2026 12 1 0 93

Prevalence and Factors Associated with Obesity among Community-Dwelling Persons 80 Years and Older: Longitudinal National Evidence from the Health, Aging, and Retirement in Thailand Study, 2015-2022 2 2 Introduction: Few studies have longitudinally assessed the prevalence and factors associated with obesity among persons 80 years and older. This study aimed to estimate these based on 4-wave national longitudinal data from Thailand. Methods: Data from the Health, Aging, and Retirement in Thailand study from 2015, 2017, 2020 and 2022 were utilized. The sample was restricted to community-dwelling persons 80 years and older with complete self-reported body weight and height values (analytic sample: n=2986 observations). For the pooled sample, the average age was 85.3 years (range 80-107 years). Thai obesity was defined using Thai criteria (body mass index-BMI ≥25 kg/m2) and World Health Organization (WHO) criteria (BMI ≥30 kg/m2). Random effects (RE) logistic regressions were utilized to estimate the factors associated with Thai and WHO obesity. Results: The average BMI was 21.6 (SD = 4.4), 23.0% were underweight, 17.4% had Thai obesity, and 3.6% had WHO obesity. RE regssions showed that age and male sex were negatively associated with Thai and WHO obesity. Being married or cohabiting and higher subjective economic status were associated with WHO obesity. Having no exercise was associated with WHO obesity. Living alone was negatively associated with Thai obesity, and having a greater number of chronic conditions was associated with both Thai and WHO obesity. Conclusion: This longitudinal study enhances our understanding of the factors associated with obesity among people 80 years of age and older. Strategies to delay or decrease chronic conditions and increase physical activity may help reduce obesity.   1 7 2025/12/7 1404/9/16 2026/05/9 1405/2/19 Supa Pengpid Supa Pengpid Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand Thailand Karl Peltzer Karl Peltzer Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40447, Taiwan Taiwan kfpeltzer@gmail.com André Hajek André Hajek Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany Germany Razak M. Gyasi Razak M. Gyasi African Population and Health Research Center, Nairobi, Kenya Kenya Aged Obesity Longitudinal Study Thailand Anantanasuwong D. Population ageing in Thailand:critical issues in the twenty first century. Education for the Ederly in the Asia Pacific. 2021; 59: 31-56.##Prasartkul P, Thaweesit S, Chuanwan S. Prospects and contexts of demographic transitions in Thailand. Journal of Population and Social Studies.2018; 27(1): 1–22.##National Statistical Office, Thailand. Statistical Yearbook Thailand 2024. Laksi Bangkok: National Statistical Office.##Kaufman ND, Chasombat S, Tanomsingh S,Rajataramya B, Potempa K. Public health in Thailand: emerging focus on non-communicable diseases. The International Journal of Health Planning and Management. 2011; 26(3): 197–212.##NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024; 403(10431): 1027-1050.##Jura M, Kozak LP. Obesity and related consequences to ageing. Age (Dordr). 2016; 38(1): 23.##Putra IGNE, Daly M, Sutin A, Steptoe A, Scholes S, Robinson E. Obesity, psychological well-being related measures, and risk of seven non-communicable diseases: evidence from longitudinal studies of UK and US older adults. International Journal of Obesity (Lond). 2024; 48(9): 1283-91.##Cao X, Wang M, Zhou M, Mi Y, Fazekas-Pongor V, Major D, et al. Trends in prevalence, mortality, and risk factors of dementia among the oldest-old adults in the United States: the role of the obesity epidemic. Geoscience. 2024; 46(5): 4761-78.##Chua KY, Lin X, Lim WS, Koh WP. Gender and physical frailty modify the association between abdominal obesity and functional disability in older adults. Aging Clinical and Experimental Research. 2022; 34(9): 2013-21.##Hajek A, Kretzler B, König HH. Prevalence and correlates of obesity among the oldest old. A systematic review, meta-analysis and meta-regression. Geriatrics Gerontology International. 2022; 22(5): 373-83.##Hajek A, Lehnert T, Ernst A, Lange C, Wiese B, Prokein J, et al. Prevalence and determinants of overweight and obesity in old age in Germany. BMC Geriatrics. 2015; 15: 1-13##Hajek A, Brettschneider C, van der Leeden C, Lühmann D, Oey A, Wiese B, Weyerer S, et al. Prevalence and factors associated with obesity among the oldest old. Archives of Gerontology and Geriatrics. 2020; 89: 104069.##Lisko I, Tiainen K, Stenholm S, Luukkaala T, Hervonen A, Jylhä M. Body mass index, waist circumference, and waist-to-hip ratio as predictors of mortality in nonagenarians: the Vitality 90+ Study. The Journal of Gerontology. 2011; 66(11): 1244-50.##Samper-Ternent R, Kuo YF, Ray LA, Ottenbacher KJ, Markides KS, Al Snih S. Prevalence of health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites. Journal of the American Medical Directors Association. 2012; 13(3): 254-9.##Brasher MS, George LK, Shi X, Yin Z, Zeng Y. Incorporating biomarkers into the study of socio-economic status and health among older adults in China. SSM Population Health. 2017; 3: 577-85.##16. Anantanasuwong D, Theerawanviwat D, Siripanich P. Panel survey and study on health and aging, and retirement in Thailand. In: Gu D, Dupre M, editors. Encyclopedia of gerontology and population aging.Springer; 2019. p. 3700-06.##Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutrition. 2009; 12(4): 497-506.##World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. [Internet]. 2000. Available from: https://iris.who.int/items/933e09aa-64f9-46e9-8dbb-78d8cddf1a3d##Pengpid S, Peltzer K, Anantanasuwong D, Kaewchankha W. Longitudinal associations between living alone, childlessness and mental health and mortality in ageing adults in Thailand. Global Transitions. 2024; 6: 145-51.##Pengpid S, Peltzer K, Hajek A, Gyasi RM. Determinants of limitations in activities of daily living among community-dwelling persons aged 80 years and older: Longitudinal national evidence from the Health, Aging and Retirement in Thailand study, 2015-2022. Geriatrics Gerontology International. 2025; 25(3): 403-10.##Pengpid S, Peltzer K, Hajek A, Gyasi RM. Number of pain points and multisite pain in people 80 years and older in Thailand. Pain Reports. 2025; 11(1): 1-7.##Cameron AC, Trivedi PK. Microeconometrics: Methods and Applications Cambridge: Cambridge University Press; 2005.##Zhang X, Sun Z, Zhang X, Zheng L, Liu S, Xu C, et al. Prevalence and associated factors of overweight and obesity in older rural Chinese. Internal Medicine Journal. 2008; 38(7): 580-6.##Fan H, Li X, Zheng L, Chen X, Lan Q, Wu H, et al. Abdominal obesity is strongly associated with cardiovascular disease and its risk factors in elderly and very elderly community-dwelling Chinese. Scientific Reports. 2016; 6: 1-9.##Roderka MN, Puri S, Batsis JA. Addressing obesity to promote healthy aging. Clinical Geriatric Medicine. 2020; 36(4): 631-643.##Luo W, Xie Y. Socio-economic disparities in mortality among the elderly in China. Population Studies (Camb). 2014; 68(3): 305-20.##Luo Y, Zhang Z, Gu D. Education and mortality among older adults in China. Social Science & Medicine. 2015; 127: 134-42.##Wilson SE. Marriage, gender and obesity in later life. Economics and Human Biology. 2012; 10(4): 431-53.##Nikolic Turnic T, Jakovljevic V, Strizhkova Z, Polukhin N, Ryaboy D, Kartashova M, et al. The association between marital status and obesity: a systematic review and meta-analysis. Diseases. 2024; 12(7): 1-20.##Bae Y, Pachucki MC. Social isolation and depression as risk factors for weight loss of 5kg or more among older Korean adults. PLoS One. 2024; 19(3): 1-23.##Madani Civi R, Mehranfar S, Plunkett R, Veenstra G, Conklin AI. A systematic review of social connections as determinants of obesity: Longitudinal evidence limited to marital transitions. Obesity Reviews. 2024; 25(11): 1-12.##Valencia WM, Stoutenberg M, Florez H. Weight loss and physical activity for disease prevention in obese older adults: an important role for lifestyle management. Current Diabetes Reports. 2014; 14(10): 539.##Valenzuela PL, Castillo-García A, Morales JS, Izquierdo M, Serra-Rexach JA, Santos-Lozano A, et al. Physical exercise in the oldest old. Comprehensive Physiology. 2019; 9(4): 1281-304.##Kang HT, Lee HR, Lee YJ, Linton JA, Shim JY. Relationship between employment status and obesity in a Korean elderly population, based on the 2007-2009 Korean National Health and Nutrition Examination Survey (KNHANES). Archives of Gerontology and Geriatrics. 2013; 57(1): 54-9##Lin H, Xiao N, Lin S, Liu M, Liu GG. Associations of hypertension, diabetes and heart disease risk with body mass index in older Chinese adults: a population-based cohort study. BMJ Open. 2024; 14(7): 1-6.##Dey DK, Rothenberg E, Sundh V, Bosaeus I, Steen B. Height and body weight in the elderly. I. A 25-year longitudinal study of a population aged 70 to 95 years. European Journal of Clinical Nutrition. 1999; 53(12): 905-14.##Dahl AK, Hassing LB, Fransson EI, Pedersen NL. Agreement between self-reported and measured height, weight and body mass index in old age--a longitudinal study with 20 years of follow-up. Age and Ageing. 2010; 39(4): 445-51.##Sahyoun NR, Maynard LM, Zhang XL, Serdula MK. Factors associated with errors in self-reported height and weight in older adults. The Journal of Nutrition, Health & Aging. 2008; 12(2): 108-15.## ##

