaknesses and strengths. The main points of weakness are that the survey is monocentric and the sample is limited. The points of strength are: the study is drawn from a longitudinal survey, which was conducted using a large database via Boolean selection; the data of all variables were derived from the database according to the predefined times of the survey; adherence to treatment was directly assessed on a month-by-month basis for twelve months; the sub-groups of adherent and non-adherent asthma adolescents had the same consistency and were well matched; the trends of all outcomes were compared using trend analysis. Long-term adherence to inhalation treatments is largely sub-optimal in adolescents with mild to moderate asthma, even if this is limited to a once-daily strategy. Good adherence to regular long-acting ICS-LABA inhalation allows the persistent normalization of lung function, bronchial hyperreactivity, and the optimization of health outcomes in the vast majority of cases, independently of age and gender. The long-term outcomes achievable in real life by good adherence to treatment should be publicized among adolescents with asthma in order to support their acceptance of the therapeutical interventions prescribed, to provide positive evidence that proper compliance can lead to substantial improvements in their quality of life, and to enhance their confidence regarding asthma. All actions oriented in this direction by families, educators, and health professionals should be extensively promoted because of their great value for young patients and society in general.


Evidence suggests that the interactive effects of physical activity, screen-time and sleep are stronger than independent effects of these behaviors on pediatric obesity. However, this hypothesis has not been fully examined among samples of young school-aged children. The aim of this study is to determine the association of weight status with meeting the physical activity, screen-time, and sleep guidelines, independently and concurrently, among 2nd grade children.n = 320,005) of children. Weighted multivariable logistic regressions were used to assess associations of weight status  with meeting the physical activity, screen-time, and sleep guidelines, while controlling for relevant covariates .The Texas School Physical Activity and Nutrition Project collected parent-reported physical activity, screen-time, and sleep, and measured body height and weight on a statewide representative weighted sample  met the physical activity, screen-time, and sleep guidelines concurrently compared to children who are thin (3.3%), or children with overweight (5.7%), obese (3.5%), and morbid obesity (1.0%). Children who were thin , overweight , obese , and morbidly obese  had lower odds of concurrently meeting the guidelines compared to children with healthy weight.Among this representative sample of Texas children, weight status was associated with meeting physical activity, screen-time, and sleep guidelines. Future studies should aim to evaluate causal relations between these behaviors and weight status. Short sleep duration, physical inactivity, and increased screen-time are independent risk factors for childhood obesity –5. The cAmong children and adolescents in the United States (U.S.), 23, 33, and 86% independently meet the PA, screen-time, and sleep guidelines, respectively . Only 12Therefore, the aim of this study is to determine whether weight status is associated with meeting the PA, screen-time, and sleep guidelines, independently and concurrently, among a statewide representative sample of 2nd grade children in Texas. We hypothesize that children with unhealthy weight will be associated with lower odds of achieving the PA, screen-time, and sleep guidelines, independently and concurrently, compared to children with healthy weight. The results from this study will help in developing more knowledge and awareness on the association between 24-hour cycle behaviors and pediatric obesity .n = 320,005) who participated in Texas SPAN during the 2015–2016 school year. Written child assent and informed consent were obtained from all Texas SPAN participants and primary caregivers to use their data for research purposes. This study was reviewed and approved by the Committee for the Protection of Human Subjects at the University of Texas Health Science Center at Houston  (HSC-SPH-00-056), the Texas Department of State Health Services Institutional Review Board (IRB# 04–062), and local school district review committees.This cross-sectional study was reported and all methods were carried out in accordance to the Strengthening the Report of Observational studies in Epidemiology (STROBE) guidelines . This anThe primary exposure of interest was body weight status. Standard protocols were used to measure and record height and weight among the participants. Body mass index (BMI) was calculated using body weight in kilograms divided by the square of height in meters. Weight status was further classified by age and sex healthy (BMI: 18.5–24.99), thin (BMI: < 18.5), overweight (BMI: 25.00–29.99), obesity (BMI: 30.00–39.99), and morbid obesity (BMI: > 35.00), according to International Obesity Task Force (IOTF) definitions .The primary outcome variables of interest were meeting the PA, screen-time, and sleep guidelines, independently and concurrently. The participating child’s primary caregiver was asked to report on their child. PA behavior was assessed by reporting the total number of days in the last week the child performed activity that increased his/her heart rate and made him/her breathe hard some of the time for a total of at least 60 minutes. Those participants reporting 7-days of PA as described were considered to have met the PA guideline . Screen-Potential covariates that are known to be associated with weight status included in the analysis were caregiver-reported demographic characteristics ; healthy food preference ; comorbidities [yes/no] including physical limitations, asthma, diabetes, attention deficit hyperactivity disorder, autism spectrum disorder), and parent BMI [continuous] –28.The proportions and 95% confidence intervals (CI) of weight status were estimated in sex strata by potential covariates . Multiple logistic regressions in sex stratum were adjusted for potential covariates and used to calculate weighted relative odds of independently and concurrently meeting the PA, screen-time, and sleep guidelines based on child weight status. All statistical analyses were conducted in STATA 15.1 .Sample demographic and health characteristics are presented in Table The prevalence of children who independently met the PA, screen-time, and sleep guidelines differed by weight status and gender Table . SpecifiThe adjusted odds ratio (aOR) of meeting the PA, screen-time, and sleep guidelines among Texas 2nd grade children, after controlling for age, race/ethnicity, financial assistance, comorbidities, and parent BMI, are presented overall and by sex in Table Children with obesity and morbid obesity of both sexes were less likely to concurrently meet the guidelines than children with healthy weight. Specifically, girls with morbid obesity had lower odds  of achieving the PA and screen-time guidelines concurrently compared to girls with healthy weight. Further, girls with morbid obesity had 0.08  times the odds of achieving all three of the guidelines concurrently compared to girls with healthy weight. Boys with morbid obesity had 0.09  times the odds of meeting the sleep and screen-time guidelines concurrently.This study found that weight status and sex are associated meeting the PA, screen-time, and sleep