Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

The impact of two different aerobic exercise intensities on cardiometabolic parameters in type 2 diabetic patients: A randomized trial

BACKGROUND

Regular exercise significantly reduces cardiovascular risk and helps prevent primary and secondary cardiac events. However, the mechanisms through which exercise affects cardiovascular health remain unclear. This study investigates the acute effects of high-intensity interval training (HIIT) versus moderate-intensity continuous exercise (MOD) on endothelial function and glycemic control in patients with type 2 diabetes (T2D).

OBJECTIVES

The study aimed to compare the acute effects of a single session of HIIT and MOD on endothelial function, hemodynamic parameters, and blood glucose levels in T2D patients.

DESIGN

This was a randomized controlled trial (RCT).

SETTING

Conducted at the Laboratory of Cardiopulmonary Rehabilitation.

PARTICIPANTS

Fifty-seven sedentary patients with type 2 diabetes (39 women and 18 men) participated in the study.

METHODS

Participants were randomly assigned to either HIIT (10 sprints of 30 s at 85-100% of maximum heart rate, with 1-min active pauses) or MOD (continuous exercise at 60-70% of maximum heart rate for 30 min). Brachial artery flow-mediated dilation (%FMD) and blood glucose levels were measured before and immediately after the sessions.

RESULTS

HIIT significantly increased %FMD (9.3 ± 5.3% vs 20.05 ± 9.3%, p < 0.01) and reduced glucose levels (189 [106-335] mg/dL vs 149 [70-448] mg/dL, p < 0.01). Although MOD also showed positive responses, HIIT yielded more pronounced improvements in endothelial function.

CONCLUSION

HIIT is more effective for cardiovascular protection than MOD, although both exercises improve glycemic control in T2D patients. Higher %FMD is associated with better physical capacity and heart rate recovery, indicating a favorable prognosis.

Barriers and facilitators to exercise-based rehabilitation in people with musculoskeletal conditions: A systematic review

BACKGROUND

Exercise-based rehabilitation is the first line of treatment for people with musculoskeletal conditions. However, uptake and adherence are suboptimal, compromising the success of rehabilitation.

OBJECTIVES

To identify the barriers and facilitators that influence adherence to exercise-based rehabilitation in people with musculoskeletal conditions. Additionally, to identify the methods and instruments used to determine these barriers and facilitators.

DESIGN

Systematic review METHODS: Five databases from inception to May 2024 using terms related to exercise, musculoskeletal conditions, methods, barriers and facilitators. Risk of bias was assessed using either the Newcastle-Ottawa Scale or Cochrane risk of bias tool. Using an inductive thematic approach, barriers and facilitators were grouped into intrapersonal, interpersonal and community factors. Methods/instruments were categorized into three groups, being questionnaires, interviews and focus-groups.

RESULTS

Eighty-one of 8380 studies were included. The majority of studies were of good or fair quality (95%). The most frequently identified barriers were lack of time (53%), pain (45%) and health (40%). The most frequent facilitators were self-efficacy (42%), perceived health benefits (32%) and previous experiences (30%). The methods used were interviews (n = 53), questionnaires (n = 44) and focus groups (n = 10).

CONCLUSION

Most barriers and facilitators to exercise were related to intrapersonal factors. Although there is a lack of consistency in instruments used, the reported barriers and facilitators were similar across studies. Clinicians and researchers should consider intrapersonal factors when promoting exercise-based rehabilitation programs. Applying a theoretical framework to investigate barriers and facilitators to exercise-based rehabilitation in people with musculoskeletal conditions might assist practitioners to prioritize their practice.

Novel uses of healthcare technology for individuals with mild to moderate hip or knee osteoarthritis: The technology, exercise and activity prescription for enhanced mobility (TEAM) study randomized controlled trial protocol

Objectives

Patient education, physical activity, and exercise are recommended as first-line treatments for mild to moderate hip and knee osteoarthritis (OA). We developed two novel healthcare interventions: an electronic medical record-embedded physical activity prescription tool (PARx) for physicians, and a free, online educational platform (Joint Management (JM)) with exercise programming and optional telerehabilitation with a physiotherapist for patients. Objectives: 1) Determine the effectiveness of PARx ​± ​JM on patient-reported outcomes, physical activity levels, and performance-based functional outcomes in individuals with mild to moderate hip or knee OA, versus usual care; 2) evaluate engagement and adherence to PARx ​+ ​JM; and 3) explore the feasibility of PARx and PARx ​+ ​JM.

Registration

NCT04544904.

Methods

Randomized controlled trial (type 1 hybrid implementation effectiveness). We will recruit 339 (113/group) participants ≥40 years old with mild to moderate hip or knee OA and randomize them into three groups: PARx, PARx ​+ ​JM, or control (usual care). Follow-up appointments will be completed at 2-, 6-, and 12-months. Primary outcome: Knee Injury/Hip Disability and OA Outcome Score. Secondary outcomes: physical activity levels, anthropometric measurements, physical function, and other patient-reported outcomes. We will assess intervention feasibility and hold focus groups with patients and providers to explore perceptions of the interventions.

Conclusion

Two novel healthcare interventions will be used to provide physical activity and exercise programming for individuals with mild-moderate knee and hip OA. This study will allow us to determine the effectiveness of these interventions on patient-reported outcomes, physical activity levels, and performance-based functional outcomes.

Effect of a 24-week supervised concurrent exercise intervention on fecal microbiota diversity and composition in young sedentary adults: The ACTIBATE randomized controlled trial

BACKGROUND

Numerous physiological responses to exercise are observed in humans, yet the effects of long-term exercise and varying intensities on the diversity and composition of human fecal microbiota remain unclear. We investigated the effect of a 24-week supervised concurrent exercise intervention, at moderate and vigorous intensities, on fecal microbiota diversity and composition in young adults.

METHODS

This ancillary study was based on data from the ACTIBATE randomized controlled trial (ClinicalTrials.gov ID: NCT02365129), and included adults (aged 18-25 years, 70 % female) that were randomized to (i) a control group (CON: no exercise, n = 20), (ii) a moderate-intensity exercise group (MOD-EX, n = 21), and (iii) a vigorous-intensity exercise group (VIG-EX, n = 20). Fecal samples were collected before and after the 24-week exercise intervention, and the diversity and composition of the fecal microbiota were analyzed by 16S rRNA sequencing. Inferential functional profiling of the fecal microbiota was performed and correlations between microbial changes and cardiometabolic outcomes were assessed.

RESULTS

Exercise did not modify beta or alpha diversities regardless of the intensity (all P ≥ 0.062). The relative abundance of the Erysipelotrichaceae family (Bacillota phylum) (-0.3 ± 1.2 %; P = 0.031) was however reduced in the VIG-EX group. Coprococcus was the only genus showed a significant difference between MOD-EX and VIG-EX after the intervention, with its relative abundance increasing in MOD-EX (+0.4 ± 0.6 %; P = 0.005). None of these changes were related to the exercise-induced cardiometabolic benefits (all P ≥ 0.05).

CONCLUSIONS

In young adults, a 24-week supervised concurrent exercise program, at moderate and vigorous intensities, resulted in minor changes in fecal microbiota composition, while neither alpha nor beta diversities were affected.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02365129.

Comparative effectiveness of various exercise interventions on cardiorespiratory fitness in adults living with overweight or obesity: A systematic review and Bayesian network meta-analysis

This study evaluated how different exercise interventions affect maximal oxygen uptake (VO2max) in adults with overweight or obesity. We systematically searched five databases from inception to February 2025 to identify relevant randomized controlled trials (RCTs). We used the Cochrane risk of bias tool. A Bayesian network meta-analysis with a random-effects model was conducted. A total of 93 RCTs involving 4,446 participants were included. The network meta-analysis showed high-intensity interval training (HIIT) ranked highest (Surface Under the Cumulative Ranking Curve [SUCRA]: 82.5%; Standardized Mean Difference [SMD]: 4.85; 95%Credible Interval [CrI]: 3.90, 5.80), followed by high-intensity aerobic training (HAT) (SUCRA: 76.7%; SMD: 4.72; 95%CrI: 3.78, 5.68), and combined aerobic and resistance training (CT) (SUCRA: 69.1%; SMD: 4.52; 95%CrI: 3.48, 5.60), with resistance training (RT) least effective (SUCRA: 18.3%; SMD: 2.57; 95%CrI: 1.32, 3.86). All six interventions effectively improved VO2max in overweight or obese adults. Among them, HIIT was most beneficial. Coaches and fitness professionals should consider these findings to help adults with overweight or obesity achieve optimal outcomes.

Physical Activity in Lower-Extremity Sarcoma Survivors: Specific Recommendations and Program Design

Survivors of lower-extremity sarcoma are at high risk of developing physical performance dysfunctions and impaired quality of life resulting from the sarcoma disease itself and the adverse side effects of the treatments. Therefore, the implementation of safe and effective exercise programs addressing survivors' functionality and life quality is an essential and complementary nonpharmacological intervention in the cancer continuum. The viability and success of physical activity and exercise in lower-extremity sarcoma survivors remains largely unknown, likely due to the heterogeneity of clinical presentation and development of this type of cancer regarding diagnosis, treatment, and prognosis. This study provides specific recommendations for designing an appropriate training program that will help maintain sarcoma survivors' physical activity and improve their quality of life. The main conclusions reported here result from scientific studies and analyses of clinical data both selected from a systematic search in PubMed database. Sarcoma survivors should be advised as soon as the disease is diagnosed to perform a simple program of low-intensity and short-duration exercise prior to surgery (prehabilitation). Later, during clinical treatments and taking into account their psychobiological status, an adapted exercise program may be developed within the hospital environment. Finally, building healthy habits is recommended so as to improve disease-free survival, including regular physical activity, always under the supervision of professionals in this field. Hopefully, these suggestions will contribute to a better professional performance by specialists in the implementation of safe, reliable, and exercise programs in lower-extremity sarcoma survivors.

