Ethan Berry

Background: Long COVID affects an estimated 400 million worldwide. Individuals with long COVID face a range of fluctuating and often debilitating symptoms including myalgia, fatigue, and cognitive difficulties. Psychological effects such as anxiety, depression, and reduced quality of life are also commonly reported. Together, these symptoms present barriers to accessing traditional healthcare services. Furthermore, a lack of satisfaction in traditional healthcare services is often reported. Mobile health has been proposed as a solution to improve long COVID symptom management whilst overcoming some barriers and improving patient experience of healthcare services. This scoping review aimed to identify mobile health technologies to support long COVID symptom management or tracking and to synthesise their reported outcomes. Methods: Following JBI guidelines and the PRISMA-ScR checklist, five databases (CINAHL ultimate, MEDLINE, ScienceDirect, Cochrane, and Scopus) were searched. Articles were eligible for the review if they examined the use of mobile health technologies for long COVID symptom management or tracking. Articles which involved individuals under 18 years or non-human samples or focussed on conditions alongside long COVID where results could not be separated were not eligible for inclusion. Risk of bias was assessed using JBI, ROB 2, and ROBINS-1 V2, and is presented using both visual summaries and narrative descriptions. Results: Of 737 articles screened, 38 met the eligibility criteria and were included in the current review. These articles totalled 3541 participants across 14 countries. Technology modality varied, with the current review synthesising findings from mobile apps, web pages, video-calling platforms, wearables, and virtual reality headsets. Findings showed that mobile health technologies were acceptable and feasible, although a one-size-fits-all approach cannot be adopted due to individual differences in symptomatology and support needs. Conclusions: Promising improvements in symptom-based outcome measures and fitness tests were reported, although intervention and methodological heterogeneity limits our conclusions regarding comparative effectiveness.

BACKGROUND Sarcopenia and age-related declines in muscle function threaten independence and increase falls risk in community dwelling older adults. Muscle strengthening exercise delivered via mobile health (mHealth) apps could help address access barriers, but scalable programs require valid remote assessments of lower limb function. The five times sit to stand test (5TSTS) is a well established indicator of lower limb strength and functional capacity, yet its validity in asynchronous, smartphone video formats remains unclear. OBJECTIVE To examine agreement, reliability, and concurrent validity of a smartphone recorded, asynchronously scored 5TSTS compared with laboratory 5TSTS and isokinetic knee extensor strength in community dwelling older adults. METHODS Thirty-four older adults aged >60 years attended a single laboratory visit for isokinetic dynamometry of dominant limb knee extensors and standardized 5TSTS testing, then completed a home based 5TSTS after a >3 day wash out, recording the test on their own smartphone. Videos were timed offline by the lead author (EB) using video analysis software. Agreement between laboratory and remote 5TSTS was assessed using Bland Altman analysis and intraclass correlation coefficient (ICC); reliability and measurement error were quantified via ICC, coefficient of variation percentage (CV%), standard error of measurement (SEM), and minimal detectable change at the 95% confidence level MDC95. Pearson correlations examined associations between bodyweight normalized peak torque and both 5TSTS measures. RESULTS Twenty nine participants provided complete laboratory and remote data. Remote 5TSTS times were, on average, 0.3 s faster than laboratory values, with 95% limits of agreement −2.24 to 2.84 s. No obvious proportional bias was observed. Reliability metrics indicated good consistency (ICC = 0.89), good repeatability (CV = 7%), SEM = 0.9 s, and MDC95 = 2.5 s. Both laboratory and remote 5TSTS showed moderate negative correlations with normalized knee extensor torque, indicating that greater strength was associated with faster performance in both conditions. CONCLUSIONS Asynchronous smartphone video 5TSTS demonstrates acceptable agreement with laboratory assessment, good reliability, and moderate concurrent validity with isokinetic knee extensor strength. This supports its use as a pragmatic remote tool for monitoring progress within mHealth muscle strengthening programs for community dwelling older adults. CLINICALTRIAL The study was pre-registered on the Open Science Framework (OSF), which included full details on study design, approach, and data analysis plan prior to the commencement of recruitment and data collection.

