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Bell K, Lawson J, Penz E, Cammer A. Systematic review of tailored dietary advice and dietitian involvement in the treatment of chronic obstructive pulmonary disease (COPD). Respir Med 2024; 225:107584. [PMID: 38467310 DOI: 10.1016/j.rmed.2024.107584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading public health concern globally. Interdisciplinary pulmonary rehabilitation programs exist and should ideally consider nutritional health impacts since the nutritional status of COPD patients is often compromised. However, little is known about the role of dietary counseling in COPD management. RESEARCH QUESTION Does providing tailored dietary advice to adult patients with COPD improve outcomes? STUDY DESIGN AND METHODS We conducted a systematic review. The following electronic databases and registrars were used: MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, and ClinicalTrials.gov. The original search was conducted in June 2021 with an updated search conducted on February 21, 2024. Validity and bias assessments were completed. RESULTS We selected 14 articles for inclusion. Multiple outcomes were considered including functional, body composition, nutritional intake, cost analyses, quality of life, and others. The most common measured outcomes were quality of life and the 6 min walk test. A number of interventions were used with most interventions being interdisciplinary pulmonary rehabilitation packages where nutrition counseling was one component. A number of interventions showed positive results but there tended to be inconsistency. INTERPRETATION Evidence shows that various interventions appear to improve outcomes, but it is difficult to determine if improvements are due to nutritional intervention specifically or a rehabilitation program as a whole. More specific randomized controlled trials should be completed regarding tailored nutritional counseling and therapy in adults with COPD to determine the benefits attributable to nutritional interventions.
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Affiliation(s)
- Kylie Bell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Respiratory Research Centre (RRC), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Josh Lawson
- Respiratory Research Centre (RRC), University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Canadian Centre for Rural and Agricultural Health (CCRAH), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Erika Penz
- Respiratory Research Centre (RRC), University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Respiratory Research Centre (RRC), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Wharton RC, Wang JG, Choi Y, Eisenberg E, Jackson MK, Hanson C, Liu B, Washko GR, Kalhan R, Jacobs DR, Bose S. Associations of a plant-centered diet and lung function across early to mid-adulthood: The CARDIA Lung Study. Respir Res 2024; 25:122. [PMID: 38468283 PMCID: PMC10926674 DOI: 10.1186/s12931-023-02632-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/07/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Lung function throughout adulthood predicts morbidity and mortality even among adults without chronic respiratory disease. Diet quality may represent a modifiable risk factor for lung function impairment later in life. We investigated associations between nutritionally-rich plant-centered diet and lung function across early and middle adulthood from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. METHODS Diet was assessed at baseline and years 7 and 20 of follow-up using the validated CARDIA diet history questionnaire. Plant-centered diet quality was scored using the validated A Priori Diet Quality Score (APDQS), which weights food groups to measure adherence to a nutritionally-rich plant-centered diet for 20 beneficially rated foods and 13 adversely rated foods. Scores were cumulatively averaged over follow-up and categorized into quintiles. The primary outcome was lung function decline, including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), measured at years 0, 2, 5, 10, 20, and 30. We estimated the association of APDQS with annual pulmonary function changes and cross-sectional differences in a repeated measures regression model, adjusting for clinically relevant covariates. RESULTS The study included 3,787 Black and White men and women aged 18-30 in 1985-86 and followed for 30 years. In multivariable repeated measures regression models, individuals in the lowest APDQS quintile (poorest diet) had declines in FEV1 that were 1.6 ml/year greater than individuals in the highest quintile (35.0 vs. 33.4 ml/year, ß ± SE per 1 SD change APDQS 0.94 ± 0.36, p = 0.009). Additionally, declines in FVC were 2.4 ml/year greater in the lowest APDQS quintile than those in the highest quintile (37.0 vs 34.6 ml/year, ß ± SE per 1 SD change APDQS 1.71 ± 0.46, p < 0.001). The association was not different between never and ever smokers (pint = 0.07 for FVC and 0.32 for FEV1). In sensitivity analyses where current asthma diagnosis and cardiorespiratory fitness were further adjusted, results remained similar. Cross-sectional analysis at each exam year also showed significant differences in lung function according to diet after covariate adjustment. CONCLUSIONS In this 30-year longitudinal cohort study, long-term adherence to a nutritionally-rich plant-centered diet was associated with cross-sectional differences in lung function as well as slower decline in lung function, highlighting diet quality as a potential treatable trait supporting long-term lung health.
