Alba Hernández-Martínez

Introduction Bariatric surgery is the most effective treatment for severe obesity. We evaluated whether a 16-week supervised exercise program initiated immediately post-surgery improves weight loss, body composition, cardiometabolic health, inflammation, and physical fitness compared with usual care. Methods In this randomized clinical trial, 80 participants undergoing bariatric surgery were assessed before surgery, 4- and 12-month post-surgery. The intervention consisted of 16 weeks of individually supervised concurrent exercise training initiated ~ 10 days post-surgery, with three 60-min sessions/week including progressive resistance training (50–75% of one-repetition maximum) and aerobic training (65–85% heart rate reserve). Adherence was monitored throughout the intervention. The main outcome was percent of total weight loss (%TWL). Results No significant differences between groups were observed for the primary outcome. At 4 months, %TWL was 24.9% in the exercise group and 23.4% in the control group; corresponding values at 12 months were 37.0% and 37.2%, respectively. Compared with usual care, the exercise group showed greater reductions in systolic blood pressure (− 6.5 mmHg; 95% CI, − 12.7 to − 0.2; p = 0.040) and glycated hemoglobin (− 0.3%; 95% CI, − 0.5 to − 0.1; p = 0.018) at 4 months. These differences were not maintained at 12 months. No significant between-group differences were observed in body composition, inflammatory markers, or physical fitness outcomes at any timepoint. Conclusion A 16-week supervised concurrent exercise program initiated ~ 10 days after bariatric surgery did not improve weight loss compared with usual care. Although short-term improvements in systolic blood pressure and glycated hemoglobin were observed, these were not sustained at 12 months.

BACKGROUND Stroke rehabilitation often requires intensive, repetitive, and engaging interventions to promote motor recovery. Virtual reality–based rehabilitation has emerged as a promising tool to enhance patient motivation and improve functional outcomes. However, the integration of immersive VR systems into routine clinical practice remains limited. OBJECTIVE To describe the design and iterative development of NeuroRehab VR, a fully immersive, gamified, stroke-specific virtual reality software intended to support upper-limb rehabilitation in patients after stroke. METHODS NeuroRehab VR was developed between 2022 and 2024 through a public–private, multidisciplinary, and multicenter collaboration involving neurologists, rehabilitation physicians, physiotherapists, exercise scientists, researchers, engineers, software developers, game designers, and digital artists. The development process followed an agile, patient-centered approach based on the SCRUM methodology and was structured into three phases: preproduction, production, and postproduction. Through iterative development cycles, multidisciplinary meetings, and continuous feedback integration, therapeutic objectives, virtual environments, interaction modalities, gamification strategies, and safety requirements were progressively defined and refined. Preliminary user testing was conducted with seven patients at different stages after stroke through five iterative sessions. Patient feedback, clinical observation, and technical assessment were used to refine usability, task complexity, hand-tracking accuracy, calibration procedures, and interaction design. RESULTS The development process resulted in NeuroRehab VR, a fully immersive software implemented on the Meta Quest 3 headset and based on controller-free hand tracking. Three virtual environments were created: nature, home, and science fiction. Each environment included five therapeutic activities, resulting in 15 gamified tasks targeting fine motor skills, gross motor skills, balance, movement speed, movement sequencing, and cognitive engagement. Iterative testing led to several refinements, including seated task execution to reduce fall risk, alignment between real and virtual tables, simplification or replacement of overly demanding activities, improved calibration procedures, auditory and visual instructions, and the incorporation of a virtual assistant to facilitate user familiarization. A clinician-facing platform was also developed to register anonymized patients, monitor completed sessions, and display performance across therapeutic domains. CONCLUSIONS NeuroRehab VR is a stroke-specific immersive virtual reality platform developed through a SCRUM-based, multidisciplinary, and patient-informed process. Preliminary testing supported refinement of its usability, safety, and therapeutic applicability, although clinical effectiveness has not yet been established. Further evaluation in controlled clinical studies is required to determine its effects on disability, upper-limb function, adherence, and quality of life after stroke.

Obesity is a chronic, heterogeneous disease with profound physical, mental, and psychosocial consequences,requiring eff ective therapeutic strategies beyond lifestyle and pharmacological approaches. Metabolic and bariatricsurgery (MBS) has emerged as the most eff ective treatment for severe obesity, inducing substantial and sustainedweight loss alongside improvements in cardiometabolic health, quality of life, and psychosocial well-being. However,long-term outcomes vary, with some patients experiencing weight regain and persistent psychosocial challenges.This Perspective highlights the additive role of structured exercise and emphasizes the need for continuouspsychological and multidisciplinary support, positioning MBS within integrated, long-term care frameworks tooptimize patient outcomes.

