10th Anniversary of JFMK: Advances in Physical Exercise for Health Promotion

Background and Objectives: The main objective of this study was to examine the psychometric properties of a French adaptation of the Physical Literacy in Children Questionnaire (PL-C Quest). Methods: A sample of 196 French-speaking Canadian and French children (aged 5 to 12 years) participated in this study. Results: Matching the results from several previous studies, our results failed to support the adequacy of the a priori four-factor and hierarchical structure of the PL-C Quest. However, results from an exploratory factor analytic solution supported a 3-factor, 13-item solution of the PL-C Quest measuring (a) Physical Competencies; (b) Motivation and Enjoyment to be Physically Active; and (c) Self-Regulation, Risk, and Safety. Subsequent analyses revealed a lack of differential item functioning (DIF) as function of countries and children’s time spent in moderate to vigorous physical activities (MVPA) providing preliminary support for the comparability of scores across these groups. However, some limited evidence of DIF was found as function of children’s age (on one item), body mass-index (on two items) and sex (on one item). Furthermore, latent mean differences (favoring younger children and boys) were identified in (a) Self-Regulation, Risk, and Safety and (b) Physical Competencies as function of children’s age and sex, respectively. These findings should be interpreted cautiously and warrant replication in independent samples. Finally, results provided preliminary evidence for the convergent validity of the 13-item French version of the PL-C Quest in relation to parental ratings of children’s overall, cognitive, and motor physical literacy. Conclusions: Scores on the new 13-item French version of the PL-C Quest present acceptable psychometric properties in terms of composite reliability, factor validity, and minimal DIF, alongside preliminary support for convergent validity. Full article

Background: During the last decades, the office workplace setting has increasingly become an inherently “obesogenic” environment, promoting unhealthy behaviors. The main objective of this study was to investigate the efficacy of a 6-month workplace combined (exercise and nutrition) intervention in obese office workers, using a randomized controlled study. An additional objective of this study was to evaluate the individual responses per participant following the program. Methods: In total, 36 obese office workers (BMI: ≥30) were randomly assigned to two equal groups: intervention (IG; age: 48.06 ± 6.60 yrs; BMI: 33.57 ± 1.58 kg/m²) and control (CG; age: 47.95 ± 5.95 yrs; BMI: 33.54 ± 1.74 kg/m²). The IG participated in a daily supervised 6-month workplace program (during working hours), including (a) exercise (flexibility, balance, strength, and aerobic) and (b) counseling and educational activities for healthy diet and hydration. The CG did not participate in any intervention. Before and after the 6-month period, the following were measured: (a) health indices (body fat, body circumferences, blood pressure, respiratory function, and lipidemic profile), (b) functional capacity indices (flexibility, balance, handgrip strength, and cardiovascular fitness), and (c) adherence to the Mediterranean diet (MedDietScore) and daily water consumption. Results: All the participants of the IG reduced body mass, body fat, and circumferences (−4.47 to −18.95%), blood pressure (−4.08 to −46.15%), lipidemic profile indicators (−2.50 to −212.67%), and heart rate recovery (−9.62 to −57.33%), while increased respiratory function (1.82–20.26%), flexibility (5.13–50%), balance (15.38–88.83%), handgrip strength (5–25%), MedDietScore (12.5–56%), and water consumption (23.08–50%). In CG, all aforementioned indices remained unchanged (p = 0.16–0.99). Conclusions: A combined workplace intervention (exercise and nutrition) constitutes an effective approach for health promotion in obese office workers. Full article