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Affiliation(s)
- Robert C Wharton
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Jing Gennie Wang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yuni Choi
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Elliot Eisenberg
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Mariah K Jackson
- Division of Medical Nutrition Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - Corrine Hanson
- Division of Medical Nutrition Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David R Jacobs
- Division of Medical Nutrition Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sonali Bose
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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Vaziri Y. The genomic landscape of chronic obstructive pulmonary disease: Insights from nutrigenomics. Clin Nutr ESPEN 2024; 59:29-36. [PMID: 38220389 DOI: 10.1016/j.clnesp.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024]
Abstract
Chronic obstructivе pulmonary disеasе (COPD), a rеspiratory disеasе, is influenced by a combination of gеnеtic and еnvironmеntal factors. Thе fiеld of nutrigеnomics, which studiеs thе intеrplay bеtwееn diеt and gеnеs, provides valuable insights into thе gеnomic landscapе of COPD and its implications for production and managеmеnt. This rеviеw providеs a comprеhеnsivе ovеrviеw of thе gеnеtic aspеcts of COPD and thе rolе of nutrigеnomics in advancing our undеrstanding of thе undеrlying mеchanisms. Through studies of gеnomе-widе associations, researchers have identified gеnеtic factors that contribute to suscеptibility to COPD. Thеsе gеnеs arе associatеd with oxidativе strеss, inflammation, and antioxidant dеfеnsе mеchanisms. Nutrigеnomics rеsеarch is currеntly invеstigating how diеtary componеnts interact with gеnеtic variations to modulatе thе dеvеlopmеnt of COPD. Antioxidants, omеga-3 fatty acids and vitamin D havе dеmonstratеd potеntial bеnеfits in rеducing inflammation, improving lung function, and minimizing еxacеrbations in patients with COPD. Therefore, there are sеvеral challеngеs that must be added to the nutrigеnomic rеsеarch. The challenges include thе nееd for largеr clinical trials, adding hеtеrogеnеity and validating biomarkеrs. In the tеrms of futurе dirеctions, prеcision nutrition, gеnе-basеd thеrapiеs, biomarkеr dеvеlopmеnt, intеgration of multi-omics data, systеms biology analysis, longitudinal studiеs, and public hеalth implications arе important arеas to еxplorе. Pеrsonalizеd nutritional intеrvеntions based on an individual's gеnеtic profilе hold grеat promisе for optimizing COPD managеmеnt. In conclusion, nutrigеnomics provides valuable insights into the gеnomic landscapе of COPD and its intеraction with the disease. This knowlеdgе can guidе thе dеvеlopmеnt of pеrsonalizеd diеtary stratеgiеs and gеnе-basеd thеrapiеs for thе prеvеntion and managеmеnt of COPD. Howеvеr, morе rеsеarch is nееdеd to validatе thеsе findings, dеvеlop еffеctivе intеrvеntions, and implеmеnt thеm еffеctivеly in clinical practicе to improvе thе quality of lifе for pеoplе with COPD.
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Affiliation(s)
- Yashar Vaziri
- Department of Nutrition and Dietetics, Sarab Branch, Islamic Azad University, Sarab, Iran.