Background: Globally, around 400 million people are estimated to be affected by long COVID, yet treatment options remain scarce. A systematic review published in 2025 indicated that non-invasive brain stimulation may help reduce some long COVID symptoms. If repetitive transcranial magnetic stimulation (rTMS) has therapeutic potential for these patients, then a clear synthesis of the evidence is necessary to determine efficacy and potential for implementation. Methodology: This systematic review and narrative synthesis was conducted in accordance with PRISMA guidelines. The search, completed on the 4th of December 2025, covered four databases and grey literature. Studies were included if they examined long COVID and rTMS. Findings: A meta-analysis was not possible due to insufficient reported data across studies. Instead, a structured narrative synthesis was conducted on four included studies. The structured narrative synthesis of four studies indicates that rTMS is feasible and is associated with reported improvements in fatigue, mood, and cognitive symptoms in individuals with long COVID. However, all included evidence is based on uncontrolled case series and retrospective analyses, meaning no causal conclusions can be drawn and findings should be interpreted as exploratory. Conclusions: Taken together, the evidence remains preliminary and highlights the need for well-designed randomised controlled trials to assess efficacy.

Background: Sarcopenia, the age-related decline in muscle mass and strength, poses a significant threat to functional independence in older adults. Despite strong evidence supporting resistance training as a preventive and therapeutic strategy, adherence to muscle-strengthening guidelines remains low. Mobile health (mHealth) technologies offer a promising avenue to bridge this gap; however, few apps are tailored to older adults or designed with their input. Objective: This study aimed to identify key features that a muscle-strengthening exercise app should include to enhance engagement and uptake among older adults. Secondary aims were to explore perceived barriers and facilitators to app use and to inform the development of an evidence-based, co-designed mHealth intervention. Methods: We used a qualitative co-design approach, involving 4 focus groups with 18 older adults (aged 60-83 years); each group comprised 3 to 6 older adults, stratified by experience with mHealth apps. Sessions were conducted online via Microsoft Teams and guided by a semistructured protocol informed by prior mHealth research and behavior change theory. Transcripts were analyzed using deductive thematic analysis, underpinned by the Technology Acceptance Model, focusing on perceived usefulness and perceived ease of use. Results: A total of 4 overarching themes and 10 subthemes were identified. Theme 1, mHealth as a tool for supporting health and well-being, highlighted participants’ recognition of digital tools in promoting activity and overcoming accessibility barriers. Theme 2, motivation and engagement through app features, revealed the importance of reminders, progress tracking, and feedback, although views on gamification were mixed. Theme 3, drawbacks of current mobile apps, captured concerns around complexity, poor usability, and lack of age-appropriate content, with skepticism regarding safety and evidence base. Theme 4, desired app elements and features, emphasized the need for customizable reminders, clear instructional videos, adaptable exercise options, and optional social features. Participants stressed the importance of simplicity, personalization, and relatable content to foster trust and sustained engagement. Conclusions: Older adults are receptive to mHealth interventions for muscle-strengthening when design is user centered and grounded in their lived experiences. This study provides a framework for future app development, highlighting the need for intuitive interfaces, personalized features, and credible educational content. By aligning design with Technology Acceptance Model constructs and co-design principles, mHealth apps can better support healthy aging and sarcopenia prevention. These findings offer actionable guidance for developers and researchers aiming to enhance digital health equity and effectiveness in older populations. Trial Registration: Open Science Framework 10.17605/OSF.IO/J64ER; https://osf.io/j64er/overview