guidelines, independently and concurrently. The prevalence of meeting the PA guideline was over three times higher among boys with morbid obesity compared to girls with morbid obesity. There are several potential explanations for the observed sex difference. In a prospective study of children aged 8 to 12 years, boys were found to be 19% more physically active than girls and these differences were attributed to less extracurricular sport participation, less parental support, and less perceived competence in physical education in girls compared to boys . In othe17 However, participants in our analysis were younger (2nd grade) than those included in similar studies [Overall, these results align with previous findings from population-based samples of U.S. adolescents, which reported that a very small proportion (5%) of students met all of the guidelines concurrently,  and thos studies , 17, whiThe prevalence of children independently meeting the guidelines provided interesting findings. In particular, it appears that the low prevalence of meeting all of the guidelines concurrently was primarily driven by the inclusion of meeting the PA guidelines, rather than meeting the sleep or screen-time guidelines. For example, among children with healthy weight (boys and girls), 32.0% met the sleep and screen-time guidelines concurrently. When adherence to the PA guideline was added to the combination, the proportion of children meeting all of the guidelines dropped to 9.9%. This was consistently observed across all weight status categories and for both sexes when evaluated per strata. This may help explain the mechanisms by which children with obesity and morbid obesity are less likely to meet all three guidelines concurrently. Social norms  and psychological barriers  may disproportionately increase the barriers to meeting the physical activity guidelines for children with obesity and morbid obesity compared to children with healthy weight .This study is not without limitations. First, the measures for the primary outcomes of interest, adherence to the PA, screen-time, and sleep guidelines, were reported by the child’s primary caregiver, which has mixed evidence of agreement compared to self-report in children , 36. HowFinally, this study added to our understanding of how pediatric body weight status is associated with a 24-hour cycle of behaviors. Importantly, most studies to this point on this young of a population have only focused on a single behavior in isolation, thereby ignoring the inherent displacing effect of the behaviors on each other, and potential interactive effects of multiple behaviors occurring simultaneously. To our knowledge, this is the first study to report the association between concurrently meeting the PA, screen-time, and sleep guidelines with weight status in a population-based sample of young school-aged children. Although the results of this analysis indicate that PA in particular is strongly related to body weight status in this age group, future studies should strive to consider PA, sleep and sedentary behaviors both independently and concurrently in studies of their effects on pediatric obesity and other related health outcomes.The results of this study should raise awareness to the potential magnitude of not adhering recommendations for 24-hour cycle of physical behaviors in pediatric populations and should inform future research to consider the interrelation of adherence to the PA, screen-time, and sleep guidelines when evaluating pediatric obesity. We found that adherence to the PA guidelines is much lower than adherence to the screen-time or sleep guidelines, therefore intervening on the PA guideline adherence may provide the most benefit. The difference in likelihood between concurrently meeting the guidelines and weight statuses suggests increased attention should be given to adherence to the guidelines in children with unhealthy weight compared to children with healthy weight.


The sex-adjusted prevalence of MetS assessed by the National Cholesterol Education Program—Third Adult Treatment Panel was 39.4% in men and 32.5% in women. The International Diabetes Federation and the Harmonized definitions had the best agreement (k = 1.000). The highest odds ratios (ORs) of cardiometabolic risk factors to develop MetS were elevated triglycerides (37.5) and reduced high-density lipoprotein cholesterol (27.3). Central obesity and hypertension prevalence were significantly higher in the non-active group , compared to the active group . Moreover, the active group  and active women group  appeared to show a lower risk of developing this syndrome. MetS is highly prevalent in this sample and changes according to the definition used. It seems that sex and frailty do not influence the development of MetS. However, PA appears to decrease central obesity, hypertension, and the risk of developing MetS.Metabolic syndrome (MetS) is a cluster of medical conditions associated with several health disorders. MetS and frailty can be related to prolonged physical deconditioning. There is a need to know whether there is concordance between the different ways of diagnosing it and to know their prevalence in Spanish older adults. Thus, the aims of this study were to describe the prevalence of MetS; to analyse the concordance between different definitions to diagnose MetS; and to study the associations between MetS, frailty status, and physical activity (PA) in older adults with decreased functional capacity. This report is a cross-sectional study involving 110 Spanish older adults of ages ≥65 years with decreased functional capacity. Clinical criteria to diagnose MetS was defined by different expert groups. Anthropometric measurements, blood biochemical analysis, frailty status, functional capacity, and PA were assessed. The Kappa statistic was used to determine the agreement between the five MetS definitions used. Student’s  Populations worldwide are living longer. Between 2015 and 2050, the percentage of the world’s population aged over 60 years will nearly double from 12% to 22% ), while only 1 or 2 items denoted pre-frailty (pre-frail group [PREF]), and people with 0 items made up the robust group (ROB) .Wrist-worn triaxial accelerometers  were used to register PA. The device was worn on the nondominant wrist. These accelerometers obtained data for 1 week at a frequency of 10 Hz, which is enough to categorize regular activities . To inclp < 0.05 in all tests. Shapiro–Wilk test was used to prove the normality of the sampling distribution, all variables had a normal distribution, and therefore parametric test were used.All analyses were performed using the Statistical Package for the Social Sciences v. 25.0 for Windows  with statistical significance set at level Sample sizes were calculated for estimating proportion with a confidence level of 95%, a sampling error (α) of 0.05, and a Z value (Z α) of 1.96. Therefore, it was estimated that a minimum of 189 participants would be needed for final sample.t-test and the Pearson chi-square test were used to examine differences in continuous and categorical variables, respectively, between frailty groups. Crosstabs were used to calculate the ORs of individual components of MetS with a 95% confidence interval. Chi-square tests were used to analyse independent associations between MetS, habitual PA, and frailty. Data are presented as prevalence, degrees of freedom (χ2), and p value.Continuous variables were presented as mean values ± standard deviation. Categorical variables were presented as frequencies (%). Sex-specific prevalence of MetS was calculated using the WHO, NCEP-ATP III, AHA/NHLBI, IDF, and Harmonized