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This study was conducted as a structured narrative review of random-ized controlled trials (RCTs) investigating virtual reality (VR)-based exer-cise and rehabilitation. PubMed and the Research Information Sharing Service were searched for peer-reviewed studies published between 2015 and 2025. Predefined search terms and eligibility criteria based on the population, intervention, comparison, and outcome framework were applied to identify relevant studies for narrative synthesis. Search terms were organized into three conceptual domains: VR, exercise or rehabil-itation, and biomechanical outcomes. Of 2,138 records initially identified, 19 RCTs were included in the final analysis. Whole-body movement was the most common intervention (11 studies), followed by center-of-mass shifting exercise (three studies). Gait-related outcomes were investigat-ed in 13 of the 19 RCTs, balance and postural control in 12 studies, and direct or instrumented biomechanical outcomes in 10 studies. Across the trials, VR-based exercise was generally associated with improve-ments in gait, balance, postural control, and selected neuromuscular outcomes; however, the direction, magnitude, and statistical significance of these effects varied across studies. Because substantial heteroge-neity was observed in study populations, intervention duration and dose, VR modality, and outcome assessment, pooled effect sizes were not estimated, and definitive conclusions regarding the magnitude of treat-ment effects could not be drawn.

In this study, we investigated whether gut microbiota-derived factors contribute to the increase in intestinal permeability and the activation of left ventricular autophagy-related signaling induced by high-intensity treadmill exercise, using an antibiotic-treated rat model. Serum levels of lipopolysaccharide (LPS), LPS-binding protein (LBP), colonic occlu-din, zonulin, and myocardial autophagy-related signaling were ana-lyzed. A total of 38 specific pathogen-free male Sprague–Dawley rats aged 8 weeks were randomly assigned to four groups: control (n=9), antibiotic control (n=9), exercise (n=10), and antibiotic plus exercise (n=10). Treadmill exercise was performed for 60 min per session, 4 times per week, for 8 weeks. Eight weeks of high-intensity treadmill exercise increased intestinal permeability and elevated circulating lev-els of gut-derived LPS and LBP. Increased LPS and LBP levels were as-sociated with the activation of adenosine monophosphate-activated protein kinase (AMPK) and upregulation of myocardial autophagy-re-lated markers, including microtubule-associated protein light chain 3 and B-cell lymphoma-2-interacting myosin-like coiled-coil protein. Al-though increased intestinal permeability was also observed in the anti-biotic-treated exercise group, circulating LPS and LBP levels did not in-crease significantly, nor did AMPK activation or the expression of auto-phagy-related markers. Prolonged high-intensity treadmill exercise may be associated with increased intestinal permeability and activation of myocardial autophagy-related signaling. The attenuation of the increas-es in circulating LPS/LBP levels and in myocardial autophagy-related signaling after antibiotic treatment suggests that gut microbiota-derived factors may mediate these gut-heart responses. Optimizing exercise benefits while minimizing risks may require considering both training in-tensity and gut health in the exercise program design.

This study examined the associations between work-related and lei-sure-time physical activity (PA) and musculoskeletal pain among early childhood teachers. A cross-sectional study was conducted with 125 teachers from childcare centers and kindergartens in Korea. Data were collected using a structured online questionnaire that included demo-graphic characteristics, Korean version of Global Physical Activity Questionnaire, and modified Nordic Musculoskeletal Questionnaire. PA was classified by domain (work-related and leisure-time) and intensity: vigorous physical activity (VPA) and moderate physical activity (MPA). Musculoskeletal pain was assessed in seven body regions. Descriptive statistics, analysis of variance, Pearson correlation, and binary logistic regression were performed. The results showed that the duration of work-related PA was significantly greater than that of leisure-time PA. Leisure-time VPA was associated with lower pain intensity in the neck, shoulder, and low back, whereas MPA was associated only with neck pain. Correlation analyses showed negative associations between lei-sure-time VPA and pain in the neck, shoulder, arm/elbow, and low back. Leisure-time VPA was independently associated with lower odds of neck pain (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.13–0.75) and shoulder pain (OR, 0.35; 95% CI, 0.14–0.89), whereas MPA showed no significant independent associations. These findings suggest that leisure-time VPA was associated with lower musculoskeletal pain among early childhood teachers.

This study evaluated the reliability and validity of a context-aware sleep holistic cycle gate algorithm and explored its potential for artificial intel-ligence (AI)-based personalized sleep management in digital health-care. A 6-week prospective observational study was conducted in 25 adults aged 20–65 years. Participants recorded daytime activities, eve-ning behaviors, presleep environmental factors, sleep outcomes, and feedback adherence using a mobile application. Five sleep-related indi-ces were calculated, and a context-aware gate algorithm comprising five domains was applied. Reliability was assessed through internal consistency and reproducibility analyses, while validity was examined using correlations with sleep quality indicators and receiver operating characteristic curve analyses. Data completion and adherence rates were 80.3%±9.8% and 72.7%±11.6%, respectively. The sleep readiness index was positively correlated with subjective sleep quality (r=0.53, P<0.01). The algorithm demonstrated moderate predictive performance (area under the curve=0.73), with the environment and presleep gates showing the highest accuracy. Following personalized feedback, sleep onset latency decreased by 12.6%, and perceived sleep quality im-proved significantly (P<0.05). In conclusions, the context-aware sleep holistic cycle gate algorithm demonstrated acceptable reliability and validity for predicting sleep quality. These findings suggest that the pro-posed framework may serve as a foundational platform for the develop-ment of AI-driven personalized sleep management systems and future digital healthcare applications related to sleep rehabilitation and health promotion.

