Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Advertisement

Scientific Reports
  • View all journals
  • Search
  • My Account Login
  • Content Explore content
  • About the journal
  • Publish with us
  • Sign up for alerts
  • RSS feed
  1. nature
  2. scientific reports
  3. articles
  4. article
Physical and respiratory training in patients with myasthenia gravis: a systematic review with meta-analysis
Download PDF
Download PDF
  • Article
  • Open access
  • Published: 04 March 2026

Physical and respiratory training in patients with myasthenia gravis: a systematic review with meta-analysis

  • Guillermo Gutierrez-Del-Val1,
  • Victor Serrano-Fernandez2,3,
  • Victoria Mazoteras-Pardo4,
  • Rosa Maria Molina-Madueño1,5,
  • Carmen Bouzas-Mosquera1,3,
  • Juan Manuel Carmona-Torres2,3,6 &
  • …
  • Jose Alberto Laredo-Aguilera2,3,6 

Scientific Reports , Article number:  (2026) Cite this article

  • 941 Accesses

  • 1 Altmetric

  • Metrics details

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Diseases
  • Health care
  • Medical research

Abstract

Myasthenia gravis is a chronic autoimmune disorder that affects the neuromuscular junction, leading to impaired muscle function. This systematic review aimed to evaluate the current scientific evidence on the effects of training programs on symptom severity, performance in activities of daily living, quality of life, physical fitness, and respiratory function in individuals with myasthenia gravis. A systematic review and meta-analysis were conducted following the PRISMA guidelines. Searches were performed in PubMed, Scopus, Web of Science, and CINAHL Complete databases. Outcomes of interest included symptom severity scores, quality of life, activities of daily living performance, physical fitness, and respiratory parameters. A total of 1564 records were identified. After removing duplicates and screening titles, abstracts, and full texts, 20 studies were included in the qualitative synthesis, with 10 of them contributing to quantitative meta-analyses. Training interventions were associated with reductions in symptoms, as well as improvements in quality of life and performance in activities of daily living. Additionally, enhancements were observed in muscle strength, distance covered, and respiratory parameters. Physical activity and respiratory training may offer multiple benefits for patients with myasthenia gravis. Nevertheless, individualized exercise programs are essential to ensure safety and optimize adherence among this population.

Data availability

All data that supports the findings of this review are available within the article itself and its supplementary data.

References

  1. Fu, Y. et al. Breaking barriers: advancing cellular therapies in autoimmune disease management. Front. Immunol. 15, (2024).

  2. Lerner, A., Jeremias, P. & Matthias, T. The World Incidence and Prevalence of Autoimmune Diseases is Increasing. Int. J. Celiac Disease. 3, 151–155 (2016).

    Google Scholar 

  3. Miller, F. W. The increasing prevalence of autoimmunity and autoimmune diseases: an urgent call to action for improved understanding, diagnosis, treatment, and prevention. Curr. Opin. Immunol. 80, 102266 (2023).

    Google Scholar 

  4. Oeztuerk, M. et al. Current Biomarker Strategies in Autoimmune Neuromuscular Diseases. Cells 12, 2456 (2023).

    Google Scholar 

  5. Choi, W. J. et al. Global carrier frequency and predicted genetic prevalence of patients with pathogenic sequence variants in autosomal recessive genetic neuromuscular diseases. Sci. Rep. 14, 3806 (2024).

    Google Scholar 

  6. Martínez Torre, S. & Gómez Molinero, I. Martínez Girón, R. Puesta al día en la miastenia gravis. Med. de Familia SEMERGEN. 44, 351–354 (2018).

    Google Scholar 

  7. García Estévez, D. A. et al. Epidemiología de la miastenia gravis en la provincia de Ourense (Galicia, noroeste de España). Neurología 38, 75–81 (2023).

    Google Scholar 

  8. Salari, N. et al. Global prevalence of myasthenia gravis and the effectiveness of common drugs in its treatment: a systematic review and meta-analysis. J. Transl Med. 19, 516 (2021).

    Google Scholar 

  9. Antonini, G. et al. Real world study on prevalence, treatment and economic burden of myasthenia gravis in Italy. Heliyon 9, e16367 (2023).

    Google Scholar 

  10. Luisa Antelo, M. et al. Análisis de costes del tratamiento con recambio plasmático terapéutico frente al tratamiento con inmunoglobulinas endovenosas en pacientes con enfermedades neurológicas de base inmune. Propuesta de optimización del uso de hemoderivados plasmáticos. Neurología. https://doi.org/10.1016/j.nrl.2023.08.002 (2024).

