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Abbreviations: | overweight | CHRONIC DISEASES, OBESE | body mass indexgut microbiotawaist circumferenceClinicalTrials.gov Identifier: NCT05667038. Saudi Food and Drug Authority (SFDA) on 12/8/2021, SCTR No. 21070702.The authors have no conflicts of interest to disclose.This study was funded by Chair for Biomarkers of Chronic Diseases (CBCD) KSU.Data sharing not applicable ... | PMC10118337 |
References | PMC10118337 | |||
Key Points | PMC10690466 | |||
Question | chronic stroke | What is the cost-effectiveness of exercise or cognitive and social enrichment activities to improve cognition among older adults with chronic stroke? | PMC10690466 | |
Findings | Cognitive and social enrichment | In this economic evaluation with 120 older adults from a randomized clinical trial, the multicomponent exercise program conducted over a 6-month period was cost-effective for cognitive function, with limited impact on health-related quality of life. Cognitive and social enrichment activities incurred higher costs compa... | PMC10690466 | |
Meaning | chronic stroke | These findings suggest that multicomponent exercise may be a cost-effective approach to improving cognitive function in older adults with chronic stroke.This economic evaluation is a cost-effectiveness and cost-utility analysis of multicomponent exercise or cognitive and social enrichment activities compared with a bal... | PMC10690466 | |
Importance | chronic stroke, stroke, Cognitive impairment | STROKE | Cognitive impairment is prevalent in survivors of stroke, affecting approximately 30% of individuals. Physical exercise and cognitive and social enrichment activities can enhance cognitive function in patients with chronic stroke, but their cost-effectiveness compared with a balance and tone program is uncertain. | PMC10690466 |
Objective | To conduct a cost-effectiveness and cost-utility analysis of multicomponent exercise or cognitive and social enrichment activities compared with a balance and tone program. | PMC10690466 | ||
Design, Setting, and Participants | stroke | STROKE | This economic evaluation used a Canadian health care systems perspective and the Vitality study, a randomized clinical trial aimed at improving cognition after stroke with a 6-month intervention and a subsequent 6-month follow-up (ie, 12 months). The economic evaluation covered the duration of the Vitality trial, betwe... | PMC10690466 |
Interventions | Participants were randomly assigned to twice-weekly classes for 1 of the 3 groups: multicomponent exercise program, cognitive and social enrichment activities program, or a balance and tone program (control). | PMC10690466 | ||
Main Outcomes and Measures | Alzheimer Disease | ALZHEIMER DISEASE | The primary measures for the economic evaluation included cost-effectiveness (incremental costs per mean change in cognitive function, evaluated using the Alzheimer Disease Assessment Scale–Cognitive-Plus), cost-utility (incremental cost per quality-adjusted life-year gained), intervention costs, and health care costs.... | PMC10690466 |
Results | Alzheimer Disease, CAD | ALZHEIMER DISEASE, CAD | Among 120 participants (mean [SD] age, 71 [9] years; 74 [62%] male), 34 were randomized to the multicomponent exercise program, 34 were randomized to the social and cognitive enrichment activities program, and 52 were randomized to the balance and tone control program. At the end of the 6-month intervention, the cost p... | PMC10690466 |
Conclusions and Relevance | chronic stroke | The findings of this economic evaluation suggest that exercise demonstrated potential for cost-effectiveness to improve cognitive function in older adults with chronic stroke during a 6-month intervention. | PMC10690466 | |
Introduction | poststroke cognitive impairment, death, disability, Stroke | STROKE | Stroke is a significant global public health concern, ranking as the second leading cause of death worldwide and a leading cause of serious disability.While there are currently no pharmacological interventions approved for poststroke cognitive impairment, interventions, such as exercise and cognitive training, have sho... | PMC10690466 |
Methods | This economic evaluation used data from a randomized clinical trial, approved by the University of British Columbia’s Clinical Research Ethics Board and the Vancouver Coastal Health Research Institute. Prior to participating in the study, all participants provided written and informed consent. The trial was registered ... | PMC10690466 | ||
Study Design | chronic stroke | We conducted an economic evaluation alongside the Vitality study, a 3-group RCT that examined the efficacy of exercise and cognitive and social enrichment activities to promote cognitive function in individuals with chronic stroke. | PMC10690466 | |