The Effect of Mind-Body Relaxation Exercises on Gait Smoothness and Gait Profile in Elderly Women 2 2 Introduction: The present study aimed to investigate the effects of mind‑body relaxation exercises on qualitative gait parameters, including movement smoothness and gait profile, in elderly women. This research focuses on how such interventions might enhance gait quality, potentially by strengthening core muscles, improving pelvic stability, and boosting neuromuscular coordination, which could play a vital role in optimizing gait patterns and reducing fall risk among this population. Methods: In this quasi-experimental study, twenty‑four elderly women aged over 55 years voluntarily participated and were randomly assigned to either an experimental or a control group. The experimental group engaged in a six-week training program consisting of three sessions per week. Gait kinematic data were recorded using a three-dimensional motion capture system at a sampling rate of 120 Hz. The smoothness index was calculated based on the integral of angular jerk, whereas the gait profile score was determined as the mean deviation of joint angles from a normative gait pattern. Data were analyzed using two-way repeated measures ANOVA. Results: The results demonstrated no significant main effects of group or time, nor a significant group × time interaction, for the movement smoothness index (all p > 0.05). In contrast, for the gait profile score, significant main effects of group (p = 0.041) and time (p = 0.001), as well as a significant group × time interaction effect (p = 0.016), were observed. These findings indicate that the six-week mind–body exercise intervention significantly improved gait movement patterns and reduced gait deviations in elderly women, whereas no significant changes were observed in movement smoothness. Conclusion: Mind-body relaxation exercises appear to enhance gait patterns and reduce fall risk in elderly women through mechanisms such as core muscle strengthening, pelvic stability improvement, and better neuromuscular coordination. Nevertheless, the lack of significant change in smoothness suggests that assessing the effects of these interventions on fine motor control may require longer training periods and more sensitive measurement tools. 8 16 2025/12/72025/11/15 1404/8/24 2026/05/92026/06/10 1405/3/20 Elham Dehghan Niri Elham Dehghan Niri Department of Behavioral and Cognitive Sciences in Sport, Faculty of Sports and Health Sciences, University of Tehran, Tehran, Iran Iran Mostafa Haj Lotfalian Mostafa Haj Lotfalian Department of Physical Education and Sport Sciences, Faculty of Psychology and Educational Sciences, Yazd University; Yazd: Iran Iran m.hajlotfalian@yazd.ac.ir Fateme Zare Bidoki Fateme Zare Bidoki Department of Sports Injury and Biomechanics, Faculty of Sports and Health Sciences, University of Tehran, Tehran, Iran Iran Aging Gait Analysis Mind-Body Therapies Gait Postural Balance Lally F, Crome P. Understanding frailty. Postgraduate Medical Journal. 2007; 83(975): 16-20.##Marzuca-Nassr GN, Alegría-Molina A, SanMartín-Calísto Y, Artigas-Arias M, Huard N, Sapunar J, et al. Muscle mass and strength gains following resistance exercise training in older adults 65–75 years and older adults above 85 years. International Journal of Sport Nutrition and Exercise Metabolism. 2023; 34(1): 11-9.##Guirguis-Blake JM, Perdue LA, Coppola EL, Bean SL. Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018: 332(1): 58-69.##Fujita K, Umegaki H, Makino T, Uemura K, Hayashi T, Inoue A, et al. Short-and long-term effects of different exercise programs on the gait performance of older adults with subjective cognitive decline: A randomized controlled trial. Experimental Gerontology. 2021. 156: 111590.##Wang X, O’Dwyer N, Halaki M. A review on the coordinative structure of human walking and the application of principal component analysis. Neural Regeneration Research. 2013; 8(7): 662-70.##Anaya-Campos LE, Sánchez-Fernández LP, Quiñones-Urióstegui I. Motion smoothness analysis of the gait cycle, segmented by stride and associated with the inertial sensors’ locations. Sensors. 2025; 25(2): 1-18.##Hostler D, Schwob J, Schlader ZJ, Cavuoto L. Heat stress increases movement jerk during physical exertion. Frontiers in Physiology. 2021; 12: 1-6.##Prince F, Corriveau H, Hébert R, Winter DA. Gait in the elderly. Gait & Posture. 1997; 5(2): 128-35.##Pau M, Mulas I, Putzu V, Asoni G, Viale D, Mameli I, et al. Smoothness of gait in healthy and cognitively impaired individuals: a study on Italian elderly using wearable inertial sensor. Sensors. 2020; 20(12): 3577.##Irez GB, Ozdemir RA, Evin R, Irez SG, Korkusuz F. Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls. Journal of Sports Science & Medicine. 2011; 10(1): 105-11.##Kloubec JA. Pilates for improvement of muscle endurance, flexibility, balance, and posture. The Journal of Strength & Conditioning Research. 2010; 24(3): 661-7.##Aibar-Almazán A, Martínez-Amat A, Cruz-Díaz D, de la Torre-Cruz MJ, Jiménez-García JD, Zagalaz-Anula N, et al. The influence of Pilates exercises on body composition, muscle strength, and gait speed in community-dwelling older women: a randomized controlled trial. The Journal of Strength & Conditioning Research. 2022; 36(8): 2298-305.##Meikis L, Wicker P, Donath L. Effects of Pilates training on physiological and psychological health parameters in healthy older adults and in older adults with clinical conditions over 55 years: a meta-analytical review. Frontiers in Neurology. 2021; 12: 1-17.##Buisseret F, Catinus L, Grenard R, Jojczyk L, Fievez D, Barvaux V, et al. Timed up and go and six-minute walking tests with wearable inertial sensor: one step further for the prediction of the risk of fall in elderly nursing home people. Sensors. 2020; 20(11): 1-16.##Shanahan CJ, Boonstra FM, Cofré Lizama LE, Strik M, Moffat BA, Khan F, et al. Technologies for advanced gait and balance assessments in people with multiple sclerosis. Frontiers in Neurology. 2018; 8: 1-10.##Sasagawa S, Arakawa A, Furuyama A, Matsumoto Y. Age-related changes in static balance in older women aged in their early sixties to their late eighties: different aging patterns in the anterior–posterior and mediolateral directions. Frontiers in Aging Neuroscience. 2024; 16: 1-9.##Pau M, Corona F, Pili R, Casula C, Sors F, Agostini T, et al. Effects of physical rehabilitation integrated with rhythmic auditory stimulation on spatio-temporal and kinematic parameters of gait in Parkinson’s disease. Frontiers in Neurology. 2016; 7: 1-12.##da Silva LD, Shiel A, McIntosh C. Effects of Pilates on the risk of falls, gait, balance and functional mobility in healthy older adults: A randomised controlled trial. Journal of Bodywork and Movement Therapies. 2022; 30: 30-41.##Fernández-Rodríguez R, Álvarez-Bueno C, Ferri-Morales A, Torres-Costoso A, Pozuelo-Carrascosa DP, Martínez-Vizcaíno V. Pilates improves physical performance and decreases risk of falls in older adults: a systematic review and meta-analysis. Physiotherapy. 2021; 112: 163-77.##Ko HS, Jung HU, Park TY, Song JK, Wang J, Jung HC. Comparisons of functional movements and core muscle activity in women according to Pilates proficiency. Frontiers in Physiology. 2024; 15: 1-11.##Işık Eİ, Başar S. Pilates training in the elderly. International Journal of Academic Medicine and Pharmacy. 2021; 3(3): 277-80.##Paquette C, Paquet N, Fung J. Aging affects coordination of rapid head motions with trunk and pelvis movements during standing and walking. Gait & Posture. 2006; 24(1): 62-69.##Ferreira JS, Cruvinel-Júnior RH, Marcos Duarte M, Isabel CN, Sacco ICN. Gait Profile Scores and their correlation with clinical outcomes in individuals with diabetic neuropathy: a cross-sectional study with 102 patients. Gait & Posture. 2025; 122: 240-6.##Choi W, Joo Y, Lee S. Pilates exercise focused on ankle movements for improving gait ability in older women. Journal of Women & Aging. 2021; 33(1): 30-40.##Geremia JM, Iskiewicz MM, Marschner RA, Lehnen TE, Lehnen AM. Effect of a physical training program using the Pilates method on flexibility in elderly subjects. Age. 2015; 37(6):1-12.##Carrasco-Poyatos M, Rubio-Arias JA, Ballesta-García I, Ramos-Campo DJ. Pilates vs. muscular training in older women. Effects in functional factors and the cognitive interaction: A randomized controlled trial. Physiology & behavior. 2019; 201: 157-64.##Mahajan L, Mahajan P, Shinde M, Prakash A. Effect of tai chi exercise versus pilates on dynamic balance and gait in elderly-a comparative study. International Journal of Health Sciences and Research. 2022; 12(7): 200-13.##Antonelli M, Caselli E, Gastaldi L. Comparison of gait smoothness metrics in healthy elderly and young people. Applied Sciences. 2024; 14(2): 911.## ##

The Effects of Aerobic and Strength Training on Plasma Sestrin 2 Levels in Inactive Elderly Men 2 2 Introduction: Aging is associated with increased oxidative stress and decreased Sestrin 2 levels.The aim of the present study was to investigate the effect of eight weeks of aerobic and strength training on plasma levels of Sestrin2 in inactive elderly men. Methods: In the present quasi -experimental study, forty-five elderly men with an age range of 60 to 74 years were selected using convenience sampling and then randomly assigned to three groups: an aerobic training group, a strength training group, and a control group. The aerobic training group trained for eight weeks, three sessions per week, at an intensity of 55-70% of heart rate reserve (HRR) based on the principle of progressive overload. The Strength training group also performed upper and lower body resistance training, three days a week and for eight weeks at an intensity of 30 to 80 percent of one Repetition Maximum(1RM). The control group did not participate in any training program. Blood samples were collected from all three groups 48 hours before and after the training intervention. Plasma Sestrin2 levels were measured using an ELISA kit. Analysis of Covariance (ANCOVA) along with Tukey's post hoc test was employed to compare the variables in the three groups. The data were analyzed at a significance level of 0.05 and using SPSS-23 software. Results: Eight weeks of aerobic and strength training resulted in a significant increase in plasma Sestrin2  levels (p < 0.05), and no significant difference was observed between the two aerobic and strength training groups (p > 0.05). Conclusion: Elderly people benefit from aerobic and resistance training to reduce oxidative stress caused by aging and, consequently, reduce the diseases caused by it.   17 22 2025/12/72025/11/152026/04/26 1405/2/6 2026/05/92026/06/102026/05/10 1405/2/20 Fatemeh Merdasi Fatemeh Merdasi Department of Physical Education, Ahv.C., Islamic Azad University, Ahvaz, Iran Iran Mehdi Bostani Mehdi Bostani Department of Physical Education, Ahv.C., Islamic Azad University, Ahvaz, Iran Iran mehdi.boustani@iau.ac.ir Aerobic Training Strength Training Sestrin 2 Aged Cui H, Kong Y, Zhang H. Oxidative stress, mitochondrial dysfunction, and aging. Journal of Signal Transduction. 2021; 2012(1): 1-13.##Birch-Machin MA, Bowman A. Oxidative stress and ageing. British Journal of Dermatology. 2016; 175(S2): 26-9.##Pasha M, Eid AH, Eid AA, Gorin Y, Munusamy S. Sestrin2 as a novel biomarker and therapeutic target for various diseases. Oxidative Medicine and Cellular Longevity. 2017; 2017(1): 1-10.##Ho A, Cho CS, Namkoong S, Cho US, Lee JH. Biochemical basis of Sestrins physiological activities. Trends in Biochemical Sciences. 2016; 41(7): 621-32.##Rai N, Dey S. Protective response of Sestrin under stressful conditions in aging. Ageing Research Reviews. 2020; 64: 101186.##Sun W, Wang Y, Zheng Y, Quan N. The emerging role of Sestrin2 in cell metabolism, and cardiovascular and age-related diseases. Aging and Disease. 2020; 11(1): 154-63.##Kim M, Kowalsky AH, Lee JH. Sestrins in physiological stress responses. Annual Review of Physiology. 2020; 83(1): 381-403.##Sun B, Wang JD, Wu MY, Chen HY, Yang SQ, Chen YM, et al. Sestrin2 alleviates sepsis-induced immunosuppression of dendritic cells by regulating mitochondrial dynamics. Free Radical Biology and Medicine. 