definitions. The agreement and disparity in diagnosis of MetS, the ORs of individual components of MetS, and the association between MetS, PA, and frailty status were calculated using NCEP-ATP III criteria. Student’s k) statistic. The Kappa value is between 0 and 1, where the value of 1 indicates perfect agreement and values less than 1 involve poorer agreement. In particular, a k index less than 0.20 implies a weak agreement, 0.21 to 0.40 represents as fair agreement, 0.41 to 0.60 is interpreted as moderate agreement, 0.61 to 0.80 means good agreement, and 0.81 to 1 suggests a very good agreement.The concordance between the five definitions of MetS was analysed by the Kappa  in men than in women according to the WHO definition, while it showed a higher prevalence in women than in men (p < 0.001) based on the IDF and Harmonized definitions.The prevalence of single components of MetS and MetS defined by the different groups of experts in Spanish older adults with decreased functional capacity is presented in k index statistics confirmed a significant agreement between the definitions. The best agreement observed was between the IDF and Harmonized definitions (k index = 1.000). The NCEP-ATP III and AHA/NHLBI criteria had the second-best agreement with the highest k index. The IDF and Harmonized criteria had the third-best agreement. The WHO and NCEP-ATP III criteria had the worst agreement with the lowest k index. All definitions showed good specificity. The NCEP-ATP III, AHA/NHLBI, IDF, and Harmonized criteria presented 100% of sensitivity, while WHO criteria showed a poor sensitivity.The concordance as well as sensitivity and specificity of the MetS for the referenced definitions are shown in n = 23, 11 women; 78.4 ± 6.5 y), followed by 33.3%  in the FRA group and 33.3%  in the PREF group. Moreover, Although no statistically significant differences were found in the prevalence of MetS between frailty groups, the ROB group showed a higher prevalence at 39.1%  and non-active group . There were no significant differences in the prevalence of MetS between PA groups. n = 29) compared to the active group at 50.0% . Hypertension prevalence was significantly higher in the non-active group at 26.8% (n = 11) compared to the active group at 7.7% . However, there were no significant differences in the presence of reduced HDL-C, elevated glucose, and TGs between groups.The PA data from 93 participants were considered in this section. Through accelerometer data, we divided the total sample into 2 groups, the active group  in the whole active group. Specifically, the active women group had ORs of 0.77  and the active men group showed ORs of 3.04  to development of this syndrome.In this cross-sectional study of Spanish older adults with decreased functional capacity, the prevalence of MetS and the prevalence of individual components of MetS has been described according to five different definitions for MetS. Moreover, the study has analysed the concordance between the different definitions to diagnose MetS and the ORs of individual components of MetS to develop this syndrome in this sample. Furthermore, the association between MetS, frailty, and PA has been evaluated in this research.As was pointed out in the results section, the prevalence of MetS in this sample depended on the definition. The WHO definition showed 15.7% of people with MetS, followed by NCEP-ATP III and AHA/NHLBI with 34.5%, and the IDF and Harmonized definitions with 37.3%. The diagnostic criteria used may explain the dissimilar magnitudes of MetS prevalence. Firstly, a higher cut-off value for glucose in the WHO and NCEP-ATP III definitions compared to the AHA/NHLBI, IDF, and Harmonized definitions leads to the inclusion of participants with a relatively lower level of this risk factor, giving a higher prevalence of MetS with the last definitions. Secondly, the WC criterion in the IDF and Harmonized definitions used a lower cut-off value compared to NCEP-ATP III and AHA/NHLBI, giving a higher prevalence of MetS with the IDF and Harmonized definitions. Thirdly, the WHO criteria have a higher cut-off value to diagnose hypertension and a lower cut-off value for reduced HDL-C compared with rest of the definitions used, giving a lower prevalence of MetS than the others when considering this definition. These differences could explain why the WHO criteria obtained the lowest prevalence of MetS.Several reports have shown prevalence of MetS in different age groups and sexes. Moreira et al.  estimateIn our study, it seems that the prevalence of MetS was higher in women than in men when the prevalence was analysed with the AHA/NHLBI, IDF, and Harmonized definitions. This may be explained by the higher prevalence of abdominal obesity, elevated TGs and low HDL-C in women than in men. However, it appears that a higher prevalence of glucose and hypertension in men does not report a higher prevalence of MetS. Sex differences are consistent with other Chinese population studies ,27,28. AThere are important differences in the results of the prevalence within individual components of MetS depending on each study. Central obesity (59.1%) and reduced HDL-C (34.5%) were the most common MetS component in our study. Similar results were obtained in a cross-sectional study that analysed the prevalence of Mets in a sample of 15,540 Chinese adults in which reduced HDL-C (33.9%) was the second most common MetS component, but hypertension (41.2%) was the most common . Anotherk = 0.708) between these definitions [k = 0.650) [k = 0.768) among these definitions [k = 0.229).In our study, an excellent agreement was observed between the IDF and Harmonized definitions. This is because the five components agree in both definitions, but there is a change in the general definitions to diagnose MetS. The other difference is that the Harmonized definition includes a specific ethnic cut-off point for WC. Our findings were similar from an observational study with Chinese adults participants that obtained the best agreement  . Moreoveinitions . Neverthinitions  reportedk = 0.859) was observed between NCEP-ATP III and IDF/Harmonized definitions. Both glucose and central obesity have different cut-off points between these definitions. Previous research in adults has shown high concordance between the NCEP-ATP III and IDF definitions in different countries like Mexico (k = 0.873) [k = 0.840) [k = 0.440) [k = 0.540; NCEP-ATP III vs. Harmonized: k = 0450) [k = 0.841) was found among NCEP-ATP III and IDF definitions in Chinese older adults [k = 0.404) was obtained between the NCEP-ATP III and WHO definitions. This result is consistent since three of the five criteria have different cut-off points. Likewise, a moderate agreement (k = 0.511) was reported in Mexican adults [k = 0.370) was observed in Turkish adults [k = 0.150) was obtained in Ethiopian adults [k = 0.875) in Malaysian T2DM patients.Similarly, a very good agreement = 0.873)  or Turke= 0.840) , while o= 0.440)  or Ethio = 0450)  populatin adults , a fair h adults , and a wn adults , whereas  or TurkThe agreement and disparity in diagnosis of MetS between definitions is very important in order to be able to compare the obtained results between different studies. This agreement can vary according to specific age ,46,48 orAccording to sensitivity results, the NCEP-ATP III, AHA/NHLBI, IDF, and Harmonized criteria seem more useful to diagnose MetS than the WHO criteria in older adults with decreased functional capacity. All definitions showed good specificity; therefore, these definitions appear to be useful to rule out MetS in older adults when they are truly negative.So, it seems that all