Navigating Loss and Growth in Chronic Illness: An Interview Study on Physical Activity and Well-Being

AIMS AND OBJECTIVES

This study explores the lived experiences of patients with chronic illnesses to understand how the meanings attributed to chronic illness, physical activity and well-being intertwine. This understanding is crucial for care practices aiming to support and enhance well-being.

METHODOLOGICAL DESIGN

We conducted a qualitative interview study grounded in hermeneutic-phenomenology to capture participants' lifeworld experiences in narrative form. COREQ is used as a reporting guideline.

ETHICAL ISSUES AND APPROVAL

Ethical considerations followed the ICN's ethical code of conduct, including addressing the sensitivity of researching vulnerable patients. All participants gave informed consent verbally and in writing. The study is registered with the Danish Data Protection Agency (REG-115-2021).

METHODS

We interviewed 22 individuals with multiple sclerosis, Alzheimer's disease or ischemic heart disease in Denmark. Thematic analysis, inspired by Van Manen's phenomenology of practice, was employed and findings were discussed with the theory of well-being by Todres and Galvin.

RESULTS

Our analysis revealed a narrative of dual experiences: significant loss and transformative existential growth. The theme 'Losing oneself determined by bodily impact' captured the profound impact of participants' illnesses, including loss of embodiment, familiar life and a promised future. Conversely, the theme 'Physical activity as a pathway to existential growth' highlighted the empowering role of physical activity in finding relief, claiming control and fostering reconnections with oneself and others.

STUDY LIMITATIONS

Limitations of this study include the timing of interviews across different stages of illness and the context-dependent nature of qualitative findings, which may affect their transferability to other settings.

CONCLUSION

This investigation highlights the value of physical activity beyond traditional health outcomes for those with chronic illnesses. Physical activity emerges as a vital component for existential growth and improved well-being. The study advocates for incorporating meaningful physical activities into care strategies to enrich the quality of life for individuals with chronic and life-threatening diseases.

Estimating Budget Impact and Joint Replacement Avoidance by Implementing a Standardized Education and Exercise Therapy Program for Hip and Knee Osteoarthritis in a Publicly Insured Health Care System

OBJECTIVE

The study objective was to estimate the budget impact of funding a standardized education and exercise therapy program, Good Life with osteoArthritis in Denmark (GLA:D) for people with hip and knee osteoarthritis (OA) waiting for total joint replacement (TJR) consultation in a universal publicly insured health care system in Canada.

METHODS

We built a budget impact analysis model to estimate the annual cost (Canadian dollars) of providing the GLA:D program to people waiting for a TJR consultation and then forecasted a three-year budget cycle. The base case assumes that 40% attend GLA:D sessions, that 11% avoid surgery, uniform care delivery, that training costs are incurred separately, and that the health care system has enough trained staff to meet demand. The population of people with hip and knee OA waiting for a TJR consultation was estimated with government statistics, peer-reviewed evidence, and routinely collected data from five orthopedic centralized intake clinics (serving 80% of people seeking TJR). Patient-level costs were collected prospectively. International published evidence informed the TJR avoidance estimates. A one-way sensitivity analysis of key parameters evaluated model robustness. Four scenarios were analyzed: public funding for everyone (base case), low-income, rural, and uninsured persons.

RESULTS

Funding GLA:D would cost $4.3 million, serve 12,500 people, and save $8.5 million by avoiding 1,300 TJRs in year one. Savings grow to $8.8 and $8.7 million in years two and three. The number of TJRs performed annually produced the most uncertainty in budget impact (-$15.3 million, -$1.8 million). The most cautious parameter estimates still produce cost savings.

CONCLUSION

Publicly funding standardized education and exercise therapy programs for everyone waiting for a TJR consultation would avoid surgeries, improve access to evidence-based treatments, and save more than the program costs.

Twelve-week interval training alters cytokines, adipokines and bone markers in women with obesity

This study aimed to investigate the effects of a 12-week high-intensity interval training on inflammatory cytokines, adipokines, and markers of bone turnover and examine whether high-intensity interval training-induced changes in inflammatory cytokines and adipokines were associated with changes in markers of bone turnover. Twenty-four women with obesity (mean [standard deviation]: age: 36.1 [3.38] years, height: 158.9 [11.9] cm, and body mass index: 31.9 [1.5] kg/m2) were randomly assigned to either control (n=10) or high-intensity interval training (n=14) groups. Body mass (- 2.7%), fat mass (- 15%), and percent body fat (- 6.2%) significantly decreased (p<0.05), while the predicted V̇O2max increased (29.6%; p<0.001) following the high-intensity interval training program. The training program resulted in increased adiponectin (7.6%) and osteocalcin (11.3%; p<0.05) and reduced tumor necrosis factor alpha (66.1%), interleukin-1α (18.6%), C-reactive protein (24.0%), leptin (21.5%), and carboxy-terminal telopeptide cross-linking type one collagen (14%; p<0.05). When high-intensity interval training and control groups were analyzed separately, training-induced changes in inflammatory cytokines and adipokines were not associated with changes in bone turnover markers (p>0.05), whereas significant associations were found when the data of the groups were analyzed together (p<0.05). In conclusion, a 12-week high-intensity interval exercise program improves the inflammatory state, adipokines, markers of bone turnover, cardiorespiratory fitness, and body composition in women with obesity.

Changes in female cancer diagnostic billing rates over the COVID-19 period in the Ontario Health Insurance Plan

Background

The initial response to coronavirus disease 2019 (COVID-19) in Ontario included suspension of cancer screening programs and deferral of diagnostic procedures and many treatments. Although the short-term impact of these measures on female cancers is well documented, few studies have assessed the mid- to long-term impacts.

Objectives

To compare annual billing prevalence and incidence rates of female cancers during the COVID-19 period (2020-2022) to pre-COVID-19 levels (2015-2019).

Design

Retrospective analysis of aggregated claims data for female cancer diagnostic codes from the Ontario Health Insurance Plan (OHIP).

Methods

Linear regression analysis was used to fit pre-COVID-19 (2015-2019) data for each OHIP billing code and extrapolate counterfactual values for the years of 2020-2022. Excess billing rates were calculated as the difference between projected and actual rates for each year.

Results

In 2020, OHIP billing prevalence rates for cervical, breast, uterine, and ovarian cancers decreased relative to projected values for that year by -50.7/100k, -13.9/100k, -3.5/100k, and -3.8/100k, respectively. The reverse was observed in 2021 with rate increases of 47.8/100k, 59.1/100k, 2.5/100k, and 3.7/100k, respectively. In 2022, the excesses were further amplified, especially for cervical and breast cancers (111.2/100k and 78.67/100k, respectively). The net excess patient billing rate for 2020-2022 was largely positive for all female cancer types (108.3/100k, 123.7/100k, 5.2/100k, and 1.8/100k, respectively). Analysis of billing incidence rates showed similar trends.

Conclusion

The expected female cancer billing rate decreases in 2020 were followed by large increases in 2021 and 2022, resulting in a cumulative excess during the COVID-19 period. Further research is required to assess the nature of these changes.

Association between metabolic syndrome and low back pain: a two-sample Mendelian randomization study

This study uses two-sample MR analysis with GWAS summary statistics to evaluate the causal relationship between metabolic syndrome and low back pain. A two-sample Mendelian randomization analysis used GWAS summary statistics for low back pain from the FinnGen database and metabolic syndrome data, including waist circumference, hypertension, fasting blood glucose, HDL cholesterol, and triglyceride levels. Various methods like inverse variance weighted, MR-Egger, weighted median, and mode assessed the causal relationship, with sensitivity analyses addressing heterogeneity and pleiotropy. Our analysis found a statistically significant causal association between essential hypertension (OR  2.38, 95% CI 1.42-3.96; Padj = 0.002), metabolic syndrome (OR  1.05, 95% CI 1.01-1.10; Padj = 0.023) and waist circumference (OR   49, 95% CI 1.32-1.68; Padj < 0.001) and low back pain (OR  1.41, 95% CI 1.30-1.53, Padj < 0.001). In contrast, fasting blood glucose (FBG), HDL cholesterol, and triglycerides showed no significant associations with low back pain across all MR methods. The results of sensitivity analyses indicated that the heterogeneity and pleiotropy were unlikely to disturb the causal estimate. Our study indicates that increased essential hypertension, metabolic syndrome and waist circumference is causally associated with a higher risk of low back pain. Interventions targeting metabolic syndrome components, particularly blood pressure control and weight management, could help reduce the risk of low back pain. Further research is needed to explore the underlying biological pathways linking these metabolic factors to low back pain.

The Effects of Exercise Intervention in Older Adults With and Without Sarcopenia: A Systematic Review

This systematic review, conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42024619693), aimed to evaluate the effects of physical exercise interventions on muscle function and fall risk in older adults with and without sarcopenia. Methods: A comprehensive search of PubMed and Web of Science databases identified 11 randomized controlled trials (RCTs) published between 2015 and 2025. A total of 792 participants (mean age 75.13 ± 4.71 years; 65.53% women, 34.47% men) were included. Interventions varied in type-strength, balance, aerobic, and multi-component programs-with a minimum duration of 8 weeks. Results: The reviewed studies showed that physical exercise interventions significantly improved neuromuscular function, physical performance, and postural control in older adults. Positive effects were observed in gait speed, stair-climbing ability, grip strength, muscle mass, and bone density. Specific modalities such as Tai Chi improved postural control and neuromuscular response; dynamic resistance and functional training increased muscle strength and improved posture; Nordic walking reduced postural sway; and multi-component and combined walking-resistance training enhanced mobility and force efficiency. Programs integrating strength and balance components yielded the most consistent benefits. However, reporting on FITT (Frequency, Intensity, Time, Type) principles was limited across studies. Conclusions: Exercise interventions are effective in improving neuromuscular outcomes and reducing fall risk in older adults, both with and without sarcopenia. The findings support the need for tailored, well-structured programs and greater methodological standardization in future research to facilitate broader clinical application and maximize health outcomes.

