Search Results (262)

Epicardial adipose tissue (EAT), the visceral fat layer next to the myocardium, has become an important focus in heart failure with preserved ejection fraction (HFpEF). When enlarged and inflamed, EAT increases pericardial restraint, releases fibroinflammatory mediators, and disrupts myocardial energetics, thereby reproducing the high-pressure, exercise-intolerant HFpEF phenotype regardless of body mass index. Modern echocardiography, cardiac CT, and MRI, enhanced by artificial intelligence texture analytics, now enable precise depot-specific quantification, making EAT a measurable therapeutic target. Early interventional studies suggest that caloric restriction, bariatric surgery, SGLT2 inhibitors, GLP-1 receptor agonists, statins, PCSK9 antibodies, and colchicine can reduce EAT volume or alter its inflammatory profile, with concurrent improvements in haemodynamics and biomarkers. However, definitive outcome trials are still pending. Priority directions include standardising imaging cut-offs, mapping EAT immune–metabolic niches, and testing combined metabolic–inflammatory regimens to translate EAT modulation into precision therapy for HFpEF. This review aims to synthesise current mechanistic, diagnostic, and therapeutic insights on EAT in HFpEF and outline future research priorities. Full article

Multiple sclerosis (MS) is a chronic, immune-mediated neurological disorder with increasing global prevalence. Emerging evidence underscores the role of lifestyle interventions (particularly diet and physical activity) in modulating disease progression and improving quality of life. This narrative review synthesizes current scientific literature on the effects of dietary interventions, including the Mediterranean, ketogenic, Swank, Wahls, gluten-free, and fasting-based diets, alongside various physical activity regimens. The Mediterranean and ketogenic diets show promise in reducing inflammation, enhancing neuroprotection, and improving metabolic health. Similarly, structured physical activity (including aerobic, resistance, sensorimotor, and mind–body exercises) demonstrates benefits in mobility, fatigue, and mental well-being. The review highlights the need for personalized, sustainable approaches that integrate nutritional and exercise-based strategies for optimal MS management in the long term. Full article

The effectiveness of upper extremity rehabilitation in post-stroke patients significantly depends on patient motivation and adherence to therapeutic regimens. Rehabilitation-assistive technologies, including wearable sensors, have been adopted to facilitate intensive and repetitive exercises aimed at reducing hand dysfunction and enhancing quality of life. Building upon the previously introduced Przypominajka (reminder) system reported in this journal—a wearable sensory glove coupled with a mobile application providing exercise guidance and monitoring—we conducted a feasibility study to evaluate its effectiveness in supporting upper limb rehabilitation. Sixteen post-stroke patients with hemiparesis were equally randomized into experimental and control groups. Both groups performed upper limb exercises for 45 min daily for over two weeks. The experimental group utilized the sensor-equipped glove and tablet-based exercises, whereas the control group followed printed exercise instructions. Clinical improvements were measured using the Fugl–Meyer Assessment–Upper Extremity (FMA-UE), Functional Independence Measure (FIM), and MORE scales. The experimental group demonstrated a minimal clinically important difference (MCID) on the FMA-UE and reported greater overall improvement than the control group. This study confirms the feasibility and potential clinical benefit of supplementing post-stroke rehabilitation with sensor-augmented exercises provided by the previously described Przypominajka device. Full article