Background: The aging population in Portugal requires interventions such as multicomponent exercise to maintain the functionality of older adults. The aim of this exploratory pilot study was to investigate preliminary changes in body composition, physical fitness, quality of life and satisfaction with life following a low-frequency multicomponent exercise program delivered in two different community-based contexts (conventional exercise room and Snoezelen room). Methods: This study followed a non-randomized quasi-experimental methodology based on participant preference and logistical availability. Following the baseline assessment, participants self-selected their participation context. Participants who chose to participate in the exercise intervention were assigned to either the Snoezelen Room Group or the Exercise Room Group according to their preference, whereas participants who did not participate in either intervention because of personal preference or logistical constraints formed a non-participating comparison Control Group. The final sample comprised 27 older women: Snoezelen Room Group (n = 14), Exercise Room Group (n = 7), and Control Group (n = 6). The intervention consisted of a 12-week multicomponent program (1 session/week, 45–60 min) carried out in different environments. Body composition, functional physical fitness, quality of life and satisfaction with life were assessed before and after the intervention. Results: The primary between-group analysis of change scores (Δ = post−pre) identified significant differences for body mass (H(2) = 9.516, p = 0.009), with a significant Bonferroni contrast between the Snoezelen and Exercise Room Groups (1 vs. 2; adjusted p = 0.008). For Back Scratch, the Δ-based omnibus test was also significant (H(2) = 7.398, p = 0.025), with Snoezelen differing from the Exercise Room Group (1 vs. 2; adjusted p = 0.020). For quality of life, the Δ-based omnibus test was significant (H(2) = 11.356, p = 0.003), with significant contrasts between Exercise Room and Control Groups (2 vs. 3; adjusted p = 0.003). Secondary between-group analyses at specific time points also identified differences in post-intervention bone mass (H(2) = 8.460, p = 0.015; 1 vs. 2, adjusted p = 0.026; 2 vs. 3, adjusted p = 0.038), muscle mass (H(2) = 7.748, p = 0.021; 1 vs. 2, adjusted p = 0.034), Back Scratch (H(2) = 7.947, p = 0.031; 1 vs. 2, adjusted p = 0.031; 2 vs. 3, adjusted p = 0.050), and 6-Minute Walk (H(2) = 9.015, p = 0.011; 1 vs. 2, adjusted p = 0.012). Conclusions: The findings suggest that a low-frequency multicomponent exercise program may be feasible in community social centers; however, the observed within-group changes and exploratory between-group differences should be interpreted cautiously given the non-randomized design, small sample size, and baseline differences. Larger controlled studies are needed to determine whether the exercise environment contributes to differential outcomes. Full article

Introduction: Most studies evaluating low-carbohydrate diets in resistance-trained individuals have focused on short-term ketogenic interventions. Whether habitual carbohydrate intake maintained under free-living conditions is associated with body composition and muscle strength remains unclear. Therefore, this study compared body composition and maximal isometric strength between recreationally resistance-trained men with a habitual low or normal carbohydrate intake. Methods: A cross-sectional analytical study was conducted in 53 recreationally resistance-trained men aged 18–35 years. Habitual dietary intake was assessed using three non-consecutive 24 h dietary recalls. Participants were classified as having low (<3 g/kg/day; n = 28) or normal (3–5 g/kg/day; n = 25) carbohydrate intake; participants also reported maintaining their respective dietary pattern for at least three months. Body composition was estimated using the Ross and Kerr anthropometric model, whereas fat mass was calculated using the Martin equation. Maximal isometric handgrip and knee extension strength were also assessed. Between-group comparisons were performed using Welch’s t-test or the Mann–Whitney U test, and multiple linear regression models were adjusted for age, height, and relative energy intake. Sensitivity analyses were additionally adjusted for relative protein intake. Results: Participants with a habitual low carbohydrate intake presented significantly lower adipose mass (β = −2.42 kg; 95% CI: −4.49 to −0.35; p = 0.02), adipose percentage (β = −4.64%; 95% CI: −7.47 to −1.80; p < 0.01), fat mass (β = −2.33 kg; 95% CI: −4.08 to −0.57; p = 0.01), and body fat percentage (β = −4.06%; 95% CI: −6.52 to −1.59; p < 0.01) than participants with a normal carbohydrate intake. No significant differences were observed in muscle mass, handgrip strength, or absolute knee extension strength after adjustment. In sensitivity analyses additionally adjusted for relative protein intake, associations with adiposity were attenuated and no longer statistically significant, whereas low carbohydrate intake was associated with lower absolute and relative handgrip and knee extension strength (all p < 0.05). No significant associations with skeletal muscle mass were observed. Conclusions: In recreationally resistance-trained men, habitual carbohydrate intake below 3 g/kg/day was associated with lower adiposity in the primary analyses; however, these associations were attenuated after additional adjustment for relative protein intake. Conversely, associations with lower maximal isometric strength emerged after adjustment for protein intake, while no associations with skeletal muscle mass were observed. These findings suggest that the associations of habitual carbohydrate intake with adiposity and muscle strength may be influenced by overall dietary composition and should be interpreted cautiously given the cross-sectional design. Full article