2025; 240: 583-96.##Crisol BM, Lenhare L, Gaspar RS, Gaspar RC, Muñoz VR, da Silva AS, et al. The role of physical exercise on Sestrin1 and 2 accumulations in the skeletal muscle of mice. Life Sciences. 2018; 194(1): 98-103.##Zeng N, D'Souza RF, Figueiredo VC, Markworth JF, Roberts LA, Peake JM, et al. Acute resistance exercise induces Sestrin2 phosphorylation and p62 dephosphorylation in human skeletal muscle. Physiological Reports. 2017; 5(24): 1-9.##Ghamarchehreh ME, Shamsoddini A, Alavian SM. Investigating the impact of eight weeks of aerobic and resistance training on blood lipid profile in elderly with non-alcoholic fatty liver disease: a randomized clinical trial. Gastroenterology and Hepatology from Bed to Bench. 2019; 12(3): 190-6.##Barzegari M, Shojaedin SS, Bayat TM. The effect of 8-week strength training, balance training and combined training on the dynamic and static balance of the elderly inactive men. Specific Physical Therapy Journal. 2019; 9(1): 15-22.##Quan N, Wang L, Chen X, Luckett C, Cates C, Rousselle T, et al. Sestrin2 prevents age-related intolerance to post myocardial infarction via AMPK/PGC-1α pathway. Journal of Molecular and Cellular Cardiology. 2018; 115: 170-8.##Mohabbat M, Arazi H. Effect of resistance training plus enriched probiotic supplement on sestrin2, oxidative stress, and mitophagy markers in elderly male Wistar rats. Scientific Reports. 2024; 14(1): 7744.##Hwang I, Kim M. Muscular Sestrins: roles in exercise physiology and stress resistance. Biomolecules. 2023; 13(5): 722.##Liu S, Li H, Zhang Y, Song H, Fu L. Exercise ameliorates chronic inflammatory response induced by high-fat diet via Sestrin2 in an Nrf2-dependent manner. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease. 2023; 1869(7): 166792.##Zeng N, D’Souza RF, Sorrenson B, Merry TL, Barnett MP, Mitchell CJ, et al. The putative leucine sensor Sestrin2 is hyperphosphorylated by acute resistance exercise but not protein ingestion in human skeletal muscle. European Journal of Applied Physiology. 2018; 118(6): 1241-53.##Huang Y, Sun S, Yang X, Li X, Zhou Y, Liu S, et al. SESN2 mediates resistance training-induced improvements in exercise performance and energy metabolism in C57BL/6J mice. Experimental Cell Research. 2025; 450(1): 114617.##Lenhare L, Crisol BM, Silva VR, Katashima CK, Cordeiro AV, Pereira KD, et al. Physical exercise increases Sestrin 2 protein levels and induces autophagy in the skeletal muscle of old mice. Experimental Gerontology. 2017; 97: 17-21.##Liu S, Yu C, Xie L, Niu Y, Fu L. Aerobic exercise improves mitochondrial function in sarcopenia mice through Sestrin2 in an AMPKα2-dependent manner. The Journals of Gerontology. 2021; 76(7): 1161-8.##Liang J, Zhang H, Zeng Z, Wu L, Zhang Y, Guo Y, et al. Lifelong aerobic exercise alleviates sarcopenia by activating autophagy and inhibiting protein degradation via the AMPK/PGC-1α signaling pathway. Metabolites. 2021; 11(5): 1-16.##Chen Y, Huang T, Yu Z, Yu Q, Wang Y, Hu JA, et al. The functions and roles of Sestrins in regulating human diseases. Cellular & Molecular Biology Letters. 2022; 27(1): 1-24.##Fang Z, Kim HG, Huang M, Chowdhury K, Li MO, Liangpunsakul S, et al. Sestrin proteins protect against lipotoxicity-induced oxidative stress in the liver via suppression of C-Jun N-terminal kinases. Cellular and Molecular Gastroenterology and Hepatology. 2021; 12(3): 921-42.## ##

The Role of Health Anxiety in Illness Perception: The Mediating Effect of Bodily Symptom Vigilance among Elderly Patients Attending Medical Clinics in Urmia 2 2 Introduction: Health anxiety is recognized as an important psychological factor influencing individuals’ perception of illness, particularly among older adults. However, the mechanisms underlying this relationship, especially the mediating role of bodily symptom vigilance, remain insufficiently explored. The present study aimed to investigate the role of health anxiety in illness perception, emphasizing the mediating effect of bodily symptom vigilance among elderly individuals attending medical clinics in Urmia. Methods: This fundamental study employed a descriptive-correlational design using structural equation modeling. The statistical population included individuals aged 60 years and older who visited medical centers in Urmia in 2024. A convenience sample of 200 participants was selected. Data were collected using the Health Anxiety Inventory, the Brief Illness Perception Questionnaire, and the Body Vigilance Scale. Data analysis was performed using SPSS and SmartPLS software. Results: Health anxiety significantly predicted illness perception both directly (β = 0.313, t = 5.04, p < 0.001) and indirectly through bodily symptom vigilance (β = 0.200, t = 4.26, p < 0.001). Health anxiety also significantly predicted bodily symptom vigilance (β = 0.323, t = 5.27, p < 0.001), while bodily symptom vigilance significantly predicted illness perception (β = 0.620, t = 10.60, p < 0.001). Model fit indices indicated an acceptable fit of the proposed model (SRMR = 0.089, NFI = 0.891). Conclusion: Health anxiety and heightened bodily vigilance play a crucial role in shaping illness perception among older adults. These findings highlight the importance of addressing psychological factors in developing mental health policies and interventions for the elderly population. 23 33 2025/12/72025/11/152026/04/262026/04/21 1405/2/1 2026/05/92026/06/102026/05/102026/06/8 1405/3/18 Shayan Maleki Shayan Maleki Department of Psychology, Faculty of Psychology and Educational Sciences, Islamic Azad University, Khoy Branch, Khoy, Iran Iran Elahe Ghafori Elahe Ghafori Department of Educational Psychology, Islamic Azad University, Urmia Branch, Urmia, Iran Iran Kosar Babalou Kosar Babalou Department of Clinical Psychology, Islamic Azad University, Urmia Branch, Urmia, Iran Iran Masoud Gorbanalipour Masoud Gorbanalipour Department of Psychology, Faculty of Psychology and Educational Sciences, Islamic Azad University, Khoy Branch, Khoy, Iran Iran masoudqorbanalipour@gmail.com Health Anxiety Disease Perception Bodily Symptom Vigilance Dharmarajan T. Physiology of aging. In: Pitchumoni CS, Dharmarajan T, editors. Geriatric gastroenterology. Springer: 2021; P. 101-53.##Shakkarpude J, Jesse AD, Kumar P, Kumar R. Physiology of Aging. In: Principles of Veterinary Animal Physiology. CRC Press; 2025. p. 242-52.##Guo J, Huang X, Dou L, Yan M, Shen T, Tang W, et al. Aging and aging-related diseases: from molecular mechanisms to interventions and treatments. Signal Transduction and Targeted Therapy. 2022; 7(1): 1-40.##Bhandari P, Paswan B. Lifestyle behaviours and mental health outcomes of elderly: Modification of socio-economic and physical health effects. Ageing International. 2021; 46(1): 35-69.##Xu X, Zhang L. How does childhood socio-economic environment affect the health of middle-aged and elderly people in China? A new perspective with four dimensions of health. Journal of Public Health. 2023; 31(8): 1249-58.##McKenna-Plumley PE, Turner RN, Yang K, Groarke JM. “It’sa feeling of complete disconnection”: experiences of existential loneliness from youth to older adulthood. BMC Psychology. 2023; 11(1): 1-14.##Alsenany SA. Psychological predictors of gerascophobia among middle-aged and older adults: the role of health anxiety and body image satisfaction. GeroScience. 2026; 48(2): 2681-93.##Howell C, Segal DL, Segal S. Diagnosis and assessment of somatic symptom and related disorders among older adults: Issues and strategies. Journal of Clinical and Basic Psychosomatics. 2025; 3(4): 21-9.##Xiong C, Jiang C, Zhang H, Chen J, Zhao M, Xiong C, Luo X, et al. Self‐management and illness perception among cervical cancer patients: A cross‐sectional study. International Journal of Nursing Practice. 2023; 29(3): 13134.##Singh A, Rejeb A. Illness perception: a bibliometric study. Heliyon. 2024; 10(11(: 1-26.##Scollan-Koliopoulos M. Lifestyle r-educing program: risk–education in groups with depression to prevent diabetes. Regis College; 2022.##Bilondi SS, Noghabi AD, Aalami H. The relationship between illness perception and medication adherence in patients with diabetes mellitus type II: illness perception and medication adherence. Journal of Preventive Medicine and Hygiene. 2022; 62(4): 966-71.##Leventhal H, Halm E, Horowitz C, Leventhal EA, Ozakinci G. Living with chronic illness: A contextualized, self-regulation approach. The Sage Handbook of Health Psychology. 2004: 197-240.##Ma H, Hu K, Wu W, Wu Q, Ye Q, Jiang X, et al. Illness perception profile among cancer patients and its influencing factors: A cross-sectional study. European Journal of Oncology Nursing. 2024; 69: 102526.##Fournier H, Calcagni N, Morice-Picard F, Quintard B. Psychosocial implications of rare genetic skin diseases affecting appearance on daily life experiences, emotional state, self-perception and quality of life in adults: a systematic review. Orphanet Journal of Rare Diseases. 2023; 18(1): 1-49.##Nie R, Han Y, Xu J, Huang Q, Mao J. Illness perception, risk perception and health promotion self-care behaviors among Chinese patient with type 2 diabetes: A cross-sectional survey. Applied Nursing Research. 2018; 39: 89-96.##de Santana Silva JP, Cruz HRA, Silva GAG, Gualdi LP, Lima ÍNDF. Illness perception and self-care in hypertension treatment: a scoping review of current literature. BMC Health Services Research. 2024; 24(1): 1-14.##Zhu Y, Cai N, Wang Z, Li J, Guo T, He J, et al. Perceived social support and psychosocial adaptation in patients with chronic skin diseases: the mediating role of self-disclosure. Frontiers in Psychiatry. 2025; 16: 1-16.##Bassi M, Falautano M, Cilia S, Goretti B, Grobberio M, Pattini M, et al. Illness perception and well-being among persons with multiple sclerosis and their caregivers. Journal of Clinical Psychology in Medical Settings. 2016; 23(1): 33-52.##Ośmiałowska E, Staś J, Chabowski M, Jankowska-Polańska B. Illness perception and quality of life in patients with breast cancer. Cancers. 2022; 14(5): 1-22.##Lebel S, Mutsaers B, Tomei C, Leclair CS, Jones G, Petricone-Westwood D, et al. Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. Plos One. 2020; 15(7): 1.-48##Bulut BP, Bozo Ö. A helix of anxiety: a qualitative analysis of the personal experiences of individuals with health anxiety. Studies in Psychology. 2022; 42(1): 165-98.##Axelsson E, Hedman-Lagerlöf E. Validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder and illness anxiety disorder in pathological health anxiety: Should we close the chapter? Journal of Psychosomatic Research. 2023; 165: 111133.##Ferguson E. A taxometric analysis of health anxiety. Psychological Medicine. 2009; 39(2): 277-85.