Adverse cardiovascular events and increased mortality are associated with cardiac autonomic nervous system dysfunction in the early stages of the systemic sclerosis (SSc), even prior to the development of cardiac fibrosis. The objective of the study was to evaluate the impact of a three-month exercise training regimen and a subsequent comparable period of detraining on the activity of the cardiac autonomic nervous system in patients with SSc. A total of forty patients with SSc were randomized to either the control group (Group COΝ) or the exercise training group (Group ET). Cardiopulmonary exercise testing was performed at baseline, three months later, and six months later to assess peak oxygen uptake (VO₂peak). They also had 24 h electrocardiogram monitoring for heart rate variability (HRV) and heart rate turbulence analysis. The following time-domain indices were evaluated in the context of HRV analysis: the standard deviation of NN intervals (SDNN), the root mean square of successive RR interval differences (rMSSD), and the percentage of successive RR intervals that differ by more than 50 ms (pNN50). Additionally, regarding the frequency-domain indicators, the low-frequency (LF) and high-frequency (HF) components, as well as the LF/HF ratio, were evaluated. Independent t-tests and Chi-square tests were used for baseline comparisons, while two-way repeated measures ANOVA with Bonferroni post hoc tests assessed changes over time and between groups. Linear and multiple regression analyses were conducted to explore relationships among variables and identify predictors of HRV indices and VO₂peak. Group ET implemented a three-month mixed-type exercise training program, while Group COΝ received standard care. Group ET improved indices of vagal activity [rMSSD by 32.6% (p = 0.017), pNN50 by 57.1% (p = 0.01) and HF by 20.1% (p = 0.01)] and sympathovagal activity [SDNN by 15.5% (p = 0.002) and LF/HF by 12.03% (p = 0.004)] after three months. Exercising patients also increased their VO₂peak by 20.8% (p = 0.001). A robust positive correlation was observed between ΔVO₂peak and ΔSDNN (r = 0.754, p < 0.001). After three months, there was no statistically significant difference in the VO₂peak or any HRV index in the group COΝ. Compared to the baseline values, there was no statistically significant difference in group ET at 6 months, whereas the control group exhibited a decline. In summary, a three-month mixed-type exercise training program can enhance the cardiorespiratory efficiency and cardiac autonomic nervous system function of patients with SSc, as well as alleviate the deterioration that arises following the detraining period. Full article

Background/Objectives: Cancer represents a significant health challenge, with high mortality and morbidity rates. Its diagnosis often triggers chronic stress, adversely affecting patient outcomes. Exercise has emerged as complementary therapy, enhancing treatment adherence and mitigating the side effects of chemotherapy. This study examines the effects of mild exercise during chemotherapy on patient anxiety. Methods: This prospective paired cohort study was conducted in the General Oncology Hospital of Kifisia “Agioi Anargyroi” in Athens, Greece. Adult cancer patients undergoing chemotherapy participated, excluding those with cognitive, hearing, or motor impairments, those who experienced side effects, or those who declined consent. Anxiety was measured before and after a 20-minute exercise routine performed during chemotherapy, using the Greek-translated State–Trait Anxiety Inventory (STAI). The exercise regimen included warm-up, full-body stretching, and cool-down exercises. Pre- and post-exercise scores were analyzed using the Wilcoxon signed-rank test. Results: Forty-five patients (20 women, 25 men; mean age 69.02 ± 10.62 years) with various cancer backgrounds participated. Pre-intervention anxiety levels were in the borderline “moderate” range, dropping post-exercise to the “low” range. Mean STAI scores decreased from 37.73 ± 13.33 to 32.00 ± 14.22 (p < 0.0001), with a medium-large effect size (Cohen’s d for paired samples = −0.646). No significant correlation was found between age and anxiety scores. Discussion: This study found a significant short-term reduction in anxiety, suggesting that incorporating mild exercise during chemotherapy may help in alleviating patient stress. The medium-to-large effect size supports the potential for meaningful short-term benefits. Conclusions: Incorporating mild exercise during chemotherapy may help reduce anxiety and psychological burden. These findings underscore the need for more comprehensive research in larger, more diverse populations to better understand the benefits of incorporating mild exercise during chemotherapy. Full article

Although exercise is known to exert anti-inflammatory effects in neurodegenerative diseases, its specific impact and underlying mechanisms in Parkinson’s disease (PD) remain poorly understood. This study explores the effects of exercise on microglia-mediated neuroinflammation and apoptosis in a PD model, focusing on the role of irisin signaling in mediating these effects. Using a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced PD mouse model, we found that a 10-week treadmill exercise regimen significantly enhanced motor function, reduced dopaminergic neuron loss, attenuated neuronal apoptosis, and alleviated neuroinflammation. Exercise also shifted microglia from a pro-inflammatory to an anti-inflammatory phenotype. Notably, levels of irisin, phosphorylated AMP-activated protein kinase (p-AMPK), and sirtuin 1 (Sirt1), which were decreased in the PD brain, were significantly increased following exercise. These beneficial effects were abolished by blocking the irisin receptor with cyclic arginine–glycine–aspartic acid–tyrosine–lysine (cycloRGDyk). Our results indicate that exercise promotes neuroprotection in PD by modulating microglial activation and the AMPK/Sirt1 pathway through irisin signaling, offering new insights into exercise-based therapeutic approaches for PD. Full article