Background: Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive and affective symptoms. Objectives: This study aimed to examine the acute effects of Resistance Training (RT) and Pilates on pain, functional impact, flexibility, and health-related quality of life in individuals with FM. Methods: In this randomized crossover pilot study, eight adults (7 females, 1 male; mean age: 48.5 ± 8.2 years) with a clinical diagnosis of FM participated. Each participant performed both RT and Pilates sessions in a randomized order. Outcomes were assessed at baseline and 24 h post-intervention using the Fibromyalgia Impact Questionnaire (FIQ), the 36-Item Short Form Health Survey (SF-36), the Visual Analog Scale (VAS) for pain, and the Wells sit-and-reach test (WELLS). Data were analyzed using two-way repeated-measures ANOVA and paired t-tests, with effect sizes (η²p and Cohen’s d) and 95% confidence intervals (95% CI). Statistical significance was set at p < 0.05. No formal sample size calculation was performed. Results: Participants presented a mean body mass index (BMI) of 27.4 ± 4.1 kg/m² and time since diagnosis of 6.2 ± 3.1 years. Within-subject variations were observed following both interventions. FIQ scores decreased at 24 h after both RT and Pilates sessions (RT: 52.21 ± 18.61; Pilates: 45.50 ± 18.63; p = 0.038, η²p = 0.42, 95% CI [−12.5, −1.2]). Conclusions: Both Resistance Training and Pilates acutely reduced overall disease impact in individuals with fibromyalgia, with Pilates promoting superior acute gains in posterior chain flexibility. Full article

Background: Aging is characterized by functional decline in different organs and systems. The present study aimed to evaluate the effects of 6-month low-to moderate intensity supervised Social Dance (SD) program on muscular fitness, and clinical–biochemical and hematological parameters associated with healthy aging. Circulating CD34+ and serum antioxidant potential were assessed as exploratory outcomes. Methods: Seventy-nine elderly (aged > 65 years) were enrolled and randomized. Analyses included 49 participants who provided baseline and follow-up data and were assigned to the SD group (SDG, n = 24) or control group (CG, n = 25). Clinical–biochemical and hematological profiles, oxidative stress markers, circulating CD34+ cells, Physical fitness components and Physical Activity Scale for the Elderly (PASE) and EuroQol five-dimensional (EQ-5D) questionnaires were assessed at T0 and T1 to both groups. Results: Significant group × time interactions favored the SDG for HDL cholesterol ($p=0.003$), Hemoglobin (p = 0.031), and Hematocrit (p = 0.005). A significant increase in BAP (∆% = 33.3; p < 0.001) and PASE (∆%= 79.6 vs. 56.9; p < 0.05) were observed among the SDG; conversely, only a positive trend (∆% = 12.9 SDG vs. −5.1 CG) was observed for EQ-VAS at T1; these findings were not supported by significant group × time interaction. CD34+ cells increased significantly only in the CG. Isometric muscular performance declined in both groups. Conclusions: a 6-month SD program may provide beneficial effects on selected biochemical markers (i.e., a positive impact on HDL, hematological profile, antioxidant defenses) and perceived health outcomes in the elderly. However, it appears insufficient to preserve isometric muscular performance, suggesting that complementary resistance-based strategies may be needed to optimize neuromuscular adaptations. Full article