Background: Mobile health (mHealth), leveraging mobile devices for health measurement and promotion, is rapidly growing. Smartphone cameras can perform photoplethysmography (PPG) to estimate pulse rate (PR) and other features of the cardiac cycle. However, establishing the validity of PR-PPG is essential before it can be adopted for health care applications. There is a pervasive belief that PR-PPG is analogous to heart rate (HR) derived from electrocardiograms (ECGs), and we will conduct a systematic review and meta-analysis to support or challenge this supposition. Objective: This study aims to synthesize quantitative evidence on the validity of PPG derived from mobile devices (ie, smartphones) for the assessment of HR compared with the gold standard ECG assessment. Methods: A comprehensive literature search will be performed on CINAHL Ultimate, MEDLINE, ScienceDirect, and Scopus using a predefined search strategy. All retrieved citations will be imported into Rayyan for screening and data management. A minimum of 2 independent reviewers will conduct the title and abstract screening, followed by 2 independent reviewers who will perform full-text screening and data extraction. All stages will be guided by predefined inclusion and exclusion criteria, which will be pilot-tested to ensure consistency and reliability. Any discrepancies will be resolved through discussion with a third reviewer or during a research team meeting. Intrarater reliability will be quantified at the title and abstract stage and the full-text review stage using Cohen κ. To ensure clarity and consistency in the presentation of study characteristics and findings, both narrative synthesis and tabular formats will be used. This review will include studies that report the association and agreement between resting HR and PR from PPG using contact-based smartphone devices versus ECG as the gold standard. PPG signals will be obtained using a contact-based approach, defined as finger-on-camera measurements with the smartphone’s built-in camera and flash. Studies will be excluded if they (1) do not use PPG using contact-based smartphone devices, (2) compare PPG to another collection method other than ECG, or (3) are review articles or case studies. Results: To inform clinical procedures and future studies, the results will contain data on PR-PPG and HR-ECG association (correlations) and agreement (Bland-Altman analysis), sampling devices, and operating systems. This project is unfunded, and the initial screening is expected to start in the first quarter of 2026, with results anticipated to be published in the first quarter of 2027. The projected timeline for the study includes title and abstract screening from the first quarter of 2026, followed by full-text screening in the second quarter of 2026. Results are anticipated by the third quarter of 2026, with publication expected in the first quarter of 2027. Throughout this period, database searches will be regularly updated to capture any newly published studies meeting the inclusion criteria. Conclusions: This review will provide a comprehensive understanding of the association and agreement between PR-PPG and HR-ECG. The findings may inform future adoption of PR-PPG and HR-ECG with insights into device or setting characteristics for best agreement or association.

Background: According to the National Institute for Health and Care Excellence (NICE), long COVID refers to symptoms persisting for four weeks or more after acute infection, with over 100 identified, including fatigue, cognitive dysfunction, and breathlessness. Women aged 45–54 are disproportionately affected, overlapping with the typical age for perimenopause and menopause. This scoping review aimed to provide an overview of existing research on the intersection between long COVID and the menopausal transition. Methods: Five database (CINAHL ultimate, MEDLINE, ScienceDirect, Cochrane, and Scopus) searches yielded 387 articles; after removing 40 duplicates and screening 347 titles and abstracts, fourteen studies were reviewed in full, with seven meeting the inclusion criteria (examined both long COVID and menopause in their scope and are written in English language). Results: This scoping review identified a significant symptomatic overlap between long COVID and menopause reported by participants, particularly fatigue, cognitive difficulties, mood changes, and sleep disturbances. Preliminary evidence also suggests that hormonal fluctuations may influence symptom severity, though biological mechanisms remain insufficiently understood. Methodological limitations restrict generalisability, underscoring the need for longitudinal symptom tracking, diverse samples, and biomarker-informed studies. Recognising the intersection of long COVID and menopausal transition is essential for improving assessment, management, and targeted care for affected women.

The cumulative global incidence of long COVID is around 400 million individuals, yet effective treatment options remain limited. A recent systematic review published in 2025 highlighted promising results for non-invasive brain stimulation in alleviating long COVID symptoms. Given the growing use of repetitive transcranial magnetic stimulation (rTMS) for people with long COVID, a focused meta-analysis on the therapeutic effectiveness of rTMS is warranted. To address this gap, this protocol outlines the planned procedures for a systematic review and meta-analysis. A comprehensive search will be conducted across CINAHL Ultimate, MEDLINE, ScienceDirect, and Scopus. Retrieved studies will be managed using Rayyan, with two independent reviewers screening titles and abstracts, followed by full-text review. Data extraction will follow PRISMA and Cochrane guidelines using a standardised form, with dual independent extraction and reconciliation of discrepancies. Risk of bias will be assessed using Cochrane RoB 2.0. Meta-analytical procedures will include calculation of standardised effect sizes (e.g., Hedges’ g), use of random-effects models, and assessment of heterogeneity via I², Cochran’s Q, and tau². Subgroup and moderator analyses will explore variations in rTMS protocols, participant characteristics, and symptom domains. Sensitivity analyses and meta-regression will be conducted where data permit. Results will be visualised using forest and funnel plots, and the GRADE framework will be used to assess the quality of evidence.