  11. Piehl, F. et al. Economic and societal burden of myasthenia gravis in Denmark, Finland, and Sweden: A population-based registry study. Eur. J. Neurol. 31, (2024).

  12. Schepelmann, K. et al. Socioeconomic burden of amyotrophic lateral sclerosis, myasthenia gravis and facioscapulohumeral muscular dystrophy. J. Neurol. 257, 15–23 (2010).

    Google Scholar 

  13. Camacho, A., Esteban, J. & Paradas, C. Informe de la Fundación Del Cerebro sobre el impacto social de la esclerosis lateral amiotrófica y las enfermedades neuromusculares. Neurología 33, 35–46 (2018).

    Google Scholar 

  14. García Estévez, D. A. Pardo Fernández, J. Miastenia gravis. Actualización diagnóstica y terapéutica. Med. Clin. (Barc). 161, 119–127 (2023).

    Google Scholar 

  15. Mishra, A. K., Varma, A. & Myasthenia Gravis Syst. Rev. Cureus https://doi.org/10.7759/cureus.50017 doi:10.7759/cureus.50017. (2023).

    Google Scholar 

  16. Sharif, K. et al. Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmun. Rev. 17, 53–72 (2018).

    Google Scholar 

  17. Luo, B. et al. The anti-inflammatory effects of exercise on autoimmune diseases: A 20-year systematic review. J. Sport Health Sci. 13, 353–367 (2024).

    Google Scholar 

  18. Peng, S. et al. Current state of research on exercise for the treatment of myasthenia gravis: A scoping review. Complement. Ther. Med. 81, 103033 (2024).

    Google Scholar 

  19. Gilhus, N. E. Physical training and exercise in myasthenia gravis. Neuromuscul. Disord. 31, 169–173 (2021).

    Google Scholar 

  20. Corrado, B., Giardulli, B. & Costa, M. Evidence-Based Practice in Rehabilitation of Myasthenia Gravis. A Systematic Review of the Literature. J. Funct. Morphol. Kinesiol. 5, 71 (2020).

    Google Scholar 

  21. Cotinat, M., Verschueren, A., Attarian, S., Viton, J. M. & Bensoussan, L. Multidisciplinary rehabilitation is relevant in severe myasthenia gravis: An observation. Ann. Phys. Rehabil Med. 65, 101593 (2022).

    Google Scholar 

  22. Mónica, M. & Monasterios, D. Edna Serrano Arancibia, D. C. Miastenia Gravis del Adulto. Rev. Med. La. Paz. 19, 46–52 (2013).

    Google Scholar 

  23. Westerberg, E., Molin, C. J., Lindblad, I., Emtner, M. & Punga, A. R. Physical exercise in myasthenia gravis is safe and improves neuromuscular parameters and physical performance-based measures: A pilot study. Muscle Nerve. 56, 207–214 (2017).

    Google Scholar 

  24. Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, 1–9 (2021).

    Google Scholar 

  25. Sterne, J. A. C. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366, l4898 (2019).

    Google Scholar 

  26. Higgins, J. P. T. et al. A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E). Environ. Int. 186, 108602 (2024).

    Google Scholar 

  27. Sterne, J. A. et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ i4919. https://doi.org/10.1136/bmj.i4919 (2016).

  28. Luo, D., Wan, X., Liu, J. & Tong, T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat. Methods Med. Res. 27, 1785–1805 (2018).

    Google Scholar 

  29. Deeks, J. J., Higgins, J. P. T., Altman, D. G., McKenzie, J. E. & Veroniki, A. A. Chapter 10: Analysing data and undertaking meta-analyses. in Cochrane Handbook for Systematic Reviews of Interventions (eds Higgins, J. P. T. et al.) (Cochrane, 2024).

  30. Tripathi, G. M., Misra, U. K., Kalita, J., Singh, V. K. & Tripathi, A. Effect of Exercise on β-Endorphin and Its Receptors in Myasthenia Gravis Patients. Mol. Neurobiol. 60, 3010–3019 (2023).

    Google Scholar 

  31. Thomsen, J. L. S., Vinge, L., Harbo, T. & Andersen, H. A population-based follow-up study of maximal muscle strength and mobility in patients with myasthenia gravis. Neuromuscul. Disord. 32, 305–312 (2022).

    Google Scholar 

  32. Salci, Y. et al. Functional exercise capacity evaluated by timed walk tests in myasthenia gravis. Muscle Nerve. 59, 208–212 (2019).

    Google Scholar 

  33. Birnbaum, S. et al. Free-Living Physical Activity and Sedentary Behaviour in Autoimmune Myasthenia Gravis: A Cross-Sectional Study. J. Neuromuscul. Dis. 8, 689–697 (2021).