Background: Carpal tunnel release (CTR) surgery may have an impact on the speed and accuracy of handwriting and digital typing using a computer or mobile devices. Methods: In this prospective cohort study, patients undergoing CTR surgery of the dominant hand, between 18 and 70 years of age, with frequent use of a QWERTY keyboard and smartphone were included. A baseline Visual Analog Scale (VAS) for subjective alteration of writing and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) were collected at a maximum 3-month follow-up. Digital typing speed (word per minute, wpm) and accuracy (number of mistakes) were tested. Handwriting was assessed by means of direct supervision of one investigator. Results: Of the 30 enrolled patients, 23 (76.7%) completed the 3-month follow-up and were included in the final analysis (mean age 55 ± 12.3 years). Pre- and post-surgery improvements in keyboard typing speed (14.8 ± 6.8 wpm to 17.6 ± 5 wpm) and mobile texting speed (16.7 ± 5.9 wpm to 21.7 ± 6.5 wpm) were significantly improved over time. Accuracy improved significantly only in keyboard typing, where the mean number of errors was reduced (13.1 ± 8.2 to 9.9 ± 5.6). QuickDASH scores decreased significantly (39.1 ± 9.1 to 17 ± 6). Conclusions: CTR surgery was associated with improved typing speed and reduced the number of errors (19% and −24%, respectively) as well as texting speed (30%). This improvement may be relevant in daily and occupational activities, as reported in the previous literature. Full article

Background: Intermittent Hypoxic–Hyperoxic Training (IHHT) induces physiological adaptations. While its efficacy in athletic performance remains debated, IHHT improves health markers in pathological and geriatric populations. This Exploratory Pilot Study aimed to explore the safety and feasibility of two IHHT protocols through preliminary responses. Methods: Twelve healthy volunteers completed a 4-week intervention (two sessions/week, 45 min/session) combining IHHT simultaneously during low-intensity exercise. The study compared a Training Group (TG: 30 min hypoxia, 7.5 min normoxia, 7.5 min hyperoxia) with a Conditioning Group (CG: 15 min hypoxia, 22.5 min normoxia, 7.5 min hyperoxia). Outcomes assessed included cardiorespiratory parameters, Acute Mountain Sickness symptoms, Perceived Exertion, a comprehensive biochemical panel, systemic inflammation, oxidative stress, and renal status. Results: Both protocols were well-tolerated. The TG exhibited significantly greater oxygen desaturation than the CG (p = 0.048). Moreover, the CG demonstrated a significantly attenuated increase in Interleukin-6 (p = 0.021) compared to the TG. Additionally, preliminary variations highlighted an interesting reduction in lipid parameters (TC, LDL, and Apo A1/B ratios) in both groups, although these did not reach statistical significance after FDR correction. Conclusions: While both protocols proved feasible and safe, a more balanced hyperoxic-to-hypoxic exposure (CG) showed better acute physiological tolerability, attenuating cardiovascular strain and mitigating systemic pro-inflammatory responses compared to the unbalanced exposure (TG). Finally, the preliminary variations observed in lipid parameters provide a rationale that warrants further controlled investigations. Full article

Background: Physical Fitness (PF) is an important health marker that should be regularly monitored with simple, time-efficient test batteries such as Diagnoform^® Kid. However, its validity remains insufficiently evaluated. Therefore, this cross-sectional study examined its concurrent and construct validity against a battery of established reference tests. Methods: 184 children were grouped by age (6–7, 8–9 and 10–11 years). The Diagnoform^® and reference batteries assessed identical PF components using the following tests: 6-min shuttle run-walk vs. reduced Cooper for cardiorespiratory fitness, hopscotch vs. quadrant jump for agility, standing broad jump with vs. without execution instructions for power, 5-s sprint vs. 20-m sprint for speed, and simplified fingertip-to-floor vs. sit-and-reach for flexibility. Concurrent validity was examined using bivariate correlations, and construct validity through responsiveness to age and sex. Results: Corresponding tests were significantly correlated for all PF components (p < 0.001), except for agility at 10–11 years (p = 0.094). Agility showed moderate correlations in the younger groups (r = −0.45 to −0.67). Correlations were strong for cardiorespiratory fitness and flexibility (r ≥ 0.70). For power and speed, correlations ranged from moderate (power: r ≥ 0.61 at 6–7 and 8–9 years; speed: r = 0.58 at 6–7 years) to strong (power: r ≥ 0.83 at 10–11 years; speed: r ≥ 0.70 at 8–9 and 10–11 years). Age and sex influenced performances in both batteries, except for agility (no sex effect observed) and flexibility (sex effect observed in both batteries, whereas an age effect was found only for boys on the reference test). Conclusions: Despite slightly lower responsiveness of the simplified fingertip-to-floor test to age, findings support the concurrent and construct validity of the Diagnoform^® Kid tests. Full article

