Juan Miguel Muñoz-Perete

(I) Background: Multiple sclerosis (MS) frequently impairs balance, gait, and autonomy, increasing fall risk and fear of falling, particularly in middle-aged adults. Blood flow restriction (BFR) training has emerged as a low-load exercise strategy that may promote neuromuscular adaptations while reducing the need for high external training loads. (II) Methods: This randomized controlled trial included 65 middle-aged adults with MS (EDSS < 7), who were allocated either to a BFR exercise program performed twice weekly for 12 weeks or to a usual-care control condition. The intervention targeted upper- and lower-limb strength using individualized loads combined with BFR. Balance, gait performance, fall risk, and fear of falling were assessed at baseline and immediately post-intervention using validated clinical scales and functional tests. Intervention effects were examined using mixed-design ANOVA, with particular emphasis on group × time interactions. (III) Results: Significant group × time interactions were observed for balance, gait-related outcomes, fall risk, and fear of falling, indicating differential changes over time between the BFR and control groups. Compared with baseline, the BFR group showed improvements in balance, walking speed, walking endurance, and self-perceived walking ability, together with improvements in functional indicators of fall risk and fear of falling. The intervention was well tolerated, with no serious adverse events or injuries reported. (IV) Conclusions: A 12-week BFR exercise program was well tolerated and was associated with significant immediate post-intervention improvements in balance, gait, functional indicators of fall risk, and fear of falling in middle-aged adults with MS. These findings support BFR-based exercise as a potential low-load rehabilitation strategy in this population. However, the absence of an active exercise comparator and post-intervention follow-up precludes conclusions regarding the effects specifically attributable to BFR and the long-term maintenance of the observed improvements.

Objectives: This study investigated how perceived social support, loneliness, and physical activity are related to cognitive performance among older adults with mild cognitive impairment. Methods: This cross-sectional investigation included 112 community-dwelling older adults with mild cognitive impairment. Perceived social support, loneliness, and physical activity were evaluated with the Multidimensional Scale of Perceived Social Support (MSPSS), UCLA Loneliness Scale, and International Physical Activity Questionnaire (IPAQ), respectively. Cognitive functioning was characterized through a battery comprising the Montreal Cognitive Assessment (MoCA), Isaac Set Test, Trail Making Test Parts A and B (TMT-A and TMT-B), Digit Symbol Substitution Test (DSST), and d2 Attention Test. Relationships among the study variables were examined through correlation and multivariable linear regression analyses, with age, sex, and educational level included as covariates. To address multiplicity, Benjamini–Hochberg false discovery rate (FDR) adjustment was conducted independently for the predefined families of correlations, main-effect regression coefficients, and interaction terms. Results: Significant bivariate relationships with cognitive performance were observed for perceived social support, loneliness, and physical activity, with all 18 correlations retaining significance following FDR adjustment. After covariate adjustment, 12 of the 36 main-effect coefficients met the FDR-corrected significance threshold. Among the factors examined, physical activity displayed the broadest pattern of independent associations, encompassing global cognition, visual attention and processing speed, executive function, processing speed, and selective attention and concentration. Perceived social support was independently related to global cognition, visual attention and processing speed, and executive function. In contrast, five effects that reached nominal significance did not withstand FDR adjustment; these included physical activity in relation to verbal fluency and loneliness in relation to global cognition and TMT-B performance. Adding the interaction terms increased the variance explained by the models for MoCA (ΔR² = 0.054, p = 0.020) and TMT-B (ΔR² = 0.059, p = 0.010); however, no individual interaction term met the FDR-corrected significance threshold. Conclusions: Among the factors examined, physical activity exhibited the broadest pattern of independent relationships with cognitive performance in older adults with MCI, although the association with verbal fluency was no longer significant after adjustment for multiple testing. Perceived social support was related to a more limited set of cognitive outcomes, while associations involving loneliness were attenuated after FDR adjustment. Because no individual interaction term reached FDR-corrected significance, the interaction results should be regarded as exploratory. The cross-sectional nature of the study precludes conclusions about causality or protective effects. Future longitudinal research incorporating objective assessments of physical activity is warranted to establish the temporal direction and clinical significance of these associations.

