Search Results (21,626)

Peripheral artery disease (PAD) is a pervasive atherosclerotic condition affecting well over 100 million adults worldwide and associated with major functional limitations, reduced quality of life, and elevated risks of myocardial infarction, stroke, limb events, and mortality. Exercise therapy—preferably supervised or delivered through structured, monitored home-based programs—is a first-line, guideline-endorsed therapy that improves walking performance and patient-reported outcomes and contributes to comprehensive secondary prevention. This review synthesizes mechanistic underpinnings (endothelial, angiogenic, metabolic, and autonomic) and appraises the comparative effectiveness, safety, and implementation models of supervised exercise therapy (SET), structured home-based and hybrid programs, and alternative modalities in PAD. Finally, we summarize policy aspects and persistent gaps to guide clinical practice and future research. Full article

Exerkines are released in response to physical exercise and play a key role in promoting health, such as taking part in modulating brain morphology and function. Expression levels of some of them are associated with an increase in neuroplasticity and a decrease in the risk of brain-related diseases such as dementia and depression. Therefore, our objective is to investigate the response of exerkines in healthy individuals and its potential to promote brain health. The search was performed in five databases. Randomized controlled trials of humans and animals of all ages who performed acute and/or long-term exercise and assessed the effects of exerkines were included. Human data were used for quantitative analysis, and animal experiments were included as part of the qualitative analysis. No meta-analyzes were conducted on animal data; preclinical findings are presented solely to contextualize mechanisms and are not used for clinical inference. Eventually, the sample consisted of 3321 individuals, with an age range from 10 to 89 years. Meta-analysis reveals that both acute and chronic exercise induced increases in the brain-derived neurotrophic factor and insulin-like growth factor 1 in older adults. Other exerkines such as cathepsin B and vascular endothelial growth factor have also demonstrated potential power for brain health. In conclusion, physical exercise by altering the levels of exerkines may be a feasible strategy for healthy individuals aiming at healthy aging of the brain. Moreover, it is advisable to analyze additional exerkines or multiple simultaneous applications to assess the cerebral effects during physical exercise. PROSPERO registration number: CRD42023438803. Full article

Exosomes (EXs) mediate intercellular communication in the tissue microenvironment. We previously demonstrated that endothelial progenitor cell-derived exosomes (EPC-EXs) from exercised mice protect neurons and cerebral endothelial cells from hypoxia- and hypertension- induced injury ex vivo, suggesting their therapeutic potential in hypertensive ischemic injury. Here, we investigated whether exercise-conditioned EPC-EXs (ET-EPC-EXs) confer protection against acute ischemic injury. Hypertensive transgenic mice were divided into donor and recipient groups. Donor mice underwent treadmill exercise to generate ET-EPC-EXs. Recipient mice was subjected to middle cerebral artery occlusion and received ET-EPC-EXs via tail vein injection (2 × 10⁸/100 μL saline) two hours after stroke onset. Cerebral blood flow (CBF) was assessed, and brains were collected on day two for histological and molecular analyses. Our data showed that ET-EPC-EXs were robustly taken up by cerebral cells, predominantly in the penumbra in the ipsilateral hemisphere. ET-EPC-EXs reduced cell death and microglia activation and restored tight-junction proteins. Moreover, ET-EPC-EX treatment preserved CBF and improved sensorimotor function on day two post-stroke. Mechanistically, ET-EPC-EXs suppressed p38 activation, accompanied by reduced matrix metalloproteinase-3 and cytochrome c levels in the ipsilateral brain. Collectively, these findings demonstrate that EPC-EXs from exercise mice improve sensorimotor functions and confer protection in hypertensive ischemic brain injury, likely through attenuation of neuroinflammation and preservation of vascular integrity via modulation of the p38 signaling. Full article

Background: Weightlifters commonly use upper-extremity high-load training, which encompasses techniques ranging from momentary failure to non-failure. However, little is known about how this training affects posture and core endurance, despite knowing that these factors are risk factors for weightlifting injuries. Therefore, this study aimed to determine the immediate effects of upper-extremity high-load training to momentary failure versus non-failure, using the dumbbell overhead press, on posture and core endurance in recreational collegiate weightlifters. Methods: Fifty recreational weightlifters aged 18–24 with two years of upper extremity resistance training experience were recruited for this study. The participants performed dumbbell overhead press exercises under high-load failure (HL-F) and high-load non-failure (HL-NF) conditions two days after 1RM testing and calculation of the 80% 1RM load. The study analyzed postural changes using photographic data processed in Kinovea, while core endurance was assessed during a prone plank test. Standardized warm-ups, controlled exercise execution, and pre- and post-exercise assessments were conducted to measure core endurance and postural alterations. Results: The thoracic kyphosis angle, together with scapular balance angle and lateral scapular slide distance, increased significantly after HL-F compared to the unloading state, while the craniovertebral angle and prone plank time decreased significantly (p < 0.05). The HL-NF condition showed no statistically significant differences relative to the unloading measurements (p > 0.05). The unloading measurements across testing days were consistent, indicating no carryover effect (p > 0.05). Conclusions: The findings indicate that high-load training to failure adversely affects posture and core endurance, increasing fatigue and potentially increasing the risk of acute injuries. Non-failure training maintains stability, underscoring the importance of strategic program design for achieving optimal performance while minimizing adverse effects. Full article