Background: Physical activity (PA) is associated with cardiometabolic health and functional performance, yet sex-specific evidence from real-world primary care populations remains limited. Objective: This study evaluated whether associations between self-reported PA categories and LDL-C concentrations and Timed Up and Go (TUG) functional performance differed between males and females in a real-world primary care cohort. Methods: This cross-sectional observational study included 863 adult primary care patients (424 males, 439 females). PA was categorized as low, moderate, or high based on World Health Organization recommendations. LDL-C and TUG were assessed as primary outcomes. Sex-stratified analyses included one-way ANOVA with Bonferroni post hoc comparisons and multivariable linear regression adjusted for age, BMI, arterial hypertension (AH), and diabetes mellitus (DM). An interaction term (PA × sex) was included to formally test for sex modification. Results: Males and females did not differ significantly in age, BMI, LDL-C, TUG, AH prevalence, DM prevalence, or PA distribution (all p > 0.05). Higher PA categories were associated with lower LDL-C in both males (ANOVA F = 13.03, p < 0.001) and females (ANOVA F = 14.92, p < 0.001), and with better TUG performance in both males (F = 44.21, p < 0.001) and females (F = 36.09, p < 0.001). In multivariable regression, PA was the strongest independent predictor of both LDL-C (males: β = −0.301, p < 0.001; females: β = −0.323, p < 0.001) and TUG performance (males: β = −1.235, p < 0.001; females: β = −1.170, p < 0.001) in both sexes. The interaction term (PA × sex) was not statistically significant for either LDL-C (p = 0.804) or TUG (p = 0.944), indicating no significant sex modification of the PA–outcome associations. Conclusions: The associations between self-reported PA and both LDL-C concentrations and TUG functional performance were consistent across sexes in this real-world primary care cohort. These findings support the clinical relevance of routine PA assessment as a sex-independent indicator of cardiometabolic risk and functional health in primary care. Because of the cross-sectional design, causality cannot be established. Full article

Background: Metabolic syndrome (MetS) is a cluster of pathologies (obesity, dyslipidemia, insulin resistance, hypertension) that affects over one quarter of old adults. MetS is a condition that markedly increases the susceptibility of various organs to dysfunctionality and is associated with the development of oxidative stress. The existing guidelines point out that exercise is highly advantageous for patients with MetS. However, there is a need for specific guidance and clinical evidence. Objective: This study aimed to investigate the effects of a moderate aerobic exercise program on older women without and with MetS. Methods: A total of 120 women aged 60–70 years old were recruited and divided into two groups: healthy old women (HOW, N = 60) and old women with MetS (OW-MetS, N = 60). Anthropometric values, biochemical parameters and markers of oxidative damage were evaluated before and after moderate aerobic exercise. Exercise was performed five days per week for three months (64 sessions). Each exercise session consisted of 40 min and included the following: (a) five minutes of warm-up exercise; (b) ten minutes of flexibility exercise with resistance using own weight and coordination; (c) twenty minutes of moderate-intensity aerobic exercise (heart rate max between 60% and 70%); and (d) five minutes to cool down/stretching with respiratory techniques. Results: A significant decrease in anthropometric variables was generated by the exercise program [waist circumference 4.35 cm (p < 0.05) in OW-MetS, body fat −1.55, −1.39% (p < 0.05) and muscle mass 0.8, 1.1% (p < 0.05) in HOW and OW-MetS, respectively]. The exercise program resulted in beneficial changes in all biochemical parameters in both groups. Importantly, HOMA values showed a significant decline of −0.85 and −6.17 in HOW and OW-MetS, respectively. Furthermore, oxidative stress was present in the OW-MetS group, which was reduced by the exercise program, resulting in a decrease in protein damage [formazan 45% and 42% in HOW and OW-MetS respectively] and an increase in antioxidant defenses (thiol groups 36%, 99% and GPx 55%, 20% in HOW and OW-MetS, respectively). Conclusions: The data of this study show that moderate aerobic exercise may be potentially useful in treating and preventing MetS in older patients. Full article

