Vol 24, No 4 (2025)

Apoptosis is crucial for maintaining tissue homeostasis in skeletal muscles. However, its dysregulation due to obesity, type 2 diabetes mellitus, or aging can result in increased muscle degeneration, decreased functional capacity, and metabolic disorders. This article reviews the regulatory mechanisms of apoptosis in skeletal muscles and examines the effects of two key factors: physical exercise and natural bioactive compounds. Scientific data analysis confirms that both physical activity and bioactive compounds such as resveratrol, curcumin, and quercetin exert a pronounced anti-apoptotic effect by reducing oxidative stress, improving mitochondrial function, and modulating signaling pathways such as Bcl-2 and AMPK/SIRT1. When combined, these interventions demonstrate a synergistic effect, offering a promising approach to the prevention and treatment of sarcopenia, obesity, and associated metabolic diseases. Despite encouraging experimental findings, further clinical trials are needed to optimize physical activity protocols and identify the most effective combinations of natural compounds for preventing muscle atrophy and improving patients’ metabolic status.

Chronic heart failure (CHF) remains one of the leading causes of morbidity, disability, and mortality worldwide. The primary clinical manifestations of CHF—dyspnea, fatigue, and exercise intolerance—significantly impair patients’ quality of life. Cardiac rehabilitation (CR) effectively improves physical performance, functional status, and compliance in patients with CHF. Conventional CR programs include moderate-intensity aerobic exercise, resistance training, respiratory muscle training, risk factor modification, and patient education. However, engagement in CR remains extremely low. Major barriers include insufficient referrals from healthcare providers, financial constraints, transportation difficulties, and limitations related to social, cognitive, and digital accessibility. This article discusses new strategies for expanding cardiac rehabilitation coverage, including the development of hybrid and home-based programs, the use of digital technology for remote monitoring, and the potential integration of artificial intelligence to personalize treatment approaches. Special attention is given to addressing digital inequality and ensuring broader access to CR programs for vulnerable populations. Innovative cardiac rehabilitation models have the potential to transform the care paradigm for patients with heart failure by increasing access to rehabilitation services and improving clinical outcomes.

BACKGROUND: Chronic post-mastectomy pain syndrome (CPMPS) affects 20%–50% of patients and significantly impairs quality of life. Venlafaxine is commonly used as part of comprehensive rehabilitation; however, side effects limit its efficacy. Transcranial electrical stimulation (TES) is being considered as a potential alternative.

AIM: The work aimed to assess the efficacy of transcranial electrical stimulation as an alternative to venlafaxine in reducing pain and improving plasma cortisol and β-endorphin levels in patients with CPMPS within the recommended comprehensive rehabilitation algorithm.

MATERIALS AND METHODS: The study included 90 outpatients with CPMPS randomized into two groups: the treatment group (n=45), in which TES was used instead of venlafaxine within the recommended comprehensive rehabilitation algorithm, and the comparison group (n=45), which received the recommended algorithm. Efficacy was assessed after 56 days using visual analog scale pain scores and plasma cortisol and β-endorphin levels. The control group included 80 individuals without CPMPS.

RESULTS: After 56 days of comprehensive rehabilitation, significant intergroup differences were found in the number of patients who achieved complete pain relief (p=0.017), as well as in cortisol levels (p = 0.001) and β-endorphin levels (p < 0.001).

CONCLUSIONS: The findings support the use of TES as an effective and safe alternative to antidepressant pharmacotherapy in the comprehensive rehabilitation of patients with CPMPS.

BACKGROUND: Cerebral palsy (CP), particularly spastic diplegia, remains a leading cause of motor impairment in children, with a prevalence of 2–3 cases per 1000 population. Although resort-based treatment (RBT) is widely used, its combinations with modern rehabilitation methods are insufficiently studied, and comparative and long-term data are limited.

AIM: The work aimed to compare the short- and long-term (6 months) efficacy of combining RBT with hydro-kinesiotherapy, multichannel myostimulation, vibrotherapy, and resistance physical therapy (PT) in children aged 8–13 years with spastic diplegia (GMFCS levels I–III).

METHODS: A prospective, non-randomized controlled study was conducted in a state-funded rehabilitation resort. Participants (n=185) were divided into five groups: the treatment group (RBT+hydro-kinesiotherapy, n=45), three comparison groups (RBT+myostimulation, vibrotherapy, or resistance physical therapy; n=30 each), and the control group (RBT, n=50). Interventions included hydro-kinesiotherapy (30 min/session, 34–36 °C), multichannel myostimulation (20–30 min, 10–150 Hz), vibrotherapy (50 Hz, 3–5 min/zone), and resistance PT (weights of 1–5% of body weight). Primary outcomes were reduced spasticity (Ashworth scale) and improved motor function (GMFM). Assessments were performed on Days 1 and 21, and after 6 months using clinical scales, stabilometry, and electromyography.

RESULTS: All participants completed treatment. Groups were comparable in age (10.2±1.5 years), sex (51% male), and GMFCS distribution (I: 38–43%, II: 33–40%, III: 23–26%; p >0.05). The greatest reduction in spasticity was observed in the myostimulation group (ΔAshworth=–25%, p <0.001, d=0.68) compared to the control (Δ=–5%, p=0.280). GMFM improved the most in group 2 (Δ=+22%, p=0.002, d=0.89), followed by hydrotherapy (Δ=+18%, p=0.001) and PT (Δ=+13%, p=0.018). Vibrotherapy was associated with balance deterioration (ΔPBS=–0.49, p=0.062). Among GMFCS II participants (n=72), a significant correlation was found between reduced spasticity and improved stabilometry findings (r=0.62, p=0.011). No adverse events were reported.

CONCLUSIONS: Multichannel myostimulation and hydro-kinesiotherapy in combination with RBT proved more effective in reducing spasticity and improving motor function in children with spastic diplegia. In contrast, the current vibrotherapy parameters should be revised. The findings support the inclusion of these modalities in guidelines; however, further research is needed to assess long-term outcomes and applicability to more severe CP forms (GMFCS IV–V).