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Background: Electroacupuncture and exercise therapy have been used to treat knee osteoarthritis, but evidence for adding cupping to this treatment is lacking. Therefore, this study aimed to investigate the effect of cupping and acupuncture combined with exercise on knee osteoarthritis. Materials and Methods: This randomized control trial was done on 56 patients with knee osteoarthritis. We had two groups: a control and an intervention group. Both groups received electroacupuncture and exercise therapy programs. The intervention group received cupping after electroacupuncture plus exercise therapy. The Western Ontario and McMaster Universities Index (WOMAC) questionnaire and Visual Analogue Scale (VAS) measured patient outcomes before and after treatment. Results: All patients' VAS and WOMAC scores decreased in these two groups after treatment. The difference between VAS and WOMAC scores and pain and knee function was significant compared to the intervention group with the control group (p<0.05). The difference in knee stiffness was not significant comparing the intervention group with the control group (p>0.05). Conclusion: Adding cupping therapy following electroacupuncture and exercise therapy significantly decreased pain and improved function. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the effect of the same volume of moderate- and high-intensity aerobic exercise on patients' liver steatosis and fibrosis. Background: Exercise is known strategy to deal with non-alcoholic fatty liver disease (NAFLD). Methods: This Randomized Control Trial was performed on 60 patients randomly assigned to three arms of the study (1:1:1). Fibrosis and steatosis of liver including Control Attenuated Parameter (CAP) determined using Transient Elastography (TE). The control group was advised to adjust their lifestyle, as a routine management. The intervention groups additionally, participated on supervised exercise programs with two different intensities but the same volume of 1000 KCal per week. The intensities of 50% and 70% of V02 reserve were considered for moderate-intensity and vigorous programs, respectively. Results: On six-month follow-up, none of outcomes were statistically significant among three arms of study. However, changes in some outcomes were reached to statistically significant difference in follow-up in comparison with baseline. The mean of CAP score changes was -19.43 (31.43) (P=0.03), 9.92 (26.81) (P=0.21), and 14.61 (18.03) (P=0.01) in control, moderate- and high-intensity groups, respectively. In the high-intensity group, in addition to steatosis, this difference was also observed in the rate of fibrosis. Besides, the level of serum aminotransferases in the group with moderate exercise after six months had a significant decrease compared to baseline. (P=0.01) Conclusion: Improvement in steatosis and fibrosis was more evident in high-intensity group. As the rate of drop out was high, caution is needed in interpretation of the results. [ABSTRACT FROM AUTHOR]

Bundle branch blocks (BBB) in the V4-V6 precordial leads and hemi blocks are typically found in athletes. However, the prevalence of arrhythmogenic right ventricular cardiomyopathy (ARVC), a recognized etiology of SCD, increases with a persistent right BBB (RBBB) in the ECG. RBBB can also reveal hypertrophic cardiomyopathy, the primary cause of SCD. RBBB and left posterior hemi block (LPH) are two abnormal ECG changes known to increase the risk of SCD in the athletic population. Furthermore, some studies have suggested a relationship between ventricular hypertrophy and SCD, possibly through RBBB. Some studies indicate that SCD can be predicted through LVH patterns in ECG. The current situation regarding ECG results in athletes of Iranian ethnic background is uncertain. So the objective of this research was to investigate the prevalence of BBB and right or left ventricular hypertrophy in ECG of Iranian professional athletes competing at the 17th Incheon Asian Games. This cross-sectional study was conducted on 100 Iranian professional athletes competing in the 17th Asian Games, Incheon, by the Sports Medicine department of Shahid Beheshti University of Medical Sciences. The participant's medical records were accessed through the Sports Medicine Federation of the Islamic Republic of Iran in 2018. Age, gender, sports branch, heart rate, and the existence of BBB or ventricular hypertrophies were documented in a checklist. The mean age of the participants was 20.35 ± 1.76. Thirty participants were female (30%), and 70 (70%) were male. RBBB was observed in 42 (42%) participants and LPH in 2 (2%) participants. The existence of BBB (both RBBB and LPH) was not significantly related to rate, age, or gender (P > 0.05). However, RBBB was significantly prevalent in Judo and Fencing (P = 0.031). 