Methodological guidelines for real-world evidence (RWE) in European Union (EU) joint clinical assessments (JCA) are lacking. This manuscript explores RWE potential in EU health technology assessment (HTA) and offers recommendations for generating high-quality RWE. An environmental scan of peer-reviewed and gray literature was conducted to review RWE frameworks and documents in EU regulatory and HTA decision-making. Extraction elements were standardized across key RWE themes: data quality, methodological rigor, stakeholder engagement, and applications. In JCA, RWE has multiple uses, including informing PICO simulation exercises, understanding disease landscape, identifying prognostic factors and effect modifiers, and directly or indirectly informing comparative clinical assessments. Methodological guidance from the HTA Coordination Group is limited to cases in which evidence from non-randomized studies is used as direct inputs in comparative assessments. Individual HTA bodies provide more detailed guidance, missing an opportunity to leverage RWE within JCAs that can offer insight for local Member State submissions. Generating high-quality RWE that is credible, actionable, and acceptable for JCA submissions and local HTA bodies requires careful attention to methodological considerations and early planning. Broader RWE integration that reflects patient journeys is needed. Expanding the HTA Coordination Group guidance can unlock RWE’s full potential in supporting EU JCA submissions. Full article

Background/Objectives: Young women with breast cancer (aged ≤ 40 years) have distinct prognostic characteristics, yet little is known about how modifiable body composition factors influence outcomes in this age group. This study examined whether CT-derived body composition measures could identify thresholds that predict overall survival (OS). Methods: This was a single-center, 10-year, matched case–control study nested within a cohort, utilizing retrospectively collected data. Using an institutional database (2009–2018) and the initial cohort of 112 patients, we performed a subset analysis of patients with stage I–III breast cancer at diagnosis who had available pretreatment CT scans to estimate associations with body composition metrics and OS. The final analytic dataset included 89 individuals (49 survivors and 40 deceased). CT scans at the L3 level were analyzed using Slice-O-Matic software to quantify visceral (VAT), subcutaneous (SAT), intermuscular (IMAT), total adipose tissue (TAT), skeletal muscle density (SMD), skeletal muscle gauge (SMG), and skeletal muscle index (SMI). Cox proportional hazard models determined optimal cutpoints for OS. Multivariable models included adjustments for disease stage and hormone receptor status. Results: The median age was 35 (IQR, 32–38); 47% were White and 37% were Black. The majority (78%) were not Hispanic or Latina. Most (67%) were overweight/obese. Specific thresholds for IMAT index (>2.57), VAT (>31.38), and SMG (<2419.89) were associated with worse survival (all p < 0.05), while no cutpoints were identified for other variables. Conclusions: These findings show that muscle fat infiltration and reduced muscle quality have important prognostic value in young women with breast cancer. Exploratory cutpoints derived from routine staging CT scans may help inform risk stratification and generate hypotheses for targeted nutritional or exercise interventions, but require validation in larger, independent cohorts before clinical application. Full article