Burn injuries result in complex physiological and psychological sequelae, including hypermetabolism, muscle wasting, mobility impairment, scarring, and disrupted body image. While advances in acute care have improved survival, comprehensive rehabilitation strategies are critical for restoring function, appearance, and psychosocial well-being. Structured physical activity, including resistance and aerobic training, plays a central role in counteracting muscle atrophy, improving cardiovascular function, enhancing scar quality, and promoting psychological resilience and body image restoration. This narrative review synthesizes the current evidence on the effects of exercise-based interventions on post-burn recovery, highlighting their therapeutic mechanisms, clinical applications, and implementation challenges. In addition to physical training, emerging technologies such as virtual reality, aquatic therapy, and compression garments offer promising adjunctive benefits. Notably, artificial intelligence (AI) is gaining traction in burn rehabilitation through its integration into wearable biosensors and telehealth platforms that enable real-time monitoring, individualized feedback, and predictive modeling of recovery outcomes. These AI-driven tools have the potential to personalize exercise regimens, support remote care, and enhance scar assessment and wound tracking. Overall, the integration of exercise-based interventions with digital technologies represents a promising, multimodal approach to burn recovery. Future research should focus on optimizing exercise prescriptions, improving access to personalized rehabilitation tools, and advancing AI-enabled systems to support long-term recovery, functional independence, and positive self-perception among burn survivors. Full article

Objectives: The objective of this study was to assess the effect of aerobic exercise on depressive symptoms and to determine the optimal exercise prescription for Parkinson’s disease (PD) patients. Methods: A comprehensive search was conducted across PubMed, Web of Science, Cochrane, Scopus, and Embase databases. A meta-analysis was conducted to determine the standardized mean difference (SMD) and 95% confidence interval. Results: Aerobic exercise significantly alleviated depressive symptoms in PD patients (SMD, −0.68, p = 0.002). Subgroup analyses revealed that moderate intensity aerobic exercise (SMD, −0.72, p = 0.0006), interventions conducted for ≥12 weeks (SMD, −0.85, p = 0.04), ≥3 times per week (SMD, −0.68, p = 0.002), ≥60 min per session (SMD, −0.57, p < 0.0001), and ≥180 min per week (SMD, −0.87, p = 0.0002) were more effective in improving depressive symptoms in PD patients, especially in PD patients with a disease duration of ≤6 years (SMD, −1.00, p = 0.04). Conclusions: Integrating the available data, it is clear that aerobic exercise is a proven method for alleviating depressive symptoms in PD patients. This meta-analysis provides empirical support for clinicians to recommend that PD patients engage in aerobic exercise regimens of no less than 12 weeks’ duration, performed at a minimum frequency of three sessions per week, with each session lasting in excess of 60 min and a cumulative weekly duration of at least 180 min, to effectively attenuate depressive symptomatology. Earlier implementation of aerobic exercise interventions is recommended, as PD patients in the early stages of the disease (up to 6 years post-diagnosis) may derive the greatest benefit in terms of depression symptom improvement from such programs. Full article

Background: Sarcopenia is a syndrome associated with aging, characterized by a progressive decline in skeletal muscle mass and function. Its onset compromises the health and longevity of older adults by increasing susceptibility to falls, fractures, and various comorbid conditions, thereby diminishing quality of life and capacity for independent living. Accumulating evidence indicates that moderate-intensity aerobic exercise is an effective strategy for promoting overall health in older adults and exerts a beneficial effect that mitigates age-related sarcopenia. However, the underlying molecular mechanisms through which exercise confers these protective effects remain incompletely understood. Methods: In this study, we established a naturally aging mouse model to investigate the effects of a 16-week treadmill-based aerobic exercise regimen on skeletal muscle physiology. Results: Results showed that aerobic exercise mitigated age-related declines in muscle mass and function, enhanced markers associated with protein synthesis, reduced oxidative stress, and modulated the expression of genes and proteins implicated in mitochondrial quality control. Notably, a single session of aerobic exercise acutely elevated circulating levels of β-hydroxybutyrate (β-HB) and upregulated the expression of BDH1, HCAR2, and PPARG in the skeletal muscle, suggesting a possible role of β-HB–related signaling in exercise-induced muscle adaptations. However, although these findings support the beneficial effects of aerobic exercise on skeletal muscle aging, further investigation is warranted to elucidate the causal relationships and to characterize the chronic signaling mechanisms involved. Conclusions: This study offers preliminary insights into how aerobic exercise may modulate mitochondrial quality control and β-HB–associated signaling pathways during aging. Full article

