Bulletin of Rehabilitation Medicine

INTRODUCTION. Cardiovascular diseases remain the leading cause of mortality in the Russian Federation, with acute myocardial infarction (AMI) accounting for a significant proportion of population disability. The presence of type 2 diabetes mellitus (T2DM) in patients after AMI occurs in 30–45 % of cases and is associated with a worse prognosis.

AIM. To provide a scientific rationale and evaluate the efficacy of a polypeptide angioprotector in improving the outcomes of medical rehabilitation in patients with T2DM and diabetic angiopathy of the lower extremities who have suffered an AMI.

MATERIAL AND METHODS. A prospective, open-label, controlled study was conducted in two parallel groups at the National Medical Research Center for Rehabilitation and Balneology in 2025. The study included 58 patients with T2DM and instrumentally confirmed diabetic angiopathy of the lower extremities 2.5 [2.0; 3.0] months after AMI. For statistical data analysis, patients were divided into 2 groups: the main group (n = 29; standard rehabilitation course + polypeptide angioprotector 5 mg intramuscularly twice a week; 10 injections) and the comparison group (n = 29, standard rehabilitation course only). The efficacy was assessed using laboratory, functional, and instrumental methods at baseline, after 15 days, and after 50 days.

RESULTS. The main group achieved significant improvements in the lipid profile (LDL reduction; p = 0.04), NT-proBNP (p = 0.004), and IL-6 (p = 0.01). Pain-free walking distance increased (p < 0.001), and the Walking Impairment Questionnaire (WIQ) score improved (p < 0.001). There was also an increase in n. tibial conduction velocity of 6 % (p = 0.008) and in peak calf muscle strength of 14 % (p < 0.001). According to cardiopulmonary exercise testing, maximum workload increased by 24 % (p < 0.001), and peak oxygen consumption increased by 12 % (p = 0.002). In the control group, the changes were minimal or absent.

DISCUSSION. The findings show that incorporation of a polypeptide angioprotector in the rehabilitation program provides a multisystem positive effect: correction of dyslipidemia, endothelial dysfunction, and systemic inflammation. This lays the groundwork for improving peripheral circulation and increasing exercise tolerance.

CONCLUSION. Incorporating a polypeptide angioprotector into the comprehensive phase II medical rehabilitation program for patients with T2DM and diabetic angiopathy of the lower extremities after AMI significantly improves the effectiveness of restorative treatment. This is achieved by correcting metabolic disorders, improving peripheral hemodynamics and neuromuscular conduction, and increasing aerobic capacity, resulting in a notable improvement in quality of life.

INTRODUCTION. It is known that the secretome of mesenchymal stromal cells exhibits high efficacy in the therapy of various diseases. However, there are limitations hindering its widespread introduction into clinical practice, such as donor variability including donor age, health status, and genetic characteristics. In this regard, the search for new approaches and methods to address this issue is ongoing. A unique natural resource is the antlers of the Altai maral, which represent a natural “bioreactor” of stem cells and growth factors. Despite the increasing interest in this subject, to date there are no studies evaluating the pro-regenerative effect of the secretome from Altai maral antler mesenchymal stromal cells.

AIM. To characterize the component composition and biological activity of the stem cell secretome from Altai maral antlers to scientifically substantiate the possibility of its use as a basis for the development of cell-free therapeutic products in regenerative medicine.

MATERIALS AND METHODS. The study was conducted at the National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of Russia, from October to December 2025. Concentration of the secretome from Altai maral antler mesenchymal stromal cells (MSC-MA) and human adipose tissue mesenchymal stromal cells (MSC-AT) was performed by lyophilization. The pro-regenerative effect of the MSC-MA and MSC-AT secretomes was evaluated using a model of acid-induced damage to human fibroblasts. Using light and luminescence microscopy, as well as flow cytometry, the morphology, proliferative activity, and the number of live, apoptotic, and dead cells in the human fibroblast population were assessed.

RESULTS. It was established that the concentration of growth factors in the MSC-MA secretome is on average 50 % higher compared to MSC-AT. The ability of MSC-MA to stimulate the viability of fibroblasts with acid-induced damage was revealed, which is expressed in the restoration of their proliferative activity, an increase in the number of live cells in the population from 48 ± 7 % to 85 ± 3 %, and a decrease in the number of apoptotic cells from 24 ± 4 % to 5 ± 1 %. It was shown that the effectiveness of the stimulating effect of the MSC-MA secretome is comparable to the pro-regenerative effect of the human MSC-AT secretome.

DISCUSSION. The obtained results complement the literature data and demonstrate that the MSC-MA secretome, which is xenogeneic with respect to human fibroblasts, is capable of exerting a pro-regenerative effect and stimulating the recovery of the fibroblast cell population with acid-induced damage.

CONCLUSION. The obtained results confirm the promising potential of using MSC-AS and MSC-AT as a biological resource for the development of cell-free therapeutic products, and also emphasize the need to select an optimal method for obtaining the secretome to maximally preserve its functional activity.

INTRODUCTION. Respiratory complications are the most common consequence of cardiac surgery involving cardiopulmonary bypass (CPB). Patients undergoing left ventricular geometric reconstruction (LVGR) constitute a high-risk group due to the prolonged duration of the surgical intervention and respiratory impairments associated with chronic heart failure.

AIM. The present study aims to investigate the effectiveness of positive expiratory pressure (PEP) training and standard breathing exercises (BE) in preventing respiratory complications in patients in the early postoperative period following LVGR surgery.