Latent profile analysis of nutrition knowledge, attitudes, and practices and their influencing factors in maintenance hemodialysis patients

To explore the current status of nutrition knowledge, attitude, and practice (KAP) among maintenance hemodialysis (MHD) patients in Anhui province in China and identify the influencing factors, providing a scientific basis for nutritional management in MHD patients. From September to October 2022 and February to March 2025, a comprehensive survey was conducted among 772 MHD patients sourced from 20 hemodialysis hospitals situated within the Anhui province in China. This survey encompassed the KAP Questionnaire, in conjunction with a general information survey. Latent profile analysis (LPA) was employed to identify potential categories of nutritional KAP among patients. Chi-square tests and multivariate logistic regression were used to analyze the distribution differences and influencing factors among different KAP categories. A total of 740 valid questionnaires were collected with a response rate of 95.9% (740/772). LPA divided the patients' nutritional KAP scores into three categories: low KAP group (40 patients, 5.41%), moderate KAP group (564 patients, 76.21%), and high KAP group (136 patients, 18.38%). Significant differences were observed in age, education level, dialysis cause, number of non-renal diseases, exercise, smoking, visiting the hospital alone, sleep duration, nursing status, albumin, hemoglobin, and sarcopenia among the different KAP categories. Multivariate logistic regression analysis indicated that independent factors affecting the nutritional KAP classification of MHD patients included education level, hemoglobin, physical exercise, and sleep duration. MHD patients exhibit distinct nutritional KAP profiles influenced by modifiable factors. Clinically, tailored interventions-such as simplified education and practice-focused support for Low and Moderate KAP Group-should address these subgroups' unique needs. This paper's limitations are its cross-sectional design, regional sampling bias in Anhui province.

Factors for adherence to a physical activity promotion program in the workplace: a systematic review

INTRODUCTION

The health benefits of physical activity (PA) are now widely accepted and proven. Promoting PA in the workplace is therefore of major public health interest, but is limited by employees' adherence.

METHOD

A systematic review was therefore carried out to identify factors for adherence to PA promotion program in the workplace (primary outcome); health outcomes were to be regarded as secondary outcomes. Four databases, PubMed, Web of Science, Cochrane Central Register of Controlled Trials (Cochrane CRCTs) and PsycInfo were searched to find all pertinent articles published from 2000 until June 2024. Only randomized controlled trials (RCTs) and clinical trials were selected.

RESULTS

More than 9000 publications were analyzed and 91 were retrieved. Two main types of study were identified: 46 non-supervised PA programs (NSPAPs) supported by socio-cognitive theories, and 45 supervised (tailored) programs (SPAPs). Concerning the primary outcome, the main factors identified for adherence were the levels of baseline PA, health and motivation of the individual; intervention individualization at the interventional level; and work environment quality at the organizational level. This review highlighted significant health benefits in both types of study, with effect sizes ranging from small to large.

DISCUSSION

Assessing these factors for adherence emerges as an essential prerequisite before implementing a PA promotion program in the workplace. According to our results, implementing NSPAPs, supported by socio-cognitive theories, is rather complex, and such programs can be difficult to operationalize in their entirety; consequently, coach-supervised PAPs based on RCT programs tend to be more effective.

CONCLUSION

Our results prove the short and medium-term beneficial effect on health of PAP in the workplace based on rigorous methodology such as RCTs. Management's support through work organization and the follow-up of actions in the long term are an essential factor for adherence to these programs. Finally, we suggest what this literature review contributes for future research or entrepreneurial and/or political projects. In fine, new models of working time will have to be considered.

Telemedicine-supported hospital-at-home for acutely admitted patients at Nordsjaellands Hospital, Denmark: a study protocol for a randomised controlled trial

INTRODUCTION

The combination of a reduction in the Danish hospital bed count, the shortage of hospital staff and demographic changes challenges the Danish hospital capacity. This was further highlighted during the COVID-19 pandemic when hospitals worldwide were overwhelmed by infected patients requiring acute hospital care. To address these challenges, a hospital-at-home (HaH) programme offers an alternative to conventional in-hospital admission. Furthermore, HaH has the potential to improve patient outcomes, reduce costs and increase patient satisfaction. However, few studies have evaluated HaH in a Scandinavian setting, and this article describes the protocol for a randomised controlled trial (RCT) comparing an HaH model with continued conventional in-hospital admission. The main aim of the trial is to evaluate physical activity level and mental wellbeing in patients admitted at home compared with conventionally admitted patients.

METHODS AND ANALYSIS

110 clinically stable patients from two internal medical wards at Nordsjaellands Hospital in Denmark will be included and randomised in a ratio of 1:1 to either continued conventional in-hospital admission (control group) or virtual HaH model (intervention group). The control group will receive standard hospital treatment, and the intervention group will be transferred home for continued treatment (eg, intravenous antibiotics or oxygen treatment). The primary outcome measures are physical activity assessed using daily step count (during the first 24 hours after inclusion, as an intermediary indicator of the risk of adverse events) and treatment satisfaction (assessed using a patient satisfaction survey). Secondary outcome measures are adverse events of special interest, escalation of care, readmission rate postdischarge (30 days and 90 days), mortality (associated and 7 days, 30 days and 90 days postdischarge), process data (eg, the number of teleconsultations) and a health economic evaluation.

ETHICS AND DISSEMINATION

The study was approved by the Danish Research Ethics Committees (no. 2303051) and the Danish Medicines Agency (CIV-23-03-042542) and will be monitored by the Copenhagen University Hospital Good Clinical Practice unit. Results will be published in peer-reviewed journals and presented at relevant national and international conferences. We also plan to communicate the results to relevant stakeholders in the Danish healthcare system.

TRIAL REGISTRATION NUMBER

NCT05920304.

Explainable predictive models of short stature and exploration of related environmental growth factors: a case-control study

BACKGROUND

Short stature is a prevalent pediatric endocrine disorder for which early detection and prediction are pivotal for improving treatment outcomes. However, existing diagnostic criteria often lack the necessary sensitivity and specificity because of the complex etiology of the disorder. Hence, this study aims to employ machine learning techniques to develop an interpretable predictive model for normal-variant short stature and to explore how growth environments influence its development.

METHODS

We conducted a case‒control study including 100 patients with normal-variant short stature who were age-matched with 200 normal controls from the Endocrinology Department of Nanjing Children's Hospital from April to September 2021. Parental surveys were conducted to gather information on the children involved. We assessed 33 readily accessible medical characteristics and utilized conditional logistic regression to explore how growth environments influence the onset of normal-variant short stature. Additionally, we evaluated the performance of the nine machine learning algorithms to determine the optimal model. The Shapley additive explanation (SHAP) method was subsequently employed to prioritize factor importance and refine the final model.

RESULTS

In the multivariate logistic regression analysis, children's weight (OR = 0.92, 95% CI: 0.86, 0.99), maternal height (OR = 0.79, 95% CI: 0.72, 0.87), paternal height (OR = 0.83, 95% CI: 0.75, 0.91), sufficient nighttime sleep duration (OR = 0.48, 95% CI: 0.26, 0.89), and outdoor activity time exceeding three hours (OR = 0.02, 95% CI: 0.00, 0.66) were identified as protective factors for normal-variant short stature. This study revealed that parental height, caregiver education, and children's weight significantly influenced the prediction of normal-variant short stature risk, and both the random forest model and gradient boosting machine model exhibited the best discriminatory ability among the 9 machine learning models.

CONCLUSIONS

This study revealed a close correlation between environmental growth factors and the occurrence of normal-variant short stature, particularly anthropometric characteristics. The random forest model and gradient boosting machine model performed exceptionally well, demonstrating their potential for clinical applications. These findings provide theoretical support for clinical identification and preventive measures for short stature.

The Effects of Cognitive Behavioral Therapy for Insomnia on Physical Activity Before and After Time in Bed Among Shift Workers

Background: Sleep and physical activity (PA) are bidirectionally related, with PA having a positive effect on sleep, and sleep quality influencing PA the following day. However, little is known about the effects of clinical interventions for sleep disorders on PA. Therefore, the aim of this secondary analysis is to evaluate the impact of cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment for insomnia, on PA. Methods: Thirty-eight nurses with shift work disorder and insomnia were randomly assigned to either CBT-I or a waitlist control group. PA was measured for one week before (T0) and after the intervention/waiting period (T1) using actigraphy and sleep diary items. The impact of CBT-I on the PA parameters was analyzed using linear mixed models. In addition, correlations of pre-to-post-treatment changes in PA and pre-to-post-treatment changes in the clinical outcomes (insomnia severity, sleep efficiency, depression) were explored in the CBT-I group. Results: CBT-I increased actigraphy-derived PA during the two hours (β = 26.17, SE = 9.41, p = 0.009) and one hour (β = 13.24, SE = 4.57, p = 0.006) after time in bed, and resulted in a higher percentage of self-reported days with PA (β = 19.11, SE = 9.36, p = 0.049) compared to the waitlist control group. No significant correlations were found between the changes in PA and clinical outcomes, except for a moderate positive correlation between changes in self-reported sleep efficiency and changes in PA one hour before time in bed (r = 0.56, p = 0.013). Conclusions: This is the first study to investigate the impact of CBT-I on PA, providing preliminary evidence of the potential positive effects. Further studies with larger sample sizes and randomized controlled designs with continuous PA monitoring are needed to confirm these preliminary results.