Background: Hypertension is a multifactorial condition influenced by physiological, behavioral, and psychosocial factors. Muscle strength, physical activity, sleep quality, and perceived stress may contribute to blood pressure variability, although their relative influence remains unclear. This study examined associations between systolic blood pressure (SBP) and demographic, anthropometric, neuromuscular, behavioral, and psychosocial variables in adults with primary hypertension, with secondary analyses for diastolic blood pressure (DBP) and sex differences. Methods: A cross-sectional study was conducted in 391 adults with hypertension (165 men, 226 women). Predictors included age, body mass index, lower-limb muscle strength, physical activity (GPAQ), sleep quality (PSQI), and perceived stress. Associations were analyzed using correlation analyses and sex-stratified multivariable regression models. Results: In men, SBP correlated positively with age and negatively with lower-limb strength. In women, SBP showed associations with physical activity and perceived stress. Regression analyses indicated that sleep quality and perceived stress were independently associated with SBP in women (adjusted R² = 0.13), whereas hamstring strength was associated with DBP in men with low explanatory capacity (R² = 0.05). Moderate-to-high collinearity was observed among strength variables. Conclusions: Blood pressure variability was associated with neuromuscular and psychosocial factors with sex-specific patterns; however, the modest explained variance suggests these factors act as complementary rather than primary determinants. Longitudinal studies are needed to clarify causal relationships. Full article

Isometric resistance training (IRT) has emerged as a promising non-pharmacological intervention for blood pressure (BP) management. Although current hypertension guidelines primarily recommend aerobic and dynamic resistance exercise, growing evidence indicates that IRT is an effective, feasible, and time-efficient alternative. This narrative review summarizes the current evidence on the efficacy, physiological mechanisms, and clinical applications of IRT. We reviewed randomized controlled trials, systematic reviews, and meta-analyses evaluating the effects of different IRT modalities, including isometric handgrip (IHG), isometric wall squat (IWS), and isometric leg extension (ILE), on BP in normotensive individuals, patients with hypertension, and those with cardiovascular disease. IRT consistently reduces resting systolic BP by approximately 5–8 mmHg and diastolic BP by 3–4 mmHg; these effects may approach those reported with first-line antihypertensive therapy and potentially be equivalent to those of other exercise modalities. These benefits have been demonstrated across normotensive and hypertensive populations and appear largely independent of age, sex, medication use, and the muscle groups involved. Preliminary evidence also supports the feasibility and safety of appropriately prescribed IRT in selected patients with ischemic heart disease and heart failure with preserved ejection fraction. Proposed mechanisms include improvements in endothelial function, nitric oxide bioavailability, autonomic regulation, oxidative stress, arterial baroreflex sensitivity, and myocardial efficiency. IRT has emerged as an effective, safe, and practical adjunct to lifestyle modification for BP control, particularly in older adults and individuals with limited ability to perform conventional exercise. However, current evidence derives from relatively small studies with limited follow-up; further large-scale randomized trials are needed to define the optimal exercise prescription, clarify the underlying mechanisms, and establish the role of IRT in patients with cardiovascular disease. Full article