Participants | RECRUITMENT | Details on participants recruitment were previously reported in the study protocol and the primary report. | PMC10690466 | |
Measures | stroke, depression, Depression | STROKE | The Vitality study collected descriptive and demographic variables, including age, body mass index, biological sex, educational status, and stroke type. Cognitive function was assessed using the Mini-Mental State Examination,Secondary outcome measures included depression (assessed using the Center for Epidemiological S... | PMC10690466 |
Intervention | The 3 interventions consisted of 60-minute classes conducted twice a week for 26 weeks. Trained instructors led the classes, maintaining a ratio of 1 instructor for every 4 participants. | PMC10690466 | ||
Exercise | There were 34 participants randomized in the exercise group. Participants in the exercise group were involved in activities adapted from the community-based Fitness and Mobility Exercise program. | PMC10690466 | ||
Cognitive and Social Enrichment | word list memorization | There were 34 participants in the cognitive and social enrichment group. Participants engaged in cognitive exercises covering memory, learning, attention, and executive functions, alongside social and cognitive enrichment activities. Activities included word list memorization, brain training using a tablet application ... | PMC10690466 | |
Active Control | STRETCHES | The balance and tone group included 52 participants. The program included stretches, deep breathing and relaxation techniques, general posture education, and core control exercises in the sitting position. This group served as a control for confounding variables, such as exercise received from community center visits a... | PMC10690466 | |
Patient Engagement | poststroke | Participants in the Vitality study were not engaged as patient partners in the study design. Interested parties, such as neurologists and physiotherapists, who actively support poststroke care were part of the study team and involved in the study design. | PMC10690466 | |
Costs | Health resource utilization was monitored using self-reported questionnaires at 3, 6, and 12 months. | PMC10690466 | ||
QALYs | QALYs were assessed using the area under the curve analysis of health state utility values obtained from the Euro-Quality of Life–3 Domains–5 Levels (EQ-5D-3L) questionnaire. | PMC10690466 | ||
Effectiveness | Alzheimer Disease | ALZHEIMER DISEASE | The Alzheimer Disease Assessment Scale–Cognitive-Plus (ADAS-Cog-Plus) was the primary measure of cognitive function. | PMC10690466 |
Overview of Economic Evaluation | Using a Canadian health care system perspective, we conducted a cost-effectiveness and cost-utility analysis alongside the Vitality RCT. | PMC10690466 | ||
Statistical Analysis | All analyses for this economic evaluation used Stata version 17 (StataCorp). Data were analyzed from June 1, 2022, to March 31, 2023. | PMC10690466 | ||
Cost-Effectiveness | The primary measure in the cost-effectiveness analysis was the incremental cost-effectiveness ratio (ICER), calculated by comparing the mean cost difference between intervention and control groups to the mean effectiveness difference, based on changes in ADAS-Cog-Plus after the 6-month exercise intervention. Although n... | PMC10690466 | ||
Cost-Utility Analysis | The outcome of the cost-utility analysis was the incremental cost-utility ratio (ICUR). The ICUR was calculated by ascertaining the mean difference in cost of providing the interventions compared with the control and dividing that by the mean difference in QALY. The difference in cost divided by the difference is utili... | PMC10690466 | ||
Base Case Analysis | The primary analysis estimated the ICERs and ICURs using the complete case data set, which included subsets for cost-effectiveness analysis (participants with complete costs and ADAS-Cog-Plus score data) and cost-utility analysis (participants with complete costs and QALY data). The number and proportion of participant... | PMC10690466 | ||
Sensitivity and Subgroup Analyses | SENSITIVITY | Sensitivity analysis was conducted using multiple imputations to assess uncertainty regarding missing data handling. We also conducted 3 subgroup analyses to examine the cost-effectiveness variation among participants based on literature indicating differing costs and cost-effectiveness for different subgroups: partici... | PMC10690466 | |
Results | Among 120 participants in the Vitality study, mean (SD) baseline age was 71 (9) years, and 74 (62%) were male ( | PMC10690466 | ||