Background/Objectives: Stroke is a leading cause of long-term disability worldwide and is frequently associated with reduced cardiorespiratory fitness, impaired functional capacity, and cognitive decline. High-intensity interval training (HIIT) has emerged as a promising rehabilitation strategy; however, its effects across multiple domains remain unclear. This systematic review and meta-analysis aimed to evaluate the effects of HIIT on cardiorespiratory fitness, cognitive function, and functional capacity in adults with stroke. Methods: A systematic search was conducted in PubMed, Scopus, CINAHL, and Web of Science up to April 2026. Randomized controlled trials involving HIIT interventions in adults with stroke were included. Outcomes of interest were cardiorespiratory fitness (VO₂peak), functional capacity (gait speed, walking distance, mobility, and balance), and cognitive function. Pooled effect sizes were calculated using a random-effects model. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated with the Cochrane RoB-2 tool. Results: In total, 17 studies (n = 809 participants) were included, with 12 contributing to the meta-analysis. HIIT significantly improved cardiorespiratory fitness (SMD = −0.849; p = 0.005), gait speed (SMD = 0.693; p = 0.014), walking distance (SMD = 0.604; p < 0.001), functional mobility (SMD = −0.711; p = 0.027), balance (SMD = 2.447; p = 0.002), and cognitive function (SMD = 1.741; p < 0.001). However, substantial heterogeneity was observed across most outcomes. Conclusions: HIIT appears to be an effective intervention for improving cardiorespiratory fitness, functional capacity, and cognitive performance in individuals with stroke. Nevertheless, the variability across studies suggests that its effectiveness is context-dependent. Further research is needed to standardize protocols and determine optimal implementation strategies.

Psychological problems such as depression, anxiety, stress, loneliness, and reduced quality of life are prevalent in older adults, yet the effectiveness of psychological interventions remains heterogeneous. This systematic review with meta-analysis evaluated the impact of psychological and psychoeducational interventions on emotional symptoms and quality-of-life outcomes in adults aged 60 years and older. Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, CINAHL, and Web of Science. Randomized controlled trials published in the last five years were included if they assessed interventions such as mindfulness, cognitive behavioral therapy, reminiscence therapy, or behavioral activation. Twenty-eight trials were included in the qualitative synthesis and twenty-two in the meta-analysis. Standardized mean differences (Hedges’ g) were pooled under fixed- and random-effects models. Heterogeneity, subgroup analyses, and publication bias were examined using Q, I², Begg–Mazumdar, Egger, and Trim-and-Fill methods. The global meta-analysis showed a moderate and significant favorable effect of psychological interventions on emotional symptoms under the random-effects model (SMD = −0.623, 95% CI −0.888 to −0.359; p < 0.001), where negative values indicate reductions in symptom severity. Subgroup analyses revealed a moderate effect on depressive symptoms, which remained significant after adjustment for publication bias, and a large effect on perceived stress (SMD = 0.581; p < 0.001); for stress outcomes, positive SMDs indicate reductions in stress (i.e., improvement) after aligning scale directionality. Anxiety showed a significant effect only under the fixed-effects model, while loneliness showed a small but significant effect (SMD = −0.110; p = 0.018). Mindfulness-specific outcomes and quality of life did not show significant pooled effects. No substantial publication bias was detected. Psychological interventions significantly improve emotional well-being in older adults, particularly by reducing depression and stress. Effects on anxiety, loneliness, mindfulness, and quality of life are more variable, emphasizing the need for methodological consistency and longer follow-up in future studies.