Background: Regular aerobic exercise during childhood promotes critical physiological adaptations in the cardiovascular and respiratory system. Finswimming, a unique aquatic sport, requires high-intensity demands and specific breathing patterns. The present study aimed to compare respiratory function and cardiorespiratory responses between young male finswimmers and sedentary age-matched non-athletes. Methods: Thirty-two boys aged 8 to 12 years old were stratified into the finswimmers group (FSG, n = 16) and the non-athletes group (NAG, n = 16). Assessments included pulmonary function (spirometry) and respiratory muscle strength (Maximum Inspiratory Pressure, MIP/Maximum Expiratory Pressure, MEP). Exercise capacity was evaluated using the modified shuttle walk test (MSWT). Results: The FSG exhibited significantly higher pulmonary function (Forced Vital Capacity, Forced Expiratory Volume in 1 s, Maximum Voluntary Ventilation; p < 0.05) and superior MIP compared to the NAG (105.3 ± 24.8 versus 87.3 ± 24.7 cmH₂O; p = 0.022). During the MSWT, FSG covered substantially greater distances (746.6 ± 97.2 versus 591.1 ± 86.4 m; p < 0.001) with lower levels of leg fatigue (Borg 0–10) (0.53 ± 0.39 versus 2.13 ± 1.93; p = 0.004) and demonstrated lower heart rate recovery time (4.47 ± 0.68 versus 5.75 ± 0.68 min; p < 0.001) compared to NAG. At the iso-level (8th level of MSWT), FSG scored lower levels of leg fatigue (0.13 ± 0.12 versus 2.02 ± 2.0; p = 0.001) compared to NAG, indicating better peripheral oxygen % saturation (100 ± 0.0 versus 98.14 ± 1.16; p < 0.001). Conclusions: Systematic exercise training enhances profound cardiorespiratory and peripheral muscle adaptations in children. Enhanced cardiorespiratory function allows young athletes to achieve higher workloads and recover faster than sedentary peers, highlighting the sport’s role in establishing a robust cardiorespiratory fitness. Full article

Exercise-derived reactive oxygen species (ROS) are required for mitochondrial and hypertrophic adaptations, creating a practical trade-off: antioxidant strategies may support short-term performance and recovery yet blunt training signals when mis-timed or over-dosed. We performed a structured narrative review informed by transparent database searches of MEDLINE, Scopus, and SPORTDiscus (2000–2025), prioritizing human intervention studies and using mechanistic evidence to interpret plausibility. Evidence was mapped by antioxidant class, dose, timing, training modality, and context. Across trials, chronic high-dose vitamins C/E taken close to key sessions are most consistently associated with attenuation of redox-sensitive signaling, whereas food-first polyphenols and selected bioactives (e.g., tart cherry/anthocyanins, pomegranate, and curcumin) more often support recovery when positioned away from adaptation-critical workouts, without clear evidence of impaired training gains. N-acetylcysteine can acutely improve tolerance to repeated high-intensity exercise, but effects during prolonged training remain uncertain and appear context-dependent. We propose Redox-Adaptive Periodization, aligning antioxidant class, dose, and timing with the primary objective (adaptation vs. immediate readiness) and environmental constraints, and we outline methodological priorities to advance precision redox management. Full article

Background: Elderly women face significant health challenges, including knee osteoarthritis (KOA) and balance disorders. Artificial intelligence (AI)-assisted exercise intervention can address limitations of traditional intervention methods, such as low compliance and high economic costs. Objective: This randomized controlled trial (RCT) evaluated the effects of AI-assisted Baduanjin exercise on physical health (balance and knee function) in elderly women, comparing it with offline manual guidance and health education. The group of 79 elderly women (60–74 years) were randomly assigned into three groups: AI-assisted Baduanjin (AI group, n = 25), offline instructor-led Baduanjin (Offline group, n = 27), and health education (Education group, n = 27). Methods: Interventions lasted 12 weeks, with three 45-min sessions per week. Two outcome measures were evaluated pre- and post-interventions: postural stability assessed by the unipedal stance test and knee function measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). This study considers two measurement methods. One is a two-way repeated-measures analysis of variance used to evaluate the effects on the three intervention groups. The other is an independent-samples t-test, with post hoc testing (Bonferroni), used to assess differences among the three groups. Results: Both the AI and Offline groups showed significant improvements in WOMAC pain and function scores at 12 weeks (p < 0.05), with the Offline group demonstrating greater functional improvement (decrease in WOMAC function score: 6.7 points, Cohen’s d = 1.23, 95% CI 0.81–1.65). No serious adverse events (e.g., falls, exacerbation of joint pain) were reported in any group. The Offline group also showed immediate balance enhancement (closed-eye stance improvement, effect size d ≈1.57), while the AI group exhibited progressive pain relief. The Education group showed minimal improvements. Inter-group comparisons showed the AI and Offline groups outperformed the Education group in balance and knee function (p < 0.05). Conclusions: AI-assisted and offline Baduanjin interventions effectively improve balance and knee function in elderly women, with offline guidance offering improvement of balance ability. AI intervention is suitable for rural elderly women with low digital literacy, as it provides simplified operation and voice prompts to ensure adherence. Full article