MATERIALS AND METHODS. This prospective study comprised 30 patients after LVGR, who were divided into two groups: Group I (n = 15) received a course of PEP-training, while Group II (n = 15) underwent a course of standard BE. The assessment was based on computed tomography (CT) scans, spirometry tests and 24-hour pulse oximetry data obtained before surgery, on the 2nd–3rd days after surgery and at discharge (days 10–12).

RESULTS. On the 2nd postoperative day, atelectasis was detected in 100 % of patients in both groups. By the time of discharge, the proportion of patients with atelectasis in Group I decreased to 53.3 %, while in Group II it remained at 93.3 % (p = 0.035). The volume of atelectasis in the lower lobes in Group I decreased by 91.9 % on the right and 84.0 % on the left, which is statistically significantly higher than the results of Group II: 63.4 and 38.6 %, respectively (p < 0.05). Group I also showed a more pronounced recovery of spirometry and 24-hour pulse oximetry parameters compared to Group II (p < 0.05).

DISCUSSION. The high incidence of atelectasis after LVGR is due to a combination of intraoperative factors and pre-existing heart failure. Standard breathing exercises have limited effectiveness in the resolution of formed atelectasis. The use of PEP-training, by creating positive airway pressure, promotes effective alveolar recruitment, improvement of bronchial patency, and acceleration of functional lung recovery.

CONCLUSION. The use of PEP-training is a more effective method of respiratory rehabilitation after LVGR compared to standard BE, promoting a faster resolution of atelectasis and recovery of lung function.

INTRODUCTION. Increasing proportion of elderly individuals foregrounds the healthy aging paradigm, a key condition of which is requiring functional capacity preservation via multicomponent physical training. Heterogeneity, multimorbidity, polypragmasy, geriatric syndromes hinder a unified approach for personalizing aerobic exercise intensity.

AIM. To systematize existing and potential approaches to personalizing physical rehabilitation programs for geriatric patients in order to formulate practice-oriented principles for determining individual aerobic training intensity.

MAIN CONTENT OF THE REVIEW. A literature search was conducted in the PubMed, Web of Science, and Cochrane Library databases. Meta-analyses, systematic reviews, and original articles focusing on the personalization of physical rehabilitation for geriatric patients based on cardiopulmonary exercise testing data were selected. The search covered the period from 2015 to 2025. Various personalization methods were reviewed. Comprehensive Geriatric Assessment, while the foundation for stratifying geriatric patients, provides no objective physiological parameters. Traditional methods (calculation formulas, 6-minute walk test, Borg scale) show high subjectivity, variability, overlooking metabolic patterns. Cardiopulmonary Exercise Testing (CPET) the reference for exercise personalization. This review identifies key limitations of applying cardiac rehabilitation and sports medicine methods to geriatric patients, stemming from reduced functional reserve, multimorbidity, and geriatric-specific conditions. Methods using percentages of maximal heart rate and peak oxygen uptake are constrained by polypragmasy, inability to reach a true physiological maximum during testing in the geriatric population and other factors. As a physiologically sound alternative, the use of ventilatory thresholds (VT) is proposed. This approach is positioned as a physiologically grounded tool for determining personalized and clinically safe physical activity regimens.

CONCLUSION. Personalization of aerobic training in geriatrics population should be implemented as a process encompassing a clinical-geriatric stratification stage followed by physiological calibration of intensity based on CPET results. The use of VT represents the most accurate and safe method to set individual training zones in geriatrics, enabling risk minimization while enhancing rehabilitation efficacy. The lack of specialized studies in the population of patients with frailty syndrome underscores the necessity for further research focused on developing physical rehabilitation programs for geriatric patients.

INTRODUCTION. Sports involve organized, competitive physical activities, with results reliant on athletes’ abilities. Intense, consistent training is vital for fitness and performance improvement. Training is structured to enhance athletes’ skills and fitness through systematic exercises. Fartlek training, also called “speed play”, integrates varied intervals to boost muscular force, aerobic capacity, and pacing skills, aiding athletes in adjusting to different intensity levels and improving performance through personalized, disciplined training.

AIM. The effectiveness of fartlek training for endurance is well studied, but its effect on skill development remains unclear. This review evaluated existing evidence and identified future directions to establish its efficacy in skill development.

MATERIALS AND METHODS. The searching had been limited to human studies only. Search engines used for this review are Google scholar, PubMed, SCOPUS, PEDro, MEDLINE, Research gate, etc. Thorough research was performed to gather relevant articles from January 2014 to December 2024. The review included randomized controlled trials (RCTs) and quasi-experimental studies that involved athletes undergoing Fartlek training.

RESULTS. Total 145 articles were received through multiple databases from which 23 studies were selected after removing duplication and as per inclusion criteria. The studies varied in design (mostly RCTs) and included athlete populations from sports like soccer, hockey, and badminton, with intervention periods ranging from 4 to 12 weeks This review shows effectiveness of fartlek training in enhancing a broad spectrum of physical and physiological attributes crucial for athletic process.

DISCUSSION. Fartlek training shows consistent benefits for speed, agility, endurance, and coordination across varied athletic groups. Despite these positive effects, differences in study designs and protocols limit direct comparison of findings. Evidence suggests that longer durations and higher-intensity intervals yield greater improvements, supporting the need for individualized training plans. Overall, fartlek training is effective, but more standardized and long-term research is required to strengthen its applicability.

CONCLUSION. Review is showing positive impact of fartlek training on skill related physical fitness among athletes. Fartlek training is a valuable and comprehensive tool for enhancing athletic performance by improving cardiovascular endurance, speed, agility, and coordination.

REGISTRATION: Clinical Trial Registry India No. CTRI/2023/12/060531, registered December 19, 2023.