89% of the participants had no ventricular hypertrophy, 10% had LVH, and 1% had RVH. The existence of ventricular hypertrophy did not have a significant relationship with age, gender, rate, or sports branches (P > 0.05). These frequencies could be expected in this population; however, great attention is needed to rule out life-threatening conditions in these patients when an abnormal ECG is observed. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis (PF) is one of the leading causes of heel discomfort worldwide. There is no definitive treatment available for PF; however, two primary therapies are under investigation: Local injection of either corticosteroids or platelet-rich plasma (PRP). There are disagreements regarding the precise and effective dosage of these therapeutic approaches and their superiority over each other. Objectives: This study was conducted to compare the effects of corticosteroids and PRP in the treatment of PF. Methods: In this single-center clinical trial, 30 patients were divided into two groups (PRP vs. corticosteroids), with 15 patients in each group. In addition to receiving medication treatment, participants were given daily exercise regimens. The PRP group had a mean age of 44.07 ± 8.21 years, while the corticosteroid group had a mean age of 44 ± 9.85 years. The efficacy of these interventions was assessed primarily using the Numeric Pain Rating Scale (NPRS), the Roles and Maudsley score (RM), and the Foot and Ankle Disability Index (FADI). Results: Over a 3-month period, the NPRS decreased in the corticosteroid group from 7.07 ± 0.95 to 3.69 ± 1.43, and in the PRP group from 7.76 ± 0.92 to 3 ± 1.68 (P < 0.001). The FADI improved in the corticosteroid group from 54.84 ± 8.33 to 75.76 ± 11.96, and in the PRP group from 49.3 ± 10.11 to 78.15 ± 16.76 (P < 0.001). Plantar fascia thickness decreased in the corticosteroid group from 5.03 ± 0.62 to 4.51 ± 0.59, and in the PRP group from 5.43 ± 0.91 to 4.38 ± 1.04 (P < 0.001). The results indicated that both groups demonstrated significant improvement in the first three months. Although the PRP group showed greater improvement than the corticosteroid group after three months, the differences between the two groups were not statistically significant. Conclusions: Our results showed that the effects of corticosteroid injections subside after one month, whereas PRP has more stable effects over time. [ABSTRACT FROM AUTHOR]

Background: Chronic low back pain (CLBP) due to the degenerative intervertebral disk diseases is one of the most common musculoskeletal conditions in contemporary societies. A variety of pharmacological, nonpharmacological and surgical options is available for treatment of CLBP. The use of non-pharmacological methods have drastically increased in recent years, offering fewer complications and expenses. This study was conducted to compare the efficacy of the neuromuscular electrical stimulation (NMES) and electro acupuncture (EAP) with exercise therapy alone in patients with chronic low back pain. Materials and Methods: This was a randomized case-controlled clinical trial. Sixty patients with CLBP were randomly assigned to 3 groups (20 cases each) of the EAP with exercise therapy, NMES with exercise therapy, and exercise therapy only. Severity of pain and disability improvement were assessed using the visual analog scale (VAS) and Quebec back pain disability scale respectively. Results: A total of 66 individuals were enrolled, out of which 6 were excluded due to patients' lack of cooperation. A significant decline in the amounts of Quebec and VAS was observed in the three groups (p<0.001). The pain and disability improvements did not display any significant difference in the NMES or EAP groups compared to the control group. However, the severity of disability and pain in the NMES group were significantly higher than the EAP group (p<0.05). Conclusion: These findings may indicate an almost identical efficacy of exercise therapy alone compared to the combination with electrical stimulation techniques in improving the pain and disability in patients suffering CLBP. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS) is the most prevalent form of peripheral neuropathy. There are various treatments for carpal tunnel. Objectives: In this study, we evaluated the effect of electroacupuncture and exercise on pinch and grip strength and wrist range of motion in patients with mild to moderate CTS. Methods: Sixty patients with carpal tunnel syndrome were evaluated in this study, only five of whom were male. In this study, patients were divided into three groups. The control group consisted of 20 patients who only used splints in the second group, in addition to splints, special exercises were administered, and the third group, electroacupuncture, and brace were prescribed for 12 sessions of 40- minute duration. study time was 6 weeks. The parameters of pinch force, grip force, ROM (flexion and extension) were evaluated at baseline and after the treatment. Results: In this study, 55 women and 5 men with an average age of 49.23 ± 8.96 were enrolled. At the final follow up, significant improvements in all parameters were found in third groups (P < 0.05), except flexion of the wrist in the control group (P = 0.098). Our findings indicate that exercise therapy had more effect on ROM of flexion than acupuncture and acupuncture had more effect on pinching than exercise therapy but the effect sizes were weak. Also, the efficacy of splint alone was less than intervention groups in all parameters. Conclusions: Results of this study demonstrated that adding exercise or acupuncture to nocturnal splinting, the functional improvement is more in patients with mild to moderate carpal tunnel syndrome and these interventions could be adopted in the management of these patients. [ABSTRACT FROM AUTHOR]

Background: The efficacy of acupuncture and exercise therapy in the treatment of carpal tunnel syndrome (CTS) has been investigated in limited studies with controversial results. The purpose of this study was to compare the short-term efficacy of acupuncture and exercise therapy in patients with mild to moderate CTS. Materials and Methods: This study was a randomized controlled clinical trial study conducted on 60 patients (55 women) with mild to moderate CTS referring to Imam Hossein Hospital in Tehran in 2017. The patients were randomly divided in to 3 equal groups; groupa1: only night splint was used for 6 weeks (control), group2: splint with tendon and nerve gliding exercises (2 times a day for 6 weeks) were applied, group3: splint and electroacupuncture was performed for 12 sessions (2 sessions/week). The score on the Boston Carpal Tunnel Questionnaire (BCTQ) for Functional Status and Symptom Severity (BCTQ FUNCT and SYMPT) and visual analog scale (VAS) score were evaluated at baseline and after the treatment. Results: At the final follow up, significant improvements in all parameters of quality of life and VAS were found in third groups (p<0.05). Acupuncture affected the score on the BCTQ FUNCT and SYMPT, the VAS score more than exercise therapy. In addition, the efficacy of splint alone was less than intervention groups in all parameters. Conclusion: Acupuncture with splint has a high effect on reducing pain and improving the quality of life in patients with mild to moderate CTS and could be adopted in the management of these patients. [ABSTRACT FROM AUTHOR]

Background: Knee medial collateral ligament (MCL) sprain is common in athletes, which keeps them away from trainings. Platelet-rich plasma (PRP) injection is used as an adjunct for treatment of musculoskeletal injuries. This study was supposed to define effect of PRP injection on high-grade MCL sprain healing, in comparison to rehabilitation alone. Materials and Methods: This study was performed on 46 healthy athletes with high-grade MCL sprains who came to sports medicine clinic of Taleghani Hospital, Tehran over a one-year period (2017-2018). In first visit injury grade, its location, baseline pain, Lysholm score and joint stability was determined. Participants randomly allocated to 2 groups (n=23), "group A" had 12-week functional rehabilitation and "group B" had the same rehabilitation plus a single PRP injection. At 4-week intervals valgus stress testing, pain and Lysholm scores was reassessed. The scores of 4th, 8th and 12th weeks was compared to the baseline scores. Results: Mean baseline pain score in control and intervention group was 5.09±0.949 and 5.26±0.810 respectively that in the fourth week of study reduced to 1.30±0.765 and 2.43±0.507 (p<0.001). In intervention group, fourth week pain was significantly reduced while stability and Lysholm scores of the groups had no significant difference. Conclusion: PRP injection had a short-term statistically significant pain reduction effect that may assist in faster rehabilitation progress, shorter return to play and less detraining which is crucial to professional athletes. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. The aim of this study was to investigate the effects of inspiratory muscle training (IMT) and aerobic exercise on healthrelated quality of life of patients with COPD. Materials and Methods: This randomized controlled clinical trial was conducted on 60 patients with moderate to severe COPD, who were referred to Imam Hossein Hospital of Tehran, Iran in 2016. The patients were randomly assigned to four groups and treated for eight weeks. Group 1 (n=16) participated in 16 sessions of IMT (15 minutes per session), group 2 (n=14) performed aerobic exercises twice a week (40 minutes per session), group 3 (n=15) performed IMT and aerobic exercises, and group 4 (n=15) received no intervention, except for routine treatments (control). Quality of life was evaluated based on the Saint George's Respiratory Questionnaire (SGRQ) at baseline, week 4, and week 8 after the intervention. Results: After eight weeks, all four groups experienced a significant improvement in their quality of life (P<0.05), and group 3 (IMT and aerobic exercise) showed the greatest improvement. However, quality of life improvement in group 4 (control) was less than the other three groups (P<0.05). Conclusion: Aerobic exercise and IMT were more effective than routine protocols in improving the quality of life of COPD patients. Furthermore, shortterm IMT plus aerobic exercise had the greatest impact on improving the health-related quality of life of COPD patients and could be used in the management of these patients. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown a high prevalence of vitamin D deficiency in different communities. Due to multiple roles of vitamin D in the body, this study was aimed to determine the effect of oral vitamin D3 on ventilatory threshold-1 in a condition of vitamin D deficiency. Materials and Methods: Recent study performed on 25 healthy young adults with the serum levels of 25 Hydroxyvitamin D3 lower than 20 ng/ml, had referred to the sports medicine clinic of Taleghani Hospital of Tehran, in a one-year period (2016-2017). After primary evaluation, baseline ventilatory threshold-1 were determined by cardiopulmonary exercise testing (CPET). Then persons were treated with 50,000 IU/week of oral vitamin D3 for 8 weeks, and one week after the completion of treatment, ventilator threshold-1 was measured again, similar to the beginning conditions of the study, and its changes were studied. Results: The mean baseline ventilatory threshold-1 of participants before any intervention was 22.46 ± 6.45 (ml/kg/min), and after 8 weeks of treatment by 50000 IU/week of oral vitamin D3, increased to 26.79 ± 5.33 (ml/kg/min) at the end of study, which there was a statistically significant increase in ventilatory threshold-1 (p<0.001). Conclusion: Recent study showed that proper treatment of the vitamin D deficiency, improves ventilatory threshold-1 in healthy young adults. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. The aim of this study was to investigate the effects of inspiratory muscle training (IMT) and aerobic exercise on health-related quality of life of patients with COPD., Materials and Methods: This randomized controlled clinical trial was conducted on 60 patients with moderate to severe COPD, who were referred to Imam Hossein Hospital of Tehran, Iran in 2016. The patients were randomly assigned to four groups and treated for eight weeks. Group 1 (n=16) participated in 16 sessions of IMT (15 minutes per session), group 2 (n=14) performed aerobic exercises twice a week (40 minutes per session), group 3 (n=15) performed IMT and aerobic exercises, and group 4 (n=15) received no intervention, except for routine treatments (control). Quality of life was evaluated based on the Saint George's Respiratory Questionnaire (SGRQ) at baseline, week 4, and week 8 after the intervention., Results: After eight weeks, all four groups experienced a significant improvement in their quality of life (P<0.05), and group 3 (IMT and aerobic exercise) showed the greatest improvement. However, quality of life improvement in group 4 (control) was less than the other three groups (P<0.05)., Conclusion: Aerobic exercise and IMT were more effective than routine protocols in improving the quality of life of COPD patients. Furthermore, short-term IMT plus aerobic exercise had the greatest impact on improving the health-related quality of life of COPD patients and could be used in the management of these patients., (Copyright© 2019 National Research Institute of Tuberculosis and Lung Disease.)