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Rim Dhahri,1,2,* Islam Mejri,2,3,* Amine Ghram,3– 5 Abir Dghaies,1,2 Marwa Slouma,1,2 Soumaya Boussaid,2,4,6 Leila Metoui,1,2 Imen Gharsallah,1,2 Khadija Ayed,2,7 Zied Moatemri,2,3 Ramadan Abdelmoez Farahat,8,* Ahmad AlHamdani,9,* Ismail Dergaa9– 11,* 1Department of Rheumatology, Military Hospital of Instruction, Tunis, Tunisia; 2University of Tunis el Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; 3Department of Pneumology, Military Hospital of instruction, Tunis, Tunisia; 4Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA; 5Research Laboratory “Heart Failure, LR12SP09”, Hospital Farhat HACHED of Sousse, Sousse, Tunisia; 6Department of Rheumatology, Rabta Hospital, Tunis, Tunisia; 7Aviation Medicine Center of Expertise, Tunis, Tunisia; 8Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt; 9Primary Health Care Corporation (PHCC), Doha, Qatar; 10Research Unit Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia; 11High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia*These authors contributed equally to this workCorrespondence: Ismail Dergaa, Primary Health Care Corporation (PHCC), Doha, Qatar, Email Phd.dergaa@gmail.com; idergaa@phcc.gov.qaObjective: Spondyloarthritis (SpA) is a chronic inflammatory rheumatic disease that can lead to spinal ankylosis and consequently, restrictive pulmonary dysfunction. Thus, the present study aimed to assess the accuracy of diaphragm ultrasound compared to spirometry in the screening of restrictive pulmonary disorders in radiographic SpA patients.Methods: We conducted a cross-sectional study of 50 patients with radiographic SpA, over six months. Sociodemographic data, clinical characteristics of the disease, as well as biological, radiological, and therapeutic data, were collected. Spirometry and diaphragm ultrasound were performed.Results: The mean age of th

Wet-cupping therapy (WCT) is one of the oldest known medical techniques, used as a traditional and complementary therapy with a wide application all around the world for general health. Research on the effects of WCT on sports performance are sparse and inconsistent. Thus, we aimed to explore the effects of WCT on repeated sprint ability, wellness, and exertion in young active males. Forty-nine active adult males (age: [28 ​± ​5] years; body height [177 ​± ​8] cm; body mass: [79 ​± ​7] kg; body mass index: [25.4 ​± ​1.8] kg/m2) were selected for the study. The participants performed a running-based sprint test on two separate occasions (Control and Post-WCT). WCT was performed 24 ​h before the testing session. They completed the Hooper questionnaire to assess their well-being (i.e., sleep, stress, fatigue, and soreness) before each session. The rating of perceived exertion (RPE) was collected after each testing session. A higher maximum power (p ​< ​0.05, effect size [ES] ​= ​0.6), mean power (p ​< ​0.01, ES ​= ​0.5) and minimum power (p ​< ​0.01, ES ​= ​0.6) were recorded post-WCT as compared to Control session along with a better perceived sleep (p ​< ​0.01, ES ​= ​0.85). Perceived stress (p ​< ​0.01, ES ​= ​0.6) and RPE (p ​< ​0.001; ES ​= ​1.1) were lower during the post-WCT compared to the Control session. The present findings demonstrated that WCT moderately enhanced repeated sprint ability and had positive effects on perceived sleep, stress, and exertion. WCT may be an effective ergogenic aid to improve repeated sprint ability and general well-being in young adult males. Future large-scale multicentric clinical studies are paramount to confirm the results of our study.

Patients with stress urinary incontinence (SUI) may be afraid to increase intra-abdominal pressure to avoid incontinence. This could lead to weak expiratory muscles. The aim of this study was to investigate the association between respiratory muscle strength, physical function, and SUI in patients with SUI. A cross-sectional study was conducted in the Physical Medicine and Functional Rehabilitation Department. Thirty-one incontinent women (IG) and twenty-nine women in a control group (CG) were enrolled in this study. Anthropometric data, respiratory muscle strength (maximal inspiratory pressure; maximal expiratory pressure), SUI (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; Pad test), and physical function (waist circumference; timed-up-and-go test; abdominal muscle strength) were assessed. Body fat, body mass index, body weight, and waist circumference were higher in IG than CG (p < 0.01), while postural gait and abdominal muscles were lower (p < 0.001). Respiratory muscle strength displayed moderate correlations with SUI severity, especially for maximal expiratory pressure (p < 0.01). Maximal expiratory pressure was moderately associated with physical function. Deterioration in respiratory muscle strength is a characteristic of women with SUI. In this population, pelvic floor muscle training may be prescribed to improve continence. By feeling more confident about increasing intra-abdominal pressure, women with SUI would strengthen their expiratory muscles and eventually improve their physical function.