definitions can diagnose the same percentage of subjects with MetS, with the exclusion of WHO criteria. These results are especially essential for Spanish healthcare professionals, since when using any of the four diagnostic definitions, the proportion of patients diagnosed of MetS will be very similar. However, if they use the WHO definition, they will not diagnose at least half of the real cases. Similar results have been found in others studies ,46,47, bThe ORs of individual components of MetS to develop MetS are related to the pathophysiology. The pathogenic mechanisms of MetS are complex. Currently, it is under debate whether MetS represents a cluster of different medical conditions or manifestations of a common pathogenic mechanism. Environmental, genetic, and lifestyle factors such as the consumption of excess calories and lack of PA have been considered as major contributors to the development MetS. Visceral adipose is a hormonally active tissue of body fat, which has specific biochemical characteristics that affect in different diseases, specifically, it has a main role in the implicated pathways in the development of MetS ,51. MoreThe present study has not focused on finding the etiology of MetS but shows results that help to understand this set of clinical signs. In this research it has been observed that participants with elevated TGs and reduced HDL-C have a high risk of developing MetS, which results logically from a pathophysiological point of view. In this way, it is known that participants with central obesity and visceral adiposity show increased TGs and glucose and reduced HDL-C . HoweverContrary to expectations, this study did not find significant associations between frailty and MetS in older adults, since the ROB and FRA groups have a very similar prevalence of MetS, with the ROB group even being higher. The high prevalence of MetS in the ROB group could be explained by other modifiable factors such as diet, smoking, and alcohol intake, among others not considered for present study. The influence of age in each group was analysed, but no significant differences were found between groups. These ROB participants might have good functional capacity, but poor metabolic health that justifies these results. When the PREF and FRA groups were analysed, it seemed that MetS is more prevalent as frailty status increases. Similar results were obtained in a cross-sectional study involving older adults with MetS which analysed the prevalence of this syndrome according to frailty, and there were no significant differences in the prevalence of reduced HDL-C, central obesity, hypertension, and general prevalence of MetS between ROB, PREF, and FRA groups . HoweverOn the other hand, the analysis of each criterion helps us to understand why the ROB group presents a prevalence of MetS similar to that of the FRA group, since they present the highest prevalence of elevated glucose and hypertension and the second of central obesity and reduced HDL-C. Therefore, subjects could maintain a good intrinsic capacity, but they could have a bad metabolic state. It is necessary to remember the great influence of individual genetics in the protective or facilitating factors of metabolic alterations ,58. In aWith respect to the last research question, an association between PA and MetS was found. Central obesity and hypertension prevalence were significantly lower in the active group than in the non-active group. However, there were no statistically significant differences in the prevalence of MetS between PA groups or in the HDL-C, glucose, and TGs levels. Moreover, it was observed that the whole active group and the active women group seemed to show that being active is associated with a lower risk of developing MetS, but not in men.n = 15). These different results could be influenced by the age of the sample and the intensity of PA performed. Another cross-sectional study of community-dwelling older men observed that higher levels of MVPA and lower levels of sedentary behaviour were associated with better metabolic health in terms of central obesity, insulin level, and MetS [The role of PA in the development of MetS is not clear, since the results vary according to the studies . There aand MetS . Finallyand MetS . It seemAlthough the effects of PA on MetS are not clear, the role of exercise in MetS is shown in different studies. A meta-analysis observed that aerobic exercise improved WC −3.4 cm; glucose −0.15 mmol/L; HDL-C 0.05 mmol/L; TGs −0.29 mmol/L; DBP −1.6 mmHg; and cardiorespiratory fitness 4.2 mL/kg/min, among other outcomes . MoreoveTo the best of our knowledge, this report is the first to investigate the prevalence of individual components, the concordance between the different definitions of MetS, and the associations between MetS, PA, and frailty in older adults with decreased functional capacity from a Spanish population. Secondly, a rigorous and systematic methodology was used to assess health outcomes through a structured questionnaire, physical examination, and biochemical analysis. Thirdly, it has been reported that the prevalence of MetS is modified according to the diagnostic criteria used, showing that IDF and Harmonized definitions can be used interchangeably in older adults. Fourthly, the importance of being physically active in older adults is highlighted.Some potential limitations should be also mentioned. First, the research has not been able to analyse the association between MetS, CVD, T2DM, and cancer. These results would be interesting as a way to explain how MetS could increase the risk of these diseases. Second, even though our study has a considerable sample size to describe the prevalence of MetS in older people, especially those with symptoms of collapsing capacity, it is still reduced to accurately estimate the prevalence of MetS in Spanish older adults with decreased functional capacity. Thus, studies with a larger sample size should be developed to establish deeper conclusions. Third, there is a lack of adaptation of the diagnostic criteria for MetS to the Spanish and/or older adult population. It would be interesting to design adjusted criteria to this sample in order to know the real prevalence of MetS.The prevalence of MetS changes according to the diagnostic criteria used, resulting with the lowest prevalence when utilizing the WHO definition and with the highest prevalence when utilizing the IDF and Harmonized definitions. No significant differences were observed in the prevalence of MetS between men and women. Central obesity is the most prevalent cardiometabolic risk factor of MetS in Spanish older adults with decreased functional capacity. The IDF and Harmonized definitions had the best agreement with the highest Kappa index. Individuals with elevated TGs, reduced HDL-C, and central obesity were at significantly elevated ORs to develop MetS in this sample. The prevalence of MetS according to frailty status did not show significant differences between groups. Finally, the present study shows that there is an association between PA and MetS, since central obesity and hypertension prevalence are significantly lower in the active group than in the non-active group. Furthermore, it seems that the whole active group and the active women group show a lower risk of developing MetS.In future investigations, it would be interesting to analyse the effect of exercise interventions on MetS in Spanish older adults with decreased functional capacity. It seems that exercise could be an effective tool to reduce the incidence of MetS in the future. Moreover, it would be interesting to analyse a representative sample of older adults in Spain.