Physical activity in the management of borderline personality disorder: A scoping review

INTRODUCTION

Borderline Personality Disorder (BPD) affects 1-2 % of the population and poses significant health challenges. Individuals with BPD face a reduced life expectancy of 14-27 years, primarily due to suicide and cardiovascular-related issues. This scoping review aimed to provide an overview of the existing literature on physical activity (PA) in BPD management, focusing on research characteristics and exploring underlying rationales.

METHODS

The PubMed, CINAHL, Embase, PsycINFO, Scopus, PEDro and Cochrane databases were searched for both unpublished and published studies from 1980 to February 2025. The search followed the PRISMA-ScR guidelines and the Population, Concept, and Context framework.

RESULTS

Twenty-one studies met the inclusion criteria, including seven RCTs (four ongoing), five non-randomized controlled trials, two non-controlled intervention studies, one single-case experimental study, and six case studies. The studies included 229 participants, primarily female, and covered six PA modalities: structured exercise, yoga, dance movement therapy, outdoor PA's, sports, and body awareness and psychomotor therapies. Analysis identified seven categories of rationales for incorporating PA: improving patient care, fostering emotional regulation, promoting mental health, regulating maladaptive behaviors, enhancing social skills, protecting physical health, and reclaiming embodiment, with fostering emotional regulation as the most prominent.

CONCLUSION

This review highlights the promising but fragmented research on PA interventions for BPD, with a primary emphasis on psychological aspects. Notable gaps include limited attention to somatic comorbidities and the lack of consistent outcome measures. Future research should prioritize the development of multidisciplinary interventions to address both psychological and physical factors.

Potential of synergist ablation to study mechanisms of skeletal muscle hypertrophy in rodent disease models

Synergist ablation (SA) is a well-established model of mechanical overload-induced hypertrophy in rodents, commonly used to infer skeletal muscle adaptation to resistance training in humans. Given the critical role of skeletal muscle atrophy in chronic conditions such as neuromuscular, metabolic, and cardiopulmonary disorders, SA represents a promising preclinical tool to study muscle hypertrophy mechanisms in pathological states. However, although extensively characterized in healthy animals, the potential applications of SA in disease models remain largely overlooked. This Mini-Review summarizes existing studies employing SA in rodent disease models, highlighting the diverse hypertrophic responses observed across conditions, including Duchenne muscular dystrophy, obesity, diabetes, cancer cachexia, and chronic kidney disease. Although hypertrophy gains are generally attenuated in diseased animals compared to healthy controls, SA-induced overload provides valuable insights into disease-specific regulatory mechanisms, including alterations in intracellular signaling, fiber type transitions, and disease phenotype. We also discuss the strengths and limitations of SA as a preclinical model for resistance training in disease contexts and propose its broader adoption for mechanistic investigations into skeletal muscle plasticity under pathological conditions.

Life Satisfaction and Healthy Lifestyle Behaviors of Individuals According to Exercise Preferences of Outdoor and Indoor

OBJECTIVE

Preference for outdoor and indoor exercises is essential when choosing a place to exercise. This study compared adults' healthy lifestyle behaviors and life satisfaction according to physical activity location preferences.

SUBJECT AND METHODS

The study is conducted using a cross-sectional design between May and October 2023, with visitors to a gym (n = 270). The study sample included participants in the activities of two outdoor sports groups and two gyms operating.

STUDY

The questionnaire for data collection consists of demographic characteristics, Health Promotion Lifestyle Profile (HPLP), Life Satisfaction Scale (SLS), Three-Factor Eating Questionnaire-R (TFEQ). Percentage, mean, standard deviation, t-test, ANOVA posthoc analysis, and Chi-square tests were used to analyze the data.

RESULTS

The mean age of the participants was 25.87 ± 8.59 years. The rate of people doing indoor activity is 67.4%. The rate of those who prefer outdoor exercise is 87.8%. Many parameters were significant for indoor and outdoor exercisers compared to those in a single location (p < 0.05).

CONCLUSION

Healthy lifestyle behaviors are better for those who prefer both locations for exercise. A fuller picture of this study is that balance is important for the preference of outdoor and indoor exercises. Individuals should be encouraged to exercise outdoors and indoors.

Moderate intensity continuous training, combined moderate-intensity continuous training vs combined high-intensity interval training in adults with hypertension: Randomized controlled trial

BACKGROUND AND PURPOSE

Despite all efforts to treat hypertension, it is still responsible for 10.8 million deaths annually. The aim of this study was to compare the effects of continuous moderate-intensity training, strength training combined with continuous moderate-intensity training and strength training combined with high-intensity interval training in adults with high blood pressure.

METHODS

A 12-week randomized control trial was performed. A total of 100 volunteers, 51 women and 49 men with hypertension participated. The sample was randomly assigned into three intervention groups and one control group.

RESULTS

All intervention groups significantly improved their hemodynamic parameters, body composition, lipid profile, glucose, and physical fitness as compared to the control group. Both combined training groups showed greater improvements than the moderate-intensity continuous training group. However, the strength group combined with the moderate-intensity continuous group showed the greatest benefits in systolic, diastolic and mean arterial pressure, of -13.4 mmHg, -6.8 mmHg and -8.9 mmHg respectively, abdominal circumference, upper and lower limb strength and VO₂peak, versus the continuous moderate-intensity group; it also achieved greater reductions in systolic and mean blood pressure, up to -6.8 mmHg and 4.3 mmHg respectively, than the strength group combined with the high intensity interval group.

CONCLUSION

Performing a strength training program combined with continuous moderate intensity training, 2 days per week for 12 weeks, produces significant improvements in cardiometabolic biomarkers, body composition, and physical condition of adults with hypertension, with these adaptations being superior to those produced by continuous moderate-intensity training and strength training combined with high-intensity intervallic training.

Neuro-Nutritional Approach to Neuropathic Pain Management: A Critical Review

Pain is a significant global public health issue that can interfere with daily activities, sleep, and interpersonal relationships when it becomes chronic or worsens, ultimately impairing quality of life. Despite ongoing efforts, the efficacy of pain treatments in improving outcomes for patients remains limited. At present, the challenge lies in developing a personalized care and management plan that helps to maintain patient activity levels and effectively manages pain. Neuropathic pain is a chronic condition resulting from damage to the somatosensory nervous system, significantly impacting quality of life. It is partly thought to be caused by inflammation and oxidative stress, and clinical research has suggested a link between this condition and diet. However, these links are not yet well understood and require further investigation to evaluate the pathways involved in neuropathic pain. Specifically, the question remains whether supplementation with dietary antioxidants, such as melatonin, could serve as a potential adjunctive treatment for neuropathic pain modulation. Melatonin, primarily secreted by the pineal gland but also produced by other systems such as the digestive system, is known for its anti-inflammatory, antioxidant, and anti-aging properties. It is found in various fruits and vegetables, and its presence alongside other polyphenols in these foods may enhance melatonin intake and contribute to improved health. The aim of this review is to provide an overview of neuropathic pain and examine the potential role of melatonin as an adjunctive treatment in a neuro-nutritional approach to pain management.

Comparative effectiveness of morning and evening aerobic exercise on weight loss and physical fitness in Chinese college students with overweight and obesity

BACKGROUND

Physiological and metabolic processes are influenced by biological rhythms. However, whether exercising in the morning or evening is more beneficial, given that these periods are two key time windows to incorporate exercise, has remained unclear. This study aimed to investigate the effects of morning versus evening exercise on weight loss, morphometric indicators, and physical fitness among Chinese college students with overweight and obesity.

METHODS

A total of 31 students with overweight and obesity (18-22 years old) were randomly assigned to exercise in the morning (7 am to 10 am, n = 16) or evening (6 pm to 9 pm, n = 15). The morning exercise group had an average age of 19.69 ± 1.01 years and a body mass index (BMI) of 27.13 ± 2.66 kg/m². The evening group had an average age of 19.47 ± 0.99 years and a BMI of 27.91 ± 3.40 kg/m². In the morning group, 87.5% of participants were male, while 73.3% were male in the evening group. The intervention was aerobic running exercise for 60 min, five times a week for 10 weeks. Measurements were taken before and after the 10-week intervention.

RESULTS

The BMI values of male and female college students were significantly and positively associated with vital capacity (p < 0.001) and significantly and negatively associated with vital capacity weight index, 50-meter, 800-/1,000-meter, standing long jump, and chin-ups and sit-ups test performances (p < 0.001). Participants who trained in the morning showed significant reductions in minimum waist circumference (MWC) (p = 0.043, d = 0.77), scapular skinfold thickness (ST) (p = 0.002, d = 1.30) and upper arm ST (p = 0.006, d = 1.05) compared with those who trained in the evening.

CONCLUSIONS

Exercise in the morning, compared with that in the evening, has superior beneficial effects on weight loss and improving body shape in Chinese college students living with overweight and obesity.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2400089594. Date of registration 11/09/2024.

Running to remember: The effects of exercise on perineuronal nets, microglia, and hippocampal angiogenesis in female and male mice

Exercise is accepted as a positive health behaviour; however, the mechanisms of exercise on neuroprotection and cognitive health are not completely understood. The purpose of this study was to explore the neurobiological benefits of chronic treadmill exercise in female and male mice through its role in microglial content and morphology, cerebral vascularization, and perineuronal net (PNN) expression. We further examined how these neurobiological changes relate to spatial memory outcomes. Adult mice were assigned to a sedentary or treadmill exercise group for eight weeks. During the final week, all mice were trained on a spatial memory task (Barnes maze) and brains were collected for immunohistochemistry. Exercised mice made fewer errors than sedentary mice during the first two days of training and probe trial. Females, regardless of exercise training, made fewer errors during Barnes maze training and demonstrated a greater frequency of spatial strategy use compared to males. Exercised mice, regardless of sex, had fewer PNNs in the dentate gyrus of the hippocampus compared to sedentary controls. The number of PNNs in the dorsal dentate gyrus was positively correlated with total errors during training. During the probe, greater errors correlated with more PNNs among the exercised group only. Microglia count and cerebral vascularization were not affected by exercise, although proportions of microglia type (ameboid, stout/thick, and thick/thin) were regulated by exercise in the ventral dentate gyrus. We conclude that exercise decreases PNNs in the dentate gyrus in both sexes and this may be related to better spatial learning and memory.