The aim of this article is to provide a literature review of current approaches and recommendations for medical rehabilitation in stroke patients, with the goal of achieving the best possible outcomes for their condition and improving their quality of life. Materials and Methods: A narrative review was conducted of articles published in the databases available to us (PubMed, ScienceDirect, Google Scholar, PEDro, ResearchGate) that contain information regarding therapeutic management of stroke and, in particular, interventions aimed at motor recovery and improving quality of life. Included in this literature review were: scientific articles, guidelines on stroke and motor rehabilitation, clinical studies, longitudinal clinical studies, controlled clinical studies, systematic reviews, and meta-analyses published before April 2026, covering a ten-year period. Results: Data showing a trend toward higher patient survival rates following acute stroke were identified. For this reason, existing non-pharmacological approaches to motor recovery should be optimized. The rehabilitation process must begin as early as possible. Motor recovery depends on the establishment of motor control and the neuroplastic processes occurring in brain tissue. Rehabilitation is conducted by a rehabilitation team with the patient’s active participation, while monitoring motor rehabilitation potential. Conclusions: Rehabilitation is an essential component of post-stroke treatment. When timely and adequate medical rehabilitation is provided to stroke patients, there is a significant improvement in their overall condition and motor functions, as well as in their independence, self-care, and quality of life. Full article

Background and Objectives: The concept of the gut–muscle–brain axis encompasses the intricate, multidirectional interactions between the gut microbiota (GM), physical exercise (PE), and the central nervous system. Within this framework, gut dysbiosis has been implicated in the pathogenesis of Alzheimer’s disease (AD). Given that cognitive functions in AD appear to benefit from PE, it is plausible to hypothesize that these improvements may be partially mediated by PE-induced alterations in GM taxonomy. Therefore, the objective of this study is to evaluate the potential effects of PE in the GM and their implications for AD. Methods: A systematic review was conducted in PubMed, Web of Science and Scopus following the PRISMA guidelines up to July 2025 for preclinical controlled trials that assessed the effects of PE on the GM of AD animal models. A random-effects model meta-analysis was performed to estimate the pooled effect of PE on GM frequency or composition. This study received no external funding. Results: Eight studies were included in the systematic review (sample size, n = 126), of which two could be meta-analyzed. We found that PE significantly reduced Actinobacteria abundance (MD = −0.005%; 95% CI, −0.008 to −0.002; p = 0.001) with no statistically significant evidence of heterogeneity (I² = 89.60%, Q = 0.102, p = 0.950) or publication bias observed (Begg’s test, p = 0.296), but no significant effects were found for other phylums or genera. Conclusions: PE appears capable of modulating the GM of animal models with AD in a selective and heterogeneous manner. Further studies are needed to clarify the mechanisms by which this is possible and to determinate its impact on the pathogenesis of the disease. Full article

Background: Obesity is a chronic condition that compromises health and quality of life, with physical exercise representing a relevant therapeutic strategy in its management. Functional training (FT) has been adopted as a modality that integrates neuromuscular and cardiorespiratory stimuli, promoting both physical and psychosocial benefits. However, gaps remain in the literature regarding the effects of FT on body composition in individuals with excess weight. In this context, a systematic review was conducted to analyze the current state of scientific knowledge on this approach. Methods: Randomized controlled clinical trials investigating FT were selected, including interventions classified as high-intensity functional training (HIIT-F), multicomponent programs, and CrossFit-like interventions when they fulfilled the predefined FT eligibility criteria. Participants were required to be between 18 and 65 years of age, physically independent, and in generally good health. The systematic search was conducted in the PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, PEDro, and LILACS databases. The risk of bias (RoB 2.0) and the certainty of the evidence (GRADE) were assessed. Results: A total of 2,972 records were identified. Seven studies met the eligibility criteria, comprising 296 participants. Two randomized controlled trials (61 participants) were eligible for meta-analysis. The pooled analysis demonstrated a significant reduction in body fat percentage (%BF) in favor of FT/HIIT-F compared with non-exercising controls (mean difference = −4.44 percentage points; 95% confidence interval −7.08 to −1.80; p = 0.001). Risk of bias assessment showed moderate methodological limitations across studies. None were classified as low risk. Three had high risk due to missing outcome data and deviations from intended interventions, whereas four showed some concerns related to allocation concealment and analysis reporting. Bias in outcome measurement was consistently low. Conclusions: Current evidence suggests that FT/HIIT-F may be associated with reductions in %BF among adults with overweight or obesity. However, these findings should be interpreted with caution because the certainty of the evidence was rated as very low according to the GRADE approach, the quantitative synthesis included only two studies, and important methodological limitations were identified. As the available data are predominantly derived from female participants, the applicability of these findings to men remains uncertain. Full article