We employed the GRADE and PEDro scales to rate the quality, certainty, and applicability of the evidence. Results showed significant differences in pain intensity, with a moderate clinical-effect , and in VO2 max, with a moderate clinical-effect . However, the meta-analysis showed no statistically significant results for disability  and QoL . We compared HIIT against other exercise models for reducing pain intensity and increasing VO2 max. The meta-analysis showed no significant differences in favour of HIIT. Meta-regression analysis revealed that pain intensity scores were negatively associated with VO2 max . There is low-moderate evidence that the HIIT intervention for patients with musculoskeletal disorders can reduce pain intensity and increase VO2 max but has no effect on disability and QoL. Results also showed that HIIT was not superior to other exercise models in reducing pain intensity and increasing VO2 max.The aim was to assess the impact of high-intensity interval training (HIIT) on patients with musculoskeletal disorders. We conducted a search of Medline, Embase, PEDro, and Google Scholar. We conducted a meta-analysis to determine the effectiveness of HIIT on pain intensity, maximal oxygen consumption (VO Musculoskeletal pain is an important public health issue because of its impact on quality of life (QoL) and the disability it can represent . More thExercise therapy has been reported to be highly effective in managing patients with musculoskeletal pain  and has 2 max)  with recovery periods, repeating the exercise several times [2 max because it is an objective variable and, in addition, it is the gold standard for assessing cardiorespiratory fitness, which seems to be affected in patients with musculoskeletal disorders with associated pain [The effects of high-intensity interval training (HIIT) on pain tolerance and threshold have sparked interest among the scientific community concerned with pain ,13. As dal times . A numbeal times ,16,17. Tal times ,19,20. Pted pain . As far Therefore, the main aim of the present study was to develop a systematic review and meta-analysis to assess the effectiveness of HIIT on pain intensity, maximal oxygen consumption, disability, and health-related QoL for patients with musculoskeletal disorders. This systematic review and the meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines described by Moher . The proThe selection criteria used in this systematic review and meta-analysis were based on methodological and clinical factors, such as the Population, Intervention, Control, Outcomes, and Study Design (PICOS) described by Stone . The participants selected for the studies were patients older than 18 years with any kind of musculoskeletal disorder. The participants’ gender was irrelevant.The intervention was the HIIT exercise modality, which could be given as an independent treatment, added to an existing intervention, or embedded in an existing intervention . For the control group, the comparators were minimal intervention, no intervention, and usual care  in combination or not with placebo interventions. In addition, we performed a sub-analysis to evaluate the effectiveness of HIIT compared with other therapeutic exercise models  in those articles that, in addition to a control or comparator with no intervention or minimal intervention, presented an additional group that performed an exercise model.2 max, disability, and health-related QoL.The measures used to assess the results and effects were pain intensity, VOWe selected randomised controlled trials (RCTs), randomised parallel-design controlled trials, randomised cross-over trials, and prospective controlled clinical trials. 2 max”, “Maximal Oxygen Consumption”, and “Maximal Oxygen Uptake”.The search for studies was performed using Medline (PubMed) (1950–2020), Embase (1950–2020), PEDro (1950–2020), and Google Scholar. The first search was run on the 8 November 2020 . We used a validated search filter for retrieving studies on measurement properties in PubMed; the same filter was adapted for all other databases . In addiTwo independent reviewers (F.C.-M. and J.F.-C.) conducted the search using the same methodology, and the differences were resolved by consensus. Additionally, meticulous manual searches were performed, including journals that have published articles related to the topic of this review as well as reference lists of the included studies. The reference sections of the original studies were screened manually. To remove duplicates, we employed the citation management software Mendeley  and hand-checked the citations . First, two independent reviewers (F.C.M. and L.S.M.), who assessed the relevance of the RCTs regarding the study questions and aims, performed a data analysis, which was performed based on information from the title, abstract, and keywords of each study. If there was no consensus or the abstracts did not contain sufficient information, the full text was reviewed. In the second phase of the analysis, the full text was used to assess whether the studies met all the inclusion criteria. Differences between the two independent reviewers were resolved by a consensus process moderated by a third reviewer . Data deWe used the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 to assess the risk of bias in the included studies . The assThe studies’ methodological quality was assessed using the PEDro scale , which aTwo independent reviewers (F.C.-M. and L.S.-M.) examined the quality of all the selected studies using the same methodology. Disagreements between the reviewers were resolved by consensus with a third reviewer. The concordance between the results (inter-rater reliability) was measured using Cohen’s kappa coefficient (κ) as follows: (1) κ > 0.7 indicated a high level of agreement between assessors; (2) κ = 0.5–0.7 indicated a moderate level of agreement; and (3) κ < 0.5 indicated a low level of agreement) .2 max, violet; disability, green; QoL, black).Type of outcome measure (bubble colour): The bubble colour represents the variables : We employed the calculation of effect sizes.Effect (y-axis): Each of the reviews was classified according to its methodological quality using the PEDro scale.Statistically significant differences: Articles with statistically significant differences were marked with white dots.We created a visual map of the scientific evidence for each article to visually display the information as a bubble plot. The review information is based on 3 dimensions:) High quality. Further research is very unlikely to change our confidence in the effect estimate. All five domains are also met; (b) Moderate quality. Further research is likely to have an important impact on our confidence in the effect estimate and might change the effect estimate. One of the five domains is not met; (c) Low quality. Further research is very likely to have a significant impact on our confidence in the effect estimate and is likely to change the estimate. Two of the five domains are not met; and, finally, (d) Very low quality. Any effect estimates are highly uncertain. Three of the five domains are not met [The certainty of evidence analysis was based on classifying the results into levels of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework, which is based on five domains: study design, imprecision, indirectness, inconsistency, and publication bias . The ass not met ,36.2 was substantial or large (greater than 50%). At indirectness domain recommendations were downgraded when severe differences in interventions, study populations or outcomes were found . For the imprecision domain, the recommendations were downgraded by one level if there were fewer than 300 participants for the continuous data [For the study design domain, the recommendations were downgraded one level in the event there was an uncertain or high risk of bias and serious limitations in the effect estimate . In terms