SIRT1 Mediates the Effects of Sera from Athletes Who Engage in Aerobic Exercise Training in Activating Cells for Wound Healing

Background/Objectives: Exercise training (ET) can improve wound healing and prevent the recurrence of skin lesions. Aerobic ET stimulates the NAD+-dependent deacetylase sirtuin 1 (SIRT1). The beneficial effects of ET and SIRT1 activation in wound healing have been characterized when considered separately. This study aimed to investigate the potential role of SIRT1 as a mediator of the effects of sera isolated from athletes who regularly participate in aerobic ET (middle-distance running, MDR) on cells primarily involved in wound healing. Methods: Human keratinocytes, fibroblasts and endothelial cells were conditioned with sera from middle-distance runners and age-matched sedentary subjects (sed). Cell motility, angiogenesis and the expression of key biomarkers of cell activation were evaluated in the presence or absence of the selective SIRT1 inhibitor EX-527. Results: Higher SIRT1 activity was detected in all of the cell lines conditioned with the MDR group sera compared with that in the cells in the sed group sera. The involvement of SIRT1 was demonstrated by EX-527's selective inhibition. Alongside the increase in SIRT1 activity, a marked increase in migration, invasion and angiogenesis was observed. The levels of E-cadherin decreased while those of integrin β1 and vinculin increased in the keratinocytes and fibroblasts conditioned with the MDR group sera compared to these values with the sed group sera, respectively. Increased levels of differentiation markers, such as involucrin in the keratinocytes, FAP1α in the fibroblasts and CD31 in the endothelial cells, were observed with the MDR group sera compared to these values using the sed group sera. Conclusions: The ex vivo/in vitro approach used here links aerobic ET-induced SIRT1 activity to proper tissue regeneration.

Counseling and Prescription of Physical Exercise in Medical Consultations in Portugal: The Clinician's Perspective

Background/Objectives: Physical exercise (PE) is essential in promoting health and quality of life and protecting against chronic diseases. Health professionals are identified as key figures in promoting and prescribing PE, yet various factors may impact this during consultations. This study aims to assess Portuguese specialist physicians' understanding of the importance of PE prescriptions. It will also investigate the approaches they utilize in promoting and prescribing PE, their knowledge of incorporating this practice into their consultations, and the major facilitators or barriers to prescription. Methods: A cross-sectional observational study was conducted using a validated questionnaire distributed via email by the Centre Regional Section of the Portuguese Medical Association to physicians. The data were analyzed using descriptive and inferential statistics. Results: In total, 414 responses were collected, with participants representing different medical specialties. The participants were primarily women (62.8%) with a mean age of 49.9 ± 14.9 years. While 85.5% of physicians promoted and prescribed PE, recognizing its cardiovascular and metabolic health benefits, only 24.0% received specific training, and 73.7% were unaware of relevant guidelines. Older male physicians (over 60 years old) expressed more confidence in PE prescriptions, while younger ones were more familiar with electronic prescribing tools. Identified barriers included patient compliance (42.3%), a lack of accessible PE resources (18.4%), and limited consultation time (17.4%). Most physicians (64.4%) relied on oral counseling for prescriptions. Conclusions: Most Portuguese specialist doctors recognize the benefits of PE prescriptions. However, barriers like inadequate training and patient compliance hinder PE implementation. Enhanced training and resources are vital for effectively integrating PE into clinical practice.

Physical Activity and Cancer Incidence and Mortality: Current Evidence and Biological Mechanisms

Objectives: There is strong evidence that not enough physical activity is among the most critical risk factors for cancer disease and premature mortality. The literature on the benefits of regular physical activity regarding cancer disease has grown in the last decades. This review aimed to present the current findings on the effect of prediagnosis physical activity on cancer incidence and mortality published between January 2019 and October 2024; this study summarizes the previous evidence, as well as the literature underlying biological mechanisms operating in the exercise-cancer relationship. The review also highlights gaps in the existing research and identifies future research directions. Methods: Medline/PubMed, ScienceDirect, and Google Scholar were searched with the search terms "physical activity" and "physical exercise" in conjunction with the MeSH terms for "cancer" and "carcinoma". Primary, review, and meta-analysis studies published in English were included if they reported a measure of the effect size of prediagnosis physical activity on cancer incidence and/or cancer mortality. Results: Evidence from 37 observational studies and 10 reviews were included in this systematic review; 22 studies reported the effect of physical activity on cancer incidence, and 15 studies on cancer mortality. Of the 37 included observational studies, 19 confirmed the previous evidence that physical activity significantly decreased all-cancer-combined and cancer-specific site incidences, and 10 studies focused on cancer mortality. However, the molecular mechanisms involved in this process require future studies. The most convincing evidence maintains the effects of physical activity on body weight and fat, insulin resistance, sex hormones, regulation of redox homeostasis, enhancing the antioxidant defense system, and reducing oxidative stress. Conclusions: These data demonstrate substantial prevention against several cancer incidences and mortality among patients who performed regular physical activity, of which dose meets at least the WHO's guidelines. Further prospective cohort studies and long-term RCT studies are warranted to address a safe and personalized activity dose for cancer-site prevention, identify more precisely the biological mechanisms operating in the physical activity-cancer relationship, and promote the benefits of being physically active.

The Role of Physical Activity on Spatial and Temporal Cognitive Processing in Young Women

Background/Objectives: Physical activity (PA) has many benefits for both physical and cognitive health. It has also been related to improvements in memory and executive functions. However, its impact on time estimation remains less explored. Time is a key component of episodic memory, which also involves spatial components to give a full context to events. Given the clear evidence of the benefits of PA in spatial navigation and the anatomical overlap with temporal estimation through the hippocampus, the latter could be affected in a similar way. Therefore, this study aimed to check how PA can influence time processing and spatial memory. We wanted to check if PA influenced time and space with the same directionality. Methods: Forty-two (n = 42) female university students participated in this study, divided into a Sport (n = 25) or Sedentary (n = 17) Group depending on their participation in PA for a minimum of 3 h a week. They were addressed in two different cognitive capabilities. The first was time processing, measured by the Time Comparison Task, which controlled for several key aspects of time literature in its design. Moreover, we measured spatial navigation skills, using a well-proven virtual spatial navigation task, The Boxes Room. Accuracy and mean response times were registered per task. Results: Significant correlations were observed between spatial and temporal task performance. In addition, PA influenced spatial and time processing in a similar way, with the Sport Group outperforming the Sedentary Group in accuracy and response times for both tasks. Conclusions: These findings provide evidence that PA influences time processing similarly to its established effects on spatial memory, which could help developing sports programs that further enhance this skill.

Mapping of rehabilitation interventions and assessment methods for patients with liver cirrhosis: a scoping review

BACKGROUND

This scoping review aimed to delineate the detailed components of exercise therapy and the evaluation methods used for patients with liver cirrhosis.

METHODS

The methodology involved searching the original PubMed, Web of Science, and Scopus for studies published between January 1975 and March 2025. The search was completed on 13 March 2025. Studies describing exercise therapy for liver cirrhosis patients were selected. Relevant information matching the study objectives, such as intervention duration, content, intensity setting, evaluation criteria, and outcomes, was extracted and documented.

RESULTS

Of the 2314 articles identified, 18 fit the inclusion and exclusion criteria, with a total of 950 participants. The most prevalent form of exercise therapy was a combined aerobic exercise and strength training program (55.6%). Commonly used assessment criteria included the 6-minute walking distance for endurance evaluation (44.4%) and the Chronic Liver Disease Questionnaire for quality of life assessment (33.3%). Intervention durations ranged from 30 to 60 min per day, 2 to 7 days per week, and 8 to 12 weeks. Concerning intensity setting, subjective fatigue levels and heart rate were frequently used (38.9%), though detailed descriptions were limited.

CONCLUSIONS

For the establishment of effective exercise therapy for patients with liver cirrhosis, future research should concentrate on tailoring intensity settings according to individual patient needs. Additionally, standardized reporting of intervention details and assessment methods is crucial for improving the quality and comparability of studies in this field.

Development and characterization of an Sf-1-Flp mouse model

The use of genetically engineered tools, including combinations of Cre-LoxP and Flp-FRT systems, enables the interrogation of complex biology. Steroidogenic factor-1 (SF-1) is expressed in the ventromedial hypothalamic nucleus (VMH). Development of genetic tools, such as mice expressing Flp recombinase (Flp) in SF-1 neurons (Sf-1-Flp), will be useful for future studies that unravel the complex physiology regulated by the VMH. Here, we developed and characterized Sf-1-Flp mice and demonstrated their utility. The Flp sequence was inserted into the Sf-1 locus with P2A. This insertion did not affect Sf-1 mRNA expression levels and Sf-1-Flp mice do not have any visible phenotypes. They are fertile and metabolically comparable to wild-type littermate mice. Optogenetic stimulation using adeno-associated virus (AAV) carrying Flp-dependent channelrhodopsin-2 (ChR2) increased blood glucose and skeletal muscle PGC-1α in Sf-1-Flp mice. This was similar to SF-1 neuronal activation using Sf-1-BAC-Cre and AAV carrying Cre-dependent ChR2. Finally, we generated Sf-1-Flp mice that lack β2-adrenergic receptors (Adrb2) only in skeletal muscle with a combination of Cre/LoxP technology (Sf-1-Flp:SKMΔAdrb2). Optogenetic stimulation of SF-1 neurons failed to increase skeletal muscle PGC-1α in Sf-1-Flp:SKMΔAdrb2 mice, suggesting that Adrb2 in skeletal muscle is required for augmented skeletal muscle PGC-1α by SF-1 neuronal activation. Our data demonstrate that Sf-1-Flp mice are useful for interrogating complex physiology.

