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Reflections On Delictual And Contractual Fault In The Dahir Of Obligations And Contracts, Françoise Monéger

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Françoise Monéger examines whether the Moroccan DOC's alleged "defect" in not strictly maintaining the distinction between tortious and contractual obligations might actually be an advantage. Citing a 1944 author who attributed this blurring to the DOC's complex origins reconciling European legislations with Islamic law, Monéger notes that French doctrine now questions this distinction due to its absurdities and difficulties. She observes that Moroccan jurisprudence has not always rigorously respected the separation, with many decisions basing liability on tortious obligation articles (77 ff.) even when parties were bound by contract. She suggests the DOC may resemble recent codes that unify both …

From The Civilist Conception Of Contractual Unilateral Termination To The Statutory Notion Of Dismissal, A Bouadhain

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

A. Bouadhain examines the evolution from civil law's contractual approach to unilateral termination toward labor law's statutory concept of dismissal in Moroccan law. The study analyzes how employment relationship cessation differs from standard contract termination. The author outlines various forms of cessation: suspension of the employment relationship (exclusive causes, illness, disciplinary layoff, force majeure), employee resignation, mutual agreement termination, non-renewal of fixed-term contracts, unilateral and substantial modification of indefinite-term contracts, and employer-fault termination. This research highlights the tension between civil law's individualistic contractual framework and labor law's protective statutory regime, demonstrating how employment termination requires distinct legal treatment beyond traditional …

Unconditional Guarantees In International Trade And Moroccan Law Of Obligations And Contracts, François-Paul Blanc Blanc

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

François-Paul Blanc explains that the global market shift to a "buyer's market" has prioritized buyer guarantees over the past fifteen years. Importers now protect themselves against all risks linked to potential exporter default, particularly in developing countries where industrial installations cannot always be precisely evaluated by local experts. The exporter's guarantee obligation is often considered insufficient. For major equipment markets, third-party guarantees from entities with unquestionable financial stature are systematically required by project owners who can impose their conditions due to competitive bidding. These conditions frequently take the form of autonomous security instruments, whose validity under Moroccan law remains subject …

The Dahir Of Obligations And Contracts And Social Law, Ahmed El Aouani

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Ahmed El Aouani narrows the broad field of social law to focus on individual labor relations. He addresses whether labor law's autonomy from civil law is fiction or necessity, as labor law embodies a more protective philosophy. While scholars disagree on absolute autonomy, they unanimously recognize two distinct spirits: civil law as "conservative" and labor law as a recognized haven of "progressivism." El Aouani rejects the idea of absolute autonomy for individual labor relations, noting that despite increased state intervention, the individual employment contract remains the true source of party obligations. However, he argues it is necessary to alter and …

The Dahir Of Obligations And Contracts And International Contracts In Private Law, Layachi Messaoudi

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Layachi Messaoudi notes that one of the most striking post-war characteristics is the unprecedented development of international trade. States now participate directly or indirectly in commercial exchanges, contributing to the emergence of international trade law as a new branch of private law. This has resulted in a proliferation of contracts and the triumph of arbitration. Practice has developed contractual techniques resistant to traditional legal categories, such as turnkey contracts, leasing, factoring, renting, know-how, and technical assistance. A central question, particularly when public legal entities face foreign private parties, concerns which law applies to these contracts. Uncertainty in this area, amplified …

The Dahir Of Obligations And Contracts As A Fundamental Source Of Commercial Law, Mohamed El Mernissi

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Mohamed El Mernissi addresses the apparent paradox of considering a civil code as a fundamental source of commercial law, given that commercial law's autonomy has long been established. He notes that after breaking away from civil law, commercial law became conquering and imperialistic, increasingly invading civil law. This encroachment led to what scholars call the "commercialization of civil law." This phenomenon occurs because civil law cannot remain indefinitely isolated from economic life. Non-merchants also need commercial techniques: everyone uses checks, bills of exchange, promissory notes, credit for purchases, bank operations, and securities investments without necessarily having legal status as a …