Background/Objectives: Cognitive impairment and sleep disturbances are highly prevalent in individuals with multiple sclerosis (MS), particularly during middle age, and negatively affect functional independence and quality of life. Although physical exercise has demonstrated cognitive and sleep-related benefits in MS, tolerance to high-intensity training is often limited. Blood flow restriction (BFR) training, which combines low-load resistance exercise with partial vascular occlusion, has emerged as a feasible alternative. This study aimed to evaluate the effects of a 12-week BFR training program on performance in specific cognitive domains and sleep quality in middle-aged adults with MS. Methods: A randomized controlled trial was conducted in 65 adults with relapsing–remitting multiple sclerosis (RRMS) aged 40–65 years and an Expanded Disability Status Scale score below 7. Participants were randomly assigned to a BFR training group or a usual-care control group. The intervention consisted of supervised low-load resistance training with BFR performed twice weekly for 12 weeks. Outcomes assessed before and after the intervention included processing speed (Symbol Digit Modalities Test), executive function (Trail Making Test A and B), verbal fluency (Isaacs Set Test), and self-reported sleep quality (Pittsburgh Sleep Quality Index). Results: Compared with controls, participants in the BFR group showed significant improvements in specific cognitive domains, including processing speed, executive function, and verbal fluency. Significant reductions were also observed in self-reported global sleep disturbance and daytime dysfunction. No adverse events were reported. Conclusions: A 12-week BFR training program improved performance in key cognitive domains and self-reported sleep quality in middle-aged adults with MS, supporting its feasibility and potential clinical relevance as an exercise-based intervention.

Background/Objectives: The global increase in life expectancy has led to a higher prevalence of cognitive and physical decline in older adults, particularly in those with mild cognitive impairment (MCI). This study aimed to evaluate the effects of a combined cognitive stimulation and resistance training intervention on cognitive performance, physical function, and fall risk in older adults with MCI. Methods: A randomized controlled trial was conducted with 80 community-dwelling older adults diagnosed with MCI. Participants were randomly assigned to an experimental group (EG), which received a 12-week intervention consisting of cognitive stimulation and progressive strength training, or a control group (CG), which maintained their usual routine. Pre- and post-intervention assessments included measures of cognitive function, verbal fluency, attention, processing speed, executive function, gait, balance, fall risk, and lower- and upper-body strength. Results: The EG showed significant improvements compared with the CG in cognitive impairment, verbal fluency, processing speed, balance, gait, and risk of falls (all p < 0.05), with effect sizes ranging from moderate to large. Notably, strength gains were observed in both lower body and grip strength. Attention and executive function also improved in the EG, although with smaller effect sizes. No adverse events were reported. Conclusions: A combined intervention of cognitive stimulation and resistance training is effective in improving multiple domains of cognitive and physical function in older adults with MCI. These findings support the integration of multidomain interventions in clinical and community settings to promote autonomy, reduce fall risk, and delay cognitive and functional decline. Future studies should explore the long-term sustainability of these effects and the individual contribution of each intervention component.

Background/Objectives: Aging leads to cognitive decline that may progress to dementia. Transcranial direct current stimulation (tDCS) has emerged as a strategy to improve cognitive functions in older adults with mild cognitive impairment (MCI). This study reviews the effectiveness of tDCS in these populations. Methods: A systematic review and meta-analysis was conducted following the PRISMA 2020 guidelines. Randomized controlled trials obtained from PubMed, Scopus, Cinahl, and Web of Science were included. Studies with tDCS intervention in older adults with MCI were selected, excluding those without a control group or that did not measure relevant cognitive variables. Methodological quality was analyzed with the PEDro scale and a meta-analysis was applied with random-effects models. Results: A total of 27 studies were included in this review, of which 13 were part of the meta-analysis. tDCS showed significant improvements in global cognitive function (p < 0.001) and selective attention (p = 0.044), but not in mental flexibility or visual attention. Positive effects on quality of life and depressive symptoms were also reported in some studies. Conclusions: tDCS may improve cognitive functions in older adults with MCI, but inconsistencies persist in its magnitude and duration. It is recommended to standardize protocols and conduct studies with greater methodological rigor and long-term follow-up.