##Salkovskis PM, Rimes KA, Warwick HM, Clark D. The health anxiety inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine. 2002; 32(5): 843-53.##Weck F, Richtberg S, MB Neng J. Epidemiology of hypochondriasis and health anxiety: comparison of different diagnostic criteria. Current Psychiatry Reviews. 2014; 10(1): 14-23.##Salkovskis PM, Warwick HM. Morbid preoccupations, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy. 1986; 24(5): 597-602.##Hannah K, Marie K, Olaf H, Stephan B, Andreas D, Wilson Michael L, et al. The global economic burden of health anxiety/hypochondriasis-a systematic review. BMC Public Health. 2023; 23(1): 1-11.##Rachman S. Health anxiety disorders: A cognitive construal. Behaviour Research and Therapy. 2012; 50(7-8): 502-12.##Bailer J, Kerstner T, Witthöft M, Diener C, Mier D, Rist F. Health anxiety and hypochondriasis in the light of DSM-5. Anxiety, Stress, & Coping. 2016; 29(2): 219-39.##Sauer KS, Witthöft M, Rief W. Somatic symptom disorder and health anxiety: assessment and management. Neurologic Clinics. 2023; 41(4): 745-58.##Tyrer P. Recent advances in the understanding and treatment of health anxiety. Current Psychiatry Reports. 2018; 20(7): 49.##Wheaton MG, Berman NC, Abramowitz JS. The contribution of experiential avoidance and anxiety sensitivity in the prediction of health anxiety. Journal of Cognitive Psychotherapy. 2010; 24(3): 229.##Schmidt NB, Lerew DR, Trakowski JH. Body vigilance in panic disorder: evaluating attention to bodily perturbations. Journal of Consulting and Clinical Psychology. 1997; 65(2): 214.##McLaughlin LE, McLeish AC, O'Bryan EM. The role of body vigilance in depression symptomatology. International Journal of Cognitive Therapy. 2016; 9(3): 217-28.##Zvolensky MJ, Kauffman BY, Shepherd JM, Viana AG, Bogiaizian D, Rogers AH, et al. Pain-related anxiety among Latinx college students: relations to body vigilance, worry, anxious arousal, and general depression. Journal of Racial and Ethnic Health Disparities. 2020; 7(3): 498-507.##Ginzburg K, Tsur N, Barak-Nahum A, Defrin R. Body awareness: differentiating between sensitivity to and monitoring of bodily signals. Journal of Behavioral Medicine. 2014; 37(3): 564-75.##Wright EC, Hostinar CE, Trainor BC. Anxious to see you: Neuroendocrine mechanisms of social vigilance and anxiety during adolescence. The European Journal of Neuroscience. 2020; 52(1): 2516-29.##Sutton R, de Jong JS, Stewart JM, Fedorowski A, de Lange FJ. Pacing in vasovagal syncope: physiology, pacemaker sensors, and recent clinical trials—precise patient selection and measurable benefit. Heart Rhythm. 2020; 17(5): 821-8.##Hedman E, Lekander M, Karshikoff B, Ljótsson B, Axelsson E, Axelsson J. Health anxiety in a disease-avoidance framework: Investigation of anxiety, disgust and disease perception in response to sickness cues. Journal of Abnormal Psychology. 2016; 125(7): 868-78.##Hayter AL, Salkovskis PM, Silber E, Morris RG. The impact of health anxiety in patients with relapsing remitting multiple sclerosis: Misperception, misattribution and quality of life. The British Journal of Clinical Psychology. 2016; 55(4): 371-86.##Kline RB. Principles and practice of structural equation modeling. New York: London: Guilford publications; 2023.##Abramowitz JS, Olatunji BO, Deacon BJ. Health anxiety, hypochondriasis, and the anxiety disorders. Behavior Therapy. 2007; 38(1): 86-94.##Nargesi F, Izadi F, Kariminejad K, Rezaii Sharif A. The investigation of the reliability and validity of Persian version of Health anxiety questionnaire in students of Lorestan University of Medical Sciences. Quarterly of Educational Measurement. 2017; 8(27): 147-160. [Persian]##Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. Journal of Psychosomatic Research. 2006; 60(6): 631-7.##Karimian Z, Haghayegh SA, Emami Najafi Dehkordi S MH, Raisi M. The Comparison of the effectiveness of trans-diagnostic treatment and the acceptance and commitment therapy (ACT) on Emotion regulation and illness perception in patients with irritable bowel syndrome (IBS). Journal of Research in Behavioural Sciences. 2021; 19(3): 477-88. [Persian]##Hair JF, Risher JJ, Sarstedt M, Ringle CM. When to use and how to report the results of PLS-SEM. European Business Review. 2019; 31(1): 2-4.##Myers JL, Well AD, Lorch Jr, Robert F. Research design and statistical analysis. Routledge; 2013.##Lomax RG. A beginner's guide to structural equation modeling. psychology press; 2004.## ##

The Effect of an Eight-Week Low-Volume High-Intensity Interval Training Compared to Moderate-Intensity Continuous Training on Liver Enzymes and Anthropometric Indices: A Comparison of Obese and Lean Men with Non-Alcoholic Fatty Liver Disease 2 2 Introduction: Nonalcoholic fatty liver disease (NAFLD) is a prevalent metabolic liver disorder associated with insulin resistance, excess adiposity, and increased cardiovascular risk. Although obesity is a major risk factor, many individuals with NAFLD are lean, and their responses to exercise remain unclear. This study compared the effects of eight weeks of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on liver enzymes and anthropometric indices in obese and lean men with NAFLD. Methods: In this quasi-experimental study, 56 men with ultrasound confirmed NAFLD (grade ≥ 2) were randomly allocated to four groups: obese + HIIT, obese + MICT, lean + HIIT, and lean + MICT. Participants completed supervised exercise sessions three times per week for eight weeks. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), body mass index (BMI), and waist to hip ratio (WHR) were measured before and after the intervention. Between group differences were analyzed using analysis of covariance (ANCOVA), with baseline values as covariates. Effect sizes were reported using partial eta squared (η²). Results: After adjustment for baseline values, no significant between-group differences were observed for ALT or AST, although both enzymes showed numerical reductions in all groups. Significant between-group differences were found for anthropometric outcomes. HIIT produced greater reductions in BMI (p < 0.001, partial η² = 0.38) and WHR (p < 0.001, partial η² = 0.29) than MICT, with the greatest improvements observed in obese participants. Conclusion: An eight-week HIIT program was more effective than MICT in improving body composition, particularly overall and central adiposity, in men with NAFLD. Although exercise was associated with favorable trends in liver enzyme levels, these changes did not reach statistical significance between groups. These findings support HIIT as a time efficient strategy for improving anthropometric outcomes in men with NAFLD. 34 45 2025/12/72025/11/152026/04/262026/04/212025/11/19 1404/8/28 2026/05/92026/06/102026/05/102026/06/82025/12/17 1404/9/26 Fatemeh Janghorbani Fatemeh Janghorbani Department of Sports Physiology, Isf.C., Islamic Azad University, Isfahan, Iran Iran Farzaneh Taghian Farzaneh Taghian Department of Sports Physiology, Isf.C., Islamic Azad University, Isfahan, Iran Iran ft.taghian@gmail.com Khosro Jalali Dehkordi Khosro Jalali Dehkordi Department of Sports Physiology, Isf.C., Islamic Azad University, Isfahan, Iran Iran Non-Alcoholic Fatty Liver Disease Body Mass Index Waist Hip Ratio Alanine Transaminase Aspartate Aminotransferases Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023; 77(4):1335-47.##Xue Y, Peng Y, Zhang L, Ba Y, Jin G, Liu G. Effect of different exercise modalities on nonalcoholic fatty liver disease: a systematic review and network meta-analysis. Scientific Reports. 2024; 14(1): 1-13.##Ye Q, Zou B, Yeo YH, Li J, Huang DQ, Wu Y, et al. Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis. The lancet Gastroenterology & Hepatology. 2020; 5(8): 739-52.##Wongtrakul W, Charatcharoenwitthaya N, Charatcharoenwitthaya P. Lean non-alcoholic fatty liver disease and the risk of all-cause mortality: an updated meta-analysis. Annals of Hepatology. 2024; 29(3): 101288.##Cruz ACD, Bugianesi E, George J, Day CP, Liaquat H. Charatcharoenwitthaya P, et al. 379 characteristics and long-term prognosis of lean patients with nonalcoholic fatty liver disease. Gastroenterology. 2014; 146(5): 909.‌##Younes R, Govaere O, Petta S, Miele L, Tiniakos D, Burt A, et al. Caucasian lean subjects with non-alcoholic fatty liver disease share long-term prognosis of non-lean: time for reappraisal of BMI-driven approach? Gut. 2022; 71(2): 382-90.##Ito T, Ishigami M, Zou B, Tanaka T, Takahashi H, Kurosaki M, et al. The epidemiology of NAFLD and lean NAFLD in Japan: a meta-analysis with individual and forecasting analysis, 1995–2040. Hepatology International. 2021;15(2):366-79.##Feldman A, Wernly B, Strebinger G, Eder SK, Zandanell S, Niederseer D, et al. Liver-related mortality is increased in lean subjects with non-alcoholic fatty liver disease compared to overweight and obese subjects. Journal of Gastrointestinal and Liver Diseases. 2021; 30(3): 366-73.##Ahmed OT, Gidener T, Mara KC, Larson JJ, Therneau TM, Allen AM. Natural history of nonalcoholic fatty liver disease with normal body mass index: a population-based study. Clinical Gastroenterology and Hepatology. 2022; 20(6): 1374-81.##Arvind A, Henson JB, Osganian SA, Nath C, Steinhagen LM, Memel ZN, et al. Risk of cardiovascular disease in individuals with nonobese nonalcoholic fatty liver disease. Hepatology Communications. 2022; 6(2): 309-19.##Pipitone RM, Ciccioli C, Infantino G, La Mantia C, Parisi S, Tulone A, et al. MAFLD: a multisystem disease. Therapeutic Advances in Endocrinology and Metabolism. 2023; 14: 1-23.##Vulchi J, Suryadevara V, Mohan P, Kamalanathan S, Sahoo J, Naik D, et al. Obesity and metabolic dysfunction-associated fatty liver disease: understanding the intricate link. Journal of Translational Gastroenterology. 2023; 1(2): 74-86.##Eslam M, El-Serag HB, Francque S, Sarin SK, Wei L, Bugianesi E, et al. Metabolic (dysfunction)-associated fatty liver disease in individuals of normal weight. Nature Reviews Gastroenterology & Hepatology. 2022; 19(10): 638-51.##Hong F, Liu Y, Lebaka VR, Mohammed A, Ye W, Chen B, et al. Effect of exercise training on serum transaminases in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis. Frontiers in Physiology. 2022; 13: 1-13.##Hejazi K, Hackett D. Effect of exercise on liver function and insulin resistance markers in patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Medicine. 2023; 12(8): 1-19.##Sabag A, Barr L, Armour M, Armstrong A, Baker CJ, Twigg SM, et al. The effect of high-intensity interval training vs moderate-intensity continuous training on liver fat: a systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2022; 107(3): 862-81.##Keating SE, Sabag A, Hallsworth K, Hickman IJ, Macdonald GA, Stine JG, et al. Exercise in the management of metabolic-associated fatty liver disease (MAFLD) in adults: A position statement from exercise and sport science Australia. Sports Medicine. 