Objective: To describe the design and development of NeuroRehab VR, a fully immersive, specific and gamified virtual reality (VR) software aimed at improving the quality of life and reducing disability in post-stroke patients. Methods: A public-private collaborative research project was carried out between 2022 and 2024 by a multidisciplinary and multicenter team comprising neurologists, rehabilitation specialists, physiotherapists, exercise and sport sciences professionals and members of the company Dynamics VR Rehab, including engineers, developers, computer programmers, game designers, and digital artists. The project was structured into three phases: preproduction, production, and postproduction, with periodic focus group meetings and testing sessions with patients in the subacute phase of stroke held every one to two months. Results: In the Preproduction phase, the multidisciplinary team discussed the initial concepts and, using the SCRUM methodology together with feedback from pilot patients, developed the software design. In this process, three thematic environments (i.e., home, nature, and science fiction) were established, along with five activity types targeting upper limb rehabilitation: fine motor skills, gross motor skills, balance, rhythmic movements, and movement speed. The software incorporated fully immersive VR, advanced hand tracking technology, and adaptive gamification elements. During the Production phase, these components were implemented and consolidated into a functional prototype. Finally, in the post-production phase, several adjustments were made after identifying minor issues, with the aim of improving activity responsiveness and refining the user experience for both patients and clinicians. Conclusion: NeuroRehab VR represents a promising tool to be integrated into post-stroke rehabilitation programs and is being tested though a clinical trial. Moreover, this public-private, multidisciplinary, and multicenter collaboration model constitutes an effective framework for the design and development of technologically driven solutions applicable to clinical rehabilitation settings.

Summary: Background: Virtual reality (VR) is increasingly used to enhance upper limb rehabilitation after stroke, yet its effectiveness during the acute and subacute phases—critical windows for neuroplasticity—remains unclear. This systematic review and meta-analysis evaluated the effects of VR-based interventions on upper limb outcomes in individuals within six months post-stroke and examined potential moderators of treatment response. Methods: Five databases and grey literature were searched to June 2024. Randomised controlled trials including adults ≤6 months post-stroke and comparing VR-based rehabilitation with non-technological interventions were eligible. Random-effects models were used to pool mean differences (MDs). Subgroup analyses, random-effects meta-regressions, and sensitivity analyses were performed when data allowed. Risk of bias (RoB2) and certainty of evidence (GRADE) were assessed. The review was registered in PROSPERO (CRD420251104058). Results: Twenty-eight trials (1,310 participants) were included. VR significantly improved motor impairment (FM-UE: MD = 3.82, 95% CI 2.16 5.48; I² = 83.8%) and movement speed (WMFT-time: MD = –0.52, 95% CI –0.87 to –0.18; I² = 0%). No significant effects were found for ARAT, BBT, or handgrip strength. Heterogeneity was substantial across most outcomes. Moderator analyses identified an age-related reduction in VR effects on handgrip strength and a time-dose interaction for BBT. Sensitivity analyses confirmed the stability of pooled estimates. Conclusions: VR-based rehabilitation may enhance motor impairment and execution speed in the subacute phase after stroke, but evidence for functional improvements is limited. High heterogeneity, low methodological quality of included trials, and very low GRADE certainty for most outcomes warrant cautious interpretation. High-quality, standardised, and adequately powered trials are needed.