    Google Scholar 

  34. Andersen, L. K., Aadahl, M. & Vissing, J. Fatigue, physical activity and associated factors in 779 patients with myasthenia gravis. Neuromuscul. Disord. 31, 716–725 (2021).

    Google Scholar 

  35. Deliana, T., Poerwandari, D., Handajani, N. I., Sugianto, P. & Melaniani, S. Effect of low intensity aerobic cycling ergometer on muscle activation and muscle endurance of patients with myasthenia gravis in Dr. Soetomo General Hospital Surabaya. J. Med. Pharm. Chem. Res. 7, 333–341 (2025).

    Google Scholar 

  36. Kartika, L., Pawana, I. P. A., Arfianti, L. & Sugianto, P. Effect of low intensity aerobic cycle ergometer on maximal walking speed and cadence of myasthenia gravis patients. Romanian J. Med. Pract. 19, 16–21 (2024).

    Google Scholar 

  37. Putri, T. D. et al. Effect of low-intensity aerobic cycling ergometer on disease severity and depression of patients with myasthenia gravis in Dr. Soetomo General Hospital, Surabaya. Romanian J. Neurol. 23, 5–11 (2024).

    Google Scholar 

  38. Muslihah, I., Meisy Andriana, R., Prawitri, Y. D., Sugianto, P. & Melaniani, S. Effect of low-intensity aerobic cycling ergometer on ability to perform activity of daily living of patients with myasthenia gravis in RSUD Dr. Soetomo Surabaya. Romanian J. Neurol. 23, 304–310 (2024).

    Google Scholar 

  39. Rahbek, M. A. et al. Exercise in myasthenia gravis: A feasibility study of aerobic and resistance training. Muscle Nerve. 56, 700–709 (2017).

    Google Scholar 

  40. Birnbaum, S. et al. Home-based exercise in autoimmune myasthenia gravis: A randomized controlled trial. Neuromuscul. Disord. 31, 726–735 (2021).

    Google Scholar 

  41. Alsop, T., Williams, K. & Gomersall, S. Physical Activity and Sedentary Behaviour in People with Myasthenia Gravis: A Cross-Sectional Study. J. Neuromuscul. Dis. 9, 137–146 (2022).

    Google Scholar 

  42. Chang, C. C., Chen, Y. K., Chiu, H. C. & Yeh, J. H. Changes in Physical Fitness and Body Composition Associated with Physical Exercise in Patients with Myasthenia Gravis: A Longitudinal Prospective Study. J. Clin. Med. 10, 4031 (2021).

    Google Scholar 

  43. Hsu, C. W. et al. Respiratory Muscle training improves functional outcomes and reduces fatigue in patients with myasthenia gravis: A single-center hospital‐based prospective study. Biomed. Res. Int. 2923907 (2020).

  44. Weiner, P. et al. Respiratory Muscle Training in Patients With Moderate to Severe Myasthenia Gravis. Can. J. Neurol. Sci. / J. Canadien des. Sci. Neurologiques. 25, 236–241 (1998).

    Google Scholar 

  45. Rassler, B. et al. The effect of respiratory muscle endurance training in patients with myasthenia gravis. Neuromuscul. Disord. 17, 385–391 (2007).

    Google Scholar 

  46. Freitag, S., Hallebach, S., Baumann, I., Kalischewski, P. & Rassler, B. Effects of long-term respiratory muscle endurance training on respiratory and functional outcomes in patients with Myasthenia gravis. Respir Med. 144, 7–15 (2018).

    Google Scholar 

  47. Rassler, B., Marx, G., Hallebach, S., Kalischewski, P. & Baumann, I. Long-term respiratory muscle endurance training in patients with myasthenia gravis: first results after four months of training. Autoimmune Dis. 1–7 (2011).

  48. Fregonezi, G. A., de Resqueti, F., Güell, V. R., Pradas, R., Casan, P. & J. & Effects of 8-Week, Interval-Based Inspiratory Muscle Training and Breathing Retraining in Patients With Generalized Myasthenia Gravis. Chest 128, 1524–1530 (2005).

    Google Scholar 

  49. Misra, U. K. et al. Rest or 30-Min Walk as Exercise Intervention (RESTOREX) in Myasthenia Gravis: A Randomized Controlled Trial. Eur. Neurol. 84, 168–174 (2021).