Participant Characteristics at Baseline | cognitive impairment, dementia, motor impairment, comorbid illnesses, Alzheimer Disease Assessment Scale-Cognitive, disability | Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); EQ-5D-3L, Euro-Quality of Life–3 Domains–5 Levels.Range, 0 (worst) to 30 (best); scores between 26 and 30 are considered within reference range.Range, 0 (worst) to 30 (best); scores between 24 and 30 are conside... | PMC10690466 | |
Health Care Resource Use and Costs | Unit costs for health care cost items are presented in | PMC10690466 | ||
Unit Cost Items for Health Care Resource Utilization for Participants in the Vitality Study | Abbreviation: NA, not applicable.Estimated from Vitality study expense records.Estimated from 2021 British Columbia Medical services plan.Calculated from the Vancouver General Hospital fully allocated cost model. | PMC10690466 | ||
Results of Cost-Effectiveness and Cost-Utility Analyses for Vitality Study at End of Intervention and Follow-Up | CAD | REGRESSION, CAD | Abbreviations: ICER, incremental cost-effectiveness ratio; ICUR, incremental cost-utility ratio; NA, not applicable; QALY, quality-adjusted life-year.There is no willingness-to-pay threshold for which we can be 95% confident that the 2 therapies differed in value.QALYs are adjusted for baseline utility using a linear r... | PMC10690466 |
QALYs | cognitive and social enrichment | REGRESSION | The mean (SD) adjusted incremental QALYs at the end of the 6-month intervention was 0.009 (0.008) QALYs for exercise vs balance and tone groups and 0.010 (0.009) QALYs for cognitive and social enrichment vs balance and tone groups. The mean (SD) adjusted incremental QALYs after follow-up was 0.002 (0.008) years for exe... | PMC10690466 |
Cost-Effectiveness of Exercise Program vs Balance and Tone Program at 6 Months | Alzheimer Disease | ALZHEIMER DISEASE | A. Orange lines indicate 0 on the x and y axes; orange dots, incremental cost effectiveness ratio estimates; light blue line and circles, 5000 bootstrapped estimates. B. Gray line indicates probability of incremental cost effectiveness ratio acceptance for different willingness-to-pay thresholds. ADAS-Cog-Plus indicate... | PMC10690466 |
Cost Utility of Exercise Program and Cognitive and Social Enrichment Program vs Balance and Tone Program at 6 and 12 Months | Thick orange lines indicate 0 on the x and y axes; orange dots, incremental cost effectiveness ratio estimates; circles, 5000 bootstrapped estimates; QALY, quality-adjusted life-year. | PMC10690466 | ||
Sensitivity and Subgroup Analyses | HEMORRHAGIC STROKE | Exercise was cost-effective for improving cognitive function, but not quality of life. Subgroup analyses revealed cost savings for exercise in participants aged 80 years and older, as well as participants who had a hemorrhagic stroke. The sensitivity analysis using imputed data produced results consistent with the base... | PMC10690466 | |
Discussion | chronic stroke, cognitive and social enrichment, cognitive improvements | This economic evaluation using data from the Vitality study found that at the end of the 6-month intervention, the exercise program was more effective in improving cognitive function among older adults with chronic stroke at additional cost compared with the control balance and tone program. As demonstrated by the prim... | PMC10690466 | |
Limitations | This study has limitations. The time horizon of the economic evaluation may not capture the longer-term costs and benefits of the interventions. | PMC10690466 | ||
Conclusions | chronic stroke, stroke, Cognitive and social enrichment | STROKE | This economic evaluation provides novel evidence supporting the potential for multicomponent exercise as a cost-effective intervention for improving cognitive function in older adults with chronic stroke and reducing the economic burden of stroke. Cognitive and social enrichment activities show promise for improving co... | PMC10690466 |
Background | Impairments of trunk movements, stroke, thoracic movements, orthosis, AFOs, gait of stroke, AFO | STROKE | Impairments of trunk movements in gait of stroke are often reported. Ankle foot orthosis (AFO) is commonly used to improve gait of stroke; however, the effect of different types of AFOs on the pelvic and thoracic movements during gait in stroke has not been clarified. | PMC9901085 |
Methods | stroke, AFO | STROKE | Thirty-four patients with stroke were randomly allocated to undergo 2 weeks of gait training by physiotherapists while wearing a rigid AFO (RAFO) with a fixed ankle or an AFO with an oil damper (AFO-OD) that provides plantarflexion resistance and free dorsiflexion. A motion capture system was used for measurements of s... | PMC9901085 |