On The Scope Of Application Of The Doc: Beyond A Border Conflict, Omar Azziman

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Omar Azziman argues that despite the DOC being seventy years old, questions about its scope of application remain relevant. Determining which legal acts fall under the DOC is not obvious beyond formal boundaries. The stakes extend beyond border disputes due to current jurisprudential uncertainties and resulting legal insecurity. More importantly, the debate reignites questions about the sources inspiring Moroccan justice. Under the protectorate, pluralism was institutionalized: the DOC applied only before French courts in the southern zone and governed primarily foreigners appearing before modern courts. Moroccans, as litigants before traditional law courts, remained outside the DOC's scope. This historical duality …

Biography Of The Code Of Obligations And Contracts: From Reception To Assimilation Of A Foreign Code In The Moroccan Legal Order, Joël Monéger

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Joël Monéger examines the journey of Morocco's Code of Obligations and Contracts (DOC) from its forced reception to its eventual assimilation. He notes that historically, Greek cities and modern Italian republics often entrusted foreigners with establishing their laws. Similarly, the DOC was introduced to Morocco under the French protectorate. The study is divided into two parts. First, he analyzes the forced reception of the DOC, its French origins, and its relationship with existing Moroccan law. Second, he explores how litigants and judges adapted to applying the DOC, including their reforms, resistance, and the validation of contractual stipulations contrary to the …

The Theory Of Simulation In Light Of The Law Of Obligations And Contracts, Mohammed Chaibi Elmadkouri

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Mohamed Chaabi Al Madkouri examines the theory of simulation in Moroccan contract law. Simulation is a tool used by some individuals to conceal the true nature of their legal transactions by presenting a fictitious appearance as real. People resort to simulation when the law does not fulfill their ambitions or when revealing the truth would cause them harm, particularly when their activities violate legal rules. The author highlights the central legal problem: balancing respect for the contracting parties who created the simulation with protecting the rights of third parties who are misled by it. He observes that for every genuine …

Article 230 Of The Moroccan Law Of Obligations And Contracts, Zaid Kadri Al Tarjuman

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Zaid Kadri Al Tarjuman examines Article 230 of the Moroccan Law of Obligations and Contracts, which states that contractually created obligations validly formed stand as law for those who created them and cannot be revoked except by mutual consent or in cases provided by law. This article establishes the principle of the authority of the will (principe de l'autonomie de la volonté), resting on two rules: the contract is the law of the parties, and a contract cannot be revoked without mutual consent or legal exception. However, the author notes that exceptions exist to this principle, some found within the …

The Legal Foundations Of Unfair Competition Under Article 84 Of The Moroccan Law Of Obligations And Contracts, Choukri Ahmed Sebai

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Choukri Ahmed Sebai compares the Moroccan Dahir of Obligations and Contracts (DOC) to an ocean, noting that like the sea, it is too vast for any researcher to fully grasp in a single article. The DOC serves as the common law (general law) of Morocco, serving as the general legal framework to which judges and lawyers refer whenever a specific law (commercial, administrative, financial, etc.) lacks a relevant provision. The author emphasizes the DOC's deep connection to human life and economic activity, including agriculture, industry, and trade. Within this broader context, the study specifically examines the legal foundations of unfair …

The Conflict Between Maliki Jurisprudence And The Dahir Of Obligations And Contracts Regarding Non-Registered Real Estate, Amine El Kechir

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Amine El Kechir examines the conflict between Maliki jurisprudence and Morocco's Dahir of Obligations and Contracts (DOC) concerning non-registered real estate. Registered properties follow the DOC, while non-registered properties traditionally fall under Maliki rules. Although the DOC became the general reference for Moroccan judges in 1965, judicial practice remains divided for non-registered land. Historically, the Maliki school dominated Morocco since the Idrisid dynasty, spread by scholars returning from Medina. This persistent legal duality creates uncertainty in adjudicating property rights. The author argues that resolving this conflict is essential for legal coherence and calls for a clearer framework to harmonize modern …