Background: Ambient air pollution, particularly particulate matter (PM), has been linked to metabolic disorders, including diabetes. We evaluated associations between long-term exposure to coarse particulate matter (PM₁₀) and fine particulate matter (PM_2.5) and glycated hemoglobin (HbA1c) levels in a Korean population and assessed whether specific subgroups exhibited heightened susceptibility. Methods: We analyzed 6940 participants without diabetes from the Korean Genome and Epidemiology Study (KoGES) Ansan-Ansung cohort. Participants contributed 35,395 observations across a mean follow-up of 5.1 visits (2005–2017). Linear mixed models estimated associations between PM exposure and HbA1c while adjusting for covariates, including body mass index (BMI), time, and region. Subgroup analyses stratified by sex, age, BMI, region, education, smoking status, drinking status, and exercise. Results: Higher long-term PM₁₀ exposure was associated with elevated HbA1c (β = 0.0347 per interquartile range [IQR] increase of 9.48 μg/m³; 95% CI: 0.0220, 0.0473; p < 0.001). PM_2.5 showed a comparable positive association (β = 0.0166 per IQR of 8.67 μg/m³; 95% CI: 0.0010, 0.0321; p = 0.037). Associations were stronger among older adults (≥60 years: β = 0.0789 vs. <60 years: β = 0.0210; p-interaction < 0.001), rural Ansung residents (β = 0.0963 vs. Ansan: β = 0.0398; p-interaction < 0.001), participants with lower educational attainment (≤middle school: β = 0.0637; p-interaction < 0.001), and never smokers (β = 0.0455; p-interaction = 0.035). Conclusions: Among nondiabetic Korean adults, long-term PM₁₀ exposure was associated with higher HbA1c; PM_2.5 demonstrated a similar positive association. Associations were more pronounced among older adults, rural residents, individuals with lower educational attainment, and never smokers. These findings support ambient air pollution as an environmental contributor to subclinical glycemic changes and underscore the need for targeted public health strategies for vulnerable populations. Full article

Forests are vital resources providing various benefits to both the environment and humanity. However, their continuous loss in many parts of the developing world highlights the urgent need for a sustainable and context-specific management model. Traditional Ecological Knowledge (TEK)-based successful forest management models have been reported in many regions of the world. Most of these practices are de facto and have been exercised for generations without any formal documentation. Their effectiveness needs to be documented to conserve this precious heritage and to highlight significance. This study is an attempt to investigate the effectiveness of TEK in communal forest management and conservation systems in Kurram Valley, Pakistan. A qualitative research design was adopted, combining field observations, semi-structured interviews with community key stakeholders, focus group discussions (FGDs), and the analysis of official and revenue records. The study results reveal the active role of TEK-based forest governance in maintaining balance between utilization and forest conservation. Communal ownership plays a vital role in empowering the community to make more independent decisions. The active indigenous institutions govern forest management and conservation practices with high efficacy. The prevailing conservation and utilization mechanisms have been constructively designed to maintain regrowth and prevent unsustainable exploitation. However, weakening of traditional institutions over time in certain localities has led to deterioration in forest sustainability, which reflects broader challenges in community-based conservation systems. Overall, TEK-based forest management plays a positive role in local forest conservation practices, and may provide useful insights for improving forest policies. Full article

Background: The Global Positioning System (GPS) and wearable monitoring technologies are increasingly applied in sport science to quantify training load; however, data from female cross-country skiers in nations with emerging competitive programs remain scarce. This case series covering the complete national team roster analyzed the complete annual training cycle of the Korean women’s national cross-country skiing team (KCF) using GPS and heart rate-based wearable sensors. Methods: All three national team members were monitored throughout the 2022–2023 season (52 weeks), structured into General Preparation Period 1 (April–July), General Preparation Period 2 (August–November), and Competition Period (December–March). Individualized five-zone intensity thresholds were established through graded exercise testing on a roller ski treadmill with ventilatory threshold and blood lactate determination, independently assessed by two exercise physiologists (PhD level). Results: The total annual training volume was 667.72 h, comprising roller/on-snow skiing (54.0%), running (23.3%), and strength training (22.7%). The endurance-only intensity distribution demonstrated a polarized pattern (Zones 1–2: 91.5%). The total annual training distance reached 4673.30 km. The mean FIS points were 108.46 ± 38.60, and the mean VO₂max was 60.17 ± 6.11 mL·kg⁻¹·min⁻¹. Conclusions: When benchmarked against world-class female (WCF) standards (800–950 h annually), the overall training volume was approximately 18–30% lower. The relative strength training allocation (22.7%) exceeded typical WCF values (10–15%). These observations should be interpreted cautiously given the small sample size and cross-study comparison design, using published literature-based benchmarks. Full article