of inconsistency, the recommendations were downgraded one level when the point estimates varied widely among studies, the confidence intervals showed minimal overlap, or when the Ious data . The statistical analysis was conducted using MetaXL software  . To compWe used the same inclusion criteria for the systematic review and the meta-analysis and included three additional criteria: (1) In the results, there was detailed information regarding the comparative statistical data of the exposure factors, therapeutic interventions, and treatment responses; (2) the intervention was compared with a similar control group; and (3) data on the analysed variables were represented in at least three studies.p-value < 0.05 was considered significant) and the inconsistency index (I2) [2 > 25% represented small heterogeneity, I2 > 50% represented medium heterogeneity, and I2 > 75% represented large heterogeneity [2 index is a complement to the Q test, although it has the same problems of power with a small number of studies [p < 0.1) and/or the result of I2 was >75%, there was heterogeneity among the studies, and the random-effects model was conducted in the meta-analysis. To detect publication bias and to test the influence of each individual study, we performed a visual evaluation of the Doi plot [2 max variables using a random effects model employing the effect size statistic (Hedges’ g) of the pain intensity scores to correlate with the VO2 max scores [The estimated SMDs were interpreted as described by Hopkins et al. , that isdex (I2) . We consogeneity . The I2  studies . When thDoi plot , seekingDoi plot . An LFK x scores .The study search strategy was presented in the form of a flow diagram .2 max, disability, and health-related QoL. The patients were diagnosed with a persistent musculoskeletal pain condition [2 knee osteoarthritis studies ,46, two In all groups, HIIT was compared to other types of training or interventions (including controls and no interventions), with the exception of Bressel et al. , which sWe evaluated the studies’ quality with the Cochrane assessment tool. Most of the studies had a low risk of selective reporting bias. The domain with the highest percentage of studies with a high risk of bias was the blinding of participants and personnel (performance bias). p < 0.05) but with evidence of significant heterogeneity . The shape of the funnel and DOI plot did not present asymmetry, and the LFK index showed minor asymmetry  indicating a low risk of publication bias (2 = 82%)  .p ≥ 0.05) with no evidence of significant heterogeneity . The shape of the funnel and DOI plot did not present asymmetry, and the LFK index showed no asymmetry  indicating a very low risk of publication bias , with no evidence of significant heterogeneity . The shape of the funnel and DOI plot did not present asymmetry, and the LFK index showed minor asymmetry  indicating a low risk of publication bias   .p ≥ 0.05), with no evidence of significant heterogeneity . The shape of the funnel and DOI plot did not present asymmetry, and the LFK index showed no asymmetry  indicating a very low risk of publication bias , with no evidence of significant heterogeneity . The shape of the funnel and DOI plot did not present asymmetry, and the LFK index showed minor asymmetry  indicating a low risk of publication bias , with evidence of significant heterogeneity . The shape of the funnel and DOI plot did not present asymmetry, and the LFK index showed minor asymmetry , indicating a low risk of publication bias (2 = 88%)  .2 max function. The results showed that pain intensity was significantly and negatively correlated with VO2 max   .2 max, pain intensity, disability, and QoL of patients with musculoskeletal disorders. Our results suggest that HIIT has a significant moderate effect size on VO2 max and pain intensity but does not seem to improve the disability and QoL of patients with musculoskeletal disorders. We also found that pain intensity was negatively associated with VO2 max.Our main goal was to analyse the effect of HIIT on the VO2 max when compared with no intervention. Several authors also found that HIIT was superior to usual care or no intervention in improving VO2 max among patients with cardiovascular disorders or cancer [2 max; however, the results across systematic reviews differ [2 max [We found a moderate certainty of evidence of a moderate effect size of HIIT on VOr cancer ,19,55. Ws differ ,57. It hs differ ,59 vascus differ , and cars differ . All of r [2 max .2 max, which is an important predictor of all-cause mortality and cardiovascular disease [We found that the patients’ pain intensity scores were negatively associated with VO disease ,64. It s disease ,66. An i disease ,68. HIITWe found a low certainty of evidence of a moderate effect size of HIIT on pain intensity compared with no intervention. Geneen et al. found that physical activity appears to induce exercise-induced hypoalgesia in patients with chronic pain; however, the results were inconsistent across the various exercise modalities . When coWe found a low level of evidence of no significant effect of HIIT on QoL compared with no intervention or usual care. Mugele et al. systematically reviewed the effect of HIIT on QoL, compared with usual care, and found unclear results . QoL app2 max and pain intensity with other exercise types, HIIT requires less training volume to achieve similar effects in the included studies that provide the control group’s training duration [Time constraints and pain are two of the main barriers to physical activity for patients with musculoskeletal disorders ,89,90. Dduration ,50. Weweduration . Major cduration  but withduration . As recoduration . Heisz eduration . Health We found low-to-moderate quality evidence for our results. Further studies are needed on the effects of HIIT on musculoskeletal disorders to confirm our results. The sample sizes of the included studies were often very small. Future studies should include larger sample sizes to improve the quality of the evidence. Due to the lack of sufficient data and the heterogeneity among the interventions , we could not establish the specific effect on each musculoskeletal disorder and the optimal HIIT parameters. Due to the small number of trials, we pooled the aerobic and anaerobic HIIT training studies; future systematic reviews should evaluate them separately. Only a few studies compared the effect of HIIT against high-intensity continuous training or other types of exercise; future studies should include this type of high-intensity training.2 peak and VO2 max and used them interchangeably [As recommended by the American Thoracic Society/American College of Chest Physicians Statement on Cardiopulmonary Exercise Testing, we included VOangeably . Quantitangeably ,45,47.2 max but not disability and QoL. The results of the subanalyses showed that HIIT was not superior to other exercise models in improving pain intensity and VO2 max. Clinically, this tells us that we can implement high-intensity interval exercise models if our goal is to improve pain intensity or increase cardiorespiratory fitness through maximal oxygen consumption. However, it is important to keep in mind two aspects: changes in pain intensity may not be accompanied by improvements in the subjective perception of quality of life or disability, at least, based on the data we currently have, and second, that this exercise model was not superior to other exercise models with respect to eliciting these clinical changes. This should be considered clinically. Low sample sizes and lack of prescription parameters emphasise the need for further research on HIIT in musculoskeletal disorders for its implementation in a clinical context.There is low to moderate quality evidence that the HIIT intervention for patients with musculoskeletal disorders can improve pain intensity and VO