Parkinson’s disease (PD) is a heterogeneous clinical syndrome representing the final stage of a complex and long-lasting neurodegenerative process that involves not only dysfunction of the dopaminergic system but also impairments in other neurotransmitter systems. The diversity of the clinical presentation of PD, together with the existence of Parkinsonian syndromes and atypical Parkinsonism—such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and dementia with Lewy bodies (DLB)—has important implications for rehabilitation outcomes and underscores the need for individualized, stage-dependent therapeutic approaches. Juggling is a complex motor activity that integrates cognitive, visuomotor, and balance processes, requiring a high level of concentration, precision, and motor adaptation. In recent years, there has been growing interest in this form of activity as a potential tool for supporting neuroplasticity, cognitive functions, and neurological rehabilitation. The aim of this review was to summarize current scientific evidence on the effects of juggling training on cognitive functions, visuomotor coordination, and balance, as well as to discuss the potential benefits of combining it with controlled hypoxia in patients with Parkinson’s disease (PD). This narrative review additionally considers how disease heterogeneity and stage of progression may influence the effectiveness of such multimodal interventions. This paper reviews the literature concerning the neurophysiological basis of learning to juggle and the mechanisms of brain plasticity, including increases in gray matter volume, improvements in white matter integrity, and reorganization of neuronal networks in motor and associative regions. Attention is drawn to the synergistic potential of combining juggling training with exposure to moderate, controlled hypoxia, which may induce an adaptive response involving the transcription factor HIF-1α, enhance the expression of brain-derived neurotrophic factor (BDNF), and promote angiogenesis and mitochondrial biogenesis. Although juggling and hypoxia are not directly related to training stimuli, both interventions activate overlapping and complementary neuroplastic pathways, providing a conceptual rationale for their parallel consideration and potential integration within future rehabilitation protocols. Juggling delivers task-specific motor–cognitive learning, whereas hypoxia may amplify molecular plasticity signaling, potentially enhancing responsiveness to motor interventions, particularly in patients at early stages of PD when compensatory mechanisms and neuroplastic capacity are relatively preserved. Findings from existing studies suggest that juggling under controlled hypoxic conditions may represent an innovative, safe, and multimodal form of training that supports both cognitive and motor components. Such effects may be particularly relevant in patients at early stages of PD, when compensatory mechanisms and neuroplastic potential are relatively preserved. Such an intervention may contribute to improvements in balance, attention, executive functions, and cognitive flexibility, which is particularly relevant in the context of rehabilitation for patients with neurodegenerative diseases. Importantly, to date, no randomized clinical trials have directly examined juggling performed under controlled hypoxic conditions in PD. Therefore, the present concept should be regarded as translational and exploratory, integrating evidence from juggling-induced neuroplasticity and hypoxia-related physiological adaptations. In this context, the proposed approach represents a proof-of-concept framework for future multimodal interventions rather than an established therapeutic strategy. Available evidence suggests that combining complex sensorimotor skill training with physiological modulation of the internal environment may constitute a novel direction in PD rehabilitation, extending beyond conventional exercise-based models. Despite promising reports, further well-designed clinical studies are needed to determine the optimal training parameters (frequency, intensity, duration, and degree of hypoxia), to evaluate the long-term sustainability of therapeutic effects, and to account for the heterogeneity of PD and related Parkinsonian disorders. Full article