Results | AFOs | INTERACTIONS | Twenty-nine patients completed the study (AFO-OD group: 14, RAFO group: 15). Interactions were found in pelvic rotation angle, change of shank-to-vertical angle (SVA) in the stance, and paretic to non-paretic step length, which increased in AFO-OD group with AFOs ( | PMC9901085 |
Supplementary Information | The online version contains supplementary material available at 10.1186/s12938-023-01068-0. | PMC9901085 | ||
Keywords | PMC9901085 | |||
Background | Stroke, stoke, stroke, disability, orthosis, AFOs, hemiplegic, impairments of the trunk function, AFO | STROKE, STROKE | Stroke is the primary cause of mortality and disability for adults [Many studies found that variability of trunk movement increased significantly in the gait of stoke. The paretic pelvis was upward in the stance phase and downward in the swing phase, contrary to the healthy group [Moreover, the impairments of the trunk... | PMC9901085 |
Relevance | AFOs | The correlation coefficient between parameters that showed interactions within each group wearing AFOs in this study was calculated and is shown in Fig. Correlation coefficient between parameters: SVA was positively correlated with pelvic tilt at contralateral foot off ( | PMC9901085 | |
Discussion | spasticity, thoracic movements, stroke, AFOs, knee flexion phenomenon, knee hyperextension, knee pain, AFO | STROKE | In the current study, we evaluated the effect of two AFOs, namely, AFO-OD and RAFO on the pelvic and thoracic movements in the gait of stroke patients after two weeks of training. Our results proved the hypothesis that there were direct effects on the thorax and pelvis movement using different AFOs in patients with str... | PMC9901085 |
Conclusion | stroke, AFOs, AFO | STROKE | This randomized controlled trial assessed the effect of different types of AFOs on gait with stroke by comparing the effects of a rigid AFO, which relatively stopped both dorsiflexion and plantarflexion, and the AFO-OD which generated plantarflexion and enabled free dorsiflexion. The findings in 29 patients with stroke... | PMC9901085 |
Methods | PMC9901085 | |||
Participants | musculoskeletal or cognitive problems, subacute stroke, spasticity, AFO | A total of 34 patients with subacute stroke (more than 14 and less than 180 days after onset) who were hospitalized for rehabilitation treatment in a rehabilitation facility in China from June 2020 to August 2021 participated in this study. The following inclusion criteria and exclusion criteria were applied. The inclu... | PMC9901085 | |
AFOs and equipment | ankle joints, damper joints, AFOs, metatarsophalangeal joints, AFO | The two types of AFOs shown in Fig. AFOs used in this study. A schematic design of the AFO with oil damper unit. The oil damper unit consists of a hydraulic cylinder(1), a ring portion metal plate (2), and a metal plate (3). An adjustment screw (4) controls the flow rate of the oil by varying the orifice diameter; the ... | PMC9901085 | |
Study protocol | AFOs, hemiplegic, AFO | First, shod gait without AFO was measured at each participant’s self-selected walking speed in an 8-m walkway. Each participant was required to land their hemiplegic lateral foot exactly intact on one of the force platforms during one test and repeat three times. We divided the gait cycle according to the ground reacti... | PMC9901085 | |
Data processing | pelvic, AFOs | Marker trajectories and force plate data were low-pass filtered by a second-order Butterworth filter with cutoffs of 6 and 18 Hz, respectively. The gait cycle was defined as the loading response, single stance, preswing, and swing phase of the paretic limb. These phases were distinguished by the vertical component of t... | PMC9901085 | |
Statistical analysis | AFOs, AFO | All gait parameters were calculated as the average of three gait cycles for each condition, with/without an AFO before training and after training. All data were checked for normality distribution by the Shapiro–Wilk test.First, we compared the consistency of the baseline data, including the first shod gait data withou... | PMC9901085 | |
Acknowledgements | The authors would like to acknowledge the support from China Rehabilitation Science Institute and China Rehabilitation Research Centre for this research. They also thank all patients who participated in this study and the physiotherapists who assisted with gait training and obtaining measurements. | PMC9901085 | ||
Author contributions | HL | RECRUITMENT | HL, JZ, L-F C, and SY conceptualized and designed the study. JZ and L-F C provided clinical support and clinical resources for experiments. HZ, HG, and L-F C performed patient recruitment physical therapy and data collection. HL, X-Q C, and Z-Y G performed data analysis and interpretation. HL drafted the manuscript. X-... | PMC9901085 |