This paper is the first attempt to interpret the visual ‘construemes’ by the constructivist poet Alexei N. Chicherin, published in the anthology Mena vsekh which appeared in Moscow in1924. ‘Construemes’ can be considered the most enigmatic artifacts of the Russian avant-garde. Although ‘construemes’ can be easily confused with meaningless visual zaum (‘the transrational’), Chicherin’s actions and the very nature of his personality prevent one from interpreting ‘construemes’ as actionist endeavors to scandalize or a ‘play on nonsense’. Analysis of the poet’s treatise Kan-Fun published in Moscow in 1926 required finding the key to deciphering the ‘construemes’, reveals the positivist nature of Chicherin’s visual–phonological exercises. In the treatise, the poet argues for the primacy of the eye and vision. He illustrates synthetic ‘signs’ or ‘pictograms’ with the quotidian example of propaganda posters, capable of influencing millions more effectively than words alone. The study emphasizes the enigmatic nature of the titles of Chicherin’s books, the Nietzschean subtexts of his self-presentation, encrypted allusions to the esoteric and magical tradition of the Tarot, and religious symbolism. Sixteen illustrations help the understanding of Chicherin’s logic behind the creation of his four ‘construemes’, including the most mysterious composition called ‘Raman’ (‘the shortest Kan-Fun Novel in the world’). The structure of this text synthesizes the verbal, visual–graphic, acoustic (phonological symbols) and musical (notes) levels. The article also examines Chicherin’s proven techniques: the appropriation of the sacred dimension and self-presentation as an actor possessing genuine knowledge and capable of competing alone with the entire literary environment. Full article

Against the backdrop of rapid population aging, investigating the intersection and impacts among lifestyle, cognitive health, and retirement holds significant academic value and great practical significance for advancing the achievement of the sustainable development goal (SDG) of “Good Health and Well-being”. This study employs data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) and adopts a Fuzzy Regression Discontinuity Design (FRDD) to examine the impact of lifestyle on cognitive health, identify lifestyle changes induced by retirement, and explore the underlying mechanisms and heterogeneous effects across population subgroups. The empirical results indicate that social engagement and physical exercise exert positive effects on cognitive health, while smoking and drinking significantly impair cognitive health. Retirement leads to reduced social participation and physical activity, as well as increased smoking and drinking, which in turn significantly lower cognitive health through the mediating role of lifestyle. Furthermore, the negative impact of retirement on cognitive health is heterogeneous: it is statistically significant among males, individuals with higher educational attainment, and those employed outside the government departments, but insignificant among females, individuals with lower educational attainment, and those working in the government sector. This study clarifies the functional logic linking retirement, lifestyle, and cognitive health, providing theoretical references and practical implications for formulating policies to safeguard cognitive health among middle-aged and older adults. Full article

Background: Patients with pancreatic cancer (PC) commonly present with reduced aerobic fitness, sarcopenia, and malnutrition, which may increase perioperative risk and compromise access to chemotherapy treatments. Although exercise-based prehabilitation can improve physical fitness, its implementation is often limited by short diagnostic-to-surgery intervals and treatment-related toxicity. Methods: We conducted a pilot prospective pretest–posttest feasibility study in Torino, Italy. Patients with PC undergoing neoadjuvant chemotherapy prior to surgery were offered a 4-week, partially supervised, home-based bimodal exercise prehabilitation program (single-arm design) combining remotely monitored high-intensity interval training (HIIT) on a cycle ergometer with functional and resistance exercises. The primary outcome was adherence to prescribed exercise frequency, intensity, and duration, objectively assessed via remote monitoring. Secondary outcomes included cardiorespiratory fitness (CPET), muscle function, body composition, fatigue, quality of life, and circulating inflammatory markers. Results: From July 2022 to February 2024, 23 patients were screened; 15 were eligible and 10 enrolled. Four participants discontinued the intervention (two due to asthenia/fatigue, one due to chemotherapy-related adverse events, and one for organizational reasons), leaving six participants who completed the program. Among completers, fatigue and quality of life did not change meaningfully. Aerobic capacity and muscle function outcomes were generally stable, with few pre–post changes exceeding the minimum clinically important difference (MCID) thresholds used. Body composition markers and the assessed circulating cytokines/chemokines remained unchanged except for IL-6 levels, which decreased significantly (p < 0.05). Conclusions: A partially supervised, home-based HIIT-based prehabilitation program is feasible for a subset of PC patients undergoing neoadjuvant therapy, but a substantial attrition rate suggests the need for more flexible symptom-adapted prescriptions and enhanced supportive strategies. Full article