How To Read The Dahir Of Obligations And Contracts?, Ahmed Khamlichi

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Ahmed Khamlichi, Professor at the Faculty of Law in Rabat, questions how to approach Morocco's Dahir of Obligations and Contracts. He asks whether to interpret it through its Latin legal source, treat that source merely as comparative law, or distinguish between the various origins of the DOC. Before answering, he emphasizes the need to clarify the DOC's sources. He criticizes scholars for debating whether French law or Islamic Sharia influenced the text more, noting that many misuse the term "Sharia." According to Khamlichi, Sharia refers strictly to explicit Quranic and Sunnah rules, while most DOC provisions belong to Islamic jurisprudence …

A Critical Reading Of The Dahir Of Obligations And Contracts, Mohamed Chaabi Al Madkouri

Revue Marocaine de Droit, d'Economie et de Gestion (Moroccan Journal of Law, Economics and Management)

Mohamed Chaabi Al Madkouri introduces private law, noting that civil law is its foundation. Other branches emerged to regulate specific relationships requiring special rules. When no specific text exists, civil law serves as the reference. Civil law is practically divided into three parts: 1) rights of persons and family (marriage, lineage), 2) financial rights including real rights (property, usufruct) and personal rights or obligations, and 3) contribution contracts. The author mentions Roman law, which governed relations among Romans but not foreigners, and the French civil code, which borrowed heavily from Roman and canon law, influenced many modern Arab legal systems, …

Prevalence Of Hyperprolactinemia And Its Association With Menstrual Abnormalities And Hypothyroidism Among Infertile Women: A Cross-Sectional Study From Saudi Arabia, Aseel Y. Alwahhabi, Rahaf H. Labban, Maryam Y. Alshaikh, Amal M. Alanazi, Samaher S. Alfaraj, Fahad M. Alsalman, Hayat A. Alrabiea

Saudi Medical Journal

Objectives: To determine the prevalence of hyperprolactinemia among infertile women and assess its association with menstrual irregularities and hypothyroidism in a tertiary-care setting in Riyadh, Saudi Arabia.

Methods: A cross-sectional study was conducted between September 2022 and August 2023 at the Reproductive Endocrinology and IVF Unit, King Abdulaziz Medical City, Riyadh. Electronic medical records of 480 infertile women who met the inclusion criteria were reviewed. Data on demographic characteristics, infertility type, thyroid status, and serum prolactin levels were collected and analyzed using SAS version 9.4. Statistical significance was set at p < 0.05.

Results: Hyperprolactinemia was identified in 27.7% of infertile women, …

Polysomnographic And Clinical Characteristics Of Narcolepsy In Saudi Arabia: A 12-Year Retrospective Study, Banan Almalki, Omar Kanbr, Ghufran Bin Afeef, Shaimaa Hawsawi, Ranya Alshumrani, Faris Alhejaili, Siraj Wali

Saudi Medical Journal

Objective: To evaluate the clinical features, polysomnographic findings, and therapeutic outcomes of narcolepsy type 1 and type 2 patients in Kingdom of Saudi Arabia (KSA). Narcolepsy is a neurological condition marked by excessive daytime sleepiness (EDS) and associated symptoms, including cataplexy and disrupted nighttime sleep. Data on narcolepsy in KSA are still limited.

Methods: Forty-three patients diagnosed with narcolepsy from 2012 to 2024 were included in this retrospective study. Diagnosis followed the International Classification of Sleep Disorders criteria and incorporated clinical features, the epworth sleepiness scale (ESS), overnight polysomnography (PSG), and multiple sleep latency testing (MSLT). Data on demographics, clinical …

Lived Experiences And Perceptions Of People With Knee Osteoarthritis In Saudi Arabia: A Qualitative Study, Sultan A. Alanazi, Amjad S. Alhabishi, Rana O. Alawafi, Samia A. Alamrani

Saudi Medical Journal

Objectives: To explore how people with knee osteoarthritis (OA) in Kingdom of Saudi Arabia (KSA) perceive and live with their condition, how they self-manage symptoms, and how they experience physiotherapy and rehabilitation services.