Funding | This research is funded by National Key R&D Program of China (Grant 2020YFC2007604, 2022YFC3600305) and Fundamental Research Funds for Central Public Welfare Research Institutes (Grant 2020CZ-6,2021CZ-11, 2022CZ-2). | PMC9901085 | ||
Availability of data and materials | The raw data were generated at China Rehabilitation Research Center. Derived data supporting the findings of this study are available from the author H.L. on request. | PMC9901085 | ||
Declarations | PMC9901085 | |||
Ethics approval and consent to participate | All procedures were approved by the local ethics committee of the International University of Health & Welfare (No.19 Io-144–2) and China Rehabilitation Research Center(2019–116-2). Trial registration:UMIN000038694, Registered 21 November 2019, | PMC9901085 | ||
Consent for publication | Not applicable. | PMC9901085 | ||
Competing interests | The authors declare that they have no competing interests. | PMC9901085 | ||
References | PMC9901085 | |||
Abstract | PMC10256891 | |||
Introduction | Learned smoking cues from a smoker’s environment are a major cause of lapse and relapse. Quit Sense, a theory-guided Just-In-Time Adaptive Intervention smartphone app, aims to help smokers learn about their situational smoking cues and provide in-the-moment support to help manage these when quitting. | PMC10256891 | ||
Methods | A two-arm feasibility randomized controlled trial ( | PMC10256891 | ||
Results | Self-reported smoking outcome completion rates at 6 months were 77% (95% CI 71%, 82%), viable saliva sample return rate was 39% (95% CI 24%, 54%), and health economic data 70% (95% CI 64%, 77%). Among Quit Sense participants, 75% (95% CI 67%, 83%) installed the app and set a quit date and, of those, 51% engaged for mor... | PMC10256891 | ||
Conclusions | Evaluation feasibility was demonstrated alongside evidence supporting the effectiveness potential of Quit Sense. | PMC10256891 | ||
Implications | RECRUITMENT | Running a primarily automated trial to initially evaluate Quit Sense was feasible, resulting in modest recruitment costs and researcher time, and high trial engagement. When invited, as part of trial participation, to install a smoking cessation app, most participants are likely to do so, and, for those using Quit Sens... | PMC10256891 | |
Introduction | The total number of smokers worldwide is increasing,Any smoking early in a quit attempt (a “lapse”) is highly predictive of longer-term return to smoking (“relapse”),There is a lack of effective support to help smokers manage cue-induced cravings. Steady-state medications such as bupropion, Varenicline, and nicotine pa... | PMC10256891 | ||
Methods | PMC10256891 | |||
Design | A two-arm parallel randomized controlled feasibility trial, allocating smokers recruited online (1:1 ratio) to a “usual care” arm (referral to NHS SmokeFree website) or an intervention arm who received “usual care” plus an invitation to install the Quit Sense app. A nested qualitative process evaluation and a Study-Wit... | PMC10256891 | ||
Participants | Inclusion criteria were: A current smoker; aged 16 years and above; smoked at least 7 cigarettes per week; willing to make a quit attempt within 14 days of enrollment; own an Android smartphone (version 5.0 or above); a resident in England; able to provide informed consent; not having previously participated in the tri... | PMC10256891 | ||
Sample Size. | Sample size was based on achieving adequate precision for key “full trial” parameters. In line with guidance on feasibility trials with binary outcome measures, | PMC10256891 | ||
Procedure | RECRUITMENT, RECRUITMENT | Recruitment took place through paid-for online adverts with Facebook (including Instagram) and Google Search, limited to England-based IP addresses and targeted at Android devices. Online adverts were managed and optimized by a partner company called Nativve. Advert campaigns were run in two phases; from November 27, t... | PMC10256891 | |
Randomization. | Randomization was stratified by smoking rate (<16 vs. ≥ 16 cigarettes/day; based on mean smoking rates from similar trials) | PMC10256891 | ||
Interventions | PMC10256891 | |||
Usual Care. | After randomization, both arms received an automated text message with a link to the NHS SmokeFree website ( | PMC10256891 | ||
Quit Sense App. | smoking behavior, mood,Stage 2 | Quit Sense arm participants also received an automated text message providing a link to the Quit Sense app on the Google Play store, along with a unique activation code. If the app had not been installed after 3 days, participants were sent a reminder text message to encourage installation. Five days later, if still no... | PMC10256891 | |