Dynamic balance is essential for performance and injury prevention in combat sports, but its relationship with isokinetic strength ratios of the lower extremity and trunk is not well understood. This study investigated the associations between knee, hip, and trunk strength ratios and dynamic balance in elite combat sport athletes. Fifty-one elite judo and wushu athletes (31 males, 20 females) underwent isokinetic testing of the knee, hip, and trunk, with peak torque normalized to body mass (%body weight). Dynamic balance was assessed using the Biodex Balance System SD. Interaction effects between strength ratios and balance variables were analyzed using three-way analysis of variance. Male athletes showed greater muscle strength, whereas female athletes demonstrated better dynamic balance. Higher knee flexor-to-extensor strength ratios (≥61%) and moderate hip (35%–40%) and trunk strength ratios were associated with better dynamic balance. Significant interaction effects were found between knee and hip strength ratios. Our findings suggest that dynamic balance in elite combat sport athletes may depend on the coordinated strength balance of the knee, hip, and trunk rather than on absolute muscle strength alone.

This study compared the effects of high-intensity functional training (HIFT) and high-intensity interval training (HIIT) on body composition, muscular strength, cardiorespiratory fitness, and exercise-related perceptual responses in insufficiently active young adults with obesity. Twenty-four participants were randomized to the CON, HIFT, and HIIT groups (n= 8 each); 22 completed the study and were included in the final analysis (CON, n= 8; HIFT, n= 7; HIIT, n= 7). Both exercise groups were prescribed three supervised sessions per week for 8 weeks. After baseline adjustment, HIIT showed significantly lower waist circumference (P< 0.01), hip circumference (P< 0.05), waist-to-hip ratio (P< 0.01), gynoid fat mass (FM) (P< 0.05), and leg FM (P< 0.05) than CON, whereas these measures did not differ significantly between HIIT and HIFT. No significant between-group differences were observed for whole-body FM, body fat percentage, or fat-free mass. After baseline adjustment, relative peak oxygen consumption (both P< 0.05) and the first ventilatory threshold (HIFT, P< 0.05; HIIT, P< 0.01) were significantly higher in both HIFT and HIIT than in CON, with no significant differences between exercise groups. Baseline-adjusted absolute upper-body strength was higher in HIFT than HIIT (P< 0.05), whereas lower-body strength did not differ. First-session-adjusted affective valence and exercise enjoyment were higher in HIFT than HIIT (both P< 0.05), whereas perceived exertion and heart rate did not differ. These findings indicate that both HIFT and HIIT improved aerobic fitness, while HIFT showed higher postintervention upper-body strength and more favorable affective and enjoyment responses than HIIT. These distinct profiles may inform individualized exercise prescription by considering both training outcomes and exercise experience in young adults with obesity.

This pilot randomized controlled trial (RCT) aimed to determine whether an 8-week progressive step exercise program improves sarcopenic outcomes compared with treadmill exercise and a nonexercise control condition in women with sarcopenia. The primary outcomes were appendicular skeletal muscle mass (ASM), grip strength, calf circumference, and five-times sit-to-stand (5×STS) performance. As secondary objectives, we examined the effects of the intervention on body composition, cardiorespiratory fitness, and skeletal muscle oxygen saturation (SmO2). Thirty-six women were randomly assigned, but 30 were included in the analysis across three groups: a control group (CON, n=10), a treadmill exercise group (TEG, n=10), and a step exercise group (SEG, n=10). Compared with the CON and TEG, the SEG demonstrated significant between-group differences in calf circumference (P=0.001, η2= 0.422), grip strength (P=0.003, η2=0.393), 5×STS (P<0.001, η2=0.617), and ASM (P=0.046, η2=0.194). Significant between-group differences were observed for postintervention maximal oxygen uptake (P<0.001, η2=0.571) and maximal heart rate (P=0.018, η2=0.193). During graded exercise, significant between-group differences in SmO2 emerged from level 4 (P<0.05) and persisted through level 10 (P<0.01). These preliminary findings suggest that step exercise may be a promising and practical intervention for improving sarcopenic outcomes, aerobic capacity, and muscle oxidative adaptation in women with sarcopenia. However, larger adequately powered RCTs are required to confirm these findings and establish the efficacy of this intervention.

This experiment was conducted to compare the effects of a 12-week Smovey-based exercise program and a conventional unloaded multi-component exercise program on functional fitness, handgrip strength, and task-related upper-extremity muscle activity in older women. In this trial, 46 community-dwelling women aged 65 years or older were allo-cated to a Smovey-based multicomponent exercise group (SMG) or a conventional unloaded multicomponent exercise group (CG). One CG participant withdrew (final n=45: SMG, 23; CG, 22). Both groups com-pleted supervised 60-min sessions three times weekly for 12 weeks with identical movement patterns, volume, and perceived-exer-tion-based progression; only the SMG held Smovey rings. Five senior fitness test items, dominant-hand grip strength, and surface electro-myographic activity of six upper-extremity muscles during a standard-ized fixed-load shoulder task, normalized to maximal voluntary contrac-tion (%MVC), were assessed before and after the intervention and ana-lyzed using 2×2 mixed-design analyses of variance. Significant time ef-fects were observed for all functional fitness outcomes and handgrip strength. Group-by-time interactions were significant for the 30-sec arm curl and handgrip strength, but not for the chair stand, 2-min step, back scratch, or 8-foot up-and-go. The %MVC increased in both groups for all six muscles, whereas interactions were significant only for the bi-ceps brachii, triceps brachii, flexor carpi radialis, and brachioradialis, not for the anterior or middle deltoid. Both programs improved function-al fitness. The Smovey-based program produced greater gains in arm-curl performance and handgrip strength, while differential changes in task-related muscle activity were confined to the elbow and forearm muscles rather than the shoulder muscles.