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Yan Z, Xu Y, Li K, Liu L. Heavy metal levels and flavonoid intakes are associated with chronic obstructive pulmonary disease: an NHANES analysis (2007-2010 to 2017-2018). BMC Public Health 2023; 23:2335. [PMID: 38001456 PMCID: PMC10675902 DOI: 10.1186/s12889-023-17250-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The association between exposure to environmental metals and chronic obstructive pulmonary disease (COPD) is preventing chronic lung diseases. However, little is currently known about the interaction between heavy metals and flavonoids in relation to the risk of COPD. This study aims to bridge this knowledge gap by leveraging The National Health and Nutrition Examination Survey (NHANES) database to evaluate thecorrelation between blood levels of heavy metals (cadmium, lead, mercury) and the intake of various flavonoid compounds (isoflavones, anthocyanidins, flavan-3-ols, flavanones, flavones, flavonols, total flavonoids). Additionally, appropriate dietary recommendations are provided based on the study findings. MATERIALS AND METHODS Cross-sectional analysis was conducted using the 2007-2010 and 2017-2018 NHANES data. Specialized weighted complex survey design analysis software was used for data analysis. Multivariate logistic regression models and restricted cubic splines (RCS) were used to evaluate the relationship between blood heavy metal levels, flavonoids intake, and COPD incidence in all participants, and to explore the effect of different levels of flavonoids intake on COPD caused by heavy metal exposure. RESULTS A total of 7,265 adults aged ≥ 40 years were analyzed. Higher levels of blood cadmium (Cd), blood lead and Anthocyanidin (AC) intake were independently associated with an increased risk of COPD (Cd highest quantile vs. lowest: OR = 1.73, 95% CI, 1.25-2.3; Lead highest quantile vs. lowest quantile: OR = 1.44, 95% CI, 1.11-1.86; AC highest quantile vs. lowest: OR = 0.73, 95% CI, 0.54-0.99). When AC intake exceeded 11.56 mg/d, the effect of Cd exposure on COPD incidence decreased by 27%, and this finding was more significant in smokers. CONCLUSION Higher levels of Cd (≥ 0.45ug/L) and lead (≥ 0.172 ug/L) were positively correlated with the risk of COPD among participants aged 40 years and above, while AC intake (≥ 11.56 mg/d) could reduce the risk related to blood Cd.
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Affiliation(s)
- Zhaoqi Yan
- Jiangxi University of Traditional Chinese Medicine, Graduate school, Yangming Road, Nanchang, Jiangxi, China
| | - Yifeng Xu
- Jiangxi University of Traditional Chinese Medicine, Graduate school, Yangming Road, Nanchang, Jiangxi, China
| | - Keke Li
- Jiangxi University of Traditional Chinese Medicine, Graduate school, Yangming Road, Nanchang, Jiangxi, China
| | - Liangji Liu
- Department of Respiratory and Critical Care Medicine, Hospital of Jiangxi University of Traditional Chinese Medicine, 445 Bayi Dadao, Nanchang, Jiangxi, China.
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Chen Z, Liu Y, Huang W. Alveolar macrophage modulation via the gut-lung axis in lung diseases. Front Immunol 2023; 14:1279677. [PMID: 38077401 PMCID: PMC10702770 DOI: 10.3389/fimmu.2023.1279677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
Several studies have demonstrated great potential implications for the gut-lung axis in lung disease etiology and treatment. The gut environment can be influenced by diet, metabolites, microbiotal composition, primary diseases, and medical interventions. These changes modulate the functions of alveolar macrophages (AMs) to shape the pulmonary immune response, which greatly impacts lung health. The immune modulation of AMs is implicated in the pathogenesis of various lung diseases. However, the mechanism of the gut-lung axis in lung diseases has not yet been determined. This mini-review aimed to shed light on the critical nature of communication between the gut and AMs during the development of pulmonary infection, injury, allergy, and malignancy. A better understanding of their crosstalk may provide new insights into future therapeutic strategies targeting the gut-AM interaction.