Objectives: This randomized controlled trial investigated the effects of an 8-week, volume-equated eccentric training program comprising Nordic hamstring and reverse Nordic exercises performed either once or twice per week on measures of physical fitness in pubertal male soccer players. Methods: A total of 34 participants were randomly assigned into a 1-day (n = 16; age = 14.58 ± 0.28 years) or 2-day (n = 18; age = 14.84 ± 0.22 years) per week training group. Physical fitness was assessed using 5 m and 10 m sprints, the 505 change in direction (CiD) speed test, Y-shaped agility test, countermovement jump (CMJ), and standing long jump (SLJ). Results: Significant group-by-time interactions were observed for the 505 CiD test, agility, and CMJ performance (effect sizes [ES] = 0.80 to 1.13). However, no significant interactions were found for the 5 and 10 m sprints or for SLJ (p > 0.05). Compared to the 1-day group, the 2-day training group showed greater improvements in CiD speed (∆7.36%; p < 0.001; ES = 0.92), agility (∆7.91%; p < 0.001; ES = 1.68), and CMJ (∆7.44%; p < 0.01; ES = 0.35), while no differences were observed in 5 and 10 m linear sprints or SLJ performance. According to individual response analysis, improvements across the physical fitness parameters beyond the smallest worthwhile change (SWC_0.2) were observed in 22–83% of players in the 1-day group and 77–100% in the 2-day group. Conclusions: In summary, the findings suggest that when training volume is matched, distributing the eccentric training regimen over two days per week may lead to greater improvements in CiD speed, agility, and CMJ performance compared to a single-day approach. Full article

Background/Objectives: Robot-led rehabilitative exercise offers a promising avenue to enhance the care provided by exercise specialists (ESs). ESs, such as physical and occupational therapists, prescribe exercise regimens to clinical populations to improve patients’ adherence to prescribed exercises outside the clinic, such as at home. Collaborative efforts among roboticists, clinical ESs, and patients are essential for developing interactive, personalized exercise systems that meet each stakeholder’s needs. This work builds upon research involving individuals with Parkinson’s disease (PD) that evaluated a robotic rehabilitative exercise system designed to address strength and flexibility deficits. Methods: To complement the findings of our previous work in people with PD (PWP), we conducted a pilot user study in which 11 ESs evaluated a novel robot-led exercise system for PWP, focusing on perceptions of the system’s efficacy and acceptance. Utilizing a mixed-methods approach, including technology acceptance questionnaires, task load questionnaires, and inductively coded semi-structured interviews, we gathered comprehensive insights into ES perspectives and experiences after interacting with the system. Results: Findings reveal a broadly positive reception, which highlights the system’s capacity to augment traditional rehabilitative exercise for PD, enhance patient engagement, and ensure consistent exercise support. We also identified two key areas for improvement: incorporating more human-like feedback systems and increasing the robot’s ease of use. Conclusion: This research emphasizes the value of incorporating robotic assistants into rehabilitative exercise for PD, offering insights that can guide the development of more effective and user-friendly rehabilitation technologies. Full article

This review aims to provide a comprehensive framework for implementing precision sports medicine, integrating genetics, pharmacogenomics, digital health solutions, and multi-omics data. Literature review was conducted using MEDLINE, EMBASE, Web of Science, and Cochrane Library databases (January 2018–April 2024), focusing on precision medicine applications in sports medicine, utilizing key terms including “precision medicine”, “sports medicine”, “genetics”, and “multi-omics”, with forward and backward citation tracking. The review identified key gene variants affecting athletic performance: endurance (AMPD1, PPARGC1A), power (ACTN3, NOS3), strength (PPARG), and injury susceptibility (COL5A1, MMP3), while also examining inherited conditions like cardiomyopathies (MYH7, MYBPC3). Pharmacogenomic guidelines were established for optimizing common sports medications, including NSAIDs (CYP2C9), opioids (CYP2D6), and cardiovascular drugs (SLCO1B1, CYP2C19). Digital health technologies, including wearables and predictive analytics, showed potential for enhanced athlete monitoring and injury prevention, while multi-omics approaches integrated various molecular data to understand exercise capacity and injury predisposition, enabling personalized assessments, training regimens, and therapeutic interventions based on individual biomolecular profiles. This review provides sports medicine professionals with a framework to deliver personalized care tailored to each athlete’s unique profile, promising optimized performance, reduced injury risks, and improved recovery outcomes. Full article