Effects of different exercise habits on mitigating physical frailty in older adults: A cross-sectional study

Encouraging regular exercise is essential for promoting health among older adults. This study aimed to examine the effects of exercise on frailty and aging, considering demographic and economic factors. Between August to December 2022, individuals aged 65 and older were recruited from 12 districts in Taipei. A self-administered questionnaire was used to collect data on exercise frequency, duration, and type. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria. A total of 2,545 participants were analyzed using logistic regression. The results indicated that 23.4% of participants were pre-frail and 8.7% were frail. Regular exercise was significantly associated with a reduced risk of frailty. Specifically, exercise duration exhibited a significant inverse relationship with frailty risk. Participants that exercised 31-60 minutes daily had a 59% lower risk of frailty compared to those who exercised less than 15 minutes daily. Those participants who exercised more than 60 minutes daily had a 69% lower risk. Additionally, participants who did not engaging in aerobic exercise had a 34% higher risk of pre-frailty. Thus, these findings underscore the importance of promoting regular exercise, particularly aerobic exercise, as key strategies to reduce frailty and improve overall health in older adults.

Battle of the Biomarkers of Systemic Inflammation

Systemic inflammation is monitored with various biomarkers; of these, C-reactive protein (CRP) is widely used due to its cost effectiveness and widespread implementation. However, its lack of specificity and delayed kinetics have directed interest in cell-free DNA (cfDNA), which offers rapid responses to cellular damage. Our review compares the use of CRP and cfDNA in myocardial infarction, sepsis, and physical exercise, focusing on their origins, kinetics, and clinical utility. cfDNA release from apoptotic or damaged cells increases within minutes to hours, providing an early marker of cellular stress. In myocardial infarction, cfDNA peaks early, indicating acute injury, while CRP rises later, reflecting prolonged inflammation. In sepsis, cfDNA correlates strongly with disease severity and prognosis, outperforming CRP in early diagnosis. During physical exercise, cfDNA offers an immediate picture of cellular stress, whereas CRP's delayed response limits its utility in this context. The interaction between CRP and cfDNA suggests their combined application could improve diagnostic accuracy and prognostic assessments. As cfDNA testing becomes more widely available, researchers will need to develop standardized protocols and determine how it can best complement CRP measurements in clinical practice. This approach offers promise for improving the management of systemic inflammation across diverse medical conditions.

Exercise-induced extracellular vesicles delay tumor development by igniting inflammation in an immunologically cold triple-negative breast cancer mouse model

BACKGROUND

Preclinical studies demonstrate that exercise reduces tumor incidence and growth. Rapid release of extracellular vesicles (EVs) during exercise suggests their potential role as mediators of exercise-induced systemic effects and physiological adaptation. This study investigated the impact of exercise-induced plasma EVs on tumor growth and immune tumor microenvironment in murine models of triple-negative breast cancer (TNBC): EO771 (a C57BL/6-derived TNBC cell line) and 4T1 (a BALB/c-derived TNBC cell line).

METHODS

Size exclusion chromatography was used to isolate exercise-induced EVs from plasma of healthy female mice (BALB/c and C56BL/6, n = 30 per strain) that underwent ten 30-min moderate-intensity treadmill running sessions over 2 weeks. Nanoparticle tracking analysis, Western blot, and electron microscopy confirmed the presence of EVs in the samples. Tumor-bearing mice (n = 72 per strain) were administered with exercise-induced EVs before or/and after tumor implantation. Local and systemic immune responses were assessed using flow cytometry, enzyme-linked immunosorbent assay (ELISA), and quantitative polymerase chain reaction (qPCR).

RESULTS

Administration of exercise-induced EVs, particularly before tumor implantation, significantly suppressed tumor growth and reduced tumor burden in both TNBC models. In EO771, endpoint tumor volumes were 278-330 mm³ in treated groups compared to 799 mm³ in untreated (p < 0.0001), while in 4T1, treated groups showed volumes of 287-564 mm³ vs. 696 mm³ in untreated (p = 0.0002). Notable differences in tumor-infiltrating lymphoid and myeloid cell subpopulations indicated immunomodulatory effects of exercise-induced EVs, particularly in the 4T1 model, where their continuous administration significantly increased intratumoral cluster of differentiation 8 (CD8) T lymphocyte proportion (5.77% vs. 0.90% in untreated, p < 0.0001). Similarly, in the EO771 model, exercise-induced EVs administered before tumor implantation led to a marked rise in intratumoral CD8 T lymphocytes (2.24% vs. 1.08% in untreated, p = 0.0181).

CONCLUSION

Our findings indicate that exercise-induced EV treatment elicits a pro-inflammatory antitumor immune response, suggesting a shift of immunologically cold TNBC tumors towards a more inflamed phenotype associated with better outcomes. Our study supports the further investigation of EVs as modulators of antitumor immunity and their potential utility in enhancing the efficacy of immunotherapy.

L-Tryptophan-Rich Diet Alleviates High-Intensity-Exercise-Induced Liver Dysfunction via the Metabolite Indole-3-Acetic Acid and AhR Activation

High-intensity exercise (HIE) induces liver dysfunction and is detrimental to exercise performance. The underlying mechanism and preventive strategy urgently need to be explored. We increased the amount of tryptophan appropriately in the diet and explored the effect of an L-tryptophan-rich diet on the alleviation of HIE-induced liver dysfunction and the underlying mechanism. In this work, by establishing a C57BL/6 mouse model of high-intensity swimming exercise, the results demonstrated an L-tryptophan-rich diet significantly attenuated HIE-induced liver dysfunction, which was associated with increased levels of the tryptophan metabolite indole-3-acetic acid (IAA). Furthermore, IAA indeed exerted a protective effect against HIE-induced liver dysfunction in vivo and LPS-induced hepatocyte dysfunction in vitro. In conclusion, an L-tryptophan-rich diet may be a promising strategy to prevent HIE-induced liver dysfunction and metabolic disturbance via the metabolite indole-3-acetic acid and AhR activation.

16 weeks of moderate intensity resistance exercise improves strength but is insufficient to alter brain structure in Gulf War Veterans with chronic musculoskeletal pain: a randomized controlled trial

Introduction

Chronic widespread musculoskeletal pain (CMP) is a primary condition of Veterans who were deployed to the Persian Gulf War. The mechanisms that underlie CMP in these Veterans are unknown and few efficacious treatment options exist. This study tested the effects of 16 weeks of resistance exercise training (RET) on gray matter (GM) volume and white matter (WM) microstructure in Gulf War Veterans (GWVs) with CMP compared to GWV waitlist controls (WLC).

Methods

Fifty-four GWVs were randomly assigned to 16 weeks of RET (n = 28) or WLC (n = 26). Training involved 10 resistance exercises to involve the whole body, was supervised and individually tailored, and progressed slowly to avoid symptom exacerbation. Outcomes assessed at baseline, 6, 11 and 17 weeks and 6- and 12-months post-intervention included GM volume (voxel-based morphometry), WM microstructure (diffusion tensor imaging), pain [short form McGill Pain Questionnaire (SF-MPQ) and 0-100 visual analog scale (VAS)], fatigue (0-100 VAS), and mood (Profile of Mood States). Muscular strength was assessed at baseline, 8 and 16 weeks, and training volume was tracked throughout the 16-week intervention. Primary analyses used linear mixed effects models with Group, Time, and the Group*Time interaction as fixed factors and subject and slope as random factors to test the differential effects of RET and WLC on brain structure and symptoms. All neuroimaging analyses used the False Discovery Rate to correct for multiple comparisons at an alpha of 0.05.

Results

Strength increased significantly across the trial for the RET group (p < 0.001). There were significant Group*Time interaction effects for pain ratings (SF-MPQ total; p < 0.01) and the Profile of Mood States total mood disturbance score (p < 0.01). There were no Group or Group*Time effects for GM volume or WM microstructure. There were no significant associations between strength, symptoms, and brain structure (p > 0.05).

Conclusion

Sixteen weeks of low-to-moderate intensity RET (i) improved musculoskeletal strength and (ii) did not exacerbate symptoms, but (iii) was insufficient to alter brain structure in GWVs with CMP.

miR-126: a bridge between cancer and exercise

The microRNA miR-126 supports endothelial cells and blood vessel integrity. Recent research has shown that it also serves as a key link between exercise and cancer. This article delves into how exercise affects the expression of miR-126, impacting cardiovascular well-being and metabolic control. The article also examines the various contributions of miR-126 in cancer, acting as both a suppressor and an enhancer depending on the particular context. Regular aerobic exercises, including HIIT, consistently increase levels of miR-126, leading to enhanced angiogenesis, endothelial repair, and improved vascular function through mechanisms involving VEGF, HIF-1α, and EPC mobilization. Resistance training affects similar pathways, but does not cause a significant change in miR-126 levels.MiR-126 involves in cancer by suppressing tumor growth and controlling key pathways such as PI3K/Akt, ERK/MAPK, and EMT. Lower levels are associated with negative outcomes, later stages of the disease, and increased spread of different types of cancer like glioblastoma, CRC, ovarian, esophageal, gastric, and prostate cancer.The relationship between exercise and cancer suggests a possible therapeutic approach, where the regulation of miR-126 through exercise could help improve vascular function and slow tumor growth. Further studies should focus on understanding the specific molecular pathways through which miR-126 connects these areas, leading to potential interventions that utilize its regulatory network to promote cardiovascular well-being and enhance cancer treatment.