The total effective rate in the Exp group (88%) was greatly superior to that of the Ctrl group (68%). In terms of TCM symptom scores, the TCM symptom scores of chest pain, chest tightness, and shortness of breath in the Exp group after intervention  were notably inferior to those in the Ctrl group . In the Exp group, after intervention, the degree of physical activity limitation (67.05 ± 5.08 points), the stable state of angina pectoris (65.28 ± 3.76 points), the frequency of angina pectoris attack (85.92 ± 2.97 points), the degree of treatment satisfaction (75.39 ± 5.94 points), the cognition score of disease (63.56 ± 5.84 points), the levels of triglyceride (1.27 ± 0.41 mmol/L), and total cholesterol (2.24 ± 0.41 mmol/L) were remarkably inferior to the Ctrl group  (P < 0.05). It suggested that intracoronary ultrasound imaging can clearly display the coronary plaques of patients and accurately evaluate the clinical efficacy of patients with CHD. The TCM nursing program can greatly improve the angina symptoms and quality of life of patients with CHD and PBSS, reduce blood lipid levels, and effectively improve the clinical efficacy of patients.This study was to explore the effect of traditional Chinese medicine (TCM) nursing intervention based on intracoronary ultrasound imaging on patients with coronary heart disease (CHD) and phlegm and blood stasis syndrome (PBSS). 100 hospitalized patients with CHD with Qi deficiency and blood stasis syndrome (QDBSS) were rolled into the experimental (Exp) group (routine nursing intervention) and control (Ctrl) group , with 50 patients in each group. They underwent the intracoronary ultrasound imaging scanning. The results showed that after intervention, the plaque load (45.08 ± 6.02%), plaque eccentricity index (0.47 ± 0.08%), vascular remodeling index (0.53 ± 0.11%), and vascular external elastic membrane area (8.67 ± 3.06 mm For patients with heart failure and arrhythmia, corresponding corrective treatment should be added, and coronary angioplasty and cardiac bypass surgery should be considered if the symptoms continue to worsen [Coronary artery disease (CHD), whose full name is coronary atherosclerotic heart disease, is caused by myocardial ischemia and hypoxia caused by coronary artery sclerosis. It is more common in middle-aged and elderly people, and its incidence increases with age , 2. Manyo worsen .In addition to drug treatment and surgical treatment, modern medicine also pays attention to nursing interventions for patients. The occurrence of CHD is related to nature, society, and individual lifestyle . In receAt present, imaging techniques are mostly used for the diagnosis of CHD. Magnetic resonance imaging (MRI) is one of the common methods for diagnosing diseases in medical clinics. It can be used to examine diseases such as cardiovascular system, nervous system lesions, and thoracic lesions. It has high diagnostic accuracy but is expensive –15. EchoTherefore, a total of 100 inpatients with QDBSS of CHD were selected as the research subjects. The Ctrl group adopted conventional nursing measures and the Exp group adopted TCM nursing intervention based on that of the Ctrl group. The intravascular ultrasound imaging technology was used as an evaluation method. Imaging indexes , total response rate, angina pectoris scale score, TCM syndrome score, and blood lipid level were used as evaluation indexes, to discuss the clinical efficacy of TCM nursing intervention program based on coronary ultrasound imaging in patients with phlegm-stasis syndrome of CHD, aiming to provide effective treatment and nursing ideas for patients with phlegm-stasis syndrome of CHD.In this study, 100 inpatients with CHD and QDBSS admitted to the hospital from November 10, 2020, to February 5, 2022, were recruited, including 63 males and 37 females. All patients were randomly assigned into the experimental (Exp) group (50 cases) and the control (Ctrl) group (50 cases). Subjects in the Ctrl group used routine nursing intervention program and intervention time for patients was from admission to discharge. The Exp group received conventional nursing combined with TCM nursing intervention program, and syndrome differentiation nursing was implemented. This study had been approved by ethics committee of hospital, and the patients and their families were informed and signed the informed consent.The inclusion criteria are as follows: patients over 35 years old; patients who can cooperate with follow-up; patients with complete basic information of the case; patients with clinical manifestations of chest pain and chest tightness, palpitations, shortness of breath, mental fatigue, and purple complexion dark, etc.; and patients who volunteered to participate in the experiment.The exclusion criteria are as follows: patients with severe heart failure; patients with mental disorders and unable to communicate normally; pregnant or breastfeeding women; patients with drug allergies; and patients who had been treated with drugs in the past six months.The specific nursing procedures in the Ctrl group were as follows. (I) First, it should ensure that the patient's ward is in good hygiene, with sufficient light, humidity, and temperature, and pay attention to regular disinfection. (II) It should assess the patient's pain situation, assist the patient to present an appropriate posture, monitor the changes of the patient's vital characteristics in real time, and pay attention to appease the patient's anxiety and tension. (III) It had to be cautious about the use of drugs, such as the use of nitrates to observe the patient's blood pressure level and monitor the patient's liver function if other statins were adopted. (IV) It should guide patients to have a healthy diet and quit smoking. Bad habits such as alcoholism and overeating.The specific operations in the Exp group were as follows. (I) Real-time attention and assessment of the patient's chest pain. If the patient had symptoms such as aggravation of pain, sweating, and cold limbs, emergency treatment was required in time, the patient was given complete bed rest and oxygen support was given. (II) Pay attention to monitoring the patient's heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, and other vital characteristics, help the patient to adopt the most appropriate body position, and perform electrocardiogram examination and timely symptomatic treatment. (III) Explain the harm caused by constipation to the patient, instruct the patients to drink more hot water, eat more cellulose-rich fruits and vegetables, and nondiabetic patients can also drink 15 mL of honey water every day. (IV) Intervene the patient's sleep situation. If the patient often suffered from insomnia, it was necessary to reduce the redundant operations during naps and late nights, and play soft music in the ward. (V) A scientific and reasonable dietary plan needed to be formulated in response to the patient's dietary problems. CHD patients needed tonic food for promoting blood circulation and removing blood stasis, such as chicken, beef, yam, and jujube. Chinese medicine diet recommended peach kernel porridge , once a week. (VI) Provide emotional nursing for the anxiety and fear of the patient, communicate with the patient more, and use the method of transference, such as music therapy, to divert the patient's attention.First, CAG was performed, and the patient's femoral artery was used as the puncture point, and local anesthesia was administered. With the help of digital subtraction angiography X-ray machine, the catheter was sent into the puncture site, the contrast agent was infused, and finally, the stenosis degree and lesion area of the culprit vessel were measured. Then, on the basis of CAG, the ultrasound catheter was sent into the puncture site, the guide wire was withdrawn, and low molecular weight heparin was given for anticoagulation. Then, the ultrasound catheter was slowly withdrawn, and ultrasound imaging was performed during this process. Finally, PB, EI, EEMA, and vascular RI of diseased vessels were calculated according to the ultrasound images.Plaque cross-sectional area/external elastic membrane cross-sectional area represented the proportion of plaque to external elastic membrane area.