Background: We assessed the association of adherence to the guidelines and subsequent changes over time in adherence with all-cause mortality. Methods: We used data from 3 518 and 3 273 older adults, aged 60–96 years at baseline, from Seniors-ENRICA 1 and 2 cohorts, respectively. Adherence to 24-hour movement guidelines was defined as ≥150 min/wk of moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB) ≤8 h/d (including ≤3 h/d of recreational screen time), and 7–9 h/d of sleep if aged 18–64 years or 7–8 h/d if aged ≥65 years. All-cause mortality was ascertained up to January 31, 2024. Analyses were performed using Cox regression adjusted for the main confounders. Results: Of the 6 613 participants with complete data, 1 353 died during a mean follow-up of 10.1 (standard deviation [SD] = 4.0) years. Meeting MVPA (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.65–0.82), SB (HR 0.89; 95% CI 0.80–0.99), and sleep (HR 0.89; 95% CI 0.80–0.99) recommendations were associated with lower mortality. Also, we noticed a reduction in mortality in meeting MVPA combined with both SB (34%) and sleep (12%), sleep and SB combined (23%), and meeting all 24-hour movement guidelines (40%). Changes in meeting 24-hour movement guidelines occurred between a mean follow-up of 2.8 (0.6) years. Meeting 24-hour movement guidelines at baseline and follow-up is associated with lower mortality (HR 0.69; 95% CI 0.47–0.99), compared to not meet them at both examinations. Conclusions: This prospective cohort study underscores the critical impact of adhering to and maintaining adherence to the 24-hour movement guidelines in reducing mortality risk among older adults.

Stroke is the leading cause of disability and the second cause of death worldwide. The increasing burden of stroke underscores the importance of optimising rehabilitation protocols. Virtual reality (VR) can improve poststroke prognosis. A VR software combining gamification, full immersion and stroke specificity (ie, the Development and validation of a novel viRtual rEality software for improving diSability and quality of lifE in patients with sTroke (RESET) software) might substantially improve disability and quality of life (QoL). However, this technology is still very scarce. The RESET trial aims to assess the effects of an early 10-week gamified, fully immersive and stroke-specific VR intervention (ie, starting at week 3 poststroke) on disability and QoL in people with stroke in the subacute phase. People with ischaemic or haemorrhagic stroke (n=94) aged ≥18 years will be randomised to receive (1) usual care (UC), (2) commercial VR or (3) gamified, fully immersive and stroke-specific VR (RESET). The three groups will receive UC (ie, three sessions/week of 90 min of standard rehabilitation). The VR groups will additionally receive three VR sessions of 20 min per week. The outcome measures will be assessed at baseline (week 2 from stroke occurrence), week 13 (approximately 90 days from the event) and week 26 (approximately 6 months from the event). The primary outcome is disability measured with the Barthel Index. Secondary outcomes include QoL, upper-extremity and lower-extremity motor function, gross manual dexterity, handgrip strength and cognitive function. This study will unravel the effects of a gamified, fully immersive and stroke-specific VR software on disability and QoL in patients with stroke in the early subacute phase. NCT06132399.

Summary: This meta‐analysis aimed to assess the effect of Roux‐en‐Y gastric bypass (RYGB) on three‐dimensionally assessed volumetric bone mineral density (vBMD) with the effect of time on these changes, on bone quality, and the agreement of dual‐energy X‐ray absorptiometry (DXA) with quantitative computed tomography (QCT) or high‐resolution peripheral QCT (HR‐pQCT) estimates of bone loss. We searched PubMed, Web of Science, Cochrane, Scopus, and EBSCO. Longitudinal studies on adults undergoing RYGB in which vBMD was assessed by QCT or HR‐pQCT with ≥6 months follow‐up were included. Total hip (TH) changes were reported in four studies, lumbar spine (LS) in eight, radius in eight, and tibia in seven. Significant post‐RYGB vBMD reductions occurred at all skeletal sites analyzed. Meta‐regression revealed that time post‐RYGB was significantly associated with vBMD deterioration in all skeletal sites except at the TH. RYGB also led to significant deterioration on bone quality. DXA underestimated LS and overestimated TH bone losses post‐RYGB. In conclusion, RYGB was associated with significant vBMD loss, which makes screening of bone mass progression by three‐dimensional technology a crucial clinical issue to prevent fracture risk and osteoporosis.

We aimed to assess if exercise applied after bariatric surgery (BS) improves bone mineral density (BMD) compared to usual care. Systematic search was conducted up to January 2021. Effect measures were determined using standardized mean difference (SMD) with 95% confidence interval (CI). Certainty evidence was assessed according to GRADE. Four clinical trials encompassing 340 patients were included. Exercise induced a positive BMD effect at total hip (SMD = 0.37 [95% CI 0.02, 0.71]; very low certainty evidence), femoral neck (SMD = 0.63 [95% CI 0.19, 1.06]; low certainty evidence), lumbar spine (SMD = 0.41 [95% CI 0.19, 0.62]; low certainty evidence), and 1/3 radius (SMD = 0.58 [95% CI 0.19, 0.97]; low certainty evidence). Exercise undertaken after BS seems to induce a positive effect on BMD.