Combined Effects of Ketogenic Diet and Aerobic Exercise on Skeletal Muscle Fiber Remodeling and Metabolic Adaptation in Simulated Microgravity Mice

Objective: Prolonged microgravity environments impair skeletal muscle homeostasis by triggering fiber-type transitions and metabolic dysregulation. Although exercise and nutritional interventions may alleviate disuse atrophy, their synergistic effects under microgravity conditions remain poorly characterized. This study investigated the effects of an 8-week ketogenic diet combined with aerobic exercise in hindlimb-unloaded mice on muscle fiber remodeling and metabolic adaptation. Methods: Seven-week-old male C57BL/6J mice were randomly divided into six groups: normal diet control (NC), normal diet with hindlimb unloading (NH), normal diet with hindlimb unloading and exercise (NHE), ketogenic diet control (KC), ketogenic diet with hindlimb unloading (KH), and ketogenic diet with hindlimb unloading and exercise (KHE). During the last two weeks of intervention, hindlimb unloading was applied to simulate microgravity. Aerobic exercise groups performed moderate-intensity treadmill running (12 m/min, 60 min/day, and 6 days/week) for 8 weeks. Body weight, blood ketone, and glucose levels were measured weekly. Post-intervention assessments included the respiratory exchange ratio (RER), exhaustive exercise performance tests, and biochemical analyses of blood metabolic parameters. The skeletal muscle fiber-type composition was evaluated via immunofluorescence staining, lipid deposition was assessed using Oil Red O staining, glycogen content was analyzed by Periodic Acid-Schiff (PAS) staining, and gene expression was quantified using quantitative real-time PCR (RT-qPCR). Results: Hindlimb unloading significantly decreased body weight, induced muscle atrophy, and reduced exercise endurance in mice. However, the combination of KD and aerobic exercise significantly attenuated these adverse effects, as evidenced by increased proportions of oxidative muscle fibers (MyHC-I) and decreased proportions of glycolytic fibers (MyHC-IIb). Additionally, this combined intervention upregulated the expression of lipid metabolism-associated genes, including CPT-1b, HADH, PGC-1α, and FGF21, enhancing lipid metabolism and ketone utilization. These metabolic adaptations corresponded with improved exercise performance, demonstrated by the increased time to exhaustion in the KHE group compared to other hindlimb unloading groups. Conclusions: The combination of a ketogenic diet and aerobic exercise effectively ameliorates simulated microgravity-induced skeletal muscle atrophy and endurance impairment, primarily by promoting a fiber-type transition from MyHC-IIb to MyHC-I and enhancing lipid metabolism gene expression (CPT-1b, HADH, and PGC-1α). These findings underscore the potential therapeutic value of combined dietary and exercise interventions for mitigating muscle atrophy under simulated microgravity conditions.

Challenges in studying air pollution to neurodegenerative diseases

Exposure to ambient air pollution is ubiquitous and unavoidable. While associations between air pollution and cardiometabolic diseases are well-established, its role in neurodegenerative diseases, such as Alzheimer's disease and related dementias (ADRD) and Parkinson's disease (PD), has only recently begun to emerge. This narrative review provides an overview of current findings and discusses challenges and opportunities for future epidemiologic research. Mechanistically, air pollution may contribute to ADRD and PD through neuroinflammation, oxidative stress, and cerebrovascular damage. Long-term exposure to high levels of air pollution may increase the risk of ADRD and PD. Over the past 20 years, more than 50 studies have examined air pollution and ADRD, while fewer studies have focused on PD. Although the estimated effects are modest in size, they translate into a substantial number of affected individuals due to the widespread nature of the exposure and an increasingly aging population worldwide. Future research should extend exposure periods to cover younger and middle ages, estimate the effects of long-term cumulative exposures, and evaluate moderators and mediators, such as diet, physical activity, green space, and noise. More studies are also needed to include large and diverse populations, including those with special vulnerabilities and emerging exposures like wildfire smoke.

Efficacy of Yijinjing for Soft Tissue Improvement in Patients with Non-specific Chronic Neck Pain: Study Protocol for a Multicenter Randomized Controlled Trial

INTRODUCTION

As a mind-body exercise, Yijinjing has shown benefits in enhancing the effects of manual therapy for the treatment of pain, disability and soft tissue status associated with non-specific chronic neck pain (NCNP). The efficacy of Yijinjing as an independent exercise regimen for the treatment of NCNP has not been established. This study is designed to assess the efficacy of Yijinjing in patients with NCNP, compared with cervical function training (CFT).

METHODS AND ANALYSIS

A total of 132 consenting NCNP participants will be randomly assigned in a 1:1 ratio to either the Yijinjing group or the CFT group (three times a week for 8 weeks). Both groups will undergo an 8-week intervention phase. Outcome variables will be assessed at baseline and at 4-week, 8-week and 12-week follow-up. The primary outcome measure is the change in visual analogue scale scores at week 8. Secondary outcomes include neck disability index, cervical range of motion and soft tissue status parameters.

ETHICS AND DISSEMINATION

This study has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki, local laws and regulations. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ITMCTR2024000323.

Perceptions of Immersive Virtual Reality for Physical Activity Among Individuals with Hypertension at Risk of Cardiovascular Disease: A Qualitative Study

Background: Hypertension, obesity, and a sedentary lifestyle are interrelated, forming a vicious cycle that deteriorates cardiovascular health. In addition to being a pathology, hypertension is a risk factor for cardiovascular diseases, one of the leading causes of mortality worldwide. Interventions that combine weight loss and physical activity (PA) reduce cardiovascular risk, but many people face barriers in adhering to regular PA regimens such as a lack of time or motivation. Immersive virtual reality (IVR) has emerged as an innovative alternative to promote PA. This study explored the perceptions of individuals with hypertension and cardiovascular risk regarding the use of IVR as a tool for PA. Methods: Fifteen hypertensive adults with cardiovascular risk completed twelve IVR exercise sessions over thirty days. Semi-structured interviews were conducted. Results: The thematic analysis identified three main themes: (1) PA, sedentary lifestyle, and health; (2) experiences and perceptions of IVR and PA; and (3) IVR as a useful and safe tool. The participants found IVR engaging, motivating, and effective in overcoming barriers such as a lack of time and social anxiety. Gamification and immersion facilitated greater adherence and enjoyment. Conclusions: The participants of this study perceived IVR as an innovative, engaging, and motivating tool for promoting PA. The participants positively valued IVR's ability to overcome common barriers such as lack of time, adverse weather conditions, and lack of motivation, as well as its immersive and gamified features, which enhanced the adherence to and enjoyment of PA. These results suggest that IVR could complement traditional exercise programs by facilitating the initiation of active routines in sedentary individuals.

Association of physical activity, cardiorespiratory fitness, grip strength, and grip strength asymmetry with incident musculoskeletal disorders in 406,080 White adults

BACKGROUND

Musculoskeletal disorders (MSDs) represent a significant global health burden. While physical activity (PA) and physical fitness are both thought to reduce MSD risk, their independent and joint associations with MSD incidence have not been fully explored. This study investigated the independent and combined effects of PA, cardiorespiratory fitness (CRF), grip strength (GS), and GS asymmetry on MSD incidence in a large prospective cohort.

METHODS

We analyzed data from the UK Biobank cohort (2006-2023), including 406,080 participants aged 37-73 years (age = 55.7 ± 8.2 years, mean ± SD; 53.0% female) who were free of MSD at baseline and during the first 2 years of follow-up. PA, derived from self-reported data and expressed in total metabolic equivalent hours per week (MET-h/week); CRF (watts (W)/kilogram (kg)), measured using a cycling exercise test; and GS (kg), measured by hydraulic hand dynamometer, were included as exposures. GS asymmetry was defined by the left-to-right hand strength ratio. MSD incidence was determined via hospital records. Time-to-event associations were analyzed using Cox proportional hazards regression models with restricted cubic splines to account for non-linear relationships. The analysis was conducted in April 2024.

RESULTS

Over a median follow-up of 14.7 years, a total of 73,002 incident cases of MSDs were recorded (rheumatoid arthritis: 2923; osteoarthritis: 54,955; degenerative spinal diseases: 15,124). Lower self-reported PA (<4.8 MET-h/week) was associated with increased MSD risk (hazard ratio (HR) = 1.07, 95% confidence interval (95% CI), 1.07-1.08). Low CRF (<1.7 W/kg; HR = 1.09, 95% CI, 1.06-1.13), low GS (<30.0 kg mean GS; HR = 1.11, 95% CI, 1.10-1.13), and GS asymmetry (HR = 1.11, 95% CI, 1.08-1.13) were also significantly associated with increased MSD risk. Good CRF and GS, and lower GS asymmetry mitigated the higher MSD risk associated with low PA levels.

CONCLUSION

Low levels of PA, CRF, GS, and GS asymmetry were associated with a higher risk of incident MSD. Meanwhile, improvements in CRF, GS, and GS balance could help offset the risk of MSD incidence in populations with insufficient PA.

Specific modes of exercise to improve rotator cuff-related shoulder pain: systematic review and meta-analysis

Objective

To investigate the effect of specific modes of exercise on rotator cuff-related shoulder pain (RCRSP) patients, aiming to provide a theoretical reference for conservative treatment and exercise prescription.

Methods

Data sources included PubMed/MEDLINE, Web of Science, ScienceDirect, and CNKI, covering studies from database inception to June 2024. Study selection followed pre-set inclusion/exclusion criteria. Cochrane methods guided quality assessment and data extraction. Outcome measures included VAS, CMS, and DASH scores. Publication bias assessed via funnel plots; forest plots created using RevMan 5.4.