Methods: A descriptive qualitative study was conducted using semi-structured interviews. Interviews were undertaken with individuals with knee OA who are aged ≥ 45 years. Interviews were audio-recorded, transcribed verbatim, de-identified and analyzed using reflexive thematic analysis with investigator triangulation.

Results: Twenty-seven (19 females) participants aged 45–74 years (mean = 61) from different regions of KSA shared lived experiences of knee OA. Four themes describing participants' experiences …

Prevalence And Risk Factors Of Surgical Site Infections In Hospitals Across Al Madinah Al Munawwarah, Saudi Arabia: A Retrospective Cohort Study, Atheer M. Aljohani, Danah O. Sandaqji, Rana A. Alahmadi, Raha Z. Ishqi, Manal A. Alanazi, Shouq N. Aloufi, Husain I. Sandugji

Saudi Medical Journal

Objectives: To determine the prevalence of surgical site infection (SSI) and identify associated risk factors in hospitals in Al Madinah Al Munawwarah, Saudi Arabia.

Methods: We conducted a retrospective cohort study of 363 adult surgical patients from major hospitals in Madinah between 2023 and 2024. We analyzed medical records using descriptive statistics, bivariate analysis, and multivariable logistic regression.

Results: The overall SSI rate was 5.2% (95% confidence interval [CI]: 3.3–7.9%). Infection types comprised superficial incisional (57.9%), deep incisional (36.8%), and organ/space infections (5.3%). Significant risk factors included younger age (adjusted odds ratio [aOR] = 0.94 per year, p = 0.014), …

A Predictive Model For Cytomegalovirus Infection Using Routine Hematological And Biochemical Parameters: A Pilot Study, Ahmad A. Shaikh, Mofareh H. Alabdaly, Nabil A. Ageeli, Sultan Z. Alasmari, Adel M. Abo Mansour, Mohammed H. Makkawi

Saudi Medical Journal

Objective: To examine whether hematological and biochemical parameters assist in diagnosing cytomegalovirus (CMV) infections and differentiating between CMV-G and CMV-M. Cytomegalovirus causes distinct hematological changes that can serve as markers for diagnosis.

Methods: A retrospective analysis was conducted on 54 patients infected with CMV (25 CMV-G and 29 CMV-M) and 82 healthy controls. Age, gender, and routine hematological and biochemical parameters were evaluated. Receiver operating characteristics (ROC) analysis and logistic regression were used for data analysis.

Results: In comparison to controls, laboratory findings of patients with CMV-G revealed characteristic decreases in red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), and …

Safety And Efficacy Of Adalimumab Biosimilar In Psoriasis And Hidradenitis Suppurativa: A Clinical Experience, Raneem H. Najjar, Sarah O. Alrashid, Rnda F. Almahfouz, Hadeel T. Alzahrani, Majed Y. Aleissa, Alanoud R. Hakami

Saudi Medical Journal

Objectives: To evaluate the clinical experience, safety, and effectiveness of adalimumab biosimilars in patients with psoriasis and hidradenitis suppurativa.

Methods: We conducted a retrospective, single-center observational study between March and September 2024 using electronic medical records from King Abdulaziz Medical City and King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Pediatric and adult patients with psoriasis or hidradenitis suppurativa who switched to adalimumab biosimilars between 2016 and 2022 were included. Variables included demographics, disease characteristics, prior therapies, biosimilar use, and adverse events.

Results: A total of 57 (93% adults; 50.9% female) patients were included. Obesity was present in 35.1%, and …

Immunoinformatic Based Development Of A Multi-Epitope Precision Vaccine Targeting Glycoprotein And Rdrp Of Oropouche Virus: An Innovative Approach To Counter Emerging Public Health Threats, Mohammed Alissa, Muhammad Suleman

Saudi Medical Journal

Objectives: To design high immunogenic vaccine against the Oropouche virus (OROV). The OROV is a neglected arbovirus endemic to Central and South America, causes oropouche fever, which can progress to severe complications such as meningitis and hemorrhagic symptoms.

Methods: We utilized immunoinformatic and molecular dynamic simulation approaches to design highly immunogenic vaccines against OROV. This observational study, carried out between January and August 2024 in Saudi Arabia. As it involves an in-silico method, ethical consent was not required.