2023; 53(12): 2347-71.##Brea A, Puzo J. Non-alcoholic fatty liver disease and cardiovascular risk. International Journal of Cardiology. 2013; 167(4): 1109-17.##Katsagoni CN, Georgoulis M, Papatheodoridis GV, Panagiotakos DB, Kontogianni MD. Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: A meta-analysis. Metabolism. 2017; 68: 119-32.##Morris EM, McCoin CS, Allen JA, Gastecki ML, Koch LG, Britton SL, et al. Aerobic capacity mediates susceptibility for the transition from steatosis to steatohepatitis. The Journal of Physiology. 2017; 595(14): 4909-26.##Dahmus J, Hummer B, Rivas G, Schmitz K, Caldwell SH, Argo CK, et al. Patients with nonalcoholic steatohepatitis and advanced liver disease have the lowest cardiorespiratory fitness. Digestive Diseases and Sciences. 2023; 68(6): 2695-703.##Heinle JW, DiJoseph K, Sabag A, Oh S, Kimball SR, Keating S, et al. Exercise is medicine for nonalcoholic fatty liver disease: exploration of putative mechanisms. Nutrients. 2023; 15(11): 1-18.##Sabag A, Way KL, Sultana RN, Keating SE, Gerofi JA, Chuter VH, et al. The effect of a novel low-volume aerobic exercise intervention on liver fat in type 2 diabetes: a randomized controlled trial. Diabetes Care. 2020; 43(10): 2371-8.##Nam H, Yoo JJ, Cho Y, Kang SH, Ahn SB, Lee HW, et al. Effect of exercise-based interventions in nonalcoholic fatty liver disease: a systematic review with meta-analysis. Digestive and Liver Disease. 2023; 55(9): 1178-86.##Stefan N, Häring HU, Cusi K. Non-alcoholic fatty liver disease: causes, diagnosis, cardiometabolic consequences, and treatment strategies. The lancet Diabetes & Endocrinology. 2019; 7(4):313-24.##Cigrovski Berkovic M, Bilic-Curcic I, Mrzljak A, Cigrovski V. NAFLD and physical exercise: ready, steady, go! Frontiers in Nutrition. 2021; 8: 1-6.##Hallsworth K, Thoma C, Hollingsworth KG, Cassidy S, Anstee QM, Day CP, et al. Modified high-intensity interval training reduces liver fat and improves cardiac function in non-alcoholic fatty liver disease: a randomized controlled trial. Clinical Science. 2015; 129(12): 1097-105.##Song X, Cui X, Su W, Shang X, Tao M, Wang J, et al. Comparative effects of high-intensity interval training and moderate-intensity continuous training on weight and metabolic health in college students with obesity. Scientific Reports. 2024; 14(1): 1-13.##Yang C, Yan P, Deng J, Li Y, Jiang X, Zhang B. Exercise, weight maintenance, and nonalcoholic fatty liver disease risk: a Chinese cohort study. Frontiers in Physiology. 2024; 15: 1-9.##Barron-Cabrera E, Soria-Rodriguez R, Amador-Lara F, Martinez-Lopez E. Physical activity protocols in non-alcoholic fatty liver disease management: A systematic review of randomized clinical trials and animal models. Healthcare. 2023; 11(14): 1-28.‌## ##

Interaction of Concurrent Exercise Training and Milk thistle Extract on Hippocampi, NF-κB, and Serotonin of PTSD in Male Rats 2 2 Introduction: Post-traumatic stress disorder (PTSD) is characterized by chronic neuroinflammation, impaired serotonergic signaling, and structural damage in both central and peripheral tissues, including the hippocampus and liver. Nuclear factor kappa B (NF-κB) plays a central role in stress-induced inflammatory responses. Exercise and phytotherapeutic agents such as milk thistle (Silybum marianum) have been suggested as potential non-pharmacological strategies for attenuating PTSD-related pathophysiology. Methods: Fifty-five male Wistar rats were randomly assigned to five groups: healthy control, PTSD, PTSD with concurrent exercise training, PTSD with milk thistle extract, and PTSD with concurrent exercise training plus milk thistle extract. PTSD was induced using a multi-stage stress protocol. The concurrent exercise training program was conducted for 4 weeks, consisting of resistance training on even days and aerobic training on odd days. Resistance training was performed with progressively increasing loads from 50% to 80% of body weight, and aerobic training from 50% to 80% of VO₂max. Milk thistle extract was administered daily at a dose of 300 mg/kg. After the intervention, hippocampal and liver tissues were collected. NF-κB mRNA expression was measured using real-time PCR, and serotonin levels were measured by ELISA. Histopathological alterations were assessed by hematoxylin and eosin staining. Data were analyzed using ANOVA and Tukey statistical tests. Results: PTSD induction significantly increased NF-κB mRNA expression and decreased serotonin levels in both hippocampal and liver tissues compared with healthy controls. Concurrent exercise training and milk thistle extract each significantly attenuated NF-κB overexpression and partially restored serotonin levels (p < 0.05). Histopathological analysis revealed severe neuronal degeneration in the hippocampus and marked structural damage in liver tissue in PTSD rats, whereas both interventions, particularly their combination, markedly improved tissue morphology. Conclusion: Concurrent exercise training and milk thistle extract exert synergistic neuroprotective and hepatoprotective effects in a rat model of PTSD. These benefits appear to be mediated through suppression of NF-κB–dependent inflammatory pathways and restoration of serotonergic homeostasis. 46 58 2025/12/72025/11/152026/04/262026/04/212025/11/192026/03/25 1405/1/5 2026/05/92026/06/102026/05/102026/06/82025/12/172026/06/9 1405/3/19 Farah Nameni Farah Nameni Department of Exercise Physiology, VaP. C., Islamic Azad University, Varamin, Iran Iran fa.nameni@iau.ac.ir Fatemeh Sorkheh Fatemeh Sorkheh Science and Research Branch, Islamic Azad University, Tehran, Iran Iran Fatemeh Soltaniesmailzade Fatemeh Soltaniesmailzade Science and Research Branch, Islamic Azad University, Tehran, Iran Iran PTSD Exercise Training Milk Thistle Extract Serotonin NF-κB Coleman BL, Gutmanis I, Maunder R, McGeer A. Psychological distress is associated with symptoms of post-traumatic stress disorder among healthcare providers during the COVID-19 pandemic: 2021–2023. Frontiers Psychology. 2025; 16: 1-9.##Aliev G, Beeraka NM, Nikolenko VN, Svistunov AA, Rozhnova T, Kostyuk S, et al. Neurophysiology and psychopathology underlying ptsd and recent insights into the PTSD therapies-a comprehensive review. Journal of Clinical Medicine. 2020; 9(9): 1-19.##Girotti M, Bulin SE, Carreno FR. Effects of chronic stress on cognitive function – From neurobiology to intervention. Neurobiology of Stress. 2024; 33: 1-23.##Sun N, Cui Q, Min M, Zhang M, Liu Z, Wu Y. A new perspective on hippocampal synaptic plasticity and post-stroke depression. The European Journal of Neuroscience. 2023; 58(4): 2961-84.##Pourhamzeh M, Moravej FG, Arabi M, Shahriari E, Mehrabi S, Ward R, et al. The roles of serotonin in neuropsychiatric disorders. Cell and Molecular Neurobiology. 2022; 42(6): 1671-92.##Tseilikman VE, Tseilikman OB, Karpenko MN, Traktirov DS, Obukhova DA, Shatilov VA, et al. Unraveling the serotonergic mechanism of stress-related anxiety: focus on co-treatment with resveratrol and selective serotonin reuptake inhibitors. Biomedicines. 2024; 12(11): 2455.##Govindula A, Ranadive N, Nampoothiri M, Rao CM, Arora D, Mudgal J. Emphasizing the crosstalk between inflammatory and neural signaling in post-traumatic stress disorder (PTSD). Journal of Neuroimmune Pharmacology. 2023; 18(3): 248-66.##Lawrence S, Scofield RH. Post-traumatic stress disorder associated hypothalamic-pituitary-adrenal axis dysregulation and physical illness. Brain, Behavior, & Immunity-Health. 2024; 41: 1-8.##Yan M, Man S, Sun B, Ma L, Guo L, Huang L, et al. Gut liver brain axis in diseases: the implications for therapeutic interventions. Signal Transduction and Targeted Therapy. 2023; 8(1): 1-26.##Ye Q, Yuan S, Cai D. Synergistic potential of natural products and exercise: unveiling molecular mechanisms and innovative therapeutic approaches for liver diseases. Frontiers in Nutrition. 2025; 12: 1-22.##Gupta S, Guleria RS. Involvement of nuclear factor-κb in inflammation and neuronal plasticity associated with post-traumatic stress disorder. Cells. 2022; 11(13): 1-14.##Mamun AA, Shao C, Geng P, Wang S, Xiao J. Polyphenols targeting nf-κb pathway in neurological disorders: what we know so far? International Journal of Biological Sciences. 2024; 20(4): 1332-55.##Zhu M, Chen W, Zhang J. Aerobic exercise, an effective intervention for cognitive impairment after ischemic stroke. Frontiers in Aging Neuroscience. 2025; 17: 1-9.##Vecchio LM, Meng Y, Xhima K, Lipsman N, Hamani C, Aubert I. The neuroprotective effects of exercise: maintaining a healthy brain throughout aging. Brain Plasticity. 2018; 4(1): 17-52.##Jaffar HM, Al-Asmari F, Khan FA, Rahim MA, Zongo E. Silymarin: Unveiling its pharmacological spectrum and therapeutic potential in liver diseases—A comprehensive narrative review. Food Science & Nutrition. 2024; 12(5): 3097-111.##Mukherjee AG, Valsala Gopalakrishnan A. The interplay of arsenic, silymarin, and NF-ĸB pathway in male reproductive toxicity: A review. Ecotoxicology and Environmental Safety. 2023; 252: 1-16.##Fan Z, Chen J, Li L, Wang H, Gong X, Xu H, Wu l, et al. Environmental enrichment modulates HPA axis reprogramming in adult male rats exposed to early adolescent stress. Neuroscience Research. 2021; 172: 63-72.‌##Richter-Levin G, Stork O, Schmidt MV. Animal models of PTSD: a challenge to be met. Molecular Psychiatry. 2019; 24(8): 1135-56.##Lisieski MJ, Eagle AL, Conti AC, Liberzon I, Perrine SA. Single-prolonged stress: a review of two decades of progress in a rodent model of post-traumatic stress disorder. Frontiers in Psychiatry. 2018; 9: 1-22.##Alway SE, Paez HG, Pitzer CR. The role of mitochondria in mediation of skeletal muscle repair. Muscles. 2023; 2(2): 119-63.##Mukhtar S, Xiaoxiong Z, Qamer S, Saad M, Mubarik MS, Mahmoud AH, et al. Hepatoprotective activity of silymarin encapsulation against hepatic damage in albino rats. Saudi Journal of Biological Sciences. 2021; 28(1): 717-23.##Kolb H, Martin S, Kempf K, Kolb H, Martin S, Kempf K. Traditional health practices may promote nrf2 activation similar to exercise. International Journal of Molecular Sciences. 2025; 26(23): 1-22.##Sivamaruthi BS, Raghani N, Chorawala M, Bhattacharya S, Prajapati BG, Elossaily GM, et al. NF-κB pathway and its inhibitors: a promising frontier in the management of Alzheimer’s disease. Biomedicines. 2023; 11(9): 1-14.##Lee B, Choi GM, Sur B. Silibinin prevents depression-like behaviors in a single prolonged stress rat model: the possible role of serotonin. BMC Complementary Medicine and Therapies. 2020; 20(1): 1-12.##Dresselhaus EC, Meffert MK. Cellular specificity of NF-κB function in the nervous system. Frontiers in Immunology. 2019; 10: 1-14.