Measures | At 6 weeks, participants were sent a text message with a questionnaire link, 1 day after receiving a prenotification text message alerting them to the questionnaire link message and a texted £5 Amazon voucher for completing it. A reminder text message was sent if the survey was not completed 4 days later, after which p... | PMC10256891 | ||
Feasibility Outcomes. | Feasibility outcomes used to estimate key parameters to inform a future trial included:Completeness of the anticipated primary outcome for a future definitive trial (see smoking outcomes).Abstinence rate of usual care arm (anticipated primary outcome).Advertising cost per recruit.Rates of app installation, use, and acc... | PMC10256891 | ||
Smoking and Related Outcomes. | As a feasibility trial, there was no primary outcome, but the anticipated primary abstinence outcome for any future definitive trial was based on the Russell standardHypothesized mechanisms of action collected at 6 weeks included lapse incidence in the first 2 weeks of a quit attempt or since enrollment if no attempt w... | PMC10256891 | ||
Analysis | REGRESSION, SENSITIVITY | Feasibility outcomes are described as proportions or summary statistics with 95% CIs. To estimate the intervention effect on abstinence, lapse incidence, and use of lapse prevention strategies, we used multiple logistic regression, providing ORs with 95% CIs, while adjusting for stratification variables and any prognos... | PMC10256891 | |
Results | Smoking Dependence | There were 1275 study website landings from the online adverts, of which 323 (25%) people completed the eligibility assessment. Of those assessed for eligibility, 93% (299) were eligible and of those eligible, 70% (209) consented and were randomized (117 in phase one and 92 in phase two). One additional individual was ... | PMC10256891 | |
Discussion | RECRUITMENT | This was the first randomized controlled trial of a JITAI smartphone app for smoking cessation that uses passive measurement to trigger behavioral support. The automated online trial design employed was feasible and successful in reaching the target sample size within the relatively short recruitment timeframe. The cos... | PMC10256891 | |
Strengths and Limitations | coronavirus disease 2019 | CORONAVIRUS DISEASE 2019, RECRUITMENT | One innovation employed was those trial procedures, other than manual follow-up and saliva sample posting, were fully automated once setup, meaning study running costs were relatively low. Approximately half of the participants did not require any human involvement at any stage of their trial involvement and for those ... | PMC10256891 |
Conclusions | The primarily automated trial design and processes for evaluating Quit Sense were feasible and enabled successful trial delivery within anticipated timeframes, cost, and participation rates. Evidence was consistent with Quit Sense leading to a higher rate of biochemically verified abstinence relative to usual care and ... | PMC10256891 | ||
Supplementary Material | A Contributorship Form detailing each author’s specific involvement with this content, as well as any supplementary data, are available online at Click here for additional data file.Click here for additional data file. | PMC10256891 | ||
Acknolwedgments | WEST, RECRUITMENT | The authors are very grateful to the following for their contribution, time and efforts in ensuring the success of this project: The participants, the patient and public involvement and engagement panel, Antony Colles and Claire West for database, website and data collection setup, Nativve, who managed the online recru... | PMC10256891 | |
Funding | This study is funded by the NIHR Public Health Research Programme (17/92/31). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Tim Coleman is an NIHR Senior Investigator. | PMC10256891 | ||
Declaration of Interests | PMC10256891 | |||
Data Availability | The data underlying this article will be shared on reasonable request to the corresponding author. | PMC10256891 | ||
References | PMC10256891 | |||
Background | Perturbation-based balance training (PBT) is an emerging intervention shown to improve balance recovery responses and reduce falls in everyday life in older adults. However, perturbation interventions were heterogeneous in nature and need improvement. This study aims to investigate the effects of a PBT protocol that wa... | PMC10191085 | ||
Methods | Community-dwelling older adults (age ≥ 65 years) who visited the hospital outpatient clinic due to a fall incident were included. Participants received PBT in addition to usual care (referral to a physiotherapist) versus usual care alone. PBT consisted of three 30-minute sessions in three weeks. Unilateral treadmill be... | PMC10191085 |
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