Results: Docking analysis confirmed the stable interaction of the designed vaccines with human toll-like receptors (TLR)-3, producing binding scores of –300.78, –306.19, …

Comparison Of The Effects Of Incubator And Radiant Environments On Physiological Criteria And Pain-Stress Levels During Heel Lance In Neonates In The Neonatal Intensive Care Unit: A Randomized Controlled Trial, Sezin Gürsu, Birsen Karaca Saydam, Oğuzhan Kalkanl\I

Saudi Medical Journal

Objectives: To compare the effects of incubator and radiant heat on physiological criteria and pain-stress levels during heel prick procedures in newborns in the neonatal intensive care unit (NICU).

Methods: This randomized controlled quasi-experimental study was conducted between June and December 2023 with newborns diagnosed with IHB hospitalized at a NICU in Turkey. Prior to the heel prick procedure, 72 newborns (gestational age: 37–41 weeks) were randomly and equally assigned to either a radiant heater or an incubator setting. Physiological parameters (temperature, SpO₂, heart rate [HR]) and pain-stress scores of the newborns were measured and compared in both …

Etiology, Management, And Outcomes Of Hospitalized Heart Failure Patients: A Single-Center Study, Adil I. Jumani, Ghada A. Rashwan, Hadiza O. Ibrahim, Safaa M. Almohdar, Khaled M. Alfakih

Saudi Medical Journal

Objectives: To describe the clinical characteristics, etiologies, management patterns, and outcomes of hospitalized heart failure patients in a tertiary care military hospital in United Arab Emirates (UAE), and to benchmark guideline directed medical therapy (GDMT) uptake and care models against regional and international registries.

Methods: We retrospectively reviewed all consecutive patients admitted with a primary diagnosis of heart failure between January and December 2024, at Zayed Military Hospital, UAE. Clinical data were extracted from electronic medical records. The GDMT adherence was assessed according to the 2022 American Heart Association (AHA)/ American College of Cardiology (ACC) and 2023 European Society of …

Identification Of Risk Factors For Renal Insufficiency In Primary Membranous Nephropathy, Lin Qi, Bolong Fang, Xiao Fang, Yamin Yu, Yunqiang Wang

Saudi Medical Journal

Objectives: To identify possible evidence linking certain characteristics associated with primary membranous nephropathy (PMN) to renal failure progression in patients diagnosed with PMN and to establish probable evidence of an association between PMN and other risk factors leading to end-stage renal failure.

Methods: A historical investigation was carried out including 436 subjects with PMN, with or without renal insufficiency, who were treated at the No. 82 Division Defense Medical Center of the People's Liberation Army and Liaocheng People's Medical Center during January 2020 and December 2023. Binary logistic regression study was applied to determine possible hazard elements. Binary logistic regression …

Evaluation Of Raqeem Health Information System In Primary Healthcare Centers In Makkah, Saudi Arabia, Using The Delone And Mclean Information System Success Model, Ali M. Alzahrani, Holly C. Felix

Saudi Medical Journal

Objectives: To evaluate the implementation of Raqeem, a new Electronic Health Information Systems (EHIS) implemented at primary healthcare centers (PHCs) in Makkah. Implementing EHIS requires huge investments, making evaluation of systems success important.

Methods: In this cross-sectional survey design study, a developed questionnaire guided by DeLone and McLean Information System success model (D&M model) was used to collect data from PHCs' providers. Descriptive and structural equation modeling (SEM) techniques were performed to describe and examine the association between the model's constructs and assess Raqeem success.