##Yang D, Su, J, Chen Y, Chen G. The NF-κB pathway: key players in neurocognitive functions and related disorders. European Journal of Pharmacology. 2024; 984: 1-19.##Hong C, Schüffler A, Kauhl U, Cao J, Wu CF, Opatz T, et al. Identification of NF-κB as determinant of posttraumatic stress disorder and its inhibition by the Chinese herbal remedy free and easy wanderer. Frontiers in Pharmacology. 2017; 8: 1-17.##Roberti A, Chaffey LE, Greaves DR. NF-κB signaling and inflammation-drug repurposing to treat inflammatory disorders? Biology (Basel). 2022; 11(3): 1-32.##Tseilikman VE, Tseilikman OB, Karpenko MN, Traktirov DS, Obukhova DA, Shatilov VA, et al. Unraveling the serotonergic mechanism of stress-related anxiety: focus on co-treatment with resveratrol and selective serotonin reuptake inhibitors. Biomedicines. 2024; 12(11): 1-21.##Pannu A, Sharma PC, Thakur VK, Goyal RK. Emerging role of flavonoids as the treatment of depression. Biomolecules. 2021; 11(12): 1-49.##Illesca-Matus R, Ardiles NM, Munoz F, Moya PR, Illesca-Matus R, Ardiles NM, et al. Implications of physical exercise on episodic memory and anxiety: the role of the serotonergic system. International Journal of Molecular Sciences. 2023; 24(14): 1-20.##Phillips C. Physical activity modulates common neuroplasticity substrates in major depressive and bipolar disorder. Neural Plasticity. 2017; 2017: 1-37.##Morikawa R, Kubota N, Amemiya S, Nishijima T, Kita I. Interaction between intensity and duration of acute exercise on neuronal activity associated with depression-related behavior in rats. The Journal of Physiological Sciences: JPS. 2021; 71(1): 1-11.##Rillich J, Stevenson PA. Serotonin mediates depression of aggression after acute and chronic social defeat stress in a model insect. Frontiers in Behavioral Neuroscience. 2018; 12: 1-12.##Strilbytska O, Koliada O, Lushchak V, Lushchak O. The effects of bioactive compounds on PTSD treatment. Current Neuropharmacology. 2025; 23(10): 1156-68.##Murrough JW, Czermak C, Henry S, Nabulsi N, Gallezot JD, Gueorguieva R, et al. The effect of early trauma exposure on serotonin type 1B receptor expression revealed by reduced selective radioligand binding. Archives of General Psychiatry. 2011; 68(9): 892-900.##Klempin F, Beis D, Mosienko V, Kempermann G, Bader M, Alenina N. Serotonin is required for exercise-induced adult hippocampal neurogenesis. The Journal of Neuroscience. 2013; 33(19): 8270-5.##Ranjan S, Gautam A. Pharmaceutical prospects of Silymarin for the treatment of neurological patients: an updated insight. Frontiers in Neuroscience. 2023; 17: 1-13.##Clemente-Suárez VJ, Martín-Rodríguez A, Curiel-Regueros A, Rubio-Zarapuz A, Tornero-Aguilera JF. Neuro-nutrition and exercise synergy: exploring the bioengineering of cognitive enhancement and mental health optimization. Bioengineering. 2025; 12(2): 1-59.##Heijnen S, Hommel B, Kibele A, Colzato LS. Neuromodulation of aerobic exercise—a review. Frontiers in Psychology. 2016; 6: 1-6.##Paraniak-Gieszczyk B, Ogłodek EA. Neurobiological and existential profiles in posttraumatic stress disorder: the role of serotonin, cortisol, noradrenaline, and IL-12 across chronicity and age. International Journal of Molecular Sciences. 2025; 26(19): 1-30.##Warner A, Iskander L, Allen K, Quatela I, Borrelli, H, Sachs B. The effects of brain serotonin deficiency on the behavioral and neurogenesis-promoting effects of voluntary exercise in tryptophan hydroxylase 2 (R439H) knock-in mice. Neuro Pharmacology. 2024; 258: 110082.##Khazaei R, Seidavi A, Bouyeh M. A review on the mechanisms of the effect of silymarin in milk thistle (Silybum marianum) on some laboratory animals. Veterinary Medicine and Science Logo. 2022; 8(1): 289-301.##Alaca N, Özbeyli D, Uslu S, Şahin HH, Yiğittürk G, Kurtel H, et al. Treatment with milk thistle extract (Silybum marianum), ursodeoxycholic acid, or their combination attenuates cholestatic liver injury in rats: Role of the hepatic stem cells. The Turkish Journal of Gastroenterology. 2017; 28(6): 476-84.##Basso JC, Suzuki WA. The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: a review. Brain Plasticity. 2017; 2(2): 127-52.## ##

Prediction of Existential Anxiety in Older Adults: The Effects of Meaning in Life and Dark Personality Traits Through Loneliness 2 2 Introduction: Existential anxiety is a fundamental psychological experience related to awareness of mortality, isolation, and meaninglessness, and it becomes more prominent in older adulthood due to aging-related changes. The present study aimed to examine the relationships among dark personality traits, meaning in life, loneliness, and existential anxiety in older adults, with emphasis on the mediating role of loneliness. Methods: This quantitative, cross-sectional correlational study was conducted using Structural Equation Modeling. The sample consisted of 204 older adults aged 60 years and above living in Khoy city, West Azerbaijan Province (2025–2026), selected through convenience sampling. Data were collected using standardized questionnaires assessing existential anxiety, meaning in life, dark personality traits, and loneliness. Analyses were performed using SPSS and SmartPLS, including Pearson correlation, SEM, and bootstrapping. Results: The results showed that dark personality traits were positively associated with loneliness (β = 0.48, p < 0.001) and existential anxiety (β = 0.51, p < 0.001). Meaning in life was negatively associated with loneliness (β = -0.46, p < 0.001) and existential anxiety (β = -0.58, p < 0.001). Loneliness also positively predicted existential anxiety (β = 0.55, p < 0.001). In addition, dark personality traits had a significant indirect effect on existential anxiety through loneliness (β = 0.26, p < 0.001), while meaning in life had a significant negative indirect effect through loneliness (β = -0.25, p < 0.001). Conclusion: Existential anxiety in older adults is influenced by both maladaptive personality traits and meaning in life, with loneliness playing a central mediating role. Strengthening meaning in life and reducing loneliness may be effective targets for reducing existential distress in late adulthood.   59 71 2025/12/72025/11/152026/04/262026/04/212025/11/192026/03/252026/04/28 1405/2/8 2026/05/92026/06/102026/05/102026/06/82025/12/172026/06/92026/05/10 1405/2/20 Shayan Maleki Shayan Maleki Department of Psychology, Faculty of Psychology and Educational Sciences, Islamic Azad University, Khoy Branch, Khoy, Iran Iran mrshayan1878khoy@gmail.com Rezvan Morsali Rezvan Morsali Department of Psychology, Faculty of Psychology and Educational Sciences, Islamic Azad University, Anar Branch, Iran Iran Nafiseh Sanaei Nafiseh Sanaei Department of Psychology, Faculty of Psychology and Educational Sciences, Islamic Azad University, Urmia Branch, Iran Iran Masoud Gorbanalipour Masoud Gorbanalipour Department of Psychology, Faculty of Psychology and Educational Sciences, Khoy Branch, Islamic Azad University, Khoy, Iran Iran masoudqorbanalipour@gmail.com Existential Anxiety Older Adults Meaning in Life Dark Personality Traits Loneliness Osborne JW. An existential perspective on death anxiety, retirement, and related research problems. Canadian Journal on Aging/La Revue Canadienne du Vieillissement. 2017; 36(2): 246-55.##Gawda B. Basic hope and existential anxiety among adulthood generations. Psychological Prospects Journal. 2022; 39: 44-55.##Maxfield M. An existential perspective on aging into older adulthood. In: Vail III KE, Van Tongeren DR, Schlegel RJ, Greenberg J, King LA, editors. Handbook of the science of existential psychology. The Guilford Press; 2026. P. 232.##Wong PT, Yu TT. Existential suffering in palliative care: an existential positive psychology perspective. Medicina. 2021; 57(9): 1-21.##Amirbagloie Daryani M, Marashi MK. Feeling guilty and anxiety in the elderly: the role of existential concerns. Aging Psychology. 2021; 7(1): 41-29.##Abad Y, Haroon Rashidi H. The Effectiveness of mindfulness-based cognitive therapy on rumination and existential anxiety in the elderly men. Aging Psychology. 2022; 8(1): 1-10. [Persian]##Barekati S, Bahmani B, Naghiyaaee M, Afrasiabi M, Marsa R. The effectiveness of cognitive-existential group therapy on reducing existential anxiety in the elderly. World Family Medicine Journal: Incorporating the Middle East Journal of Family Medicine. 2017; 99(5480): 1-9.##Sezer S, Gülleroğlu HD. The predictive power of life satisfaction and self-esteem in existential anxieties. European Journal of Education Studies. 2017; 3(7): 1-17.##Veysi B, Hamarta E, Koksal O. The correlations between the meaning of life, depression, stress and anxiety among university students. Agora Psycho-Pragmatica. 2014; 8(2): 36-50.##Yek MH, Olendzki N, Kekecs Z, Patterson V, Elkins G. Presence of meaning in life and search for meaning in life and relationship to health anxiety. Psychological Reports. 2017; 120(3): 383-90.##Kesebir P, Pyszczynski T. Meaning as a buffer for existential anxiety. Meaning in Positive and Existential Psychology. 2014: 53-64.##Pellens H, Dezutter J, Luyten P, Vanhooren S. To be scared or scared to be: existential anxiety as a mediator between meaning experience and depression. Journal of Humanistic Psychology. 2022: 66(3).##Shek DT, Chai W, Tan L. The relationship between anxiety and depression under the pandemic: The role of life meaning. Frontiers in Psychology. 2022; 13: 1-14.##Eken FO, Kaya ME. Understanding dark triad traits through the lens of existential theory: the roles of insight, meaning in life, and existential anxiety. Universitas Psychologica. 2025; 24: 1-11.##Shumaker D, Killian K, Cole C, Hruby A, Grimm J. Existential anxiety, personality type, and therapy preference in young adults. Journal of Humanistic Psychology. 2020; 60(6): 849-64.##Stynska V, Popovych I, Kravets N, Piletska L,Стинська ВВ. Research of the relationship between existential anxiety and the sense of personality’s existence. Revista Inclusiones. 2020; 7: 41-59.##Husain W, Babar F, Raza F, Trabelsi K, Pakpour AH, Jahrami H. The predictive role of personality disorders and personality traits in death anxiety. OMEGA-Journal of Death and Dying. 2024: 00302228241298137.##Diamond SA. Existential perspectives of psychopathy. In: The complexity of psychopathy. Cham: Springer International Publishing; 2022. pp. 413-58.##Masui K. Loneliness moderates the relationship between Dark Tetrad personality traits and internet trolling. Personality and Individual Differences. 2019; 150: 109475.##Masui K. Loneliness and dark personality. In: the handbook of loneliness. Cham: Springer Nature Switzerland; 2025.P. 105-17.##Kealy D, Finch EF. Pathological narcissism and loneliness. In: Nelson T. The Handbook of Loneliness. Springer Cham; 2025. P. 89-103.