BACKGROUND Sarcopenia, the age-related decline in muscle mass and strength, poses a significant threat to functional independence in older adults. Despite strong evidence supporting resistance training as a preventive and therapeutic strategy, adherence to muscle-strengthening guidelines remains low. Mobile health (mHealth) technologies offer a promising avenue to bridge this gap; however, few apps are tailored to older adults or designed with their input. OBJECTIVE This study aimed to identify key features that a muscle-strengthening exercise app should include to enhance engagement and uptake among older adults. Secondary aims were to explore perceived barriers and facilitators to app use and to inform the development of an evidence-based, co-designed mHealth intervention. METHODS We used a qualitative co-design approach, involving 4 focus groups with 18 older adults (aged 60-83 years); each group comprised 3 to 6 older adults, stratified by experience with mHealth apps. Sessions were conducted online via Microsoft Teams and guided by a semistructured protocol informed by prior mHealth research and behavior change theory. Transcripts were analyzed using deductive thematic analysis, underpinned by the Technology Acceptance Model, focusing on perceived usefulness and perceived ease of use. RESULTS A total of 4 overarching themes and 10 subthemes were identified. Theme 1, mHealth as a tool for supporting health and well-being, highlighted participants’ recognition of digital tools in promoting activity and overcoming accessibility barriers. Theme 2, motivation and engagement through app features, revealed the importance of reminders, progress tracking, and feedback, although views on gamification were mixed. Theme 3, drawbacks of current mobile apps, captured concerns around complexity, poor usability, and lack of age-appropriate content, with skepticism regarding safety and evidence base. Theme 4, desired app elements and features, emphasized the need for customizable reminders, clear instructional videos, adaptable exercise options, and optional social features. Participants stressed the importance of simplicity, personalization, and relatable content to foster trust and sustained engagement. CONCLUSIONS Older adults are receptive to mHealth interventions for muscle-strengthening when design is user centered and grounded in their lived experiences. This study provides a framework for future app development, highlighting the need for intuitive interfaces, personalized features, and credible educational content. By aligning design with Technology Acceptance Model constructs and co-design principles, mHealth apps can better support healthy aging and sarcopenia prevention. These findings offer actionable guidance for developers and researchers aiming to enhance digital health equity and effectiveness in older populations. CLINICALTRIAL Open Science Framework 10.17605/OSF.IO/J64ER; https://osf.io/j64er/overview

Objective: To synthesise quantitative evidence on the validity of photoplethysmography (PPG) derived from mobile devices (i.e. smartphones) for the assessment of heart rate (HR) compared to the gold standard electrocardiogram (ECG). Introduction: Mobile health (mHealth), the use of mobile devices for promotion or measurement of health is on the rise. Smartphone cameras can perform photoplethysmography (PPG) for the assessment of heart rate (HR) and other cardiac cycle characteristics. However, rigorous validity is necessary before smartphone measurement of PPG can be utilized for healthcare provision. There is a pervasive belief that HR-PPG is analogous to HR-ECG, and herein we will provide an updated systematic review and meta-analysis to support or challenge this supposition. Inclusion criteria: This review will include studies that investigate the correlation coefficient between of resting heart rate (RHR) acquisition from PPG utilizing contact-based smartphone devices versus ECG as the gold standard, Studies will be excluded if they (a) do not use PPG utilizing contact-based smartphone devices (b) compare PPG to another collection method other than ECG, or (c) are review articles or case studies. Methods: A comprehensive literature search will be conducted in CINAHL Ultimate, MEDLINE, ScienceDirect, and Scopus using a search strategy developed in collaboration with the research team. All retrieved citations will be imported into Rayyan for screening and data management. A minimum of two independent reviewers will conduct the title and abstract screening, followed by two independent reviewers who will perform full-text screening and data extraction. All stages will be guided by predefined inclusion and exclusion criteria, which will be pilot tested to ensure consistency and reliability. Any discrepancies will be resolved through discussion with a third reviewer or during a research team meeting. Intra-rater reliability will be quantified at the title and abstract stage, and the full-text review stage using Cohen’s Kappa. To ensure clarity and consistency in the presentation of study characteristics and findings, both narrative synthesis and tabular formats will be employed. Review registration: https://doi.org/10.17605/OSF.IO/83V7A