    Google Scholar 

  50. Aupetitallot, V. & Franco, A. B. Effects of Physical Exercise on Functional and Respiratory Capacity, Quality of Life, and Fatigue Perception in Myasthenia Gravis Patients: A Systematic Review. Crit. Rev. Phys. Rehabil Med. 33, 87–101 (2021).

    Google Scholar 

  51. Wang, M., Wu, X., Jiao, Y., Yin, W. & Zhang, L. Life-Long Aerobic Exercise is a Non-Pharmacological Approach for Inducing Autophagy and Delaying Muscle Atrophy in the Aging Population. Aging Dis. https://doi.org/10.14336/AD.2024.0318 (2024).

  52. Iyer, S. R., Shah, S. B. & Lovering, R. M. The Neuromuscular Junction: Roles in Aging and Neuromuscular Disease. Int. J. Mol. Sci. 22, 8058 (2021).

    Google Scholar 

  53. Diez Porras, L., Homedes, C., Alberti, M., Velez Santamaria, V. & Casasnovas, C. Quality of Life in Myasthenia Gravis and Correlation of MG-QOL15 with Other Functional Scales. J. Clin. Med. 11, 2189 (2022).

    Google Scholar 

  54. Shah, N., Shrivastava, M., Kumar, S. & Nagi, R. S. Supervised, individualised exercise reduces fatigue and improves strength and quality of life more than unsupervised home exercise in people with chronic Guillain-Barré syndrome: a randomised trial. J. Physiother. 68, 123–129 (2022).

    Google Scholar 

  55. Andries, A., Van Walsem, M. R., Ørstavik, K. & Frich, J. C. Functional Ability and Physical Activity in Hereditary Neuromuscular Diseases. J. Neuromuscul. Dis. 9, 437–446 (2022).

    Google Scholar 

  56. Farrugia, M. E., Di Marco, M., Kersel, D. & Carmichael, C. A. Physical and Psychological Approach to Managing Fatigue in Myasthenia Gravis: A Pilot Study. J. Neuromuscul. Dis. 5, 373–385 (2018).

    Google Scholar 

  57. O’Connor, L., Westerberg, E. & Punga, A. R. Myasthenia Gravis and Physical Exercise: A Novel Paradigm. Front. Neurol. 11, 675 (2020).

    Google Scholar 

  58. Moreira-Pais, A., Ferreira, R., Oliveira, P. A. & Duarte, J. A. A neuromuscular perspective of sarcopenia pathogenesis: deciphering the signaling pathways involved. Geroscience 44, 1199–1213 (2022).

    Google Scholar 

  59. Oorschot, S., Brehm, M. A., Daams, J., Nollet, F. & Voorn, E. L. Efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases: A systematic review and meta-analysis. Ann. Phys. Rehabil Med. 66, 101637 (2023).

    Google Scholar 

  60. Voet, N. B., van der Kooi, E. L., van Engelen, B. G. & Geurts, A. C. Strength training and aerobic exercise training for muscle disease. Cochrane Database Syst. Rev. (2019).

  61. Silva, I. S. et al. Respiratory muscle training in children and adults with neuromuscular disease. Cochrane Database Syst. Rev. CD011711 (2019).

  62. Claytor, B., Cho, S. & Li, Y. Myasthenic crisis. Muscle Nerve. 68, 8–19 (2023).

    Google Scholar 

  63. O’Connor, L., Westerberg, E. & Punga, A. R. Myasthenia gravis and physical exercise: A novel paradigm. Front. Neurol. 11, (2020).

  64. Tekeşi̇n, A. et al. Evaluation of nonmotor symptoms in myasthenia gravis patients. Turk. J. Med. Sci. 55, 127–139 (2025).

    Google Scholar 

  65. Alsop, T., Cassimatis, M., Williams, K. L. & Gomersall, S. R. Perspectives of people with myasthenia gravis on physical activity and experience of physical activity advice from health professionals in the Australian context: a qualitative study. Disabil. Rehabil. 47, 156–163 (2025).

    Google Scholar 

Download references

Funding

This work was funded by FEDER-UCLM with grant number UCLM 2022.