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Affiliation(s)
| | | | - Weizhe Huang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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Catalin RE, Martin-Lujan F, Salamanca-Gonzalez P, Palleja-Millan M, Villalobos F, Santigosa-Ayala A, Pedret A, Valls-Zamora RM, Sola R. Mediterranean Diet and Lung Function in Adults Current Smokers: A Cross-Sectional Analysis in the MEDISTAR Project. Nutrients 2023; 15:nu15051272. [PMID: 36904270 PMCID: PMC10005310 DOI: 10.3390/nu15051272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Previous studies have shown that adherence to the Mediterranean Diet (MeDi) has a positive impact on lung function in subjects with lung disease. In subjects free of respiratory diseases, but at risk, this association is not yet well established. METHODS Based on the reference data from the MEDISTAR clinical trial (Mediterranean Diet and Smoking in Tarragona and Reus; ISRCTN 03.362.372), an observational study was conducted with 403 middle-aged smokers without lung disease, treated at 20 centres of primary care in Tarragona (Catalonia, Spain). The degree of MeDi adherence was evaluated according to a 14-item questionnaire, and adherence was defined in three groups (low, medium, and high). Lung function were assessed by forced spirometry. Logistic regression and linear regression models were used to analyse the association between adherence to the MeDi and the presence of ventilatory defects. RESULTS Globally, the pulmonary alteration prevalence (impaired FEV1 and/or FVC) was 28.8%, although it was lower in participants with medium and high adherence to the MeDi, compared to those with a low score (24.2% and 27.4% vs. 38.5%, p = 0.004). Logistic regression models showed a significant and independent association between medium and high adherence to the MeDi and the presence of altered lung patterns (OR 0.467 [95%CI 0.266, 0.820] and 0.552 [95%CI 0.313, 0.973], respectively). CONCLUSIONS MeDi adherence is inversely associated with the risk impaired lung function. These results indicate that healthy diet behaviours can be modifiable risk factors to protect lung function and reinforce the possibility of a nutritional intervention to increase adherence to MeDi, in addition to promoting smoking cessation.
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Affiliation(s)
- Roxana-Elena Catalin
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Francisco Martin-Lujan
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Departament of Medicine and Surgery, Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, 43201 Reus, Spain
- Correspondence:
| | - Patricia Salamanca-Gonzalez
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Meritxell Palleja-Millan
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Departament of Medicine and Surgery, Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Felipe Villalobos
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Antoni Santigosa-Ayala
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Departament of Medicine and Surgery, Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Anna Pedret
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Rosa M. Valls-Zamora
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Rosa Sola
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Universitat Rovira i Virgili, 43201 Reus, Spain
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Cao Y, Li P, Wang Y, Liu X, Wu W. Diaphragm Dysfunction and Rehabilitation Strategy in Patients With Chronic Obstructive Pulmonary Disease. Front Physiol 2022; 13:872277. [PMID: 35586711 PMCID: PMC9108326 DOI: 10.3389/fphys.2022.872277] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects the whole body and causes many extrapulmonary adverse effects, amongst which diaphragm dysfunction is one of the prominent manifestations. Diaphragm dysfunction in patients with COPD is manifested as structural changes, such as diaphragm atrophy, single-fibre dysfunction, sarcomere injury and fibre type transformation, and functional changes such as muscle strength decline, endurance change, diaphragm fatigue, decreased diaphragm mobility, etc. Diaphragm dysfunction directly affects the respiratory efficiency of patients and is one of the important pathological mechanisms leading to progressive exacerbation of COPD and respiratory failure, which is closely related to disease mortality. At present, the possible mechanisms of diaphragm dysfunction in patients with COPD include systemic inflammation, oxidative stress, hyperinflation, chronic hypoxia and malnutrition. However, the specific mechanism of diaphragm dysfunction in COPD is still unclear, which, to some extent, increases the difficulty of treatment and rehabilitation. Therefore, on the basis of the review of changes in the structure and function of COPD diaphragm, the potential mechanism of diaphragm dysfunction in COPD was discussed, the current effective rehabilitation methods were also summarised in this paper. In order to provide direction reference and new ideas for the mechanism research and rehabilitation treatment of diaphragm dysfunction in COPD.
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Affiliation(s)
- Yuanyuan Cao
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Peijun Li
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yingqi Wang
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaodan Liu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xiaodan Liu, ; Weibing Wu,
| | - Weibing Wu
- Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, China
- *Correspondence: Xiaodan Liu, ; Weibing Wu,
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