Results

13 studies (n = 690) met inclusion criteria for RCRSP exercise interventions. It is indicated that: (1) specific exercises led to modest improvements in performance of pain (SMD = -0.31, 95% CI: 0.46 to -0.16, P < 0.0001) and function, with enhancements in CMS (SMD = 0.59, 95% CI: 0.44 to 0.74, P < 0.00001) and DASH (SMD = -0.60, 95% CI: 0.80 to -0.39, P < 0.00001). (2) Interventions lasting less than 2 months were slightly more effective than those lasting 2 months or longer, observed in VAS (SMD = -0.35, 95% CI: 0.56 to -0.15, P = 0.0007), CMS (SMD = 0.71, 95% CI: 0.47 to 0.96, P < 0.00001), and DASH (SMD = -0.71, 95% CI: 0.99 to -0.43, P < 0.00001). (3) Subgroup analyses revealed that handgrip strength exercises enhanced shoulder pain relief, shoulder mobilization/stretching improved both function and pain levels over 2 months, scapular stabilization exercise improved pain and DASH performance over 2 months, eccentric exercises boosted CMS and DASH performance over 2 months, while proprioceptive exercises showed no significant improvement in pain or CMS performance.

Conclusion

Compared to non-specific exercises, specific exercise programs moderately alleviate RCRSP symptoms, with shorter interventions (<2 months) demonstrating marginally superior outcomes. Efficacy varies by exercise type, emphasizing the need for individualized prescriptions.

Systematic Review Registration

PROSPERO (CRD42024550602).

Factors influencing functional recovery after limb-salvage surgery for lower extremity musculoskeletal tumours: a qualitative study combining patients' and healthcare professionals' perspectives

PURPOSE

Survival rates of lower extremity musculoskeletal tumours (LEMTs) have been increasing. However, patients continue to experience functional limitations after LEMT followed by limb-salvage surgery (LSS). This study aimed to identify factors influencing functional recovery after LSS for LEMT.

METHODS

A qualitative study was conducted using semi-structured interviews with a purposive sample of adult patients who underwent LSS for LEMT (n=7) and healthcare professionals (HCPs) with expertise in orthopaedic oncology (n=7). Recruitment continued until data saturation. A combination of deductive and inductive qualitative content analysis was performed to analyse the transcribed data, producing subthemes under the main International Classification of Functioning, disability and health (ICF)-model domains.

RESULTS

Four themes were described: (1) bodily functions and structures, (2) activities and participation, (3) environmental factors, and (4) expectations. Physical aspects such as larger resection size and complications negatively affected recovery. The importance of communication strategies of tertiary HCPs and the unfamiliarity of the primary physical therapists with the disease, its surgical treatment, and related consequences were emphasised by both the interviewed patients and HCPs.

CONCLUSIONS

Functional recovery after LSS for LEMT is a multifactorial process. To improve patient care, improving (intercollegiate) communication strategies on treatment details and expectations about functional outcomes is warranted.

The Various Mechanisms by Which Exercise-Induced Fatigue (EIF) Affects Spermatogenesis Through Testosterone

Currently, a great number of researches have proven that the EIF triggered by inappropriate and excessive exercise will affect normal function of the male reproductive system, resulting in various disorders or increasing disease risks. Reproductive system and motor system are highly correlated. Now, it is mainly considered that the testicular cell is modulated via hypothalamus-hypophysis-gonad(HPG) axis in the process of exercise, which involves the whole male reproductive system and affects spermatogenesis. However, there are many mechanisms leading to EIF, including hormonal levels, lactic acid accumulation, oxidative stress, calcium ion disorder, and inflammatory responses. These mechanisms interact with each other and can directly or indirectly affect spermatogenesis through testosterone hormones in various ways, with the majority having a negative impact. This ultimately leads to dysfunction of spermatogenesis and decreased sperm quality in the male reproductive system under the state of EIF. Therefore, this article reviews various theoretical mechanisms leading to EIF and their intervention methods on spermatogenesis through testosterone hormones, explaining the correlation between EIF and spermatogenesis from the perspective of endocrine regulation, providing new directions for the prevention and treatment of related symptoms.

Effects of 10 weeks of walking-based exercise training on resting substrate oxidation in postmenopausal women with obesity

BACKGROUND AND AIMS

Accumulating evidence supports the effectiveness of moderate-intensity aerobic training on metabolic health, with limited studies investigating change in resting substrate oxidation. The aim of this study was to explore whether 10 weeks of walking-based aerobic training would alter substrate oxidation in postmenopausal women with obesity.

METHODS AND RESULTS

Twenty-four postmenopausal women with obesity who were assigned into the control (n = 12) or exercise groups (n = 12) undertook a 10-week aerobic training program (3 d·week-1) that involved walking exercises at 50-70% of heart rate reserve on a treadmill, with exercise volume increased from 25 to 40 min·day-1. Resting metabolic rate (RMR) and body composition were measured pre- and post-training. Whole-body substrate oxidation was calculated using respiratory data collected during RMR measurement via indirect calorimetry. No significant change was noted (p > 0.05) in resting fat oxidation and carbohydrate oxidation in the exercise group. Resting respiratory exchange ratio and RMR did not alter in response to the training program (p > 0.05).

CONCLUSION

Our results show that a 10-week of moderate-intensity aerobic training does not modify substrate oxidation in postmenopausal women with obesity.

Lack of ALCAT1 enhances the protective effects of aerobic exercise on kidney in HFpEF mice

AIMS

Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent cardiovascular disease, which is often accompanied by kidney dysfunction. Exercise has been recognized as a feasible strategy to improve renal function. The aim of this study was to investigate whether aerobic exercise (AE) could ameliorate HFpEF-induced renal injury by regulating the expression of acyl-coenzyme A: lysocardiolipin acyltransferase-1 (ALCAT1).

MATERIALS AND METHODS

Eight-week-old C57BL/6 and Alcat1 knockout mice were used to establish a HFpEF induced kidney injury model. Mice in the exercise-intervention group were performed a six-week of AE training. Cardiac function and blood pressure were assessed using echocardiography and a non-invasive intelligent blood pressure monitor. Renal morphology and function were detected by HE, Masson, and PAS staining, as well as biochemical assays using commercial kits. Oxidative stress, inflammation, apoptosis, and renal fibrosis-related proteins were detected by Western Blotting.

KEY FINDINGS

In the HFpEF induced kidney injury model, ALCAT1 protein expression was upregulated, accompanied by cardiac and renal dysfunction. These pathological changes were reversed by AE. In addition, Alcat1 knockout significantly alleviated HFpEF-induced oxidative stress, inflammation, apoptosis, and fibrosis in the kidneys. Furthermore, Alcat1 knockout further enhanced the protective effects of exercise, ameliorating renal injury and improving renal function in HFpEF mice.

SIGNIFICANCE

AE significantly improved renal function by alleviating oxidative stress, inflammation, apoptosis, and fibrosis in HFpEF mice. These beneficial effects were further enhanced in the lack of ALCAT1. Thus, ALCAT1 might represent a potential therapeutic target for the treatment of HFpEF-induced kidney injury.

Internet-Based Psycho-Physical Exercise Intervention Program in Mild-to-Moderate Depression: The Study Protocol of the SONRIE Randomized Controlled Trial

The COVID-19 pandemic has intensified depression due to isolation and reduced physical activity, highlighting the need for accessible remote treatments. The SONRIE study evaluates the effectiveness of a 12-week online intervention combining physical exercise and internet-based cognitive-behavioral therapy on depressive symptoms in adults with mild-to-moderate depression. This randomized controlled trial involved 80 adults aged 25-65 years diagnosed with depression according to the ICD-10 criteria. Participants were randomized to an experimental group receiving the combined online intervention or to a control group receiving standard care. The primary outcome was the change in depression severity, assessed by the Beck Depression Inventory, with outcomes measured at baseline, immediately post-intervention, and after an 8-week follow-up phase. Statistical analyses include analysis of covariance to compare group changes over time, with effect sizes quantifying the intervention's impact. The SONRIE study demonstrates a promising online approach for treating depression, with potential implications for clinical practice and public health strategies.

Melatonin and Exercise Restore Myogenesis and Mitochondrial Dynamics Deficits Associated With Sarcopenia in iMS-Bmal1-/- Mice

Sarcopenia, a condition associated with aging, involves progressive loss of muscle mass, strength, and function, leading to impaired mobility, health, and increased mortality. The underlying mechanisms remain unclear, which limits the development of effective therapeutic interventions. Emerging evidence implicates chronodisruption as a key contributor to sarcopenia, emphasizing the role of Bmal1, a circadian clock gene critical for muscle integrity and mitochondrial function. In a skeletal muscle-specific and inducible Bmal1 knockout model (iMS-Bmal1-/-), we observed hallmark features of sarcopenia, including disrupted rhythms, impaired muscle function, and mitochondrial dysfunction. Exercise and melatonin treatment reversed these deficits independently of Bmal1. Building on these findings, the present study elucidates several mechanisms underlying these changes and the pathways by which melatonin and exercise exert their beneficial effects. Our findings indicate that iMS-Bmal1-/- mice exhibit reduced expression of satellite cell and muscle regulatory factors, indicating impaired muscle regeneration. While mitochondrial respiration remained unchanged, notable alterations in mitochondrial dynamics disrupted mitochondria in skeletal muscle. In addition, these mice showed alterations in muscle energy metabolism, compromised antioxidant defense, and inflammatory response. Remarkably, exercise and/or melatonin successfully mitigated these deficits, restoring muscle health in Bmal1-deficient mice. These findings position exercise and melatonin as promising therapeutic candidates for combating sarcopenia and emphasize the need to elucidate the molecular pathways underlying their protective effects.