Heart failure with preserved ejection fraction (HFpEF) shows diverse disease patterns, with various combinations of comorbidities and symptoms. A common hallmark is exercise intolerance, caused by alterations in the peripheral skeletal muscle (SKM) including a recently indicated titin hyperphosphorylation. Our aim is to compare a metabolic syndrome- (ZSF-1 rats) and a hypertension-driven (Dahl salt-sensitive (DSS) rats) HFpEF rat-model in relation to SKM function and titin phosphorylation. Obese ZSF-1 and high-salt fed DSS rats (HFpEF) were compared to lean ZSF-1 and low-salt fed rats (con). HFpEF was confirmed by echocardiography and invasive haemodynamic measurements. SKM atrophy, in vitro force measurements, titin- and contractile protein expression were evaluated. Obese ZSF-1 HFpEF rats showed muscle atrophy, reduced muscle force and increased titin phosphorylation compared to controls, which was not detected in hypertensive DSS rats. Fiber type specific troponins, myostatin and four and a half LIM domain 1 were differently regulated between the two models. Altogether, our results show that both animal models of HFpEF exhibit different SKM phenotypes, probably based on the divergent disease etiologies, which may help to define the most suitable animal model for HFpEF to test potential treatment regimens. Full article

Background: Physical activity induces a range of physiological and molecular adaptations, particularly affecting skeletal muscle and the cardiovascular system, regulating both tissue architecture and metabolic pathways. Emerging evidence suggests that PIWI-interacting RNAs (piRNAs) may serve as potential biomarkers for these adaptations. Here, we analyzed piRNA patterns in the context of exercise. Methods: This study selected eight participants of the iReAct study (DRKS00017446) for piRNA analysis. Baseline assessments included demographic profiling and fitness evaluation, particularly maximal oxygen uptake (V̇O2max) assessment. In addition, blood samples were collected pre- and (for six of the eight participants) post- standard reference training sessions. Subsequently, subjects underwent 6-week training protocols, employing standardized high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) regimens. Next, RNA sequencing was conducted to identify differentially expressed piRNAs, and correlation analyses were performed between piRNA expression patterns and training-associated changes in V̇O2max. Finally, to identify piRNAs potentially of interest in the context of exercise, different screening procedures were applied. Results: There were unique and specific changes in individual piRNA expression levels in response to exercise. In addition, we could define correlations of piRNA expression patterns, namely of piR-32886, piR-33151, piR-12547, and piR-33074, with changes in V̇O2max. These correlations did not reach significance in the small sample size of this pilot study, but might be verified in larger, confirming studies. Conclusions: This hypothesis-generating study identifies characteristic piRNA patterns in the context of exercise. Their significance as biomarkers is yet to be determined. Full article

During periods of exercise, the primary cause of metabolic acidosis is the accumulation of lactate from anaerobic metabolism, whereas a transient increase in CO₂ triggers a mild respiratory acidosis through the production of carbonic acid (H₂CO₃). The combined effects of these reactions result in a slight acidifying shift in arterial blood pH. Proton-sensing G protein-coupled receptors (including GPR68, GPR4, GPR132, and GPR65) represent the primary receptors within the body for detecting alterations in extracellular proton concentrations. These receptors have been demonstrated to possess potential roles in mechanosensation, intestinal inflammation, oncoimmunological interactions, hematopoiesis, as well as inflammatory and neuropathic pain. Recent studies have shown that the activation or inhibition of these receptors modulates a number of arterial functions, including angiogenesis, arterial relaxation, and arterial inflammation. It is well established that moderate exercise has a beneficial effect on the regulation of arterial function. This study examines the effect of exercise on proton concentrations in the microenvironment of the organism and its influence on proton-sensing G protein-coupled receptors located on cell membranes, as well as possible mechanisms involved in the regulation of arterial function. The objective is to present novel perspectives for the exploration of potential drug targets for the prevention and treatment of arterial dysfunction and the development of exercise regimens. Full article