Results: A total of 490 providers submitted completed records and were included in this study. …

Molecular Mechanisms Of Diffuse Large B-Cell Lymphoma And The Complexities Of Tumor Development, Wael I. Alzahrani

Saudi Medical Journal

Diffuse large B-cell lymphoma (DLBCL), the most prevalent aggressive non-Hodgkin lymphoma, exhibits substantial molecular heterogeneity and arises from germinal center or post-germinal center B cells through recurrent genetic and epigenetic dysregulation of critical signaling pathways. Aberrations involving BCL6, MYC, MYD88, and components of B cell receptor and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κ B) signaling play central roles in lymphomagenesis, treatment resistance, and clinical outcomes. Gene expression profiling has defined major molecular subgroups in DLBCL, including germinal center B cell–like and activated B cell–like tumors, that show distinct pathogenesis and prognosis. High-risk entities, such as double- and …

Integrating Traditional And Complementary Medicine Into Saudi Primary Care: A Literature Review In Light Of The Who 2025–2034 Strategy, Abeer Al Shahrani

Saudi Medical Journal

Complementary and alternative medicine (CAM) is widely practiced in Saudi Arabia, particularly for health promotion and chronic diseases management. Despite cultural acceptance and high utilization, CAM remains largely unintegrated within the formal healthcare system, particularly in primary care settings. The newly adopted World Health Organization (WHO) Traditional, complementary, and integrative medicine (TCIM) Strategy 2025–2034 offers a global framework for evidence-based, culturally appropriate integration of TCIM into national systems. This review evaluates the status of CAM in Saudi Arabia in light of strategic objectives outlined in the WHO Strategy: building the evidence base, ensuring quality and safety, integrating into health systems, …

Interleukin-6 Inhibition For Patients With Acute Myocardial Infarction: A Systematic Review And Meta-Analysis, Mohammed Y. Alasmary, Mohammed J. Almalki, Faisal H. Almalki, Waleed D. Khubzan, Mohammed H. Rajab, Mohammed S. Almalki, Hussam A. Almalki, Omar M. Alsuwat, Hussam M. Alghannami

Saudi Medical Journal

Objective: To explore the outcomes associated with interleukin-6 (IL-6) pathway blockade, using tocilizumab, in patients with ST-elevation myocardial infarction (STEMI) and non (NSTEMI). Acute myocardial infarction (AMI) denotes myocardial necrosis due to ischemia and presents in distinct electrocardiographic phenotypes. Inflammation driven by IL-6 contributes to ischemia-reperfusion injury, with tocilizumab showing promise in reducing myocardial damage and improving outcomes.

Methods: This work followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Framework and was registered in international prospective register of systematic reviews (PROSPERO). Relevant studies were identified through structured searches of PubMed, MEDLINE, the Cochrane Library, and Google Scholar up …

Effect Of Anesthetic Agents On Middle Ear Pressure: Systematic Review And Meta-Analysis, Nasser Almujaiwel, Reem Alkublan, Latifah Almakoshi

Saudi Medical Journal

Objective: To assess and compare the effects of these agents on middle ear pressure (MEP). Anesthetic agents can significantly alter MEP, which is a critical factor in middle ear surgeries that require stability to prevent complications. Different anesthetics, including inhalational and intravenous agents, have varying effects on MEP.

Methods: A systematic search was conducted across PubMed, Embase, the Cochrane Library, and Scopus, following preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Studies that evaluated MEP changes before and after anesthesia using tympanometry were included. Relevant data, such as anesthetic type, patient demographics, MEP measurements, and reported complications, were …

The Impact Of Exercise Intervention On Pulmonary And Physical Function In Patients With Cystic Fibrosis: A Comprehensive Systematic Review, Abdullilah Alghamdi, Muroj Al-Attas, Abrar Radhi, Amnah Alfaqih, Bashair Aljabri, Rawan Alharbi, Sumayyah Alsubaie, Raneem Aljawaied, Sarah Alenazi, Ahlam Mazi, Ebtehal Qulisy

Saudi Medical Journal

Objective: To evaluate the effect of various exercise interventions on lung function, specifically forced expiratory volume in 1 second (FEV₁), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP), as well as on cardiorespiratory fitness (peak oxygen uptake [VO₂peak]), and muscle strength (handgrip strength). The review also considers factors such as patient adherence, follow-up duration, and statistical significance to inform clinical practice.

Methods: This systematic review followed preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines and was prospectively registered in international prospective register of systematic reviews. PubMed, Google Scholar, OVID, and Web of Science …