##Macià D, Cattaneo G, Solana J, Tormos JM, Pascual-Leone A, Bartrés-Faz D. Meaning in life: A major predictive factor for loneliness comparable to health status and social connectedness. Frontiers in Psychology. 2021; 12: 1-12.##Yıldırım M. Loneliness and psychological distress: A mediating role of meaning in life during COVID-19 pandemic. In: Gabrielli F, Irtelli F, editors. Anxiety, uncertainty, and resilience during the pandemic period-Anthropological and psychological perspectives. IntechOpen; 2021.##Kim C, Chun J. “Meaning in Life” mediates the relationship between loneliness and depressive symptoms among older adults during the COVID-19 pandemic. InHealthcare. 2024; 12(5): 1-11.##Borawski D. When you are lonely, look inside yourself: The moderating role of reflection in the relationship between loneliness and meaning in life. Personality and Individual Differences. 2022; 194: 1-6.##de Maio Nascimento M, Marques A, Gouveia ÉR, Green G, Lampraki C, Ihle A. The role of meaning in life in the association between loneliness and depression: a mediation study among older adults from 26 European countries. The Psychiatric Quarterly. 2024; 95(4): 599-617.##Bolmsjö I, Tengland PA, Rämgård M. Existential loneliness: An attempt at an analysis of the concept and the phenomenon. Nursing Ethics. 2019; 26(5): 1310-25.##Besharat MA, Khadem H, Zarei V, Momtaz A. Mediating role of perceived stress in the relationship between facing existential issues and symptoms of depression and anxiety. Iranian Journal of Psychiatry. 2020; 15(1): 80-7.##Alshehri H, Alturkestani R, Hijan B, Almalki S, Alobaidi R, Almufti S, et al. The prevalence of existential anxiety and its association with depression, general anxiety, and stress in Saudi university students. Middle East Current Psychiatry. 2024; 31(1): 1-9.##Davidov J, Russo-Netzer P. Exploring the phenomenological structure of existential anxiety as lived through transformative life experiences. Anxiety, Stress, & Coping. 2022; 35(2): 232-47.##Temple M, Gall TL. Working through existential anxiety toward authenticity: A spiritual journey of meaning making. Journal of Humanistic Psychology. 2018; 58(2): 168-93.##Arndt J, Vess M. Tales from existential oceans: Terror management theory and how the awareness of our mortality affects us all. Social and Personality Psychology Compass. 2008; 2(2): 909-28.##Sarstedt M, Ringle CM, Hair JF. Partial least squares structural equation modeling. In: Handbook of market research. Cham: Springer International Publishing; 2021. P.587-632.##van Bruggen V, Ten Klooster P, Westerhof G, Vos J, de Kleine E, Bohlmeijer E, et al. The Existential Concerns Questionnaire (ECQ)–development and initial validation of a new existential anxiety scale in a nonclinical and clinical sample. Journal of Clinical Psychology. 2017; 73(12): 1692-703.##Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: assessing the presence of and search for meaning in life. Journal of Counseling Psychology. 2006; 53(1): 80-93.##Mesrabadi J, Jafarian S, Ostovar N. Discriminative and construct validity of meaning in life questionnaire for Iranian students. International Journal of Behavioral Sciences. 2013; 7(1): 1–33.##Moshagen M, Hilbig BE, Zettler I. The dark core of personality. Psychological Review. 2018; 125(5): 656-88.##Ebrahimi Ghavam S. Psychometric properties of the Nine Dark Traits of Personality questionnaire by Moshagen, Hilbig and Zettler (2018). Quarterly Journal of Psychological Methods and Models. 2020; 11(41): 141–58.##DiTommaso E, Brannen C, Best LA. Measurement and validity characteristics of the short version of the social and emotional loneliness scale for adults. Educational and Psychological Measurement. 2004; 64(1): 99-119.##Hosseinzadeh Arani SS, Kalantari A. Religion, mental health and loneliness: examine the relationship between the level of religiosity and mental health with loneliness (study case: Tehran citizens). Journal of Applied Sociology. 2016; 26(4): 25–44. [Persian]##Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Routledge; 2013.##Martela F, Steger MF. The three meanings of meaning in life: distinguishing coherence, purpose, and significance. The Journal of Positive Psychology. 2016; 11(5): 531-45.##Temple M, Gall TL. Working through existential anxiety toward authenticity: a spiritual journey of meaning making. Journal of Humanistic Psychology. 2018; 58(2): 168-93.##Lee RT, Surenkok G, Zayas V. Mitigating the affective and cognitive consequences of social exclusion: an integrative data analysis of seven social disconnection interventions. BMC Public Health. 2024; 24(1): 1-15.## ##

Effectiveness of Tele-nursing Supportive Educational Intervention Based on Health Belief Model on Preventive Behaviors of Urinary Tract Infection in People with Spinal Cord Injury: A Protocol Study 2 2 Introduction: Urinary tract infection (UTI) is one of the complications of people with spinal cord injury (SCI). The present study aims to design a protocol for the effectiveness of a telenursing educational intervention based on the health belief model (HBM) on preventive behaviors against UTI in people with SCI in Iran. Methods: The present study is a randomized controlled trial protocol that will be conducted in 44 individuals with SCI and UTI in rehabilitation centers in Shahrekord, Iran in 2025. The design of this study includes three phases. The first phase of the study is to design a researcher-made questionnaire based on the Health Belief Model (HBM) to assess knowledge, attitude, and preventive behavior of UTI in people with SCI. In the second phase of the study, a telenursing educational-support program will be designed. The third phase will include a pre-test, implementation of the educational intervention, and a post-test two months after the intervention in the intervention and control groups. Data analysis will be performed with SPSS-23 software. Discussion: This study presents a novel approach to promote preventive behaviors against UTI in individuals with SCI by designing an integrated educational protocol based on telenursing and the HBM. The findings of this study can lead to a significant reduction in complications from UTI and improve the quality of life of these patients.   72 79 2025/12/72025/11/152026/04/262026/04/212025/11/192026/03/252026/04/282026/05/22 1405/3/1 2026/05/92026/06/102026/05/102026/06/82025/12/172026/06/92026/05/102026/06/18 1405/3/28 Alireza Mohammadi Alireza Mohammadi Department of Nursing, Shk.C., Islamic Azad University, Shahrekord, Iran Iran Fatemeh Karamizadeh Fatemeh Karamizadeh Department of Nursing, Shk.C., Islamic Azad University, Shahrekord, Iran Iran Zohreh Karimiankakolaki Zohreh Karimiankakolaki Department of Health, Shk.C., Islamic Azad University, Shahrekord, Iran Iran zohrehkarimian68@gmail.com Health Belief Model Urinary Tract Infection Spinal Cord Injury Education Telenursing National Spinal Cord Injury Statistical Center. Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham; 2021.##Lavelle JP. Intermittent catheters: to reuse or not. Spinal Cord Series and Cases. 2020; 6: 1-2.##Chang SC, Zeng S, Tsai SJ. Outcome of different approaches to reduce urinary tract infection in patients with spinal cord lesions: a systematic review. American Journal of Physical Medicine & Rehabilitation. 2020; 99(11): 1056-66.##Milligan J, Goetz LL, Kennelly MJ. A primary care provider's guide to management of neurogenic lower urinary tract dysfunction and urinary tract infection after spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2020; 26(2): 108-15.##D'Hondt F, Everaert K. Urinary tract infections in patients with spinal cord injury. Current Infectious Disease Reports. 2011; 13(6): 544-51.##Garcia-Arguello LY, Gater DR Jr. Urinary tract infection in the patient with spinal cord injury. Physical Medicine and Rehabilitation Clinics of North America. 2021; 32(2): 351-67.##Taghdisi MH, Nejadsadeghi E. The effect of health education based on health belief model on behavioral promotion of urinary infection prevention in pregnant women. Journal of Research & Health. 2012; 2(1): 44-54.##Mohammad ACS, Mirghafourvand M, Rahmani A, Seidi S, Safari E, Mahini M, et al. The effect of software on knowledge and performance of teenage girls toward puberty hygiene: a randomized controlled trial. Iranian Journal of Medical Education. 2014; 14(2): 110-21.##Nageswaran L, Giurleo C, Seliman M, Askes HK, Abu-Jurji Z, Craven BC, et al. Parkwood's VIP4SCI platform: A virtual e-health self-management solution for persons with spinal cord injury across the care continuum. Digital Health. 2024; 10: 1-13.##Lee S, Kim J, Kim J. Substantiating clinical effectiveness and potential barriers to the widespread implementation of spinal cord injury telerehabilitation: a systematic review and qualitative synthesis of randomized trials in the recent past decade. Telemedicine Reports. 2021; 2(1): 64-77.##Tabari L, Kamada I, Rabeh SAN, Nogueira PC. Nursing teleconsultation for people with spinal cord injury: nurses' opinion on the main guidelines. ESTIMA, Brazilian Journal of Enterostomal Therapy. 2023; 21: 1475.##Behzad Y, Bastani F, Haghani H. Effect of empowerment program with the telephone follow-up (tele-nursing) on self-efficacy in self-care behaviors in hypertensive older adults. Nursing and Midwifery Journal. 2016; 13(11): 1004-15.##Seyed-Rajabizadeh S, Shojaizadeh D. The effect of educational intervention based on health belief model on the promotion of preventive behaviors of urinary tract infections in pregnant women referred to comprehensive health centers in Dezful, Iran, 2019-2020. Journal of Health System Research. 2021; 17(2): 104-10.##Ashta K, Mohan C, Nair BT, Arora S. Study of prevalence, microbiologic agents, and bladder management methods of urinary tract infections among spinal cord injury patients. Archives of Medicine and Health Sciences. 2023; 11(1): 64-69.##Javaheri Tehrani F, Nikpour S, Haji Kazemi EA, Sanaie N, Panahi SAS. The effect of education based on health belief model on health beliefs of women with urinary tract infection. International Journal of Community Based Nursing and Midwifery. 2014; 2(1): 2-11.##Gibson NA, Arends R, Hendrickx L. Tele-U to tele-ICU: telehealth nursing education. Critical Care Nurse. 2021; 41(5): 34-9.##Madadkar Dehkordi S, Okhovat F, Karimiankakolaki Z. Designing a clinical trial protocol about the impact of family-based multimedia education based on telephone tracking (tele nursing) to improve the quality of life and self-efficacy in patients with myocardial infarction. International Journal of Surgery Protocols. 2021; 25(1): 92-7.##Rizk S, Siam B. Effect of tele-nursing education program on nurses’ compliance with standard precautions during COVID-19 pandemic. Assiut Scientific Nursing Journal. 2021; 9(25): 10-9.## ##