Background: Mild cognitive impairment (MCI) represents an early stage of cognitive loss that significantly increases the risk of dementia. The aim of this study was to comprehensively synthesize the current evidence on the effect of combined physical and cognitive therapies in older adults with MCI. Methods: A systematic review with meta-analysis was conducted by searching for specific keywords in the PubMed, Scopus, Cinhal, and Web of Science databases. This meta-analysis included a total of 2256 participants distributed across 21 studies that evaluated the benefits of combining physical exercise with cognitive stimulation. Results: This review revealed that these types of therapies present a significant improvement in memory, attention, and executive functions. Participants showed notable improvements in these cognitive areas, highlighting the synergistic effects of physical exercise and cognitive stimulation, which exceeded the benefits of each therapy separately. These results contribute to the understanding of how these combined therapies can improve cognitive health in this population, offering robust evidence supporting their application in clinical practice. Conclusions: This meta-analysis shows that combined physical exercise and cognitive stimulation interventions may be an effective strategy for improving cognitive health in older adults with MCI. The findings of this study offer a valuable contribution to the field, highlighting the potential of these combined therapies to prevent cognitive decline and improve the quality of life of this population. The results may be of interest to health professionals and guide future research and clinical applications.

Background/Objectives: The purpose of this study has been to evaluate the effects of a dance-based aerobic training program on frailty, cognitive impairment, executive functions, and verbal fluency in older adults with mild cognitive impairment. Methods: Randomized clinical trial, whose sample was made up of 92 older adults, of which 47 performed rhythmic physical activity for 12 weeks. Data on frailty were collected through FRAIL, cognitive function through the Mini-Mental State Examination (MMSE), cognitive impairment through The Montreal Cognitive Assessment (MoCA), verbal fluency using the Isaac test, and executive functions with the Trail Making Test (TMT). All variables were measured before and after the intervention by an independent researcher blinded to the treatment. Results: Participants in the experimental group showed statistically significant improvements in frailty (Cohen’s d = 0.60), cognitive function (Cohen’s d = 0.98), cognitive impairment (Cohen’s d = 1.22), verbal fluency (Cohen’s d = 0.61) and executive functions (Cohen’s d = 0.64). Conclusions: This study demonstrated that a 12-week dance-based aerobic training program can significantly reduce frailty and improve cognitive abilities in older adults with mild cognitive impairment. These improvements suggest that the intervention is not only effective in terms of physical health, but also in promoting mental health and general well-being.

(1) Background: This study determined the factors associated with manual grip strength in people with high blood pressure (HBP); (2) Methods: 219 subjects participated in this cross-sectional study, which evaluated muscle strength (manual dynamometer), sociodemographic factors, clinical characteristics, level of physical activity (International Physical Activity Questionnaire-IPAQ score), and depression (Zung’s Depression Self-Rating Scale); (3) Results: The bivariate analysis found that handgrip strength in people with HPB was associated with sex (p = 0.000), age (p = 0.000), ethnicity (p = 0.019), smoking habits (p = 0.037), alcohol consumption (p = 0.004), diastolic blood pressure (p = 0.012), weight (p = 0.000), height (p = 0.000), measurement of waist circumference (p = 0.002), depression (p = 0.041), and IPAQ score (p = 0.000). Regardless of being male or female, handgrip strength was associated with age (p = 0.009), IPAQ (p = 0.000), weight (p = 0.038), height (p = 0.000), DPB units (p = 0.043), and depression (p = 0.020). The multivariate generalized linear gamma regression model showed that the coefficient with the greatest weight, regardless of sex, was age (p = 0.043), level of physical activity (24% more at high level than at low level, p = 0.031), and depression (moderate/severe depression level) associated with lower handgrip strength (p = 0.025); (4) Conclusions: Handgrip strength showed an association with level of physical activity, age, and level of depression in a middle-aged population with HBP.