COVID-19 restrictions are associated with poor physical-activity (PA). Less is known about the relationship between the combination of these restrictions with Ramadan intermittent fasting (RIF), PA, mental health, and sleep-quality. The present study aimed to evaluate whether COVID-19 restrictions and RIF during the fourth wave of the COVID-19 pandemic in Iran are associated with poor PA, anxiety, well-being, and sleep-quality outcomes. A total of 510 individuals participated in an online questionnaire that was disseminated to adults (≥18 years) residing in Iran from 13 May 2021 to 16 May 2021 (~3 days), just after the end of Ramadan 2021. PA behavior (Godin-Shephard Leisure-Time Exercise Questionnaire), anxiety (General Anxiety Disorder-7), well-being (Mental Health Continuum-Short Form), and sleep-quality (Pittsburgh Sleep Quality Index). Of 510 individuals included in the study (331 female (64.9%); mean ± SD, 31 ± 12 years), 172 (33.7%) reported less PA during the Ramadan 2021. PA was associated with better well-being and sleep-quality outcomes. Regardless of PA, participants who fasted for all of Ramadan had less anxiety and better well-being outcomes than those who fasted part of Ramadan or did not fast at all. However, the fasting part of Ramadan decreased the sleep-quality of active participants. The Ramadan 2021 was associated with poor PA, well-being, and sleep-quality of Iranians. However, PA was associated with better well-being and sleep-quality outcomes, and those who fasted all Ramadan had better anxiety and well-being outcomes. Therefore, PA during Ramadan might be an essential and scalable mental health resilience builder during COVID-19 restrictions which should be encouraged. Keywords: SARS-CoV-2; exercise training; feasting; holy month; lockdown; mental health; sleep-quality.

This study aimed to investigate the effect of a walking football (WF) program during Ramadan fasting (RF) on heart rate variability (HRV) indices, body composition, and physical fitness in middle-aged males. Thirty-one healthy sedentary men were randomized to WF ( n = 18) and control ( n = 13) groups. Both groups participated in RF. The WF group were involved in a training program (small-sided games) of three sessions a week during RF. The time and frequency domains of HRV, body composition, handgrip, lumbar strength, Modified Agility Test (MAT), and 6-minute walk test (6MWT) were measured before Ramadan (BR), during Ramadan (DR), and after Ramadan (AR). We reported that RF has significantly altered some parameters of HRV DR; the mean HR decreased while the mean RR, LF, and HF increased. WF had a significant effect on HRV and mean HR DR compared with BR and AR decreased while mean RR, HF and LF increased. DR, body mass decreased in both groups, while body mass index (BMI) decreased and lean mass increased only in WF group. Lower body mass and BMI levels were reported AR only in WF group. Physical capacity improved AR, compared with BR, only in the WF group with longer distance in 6MWT, shorter time(s) in MAT, and higher lumbar strength levels. We conclude that RF increases parasympathetic system activity. WF practice during RF is safe and might improve body composition, physical fitness, autonomic cardiac function, and physical fitness in middle-aged males.

INTRODUCTION Several studies examined the effects of creatine monohydrate supplementation on renal function, but no previous study has investigated its effects on kidney stones in humans. OBSERVATION A renal ultrasound in a healthy young athlete (without a known renal morphological anomaly, normal kidney function, normal phospholipid and uric acid data) revealed a kidney stone of 11 mm in the lower right calyx. Extracorporeal shock wave lithotripsy was applied in order to break the down stone. Twentyone days later, a follow-up renal ultrasound showed the absence of stones in the kidney. One week later, the athlete started creatine monohydrate supplementation for two months. Fourteen months after stopping creatine monohydrate supplementation, a third renal ultrasound confirmed the absence of stones in the kidney. CONCLUSION Two months of creatine monohydrate supplementation in an athlete with a history of kidney stones could not be associated with kidney stone recurrence in the long run.

Background: Vision, vestibular sense, proprioception and muscle strength are required to maintain balance. However, gender could also play a crucial role in postural sway. Objectives: This study was used to examine (i) the impact of gender, surface type, and vision on postural sway; (ii) the effects of gender and vision on the limb symmetry of postural sway; and (iii) to understand the effects of gender, stance, surface type and vision on the alterations of dynamic postural sway alterations. Methods: This was a cross-sectional study in which young, healthy men (n = 15) and women (n = 12) underwent a balance control assessment using a force plate (SATEL, 40 Hz). Postural stances were evaluated in different conditions: opened eyes (EO) and closed eyes (EC), on different surface foam vs. firm, a dominant leg stance (DL) vs. a non-dominant leg stance (NDL), and a mediolateral stance (ML) vs. an anteroposterior stance (AP). The mediolateral sway (ML sway), anteroposterior sway (AP sway), and sway area were calculated from the centre of pressure displacements. Results: ML sway, AP sway and sway area increased when eyes were closed (P < 0.000). Foam surface perturbs balance control more than firm surface under EO and EC conditions for both genders, as observed in the AP sway curve (P < 0.000). A functional symmetry exists between the DL and NDL for all sway parameters: the ML sway, AP sway, and sway area (P = 0.720; P = 0.292; P = 0.954). The AP stance is more stable for the ML sway than the ML stance for both genders (P < 0.001). For the AP sway, the ML stance is more stable than the AP sway AP direction stance for both genders (P < 0.001). Women were significantly more stable than men in the ML stance when vision was absent (P < 0.01). Conclusions: Postural sway was altered more significantly on a foam surface than on a firm surface and symmetry between the DL and NDL was observed. Furthermore, we concluded that women have better dynamic balance control than men.