(Maximum plaque thickness-minimum plaque thickness)/maximum plaque thickness. EI < 0.5 referred to centripetal plaque, and EI ≥ 0.5 referred to eccentric plaque. The higher the EI value was, the more obvious the degree of plaque eccentricity was.The inner edge of the outer membrane was recorded manually and measured by a computer automatic edge measurement system.Mean cross-sectional area of external elastic membrane at the lesion/mean cross-sectional area of reference segment. If RI > 1.05, positive reconstruction was considered. If RI < 0.95, inverse reconstruction was considered.The gender, age, height, weight, disease duration, comorbidities, and stability angina pectoris classification under Canadian Cardiovascular Society (CCS) of patients were collected. The frequency of angina pectoris and degree of angina pectoris of the patients were recorded. The data of patients before and after nursing intervention and two weeks after discharge in outpatient follow-up were recorded. The Seattle Angina-pectoris Scale (SAQ) was adopted to evaluate the patients' quality of life, including five items: degree of physical activity limitation, stable state of angina pectoris, frequency of angina pectoris, treatment satisfaction, and disease awareness. In addition, the satisfaction with nursing interventions was assessed using the Mueller/McCloskey Nurse Job Satisfaction Scale. Before and after nursing intervention, serum lipid levels  in fasting state were detected in the morning.s). Counting data were statistically inferred by χ2 test. P < 0.05 was statistically considerable.SPSS 26.0 was employed for data process. Measurement data were denoted as mean ± standard deviation (P > 0.05).The general data of the patients in the Exp group and Ctrl group were compared . The numP < 0.05).In P > 0.05). The TCM symptom scores of chest pain, chest tightness, and shortness of breath in the two groups after intervention were notably inferior to those before intervention (P < 0.05). The abovementioned TCM symptom scores in the Exp group after intervention were remarkably inferior to those of the Ctrl group (P < 0.05).In P > 0.05). The degree of physical activity limitation, stable state of angina pectoris, frequency of angina pectoris, treatment satisfaction, and disease awareness score in the two groups after intervention were notably inferior to those before intervention (P < 0.05), while those in the Exp group after intervention were remarkably inferior to the Ctrl group, with statistical significance (P < 0.05).In P > 0.05). The PB, plaque EI, vascular RI, and EEMA after intervention in the two groups were notably inferior to those before intervention (P < 0.05). After intervention, the PB, plaque EI, vascular RI, and EEMA in the Exp group were remarkably inferior to the Ctrl group (P < 0.05).In P > 0.05). The TG and TC of the two groups of patients after intervention were notably inferior to those before intervention (P < 0.05). After intervention, the TG and TC in the Exp group were remarkably inferior to those in the Ctrl group (P < 0.05). In addition, there was no evident difference in the LDL level between groups before and after the intervention (P > 0.05).In P < 0.05).In CHD is an aging disease with extremely high morbidity, disability, and fatality rate, which brings huge economic burden and mental pressure to people's daily life and society. In recent years, there has been a trend toward younger age. Therefore, seeking better diagnosis and treatment methods is also the focus of current research . InterveP > 0.05), which provided conditions for the follow-up case-control study. Then, the intracoronary ultrasound imaging performance of a 62-year-old male patient before and after intervention was analyzed. Before treatment, CAG showed that the patient's anterior descending artery was closed together with ischemia symptoms, and the route of the occlusion end was unclear. The diameter and effective lumen area of patients after treatment were greatly smaller than those before treatment, which indicated that intracoronary ultrasound imaging can accurately assess the clinical efficacy of CHD patients. From the quantitative indexes of intracoronary ultrasound, the PB, plaque EI, vascular RI, and EEMA of the Exp group after intervention were notably inferior to those of the Ctrl group (P < 0.05). This confirms the considerable effect of TCM care on CHD patients from an imaging point of view.Therefore, this work selected 100 inpatients with CHD and QDBSS as the research objects. All patients were divided into an Exp group (routine nursing intervention program) and a Ctrl group (the TCM nursing intervention program on the basis of routine nursing to carry out syndrome differentiation nursing), with 50 cases in each group. Intracoronary ultrasound imaging scans before and after concurrent treatment. First, the basic data were compared, and it was found that there were no statistical differences in the number of males and females, age distribution, height, weight, comorbidities , CCS stability angina pectoris classification, and average course of disease between groups of patients showed no great significance (P < 0.05). Such result is similar to the findings of Richards et al. [P < 0.05). The TCM nursing program pays attention to dialectical nursing, and can provide corresponding nursing intervention measures according to the individual situation of the patient, which can be supplemented by the technical treatment of TCM characteristics, which shows that the TCM nursing program has high clinical application value [P < 0.05). This shows that the TCM nursing program can remarkably alleviate the adverse physiological and psychological changes caused by the progression of the disease, relieve the physical and mental pain of the patient, and improve the quality of life. The TG and TC in the Exp group after intervention were remarkably inferior to the Ctrl group (P < 0.05). TG and TC are two of the four indicators of blood lipids. Elevated TG and TC levels can cause cardiovascular and cerebrovascular damage, accelerate atherosclerosis and plaque formation, and increase the occurrence of cardiovascular events such as myocardial infarction and cerebral infarction [In terms of clinical efficacy, it was found in this work that the total effective rate of patients in the Exp group (88%) was greatly higher versus the Ctrl group (68%) (s et al. , which son value . After ifarction . Thus, tIn this study, different nursing intervention schemes were adopted for patients in the Exp group and Ctrl group, and coronary ultrasound scan was performed before and after treatment. The results found that intravascular ultrasound can clearly display the coronary plaque and accurately evaluate the clinical efficacy of patients with CHD. Compared with conventional nursing, TCM nursing program can greatly improve angina pectoris symptom and life quality of patients with phlegm-stasis syndrome of CHD, reduce blood lipid level, and effectively improve clinical efficacy. Limited by time and region, this study only included cases of phlegm-stasis syndrome of CHD admitted to hospital. The sample size was small and the study was not comprehensive enough. Moreover, subjective questionnaires were mostly used as evaluation criteria, which may have some influence on the results. In the future, the scope of the study will be expanded to include CHD patients from different regions and hospitals and patients of different TCM syndromes for further analysis. In conclusion, this study provides a reference for the combined application of imaging technology and TCM nursing intervention in the clinical treatment of CHD.