Yogic Dietary Interventions for Nutritional Health and Well-Being in Older Adults: A Systematic Review and Conceptual Framework 2 2 Introduction: Geriatric malnutrition is a pervasive clinical and public health challenge linked to functional decline, increased hospitalization rates, and diminished quality of life. Traditional Indian dietary systems, rooted in the classical frameworks of Yoga and Ayurveda, offer structured, culturally embedded philosophical approaches to nutritional management in older adults. Despite growing scholarly and clinical interest, the evidence base for Yogic dietary interventions in geriatric populations has not yet been formally synthesized. Methods: A systematic literature search was conducted across PubMed/MEDLINE, ScienceDirect, Google Scholar, Semantic Scholar, JSTOR, and Indian databases (IAMJ, IndMED, Cureus), supplemented by hand-searching classical primary sources. Studies enrolling community-dwelling older adults who received Yogic or Ayurvedic dietary interventions and reported validated nutritional outcomes were eligible. Two reviewers independently screened records, extracted data, and assessed methodological quality. Results: Six empirical studies and four classical textual sources were included. Yogic dietary interventions consistently improved Mini-Nutritional Assessment (MNA) scores across studies. Two RCTs and two pre-post interventional studies demonstrated consistent improvements in MNA scores and malnutrition risk reduction following dietary and nutrition education interventions. The methodologically strongest available Indian evidence demonstrated a rise in mean MNA from 21.4 ± 1.12 to 23.15 ± 1.71 (p < 0.001), substantially improving mean MNA scores from the at-risk range (21.4) to near the normal threshold (23.15). A community-based interventional study (n = 205)  confirmed a significant reduction in malnutrition prevalence from 40.5% to 30.7% (p < 0.05). A novel Panchakosha-Nutritional Integration Model is proposed, mapping classical Yogic constructs onto five modern nutritional and well-being domains. Conclusion: Yogic dietary interventions appear to be associated with improved nutritional well-being in older adults, though causal inference is limited by the observational nature of most included studies. The proposed Panchakosha model offers a translational framework for integrating these ancient principles into geriatric nutrition research and practice. Larger, multi-centre trials incorporating biochemical markers and extended follow-up are recommended.   80 93 2025/12/72025/11/152026/04/262026/04/212025/11/192026/03/252026/04/282026/05/222026/05/3 1405/2/13 2026/05/92026/06/102026/05/102026/06/82025/12/172026/06/92026/05/102026/06/182026/06/14 1405/3/24 Divya Sharma Divya Sharma School of Buddhist Studies, Philosophy & Comparative Religions / School of Languages and Literature/Humanities, Nalanda University, Rajgir, Bihar, India India mdivyarkl@gmail.com Yogic Diet Malnutrition Circadian Nutrition Systematic Review Ayurveda World Health Organization. Ageing and health [Internet]. 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health##Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider ST, et al. Introductory to the ESPEN Guidelines on enteral nutrition: terminology, definitions and general topics. Clinical Nutrition. 2006; 25(2): 180-6.##White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition. Journal of Parenteral and Enteral Nutrition. 2012; 36(3): 275-83.##Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas. 2013; 76(4): 296-302.##Rasheed S, Woods RT. Malnutrition and quality of life in older people: a systematic review and meta-analysis. Ageing Research Reviews. 2013; 12(2): 561-6.##Sullivan DH, Bopp MM, Roberson PK. Protein-energy undernutrition and life-threatening complications among the hospitalized elderly. Journal of General Internal Medicine. 2002; 17(12): 923-32.##Govindaraju T, Owen AJ, McCaffrey TA. Past, present and future influences of diet among older adults -- a scoping review. Ageing Research Review. 2022; 77: 101600.##Morley JE. Undernutrition in older adults. Family Practice. 2012; 29(Suppl 1): 89-93.##Neumann SA, Miller MD, Daniels L, Crotty M. Nutritional status and clinical outcomes of older patients in rehabilitation. Journal of Human and Nutrition and Dietetics. 2005; 18(2): 129-36.##Firth J, Gangwisch JE, Borsini A, Wootton RE, Mayer EA. Food and mood: how do diet and nutrition affect mental wellbeing? BMJ. 2020; 369: 2382.##Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Ruusunen A. Dietary recommendations for the prevention of depression. Nutritional Neuroscience. 2017; 20(3): 161-71.##Kris-Etherton PM, Petersen KS, Hibbeln JR, Hurley D, Kolick V, Peoples S. Nutrition and behavioral health disorders: depression and anxiety. Nutrition Reviews. 2021; 79(3): 247-60.##Chapple CK, editor. The Bhagavad Gita [Sargeant W, trans]. 25th anniversary ed. Albany: State University of New York Press; 2009. Chap. 17, P. 7-10.##Muktibodhananda S. The Hatha Yoga Pradipika [Akers BD, trans]. Woodstock: YogaVidya.com; 2002. Chap. 1, P. 59-63.##Mallinson J. The shiva samhita: a critical edition and an English translation. Woodstock: YogaVidya.com; 2007. Chap. 3, P. 33-39.##Chordia N. Concept of yogic diet according to yoga literature. International Journal of Physiology, Nutrition and Physical Education Sports Health. 2018; 3(2): 2255-57.##Sharma A. Sushrut Samhita of Sushrut, Chikitsasthan. Chap. 24, Verse 68. Varanasi: Choukhamba Surbharti Prakashan; 2015: 362.##Shrilakshmipatishastri V. Vidyotini Hindi Tika on Yogratnakar, Nityapravruttiprakar. Varanasi: Choukhamba Prakashan; 2021. P. 140.##Leitzmann C. Vegetarian diets: what are the advantages? Forum of Nutrition. 2005; 57: 147-56.##Flanagan A, Bechtold DA, Pot GK, Johnston JD. Chrono-nutrition: from molecular and neuronal mechanisms to human epidemiology and timed feeding patterns. Journal of Neurochemistry. 2021; 157(1): 53-72.##Agnivesha. Charaka Samhita (revised by Charaka and Dridhabala), with Ayurveda Dipika commentary by Chakrapanidatta, ed. Yadavji Trikamji Acharya. Varanasi: Chaukhamba Sanskrit Sansthan; 2016.##Shuremu M, Hassen Abate K, Belachew T. Effect of nutrition education intervention to improve dietary diversity practice and nutritional status of the older people: A cluster randomized controlled trial. Food Science & Nutrition. 2023; 11(10): 6071–83.##Carcelén-Fraile MC, Martín-Baute MR, Ledesma-Cerrato MI, Castellote-Caballero Y, González-Martín AM, Hita-Contreras F, et al. Effects of a yoga program combined with a Mediterranean diet on nutritional status and functional capacity in community-dwelling older adults: A randomized controlled clinical trial. Nutrients. 2024; 16(11): 1601.##Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Anbar R, Gross Nevo RF, et al. Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients. Clinical Nutrition. 2016; 35(5): 1053-8.##Krishnamoorthy Y, Vijayageetha M, Saya GK. Validation and reliability assessment of the Mini-Nutritional Assessment–Short Form questionnaire among older adults in South India. Indian Journal of Community Medicine. 2021; 46(1): 70–4.##Shalini T, Chitra PS, Naveen Kumar B, Madhavi G, Bhanuprakash Reddy G. Frailty and nutritional status among urban older adults in South India. Journal of Aging Research. 2020; 2020: 1-11.##Karthikeyan MS, Vijaykumar P, Chandana L, Paul AB. Impact of nutritional education in malnourished elderly patients with the comparison of mini nutritional assessment (MNA) score. Journal of Family Medicine and Primary Care. 2021; 10(3): 1167–70.##Meena JJ, Singh A, Gupta N, Meena GS. Effect of health education on nutritional status of elderly population in a rural area in Delhi: An interventional study. Cureus. 2025; 17(5): 1-8.##The Gheranda Samhita: the original Sanskrit and an English translation [Mallinson J, trans]. Woodstock: YogaVidya.com; 2004. Chap. 5, P. 16-21.##Manoogian ENC, Chaix A, Panda S. When to eat: the importance of eating patterns in health and disease. Journal of Biological Rhythms. 2019; 34(6): 579-81.##Fontana L, Partridge L, Longo VD. Extending healthy life span -- from yeast to humans. Science. 2010; 328(5976): 321-6.##Longo VD, Anderson RM. Nutrition, longevity and disease: from molecular mechanisms to interventions. Cell. 2022; 185(9): 1455-70.##Dahl WJ, Zhu H, Guan G, Telle-Hansen VH. Dietary fibre, gut microbiota and metabolic regulation -- current status in human randomised trials. Nutrients. 2023; 15(9): 1-18.##Cryan JF, O'Riordan KJ, Cowan CSM, Sandhu KV, Bastiaanssen TFS, Boehme M, et al. The microbiota-gut-brain axis. Physiological Reviews. 2019; 99(4): 1877-2013.##Lane MM, Gamage E, Travica N, Dissanayaka T, Ashtree DN, Gauci S, et al. Ultra-processed food consumption and mental health: A systematic review and meta-analysis of observational studies. Nutrients. 2022; 14(13): 1-22.##Valmorbida E, Trevisan C, Imoscopi A, Mazzochin M, Manzato E, Sergi G. Malnutrition is associated with increased risk of hospital admission and death in the first 18 months of institutionalization. Clinical Nutrition. 2020; 39(12): 3687-94.##Fernandez-Barres S, Garcia-Barco M, Basora J, Martínez T, Pedret R, Arija V, et al The efficacy of a nutrition education intervention to prevent risk of malnutrition for dependent elderly patients receiving Home Care: A randomized controlled trial. International Jourmal of Nursing Studies. 2017; 70: 131-41.##Gomez G, Botero-Rodriguez F, Misas JD, Garcia-Cifuentes E, Sulo S, Brunton C, et al. A nutritionally focused program for community-living older adults was associated with improved health and well-being. Clinical Nutrition. 2022; 41(7): 1549-56.##Morley JE, Miller DK, Perry HM, Patrick P, Guigoz Y, Vellas B. Anorexia of aging, leptin, and the Mini Nutritional Assessment. Nestle Nutrition Workshop Series: Clinical & Performance Programme. 1999; 1: 67-76.##Tapsell LC, Hemphill I, Cobiac L, Patch CS, Sullivan DR, Fenech M, et al. Health benefits of herbs and spices: the past, the present, the future. The Medical Journal of Australia. 2006; 185(S4): 1–24.##Wu KL, Rayner CK, Chuah SK, Changchien CS, Lu SN, Chiu YC, et al. Effects of ginger on gastric emptying and motility in healthy humans. Europen Journal of Gastroenterology & Hepatology. 2008; 20(5): 436-40.##Rao SSC, Rattanakovit K, Patcharatrakul T. Diagnosis and management of chronic constipation in adults. Nature Reviews, Gastroenterology & Hepatology. 2016; 13(5): 295-305.##Bloom HG, Ahmed I, Alessi CA, Ancoli-Israel S, Buysse DJ, Kryger MH, et al. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. Journal of the American Geriatrics Society. 2009; 57(5): 761-89.##Peuhkuri K, Sihvola N, Korpela R. Diet promotes sleep duration and quality. Nutrition Research. 2012; 32(5): 309-19.##Iyengar BKS. Light on Yoga. London: HarperCollins; 2005## ##