Author information

Authors and Affiliations

  1. Hospital Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain

    Guillermo Gutierrez-Del-Val, Rosa Maria Molina-Madueño & Carmen Bouzas-Mosquera

  2. Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Avda. Carlos III s/n, 45071, Toledo, Spain

    Victor Serrano-Fernandez, Juan Manuel Carmona-Torres & Jose Alberto Laredo-Aguilera

  3. Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla- La Mancha, Avda. Carlos III s/n, 45071, Toledo, Spain

    Victor Serrano-Fernandez, Carmen Bouzas-Mosquera, Juan Manuel Carmona-Torres & Jose Alberto Laredo-Aguilera

  4. Facultad de Enfermería de Ciudad Real, Universidad de Castilla-La Mancha, C. Altagracia 50, 13001, Ciudad Real, Spain

    Victoria Mazoteras-Pardo

  5. Hospital Universitario Rey Juan Carlos, C/ Gladiolo, s/n, 28933, Móstoles, Spain

    Rosa Maria Molina-Madueño

  6. Instituto de Investigacion Sanitaria de Castilla-La Mancha (IDISCAM), 45004, Toledo, Spain

    Juan Manuel Carmona-Torres & Jose Alberto Laredo-Aguilera

Authors
  1. Guillermo Gutierrez-Del-Val
    View author publications

    Search author on:PubMed Google Scholar

  2. Victor Serrano-Fernandez
    View author publications

    Search author on:PubMed Google Scholar

  3. Victoria Mazoteras-Pardo
    View author publications

    Search author on:PubMed Google Scholar

  4. Rosa Maria Molina-Madueño
    View author publications

    Search author on:PubMed Google Scholar

  5. Carmen Bouzas-Mosquera
    View author publications

    Search author on:PubMed Google Scholar

  6. Juan Manuel Carmona-Torres
    View author publications

    Search author on:PubMed Google Scholar

  7. Jose Alberto Laredo-Aguilera
    View author publications

    Search author on:PubMed Google Scholar

Contributions

Conceptualization: GGV, VSF, JALA. Formal analysis: VSF, VMP, RMMM. Funding adquisition: VMP, RMMM, CMB. Investigation: GGV, VSF, JMCT. Methodology: GGV, VSF, RMMM, CMB. Project administration: JALA, JMCT. Resources: VSF, VMP, JMCT. Software: VSF. Data curation: JMCT. Supervision: JALA. Validation: GGV, VSF, VMP, RMMM, CMB, JALA, JMCT. Visualization: VMP, RMMM, CMB. Writing – original draft: GGV, VSF, JALA. Writing – review and editing: GGV, VSF, VMP, RMMM, CMB, JALA, JMCT.

Corresponding author

Correspondence to Victor Serrano-Fernandez.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Material 1 (download PDF )

Supplementary Material 2 (download PDF )

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gutierrez-Del-Val, G., Serrano-Fernandez, V., Mazoteras-Pardo, V. et al. Physical and respiratory training in patients with myasthenia gravis: a systematic review with meta-analysis. Sci Rep (2026). https://doi.org/10.1038/s41598-026-42949-3

Download citation

  • Received: 30 July 2025

  • Accepted: 28 February 2026

  • Published: 04 March 2026

  • DOI: https://doi.org/10.1038/s41598-026-42949-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Keywords

  • Myasthenia gravis
  • Physical activity
  • Respiratory training
  • Systematic review
  • Meta-analysis
Download PDF

Advertisement

Explore content

  • Research articles
  • News & Comment
  • Collections
  • Subjects
  • Follow us on Facebook
  • Follow us on X
  • Sign up for alerts
  • RSS feed

About the journal

  • About Scientific Reports
  • Contact
  • Journal policies
  • Guide to referees
  • Calls for Papers
  • Editor's Choice
  • Journal highlights
  • Open Access Fees and Funding

Publish with us

  • For authors
  • Language editing services
  • Open access funding
  • Submit manuscript

Search

Advanced search

Quick links

  • Explore articles by subject
  • Find a job
  • Guide to authors
  • Editorial policies

Scientific Reports (Sci Rep)

ISSN 2045-2322 (online)

nature.com footer links

About Nature Portfolio

  • About us
  • Press releases
  • Press office
  • Contact us

Discover content

  • Journals A-Z
  • Articles by subject
  • protocols.io
  • Nature Index

Publishing policies

  • Nature portfolio policies
  • Open access

Author & Researcher services

  • Reprints & permissions
  • Research data
  • Language editing
  • Scientific editing
  • Nature Masterclasses
  • Research Solutions

Libraries & institutions

  • Librarian service & tools
  • Librarian portal
  • Open research
  • Recommend to library

Advertising & partnerships

  • Advertising
  • Partnerships & Services
  • Media kits
  • Branded content

Professional development

  • Nature Awards
  • Nature Careers
  • Nature Conferences

Regional websites

  • Nature Africa
  • Nature China
  • Nature India
  • Nature Japan
  • Nature Middle East
  • Privacy Policy
  • Use of cookies
  • Legal notice
  • Accessibility statement
  • Terms & Conditions
  • Your US state privacy rights
Springer Nature

© 2026 Springer Nature Limited

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing