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26 pages, 16839 KB  
Article
Effects of a Plant-Based Multi-Strain Limosilactobacillus fermentum Probiotic on Weight Loss Outcomes in Overweight and Obese Adults: A Preliminary Study
by Sarah Johnson, Broderick L. Dickerson, Jisun Chun, Olivia Haskell, Elena Chavez, Leah Kirkegaard, Kelly Elizabeth Hines, Choongsung Yoo, Joungbo Ko, Dante Xing, Martin Purpura, Ralf Jäger, Ryan J. Sowinski, Drew E. Gonzalez, Christopher J. Rasmussen and Richard B. Kreider
Nutrients 2026, 18(12), 1908; https://doi.org/10.3390/nu18121908 - 12 Jun 2026
Viewed by 445
Abstract
Background/Objectives: Multi-strain Limosilactobacillus fermentum supplementation has been reported to promote weight loss outcomes in free-living conditions, but limited evidence exists on these probiotic strains added to an energy-restricted diet and walking program in overweight adults. Methods: In a double-blind, placebo-controlled, parallel-arm randomized trial, [...] Read more.
Background/Objectives: Multi-strain Limosilactobacillus fermentum supplementation has been reported to promote weight loss outcomes in free-living conditions, but limited evidence exists on these probiotic strains added to an energy-restricted diet and walking program in overweight adults. Methods: In a double-blind, placebo-controlled, parallel-arm randomized trial, overweight adults (35.2 ± 13.2 years old, 167.6 ± 8.6 cm, 79.9 ± 11.8 kg, 28.4 ± 2.7 kg/m2 body mass index, 36.1 ± 6.6% body fat) completed a 12-week weight loss program that included a 500 kcal/day energy deficit and walking 10 k steps/d. Participants ingested one daily capsule containing a three-strain probiotic blend (L. fermentum K7-Lb1, L. fermentum K8-Lb1, L. fermentum K11-Lb3; 6 billion CFU/day) (PRO) or maltodextrin placebo (PLA). Assessments were performed at baseline, week 6, and week 12 and included body composition, resting energy expenditure, substrate utilization, peak oxygen uptake, dietary intake, step counts, blood biomarkers, quality of life, and side effects. Data were analyzed using multivariate and univariate repeated-measures general linear models (GLM), with mean changes from baseline presented alongside 95% confidence intervals. Results: All participants significantly reduced body weight, fat mass, body fat percentage, and waist circumference. At 12 weeks, PRO reduced fat mass more than PL (−2680.7 ± 1276.7 g; p = 0.039). In PRO, android and gynoid fat percentage decreased at 6 weeks (p < 0.001; p = 0.008) and 12 weeks (p = 0.004; p < 0.001), respectively. Visceral adipose tissue mass, volume, and area were lower at 6 weeks and trended lower at 12 weeks. In PRO, bone mineral content and bone mineral area decreased at 12 weeks, while bone mineral density paradoxically increased (0.007 ± 0.003 g/cm2; p = 0.024). Conclusions: During a 12-week weight loss program, supplementation of a multi-strain L. fermentum probiotic significantly reduced body fat and central adiposity. Full article
(This article belongs to the Section Prebiotics, Probiotics and Postbiotics)
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15 pages, 636 KB  
Article
A Derivation Study of a Cardio-Nutrition-Inflammation-Oxygen Index and 3-Month Functional Outcomes After Outpatient Pulmonary Rehabilitation
by Sae Rom Kim, Jinkyeong Park, Ga Yang Shim, Seung Don Yoo and Eo Jin Park
Nutrients 2026, 18(12), 1879; https://doi.org/10.3390/nu18121879 - 11 Jun 2026
Viewed by 201
Abstract
Background/Objectives: Short-term functional outcomes after outpatient pulmonary rehabilitation are heterogeneous. We examined whether a study-derived cardio-nutrition-inflammation-oxygen (CNIO) index integrating echocardiographic filling pressure, nutritional status, inflammation, and oxygen requirement was associated with 3-month functional outcomes in chronic respiratory disease. Methods: This single-center retrospective cohort [...] Read more.
Background/Objectives: Short-term functional outcomes after outpatient pulmonary rehabilitation are heterogeneous. We examined whether a study-derived cardio-nutrition-inflammation-oxygen (CNIO) index integrating echocardiographic filling pressure, nutritional status, inflammation, and oxygen requirement was associated with 3-month functional outcomes in chronic respiratory disease. Methods: This single-center retrospective cohort study included 60 adults with chronic obstructive pulmonary disease, interstitial lung disease, or bronchiectasis who completed outpatient pulmonary rehabilitation and had baseline and 3-month functional assessments. The CNIO index was calculated as standardized E/e′ plus standardized ln(neutrophil-to-lymphocyte ratio) plus standardized resting oxygen flow rate minus standardized Geriatric Nutritional Risk Index, and the summed score was then standardized to mean 0 and SD 1. The primary outcome was 3-month 6 min walk test (6MWT) distance, and the exploratory secondary outcome was 3-month Short Physical Performance Battery (SPPB) score. The primary 6MWT analysis used multivariable analysis of covariance adjusted for baseline 6MWT, age, sex, body mass index, and diagnosis, whereas the exploratory SPPB analysis used ordinal logistic regression adjusted for baseline SPPB and the same covariates. Results: Mean 6MWT increased from 340.3 ± 61.0 m to 368.0 ± 102.0 m, corresponding to a mean change of 27.7 ± 90.3 m. Each 1-SD increase in CNIO was associated with a lower 3-month 6MWT distance (β = −43.42 m; 95% confidence interval [CI], −77.55 to −9.30; p = 0.014). In the exploratory ordinal logistic regression model for SPPB, each 1-SD increase in CNIO was associated with lower odds of being in a higher 3-month SPPB category, although the estimate was fragile and the confidence interval was close to the null (odds ratio = 0.39; 95% CI, 0.15 to 0.99; p = 0.048). Bootstrap internal stability analysis for the primary 6MWT model showed a wide percentile bootstrap 95% CI of −76.05 to −13.97 m per 1-SD increase in CNIO, supporting the need for cautious interpretation. Conclusions: In this hypothesis-generating derivation study, a higher standardized CNIO index was associated with lower 3-month 6MWT distance among adults with chronic respiratory disease who completed outpatient pulmonary rehabilitation. The association with SPPB was weaker and should be interpreted cautiously. These findings are not generalizable to patients who discontinue rehabilitation or are hospitalized for exacerbation during follow-up, and prospective external validation in larger, diagnostically stratified cohorts is required before CNIO can be considered for clinical risk stratification or rehabilitation planning. Full article
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21 pages, 2965 KB  
Article
Anthropometric, Functional, and Haemodynamic Changes in Bariatric Surgery Patients Within the Polish KOS-BAR Pathway: A Retrospective Cohort Study
by Michalina Damrath, Martyna Hromiak, Bartosz Wilczyński and Katarzyna Gierat-Haponiuk
Diagnostics 2026, 16(11), 1736; https://doi.org/10.3390/diagnostics16111736 - 4 Jun 2026
Viewed by 218
Abstract
Background/Objectives: Bariatric surgery is an effective treatment for severe obesity. Although physiotherapy delivered before and after surgery may support functional recovery, evidence describing real-world multidisciplinary bariatric pathways with embedded perioperative physiotherapy remains limited. This study evaluated perioperative changes in anthropometric, functional, and haemodynamic [...] Read more.
Background/Objectives: Bariatric surgery is an effective treatment for severe obesity. Although physiotherapy delivered before and after surgery may support functional recovery, evidence describing real-world multidisciplinary bariatric pathways with embedded perioperative physiotherapy remains limited. This study evaluated perioperative changes in anthropometric, functional, and haemodynamic outcomes in adults who completed preoperative and postoperative physiotherapy within the multidisciplinary Polish KOS-BAR bariatric pathway. Methods: We conducted a single-centre retrospective medical-record study at the University Clinical Centre in Gdańsk. The analysis included a complete-case cohort of 91 adults who completed both supervised physiotherapy cycles and had paired outcome data available. Assessments were performed at four time points: before and after prehabilitation (T1–T2) and before and after postoperative rehabilitation (T3–T4). Outcomes included body mass, body mass index (BMI), waist and chest circumference, 6 min walk test (6MWT) distance with Borg-rated exertion, and haemodynamic measures (heart rate, blood pressure, oxygen saturation) recorded before and after the 6MWT. Results: From T1 to T4, body mass decreased by a median of 26.0 kg and BMI by 8.98 kg/m2, with reductions in waist (−19.0 cm) and chest (−13.0 cm) circumference. Exercise tolerance improved (6MWT median change +30.0 m), and post-test perceived exertion decreased (median −1.0 point). Pre-6MWT resting HR, post-6MWT HR, and blood pressure decreased. The 6MWT distance increased after prehabilitation (T1 → T2) and again after postoperative rehabilitation (T3 → T4). Exploratory correlations suggested weak nominal associations between greater weight loss and larger 6MWT improvement (Spearman r = 0.251, p = 0.016) and between BMI reduction and 6MWT improvement (r = 0.226, p = 0.031), but these associations did not remain statistically significant after Bonferroni correction. Conclusions: In this retrospective cohort of programme completers, participation in the multidisciplinary KOS-BAR pathway with embedded preoperative and postoperative physiotherapy was associated with improved anthropometric, functional, perceived-exertion, and haemodynamic outcomes across follow-up. Because of the uncontrolled retrospective design, these findings cannot establish the independent effect of physiotherapy relative to surgery and other components of multidisciplinary care. Prospective controlled studies are needed to clarify causality and long-term durability. Full article
(This article belongs to the Special Issue Clinical and Biochemical Diagnosis and Management of Obesity)
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12 pages, 693 KB  
Article
Acute Effects of Anthocyanin-Rich Blackcurrant Extract on Individual Cardiovascular and Metabolic Responses During Supine Rest and Moderate-Intensity Walking in Healthy Men
by Mark E. T. Willems, Pelin Bilgiç, Stefano Montanari and Mehmet A. Şahin
Nutrients 2026, 18(10), 1631; https://doi.org/10.3390/nu18101631 - 21 May 2026
Viewed by 444
Abstract
Background/Objectives: Chronic intake for 7 to 14 days of anthocyanin-rich blackcurrant extract or powder has been shown to alter cardiorespiratory and metabolic responses during rest and moderate-intensity exercise. Whether the observed effects were due to the final intake on the day of [...] Read more.
Background/Objectives: Chronic intake for 7 to 14 days of anthocyanin-rich blackcurrant extract or powder has been shown to alter cardiorespiratory and metabolic responses during rest and moderate-intensity exercise. Whether the observed effects were due to the final intake on the day of testing is not known. We examined whether there were effects of an acute intake of blackcurrant extract on the cardiorespiratory and metabolic responses during supine rest and moderate-intensity treadmill walking. Methods: Healthy men (n = 15, age: 24 ± 6 years, body mass index: 24.4 ± 4.5 kg·m−2) volunteered in a randomized, cross-over designed exploratory study. Acute intake effects of blackcurrant extract (210 mg of anthocyanins) were compared to a control condition. Hemodynamic recordings and indirect calorimetry techniques were used to record physiological and metabolic responses during 10 min of supine rest and 30 min of moderate-intensity treadmill walking. Results: At rest, there may have been an effect for an increase in cardiac output (p = 0.088). Based on the smallest worthwhile change (i.e., 0.2 × the standard deviation in the control condition), eight participants were classified as responders with an increase in cardiac output of 13.5 ± 8.4% (range: 4.0 to 24.7%). For total peripheral resistance, a decrease was observed (p = 0.048, d = −0.40, small effect size), with nine participants classified as responders with a decrease of 17.5 ± 6.1% (range: −9.7 to −28.0%). No changes were observed for other cardiorespiratory and metabolic parameters during supine rest. During moderate-intensity exercise, only heart rate was lower by 2 beats·min−1 for the cohort (d = −0.11, trivial effect size) with four participants considered responders when presenting a heart rate lower than the smallest worthwhile change of 3 beats·min−1. Conclusions: An acute intake of a blackcurrant extract with 210 mg of anthocyanins may have had an effect on vascular regulation mechanisms affecting total peripheral resistance and cardiac output during rest in at least ~50% of the male participants. No acute effects were observed for metabolic responses during rest and exercise. Our findings regarding the metabolic effects are not consistent with previous chronic dosing studies suggesting that repeated daily intake with a dose of 210 mg of anthocyanins is needed to alter substrate oxidation at rest and during moderate-intensity exercise. Full article
(This article belongs to the Section Sports Nutrition)
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7 pages, 1632 KB  
Proceeding Paper
Laying Hens Behavior Recognition Using Computer Vision and Deep Learning
by Heidee Soliman-Cuevas and Jocelyn F. Villaverde
Eng. Proc. 2026, 134(1), 93; https://doi.org/10.3390/engproc2026134093 - 8 May 2026
Viewed by 546
Abstract
Native chicken production in the Philippines is increasing, accounting for nearly half of the total population of raised chickens. Health-conscious consumers prefer native chicken due to its lower fat content. To support this growth, the government established a breeding facility featuring 10 pens, [...] Read more.
Native chicken production in the Philippines is increasing, accounting for nearly half of the total population of raised chickens. Health-conscious consumers prefer native chicken due to its lower fat content. To support this growth, the government established a breeding facility featuring 10 pens, each housing 2 to 6 laying hens and a rooster, which began operation in November 2023. In recent months, staff observed a decline in laying performance in some pens. Because chicken behavior is a key indicator of growth and production performance, this study aims to implement a real-time laying hen activity recognition system using You Only Look Once Version 11 (YOLOv11) to classify hen behaviors into multiple categories. These include active behaviors (walking, eating, drinking, pecking, dust bathing, and preening), inactive behaviors (resting or inactivity), and environmental objects (feeders and water cans). A dataset of 464 images was collected from the breeding facility in Zamboanga City, Philippines. To capture hen behavior, a TP-Link Tapo C510W outdoor WiFi camera was mounted on the ceiling at a height of 80 cm above the ground. The model demonstrated excellent performance in detecting static objects such as feeders and water cans. Among behaviors, pecking and walking were identified as the most common, while drinking and dust bathing were relatively rare. The YOLOv11-based activity recognition system successfully achieved real-time classification of hen behaviors with strong performance across most activity classes. The system reached 95% mAP50, with particularly high accuracy in detecting static objects and distinctive behaviors, thereby providing a solid foundation for future improvements in recognizing more complex or challenging behaviors. Full article
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22 pages, 1770 KB  
Article
Walking Improves Cardiac Function: A Trial on the Effects of Walking on Left Ventricular Function in Type 2 Diabetes Patients
by Roman Leischik, Patrick Bank, Christian Erik Gerlach and Fabian Sanchis-Gomar
J. Cardiovasc. Dev. Dis. 2026, 13(3), 136; https://doi.org/10.3390/jcdd13030136 - 12 Mar 2026
Viewed by 1136
Abstract
Cardiometabolic abnormalities, which are common in diabetes patients, can be alleviated through exercise. We examined the specific effects of walking (4–5 METS) on diabetic patients’ cardiac function in a randomized study. Patients with type 2 diabetes (metformin-, insulin-, and diet-controlled; n = 32) [...] Read more.
Cardiometabolic abnormalities, which are common in diabetes patients, can be alleviated through exercise. We examined the specific effects of walking (4–5 METS) on diabetic patients’ cardiac function in a randomized study. Patients with type 2 diabetes (metformin-, insulin-, and diet-controlled; n = 32) were randomized to a 12-week walking intervention (40 min, three times/week; n = 16) or standard care (control group, n = 16). We prospectively compared metabolic, anthropometric, cardiac function and cardiorespiratory fitness parameters between the two groups via linear regression. Compared with that of the control group, the postintervention global strain of the walking group improved significantly (−19.0 (±3.0) vs. −20.9 (±2.6), Diff = −1.92 (CI = −2.61–−1.24), p < 0.001; control: −18.7 (±3.2) vs. −18.9 (±3.6), Diff = −0.19 (CI = −1.00–0.63), p = 0.650), with a pre/post between-group estimated mean difference of ~−1.73 (CI = −2.78–−0.69; p < 0.001). Abdominal circumference (−3 cm (CI = −4.41–−1.59), p < 0.001)), resting heart rate/bpm (−6.50 (CI = −9.69–−3.31, p < 0.001)) and body fat percentage (−2.74 (CI = −4.71–−0.76, p < 0.007)) changed significantly only in the walking group. Spiroergometric data revealed improved oxygen uptake in the walking group vs. the control group: abs_VO2max/L·min−1 (0.19 (0.05–0.33), p < 0.008); rel_VO2max/mL·kg−1·min−1 (2.43 (1.03–3.83), p < 0.001). This first randomized intervention study of supervised walking in patients with type 2 diabetes demonstrated that even moderate-intensity physical activity (such as walking) can improve cardiac function and body composition, reduced waist circumference, and increased oxygen uptake, making it a cost-effective treatment with significant preventive and restorative benefits for cardiac function and body composition in these patients. Full article
(This article belongs to the Section Imaging)
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13 pages, 668 KB  
Article
Spinal Cord Stimulation for Non-Reconstructable Chronic Limb-Threatening Ischemia: A Real-World, Multidisciplinary, Single-Center Experience
by Naoufel Ouerchefani, Edward Goldberg and Pascal Desgranges
J. Clin. Med. 2026, 15(5), 1760; https://doi.org/10.3390/jcm15051760 - 26 Feb 2026
Viewed by 595
Abstract
Background/Objectives: Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease characterized by ischemic rest pain or ulcer necrosis. In Europe, spinal cord stimulation (SCS) can be offered to CLTI patients with chronic pain to improve mobility and prolong limb [...] Read more.
Background/Objectives: Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease characterized by ischemic rest pain or ulcer necrosis. In Europe, spinal cord stimulation (SCS) can be offered to CLTI patients with chronic pain to improve mobility and prolong limb preservation. We evaluated the long-term, real-world outcomes of SCS therapy in patients with CLTI. Methods: In this observational study, medical chart review data from consecutive CLTI patients treated with SCS were analyzed. Results: Fifty-three patients (56.6% Fontaine Stage III, 39.6% Fontaine Stage IV, 3.8% Fontaine Stage IIb) had a single-stage SCS implant procedure between 2013 and 2022. Two years after SCS therapy activation, claudication pain intensity had significantly improved; the overall numerical rating scale pain score decreased from 9.4 ± 0.9 at baseline to 3.7 ± 3.2 (p < 0.0001). In addition, walking distance increased by more than 350 m (from 70 ± 87 to 429 ± 320 m, p < 0.0001), and pre-existing skin lesions stabilized in ten patients (63%). The probability of limb survival in Fontaine’s stage IIb/III and Fontaine’s stage IV patients at 12 months was 90% and 70%, respectively (log-rank p-value = 0.04). Finally, significant associations were found between the occurrence of an amputation after SCS and Fontaine Stage (p = 0.01), active smoking (p = 0.02), hypertension (p = 0.04), and prior minor amputation (p = 0.02). No major complications were reported. Conclusions: Our real-world experience suggests that SCS for CLTI patients provides significant and durable improvements in ischemic pain and functional outcomes. SCS may also help reduce the natural risk of major amputation, especially when implemented at early CLTI stages. Full article
(This article belongs to the Section Vascular Medicine)
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15 pages, 3263 KB  
Article
DeepPanda: A Video-Based Framework for Automatic Behavior Recognition of Giant Pandas
by Shiqi Luo, Shibin Chen, Guo Li, Shaoqiu Xu, Jianbin Cheng, Nian Cai and Rongping Wei
Appl. Sci. 2026, 16(3), 1579; https://doi.org/10.3390/app16031579 - 4 Feb 2026
Viewed by 726
Abstract
Ex situ conservation in breading centers is one of the key strategies for saving giant pandas (Ailuropoda melanoleuca). Abnormal behaviors (e.g., inappetence) are key symptoms of potential health issues (e.g., Klebsiella pneumoniae) for the captives. Therefore, monitoring their normal activity [...] Read more.
Ex situ conservation in breading centers is one of the key strategies for saving giant pandas (Ailuropoda melanoleuca). Abnormal behaviors (e.g., inappetence) are key symptoms of potential health issues (e.g., Klebsiella pneumoniae) for the captives. Therefore, monitoring their normal activity patterns could set a baseline to detect these abnormalities for implementing timely interventions. However, traditional monitoring methods are labor-intensive, which often rely on manual observations. Here, we proposed a deep learning framework, termed as DeepPanda, for automatically recognizing four essential behaviors (i.e., eating, walking, resting and drinking) of giant pandas based on videos from common surveillance cameras. Experimental results demonstrated that the DeepPanda model achieved high performance on the self-established APanda dataset, with the testing mean average precision at an IoU threshold of 0.5 (mAP@0.5) of 98.8%. This methodology provides a powerful tool for monitoring the captive giant panda’s behaviors. Full article
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16 pages, 326 KB  
Article
Metabolically Guided Walking and Plant-Based Nutrition Enhance Body Composition and Weight Loss
by Harold C. Mayer, Lucas G. Valenca, Gregory W. Heath, Chris S. Hansen, Kristina Nelson Hall and Cassie J. White
Int. J. Environ. Res. Public Health 2026, 23(1), 136; https://doi.org/10.3390/ijerph23010136 - 22 Jan 2026
Viewed by 1068
Abstract
Sedentary behavior contributes to obesity and metabolic dysfunction, yet few interventions individualize exercise intensity using fuel-based metrics such as the respiratory exchange ratio (RER; VCO2/VO2). This study investigated the effects of metabolically guided walking combined with whole-food, plant-based nutrition [...] Read more.
Sedentary behavior contributes to obesity and metabolic dysfunction, yet few interventions individualize exercise intensity using fuel-based metrics such as the respiratory exchange ratio (RER; VCO2/VO2). This study investigated the effects of metabolically guided walking combined with whole-food, plant-based nutrition on body composition and metabolic outcomes in sedentary overweight and obese women. Forty-four women mean age 43 years; BMI 30.1 kg·m−2) were randomized to low-intensity continuous training (LICT; RER ≈ 0.75), moderate-intensity intermittent training (MIIT; RER ≈ 0.85), or high-intensity continuous training (HICT; RER ≈ 0.95). Following a 2-week dietary lead-in with an individualized ~200 kcal·day−1 energy deficit, participants completed an 8-week RER-guided walking program (5 sessions·week−1; 15–50 min·session−1). Assessments included air-displacement plethysmography (BodPod) body composition, resting metabolic rate and substrate utilization, and oxygen uptake at the first ventilatory threshold (VT1). Data were analyzed using ANCOVA, mixed-factorial ANOVA, and Pearson correlations. Percent body fat decreased significantly across participants (p < 0.0001, η2 = 0.827), with MIIT demonstrating the most favorable integrated outcomes. MIIT elicited the largest reductions in total body mass (−11.2%), fat mass (−25.9%), and percent body fat (−17.1%), alongside improvements in VT1 VO2 (Δ = 1.487 ± 0.895 L·min−1; p = 0.038). Resting respiratory quotient (RQ) declined in LICT and MIIT but increased in HICT, corresponding with increased fat oxidation in LICT and MIIT and reduced fat oxidation in HICT. Changes in RQ were significantly associated with changes in percent body fat (r = 0.316, p = 0.039). Metabolically guided moderate-intensity intermittent walking combined with whole-food, plant-based nutrition produced the most consistent improvements in adiposity, substrate utilization, and submaximal fitness, supporting the public-health feasibility of a community-deliverable, substrate-informed walking prescription. Full article
(This article belongs to the Section Exercise and Health-Related Quality of Life)
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15 pages, 1136 KB  
Systematic Review
Validity and Reliability of the Six-Minute Walking Test Compared to Cardiopulmonary Exercise Test in Individuals with Heart Failure Systematic Review and Meta-Analysis
by Garyfallia Pepera, Varsamo Antoniou, Eleni Karagianni, Ladislav Batalik and Jing Jing Su
J. Clin. Med. 2025, 14(23), 8303; https://doi.org/10.3390/jcm14238303 - 22 Nov 2025
Cited by 7 | Viewed by 5168
Abstract
Background: Reduced cardiorespiratory fitness along with poor exercise tolerance are regarded as potential morbidity and mortality predictors within the heart failure (HF) population. Despite the reliability and accuracy of the gold-standard cardiopulmonary exercise test (CPET) for assessing cardiorespiratory fitness, its complexity and tolerability [...] Read more.
Background: Reduced cardiorespiratory fitness along with poor exercise tolerance are regarded as potential morbidity and mortality predictors within the heart failure (HF) population. Despite the reliability and accuracy of the gold-standard cardiopulmonary exercise test (CPET) for assessing cardiorespiratory fitness, its complexity and tolerability issues among HF patients mean that the 6 min walk test (6MWT) is a cost-saving and well-tolerated complementary assessment. We aimed to systematically review the validity, reliability, and safety of the 6MWT compared to CPET for patients with HF. Methods: This study is a systematic review and meta-analysis. Embase, Medline, and Scopus were searched from inception to November 2023. We applied Fisher’s z-transformation to correlation coefficients and pooled effects under a random-effects model; heterogeneity (I2), leave-one-out sensitivity, and Egger’s test were reported. Results: Twenty studies were finally included, involving 5379 HF participants. A significant moderately strong positive correlation was shown between the 6MWT distance and CPET peak oxygen consumption: (r) = 0.62, 95% CI 0.58–0.66; I2 = 56.95%; p < 0.001. The results showed an excellent test–retest reliability, with a pooled intraclass correlation coefficient of 0.93 (95% CI 0.89–0.95; I2 = 92.06%; p < 0.001). A pooled weighted mean difference of 15.5 m (95% CI 10.2–20.8) was found for the learning effect between the first and second 6MWT. Although some patients required rest stops or reported symptoms such as fatigue or dyspnea, no 6MWTs were terminated due to serious adverse events. Conclusions: Compared with CPET, the 6MWT distance demonstrated a moderately strong correlation with peak VO2, excellent test–retest reliability, and a small learning effect. The 6MWT can therefore complement CPET or serve as a pragmatic alternative when CPET is not feasible; it does not replace comprehensive CPET assessment. Full article
(This article belongs to the Special Issue Insights and Innovations in Sports Cardiology)
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15 pages, 912 KB  
Article
A Structured Low-Intensity Home-Based Walking Program to Improve Physical and Mental Functioning After Hospitalization for Severe COVID-19: A Pragmatic Nonrandomized Controlled Trial
by Nicola Lamberti, Andrea Baroni, Giovanni Piva, Giulia Fregna, Nicola Schincaglia, Anna Crepaldi, Lorenzo Gamberini, Antonella Occhi, Sofia Straudi and Fabio Manfredini
J. Clin. Med. 2025, 14(19), 6938; https://doi.org/10.3390/jcm14196938 - 30 Sep 2025
Cited by 1 | Viewed by 957
Abstract
Background/Objectives: We aimed to test whether home-based low-intensity interval training (LIIT) could be equally or more effective than traditional continuous walking advice (TWA) in a population hospitalized and healed from severe COVID-19. Methods: This pragmatic nonrandomized controlled trial (NCT04615390) enrolled patients [...] Read more.
Background/Objectives: We aimed to test whether home-based low-intensity interval training (LIIT) could be equally or more effective than traditional continuous walking advice (TWA) in a population hospitalized and healed from severe COVID-19. Methods: This pragmatic nonrandomized controlled trial (NCT04615390) enrolled patients admitted to intensive care units due to COVID-19 who at discharge from the hospital were given a choice between either a home-based LIIT program or TWA. The former received a structured LIIT walking (1:1 walk:rest ratio per 10 times) to be performed at a prescribed progressively increasing speed maintained with a metronome. The latter received TWA according to the guidelines (30 min or moderate intensity activity, 5 days/week). Outcome measures, collected at baseline, at the end of the 3-month training and at the 6-month follow-up, included 6 min walking distance (primary), lower limb strength, quality of life, depression and cognitive status. Results: From a total of 85 enrolled patients, 69 of them (LIIT n = 32; TWA n = 37) completed the study. Home exercise was safely executed with an 82% adherence for the LIIT group and 64% adherence for TWA. After the 3-month program, both groups significantly improved the 6MWD (LIIT: +87 m vs. TWA +42 m; p < 0.001) with a significant difference that was also maintained at follow-up (LIIT: +138 m vs. TWA +69 m; p < 0.001). No other significant between-group differences were noted. However, patients in the LIIT group significantly improved in the majority of the outcomes, while patients of TWA improved in only the primary outcome and the physical component of quality of life. Conclusions: Compared with TWA, LIIT walking was feasible, safe and associated with more favorable multidimensional recovery in COVID-19 survivors after hospitalization for severe pneumonitis. Full article
(This article belongs to the Special Issue Rehabilitation and Treatment of Post-COVID-19 Condition)
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15 pages, 1075 KB  
Article
Sympathetic Burden Measured Through a Chest-Worn Sensor Correlates with Spatiotemporal Gait Performances and Global Cognition in Parkinson’s Disease
by Gabriele Sergi, Ziv Yekutieli, Mario Meloni, Edoardo Bianchini, Giorgio Vivacqua, Vincenzo Di Lazzaro and Massimo Marano
Sensors 2025, 25(18), 5756; https://doi.org/10.3390/s25185756 - 16 Sep 2025
Cited by 2 | Viewed by 1426
Abstract
Autonomic dysfunction is a key non-motor feature of Parkinson’s disease (PD) and may influence motor performance, particularly gait. While heart rate variability (HRV) has been associated with freezing of gait, its relationship with broader gait parameters remains unclear. The objective was to investigate [...] Read more.
Autonomic dysfunction is a key non-motor feature of Parkinson’s disease (PD) and may influence motor performance, particularly gait. While heart rate variability (HRV) has been associated with freezing of gait, its relationship with broader gait parameters remains unclear. The objective was to investigate correlations between resting-state HRV time-domain measures and spatiotemporal gait parameters during comfortable and fast walking in patients with idiopathic PD. Twenty-eight PD patients (mean age 68 ± 9 years) were evaluated at Campus Bio-Medico University Hospital. HRV was recorded at rest using the e-Sense pule™ portable sensor, including the Baevsky’s Stress Index a measure increasing with sympathetic burden. Gait parameters were assessed via the 10 m Timed Up and Go (TUG) test using the Mon4t™ smartphone app at comfortable and fast pace. Clinical data included UPDRS III, MoCA, and disease characteristics. Gait metrics significantly changed between walking conditions. HRV parameters clustered separately from gait metrics but intersected with significant correlations. Higher Stress Index values, reflecting sympathetic dominance, were associated with poorer gait performance, including prolonged transition times, shorter steps, and increased variability (p < 0.001, r = 0.57–0.61). MoCA scores inversely correlated with the Stress Index (r = −0.52, p = 0.004), linking cognitive and autonomic status. UPDRS III and MoCA were related to TUG metrics but not HRV. Time-domain HRV measures, particularly the Stress Index, are significantly associated with spatiotemporal gait features in PD, independent of gait speed. These findings suggest that impaired autonomic regulation contributes to functional mobility deficits in PD and supports the role of HRV as a biomarker in motor assessment. Full article
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16 pages, 1107 KB  
Article
Validation of the Polar Fitness Test for Estimation of Maximal Oxygen Consumption at Rest in Medically Supervised Exercise Training: Comparison with CPET and the 6-Minute Walk Test
by Michael Neudorfer, Lukas Ötzlinger, Devender Kumar, Josef Niebauer, Jan David Smeddinck, Mahdi Sareban and Gunnar Treff
Sensors 2025, 25(18), 5649; https://doi.org/10.3390/s25185649 - 10 Sep 2025
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Abstract
The Polar Fitness Test (PFT) estimates maximal oxygen consumption (V̇O2max) under resting conditions using heart rate data from the manufacturer’s wearable devices. We aimed to validate the PFT in a population with cardiovascular risk factors and to compare [...] Read more.
The Polar Fitness Test (PFT) estimates maximal oxygen consumption (V̇O2max) under resting conditions using heart rate data from the manufacturer’s wearable devices. We aimed to validate the PFT in a population with cardiovascular risk factors and to compare its results with five established equations predicting V̇O2max based on the 6-min walk test (6MWT). Twenty-four participants (9 female; age 57.4 ± 10.2 years) undergoing medically supervised exercise training—including seven individuals on heart rate-limiting medication—completed the PFT, 6MWT, and cardiopulmonary exercise testing (CPET), which served as the criterion V̇O2max measurement. The PFT showed a mean absolute percent-age error (MAPE) of 13.7%, an intraclass correlation coefficient (ICC) of 0.743, a mean bias of −1.0 mL/min/kg, and limits of agreement (LoA) of ±11.4 mL/min/kg compared to CPET. Among the 6MWT-based equations, only the Porcari equation demonstrated similar performance (MAPE 12.6%, ICC 0.725, mean bias 0.2 mL/min/kg, LoA ± 9.7 mL/min/kg), while other equations showed larger errors and systematic deviations. Our data indicate that the PFT may present an easily accessible option to estimate V̇O2max on population level when exercise-based testing is not feasible. However, its variability limits use for individual clinical decisions, reaffirming the relevance of CPET for accurate assessment. Full article
(This article belongs to the Special Issue Wearable Biomedical Sensors for Mobile Health)
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15 pages, 2064 KB  
Article
A Low-Sugar Flavored Beverage Improves Fluid Intake in Children During Exercise in the Heat
by Sajjad Rezaei, Rocio I. Guerrero, Parker Kooima, Isabela E. Kavoura, Sai Tejaswari Gopalakrishnan, Clarissa E. Long, Floris C. Wardenaar, Jason C. Siegler, Colleen X. Muñoz and Stavros A. Kavouras
Nutrients 2025, 17(15), 2418; https://doi.org/10.3390/nu17152418 - 24 Jul 2025
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Abstract
Objectives: This study examined the impact of a low-sugar flavored beverage on total fluid intake and hydration biomarkers during intermittent exercise in a hot environment among healthy children. Methods: Twenty-one children (11 girls, 8–10 y) completed a randomized, crossover study with [...] Read more.
Objectives: This study examined the impact of a low-sugar flavored beverage on total fluid intake and hydration biomarkers during intermittent exercise in a hot environment among healthy children. Methods: Twenty-one children (11 girls, 8–10 y) completed a randomized, crossover study with two trials. Each trial involved three bouts of 10 min walking, 5 min rest, 10 min walking, and 35 min rest for a total of 3 h in a hot (29.9 ± 0.6 °C) and dry environment (26 ± 7% relative humidity). Walking intensity was 69 ± 7% of age-predicted maximum heart rate. Participants consumed either plain water (W) or a low-sugar flavored beverage (FB). Body weight, fluid intake, urine samples, and perceptual ratings were collected. Results: Total ad libitum fluid intake was significantly higher with the FB (946 ± 535 mL) than with W (531 ± 267 mL; p < 0.05). This difference was 128% higher for FB compared to W, with 19 out of the 21 children ingesting more fluids in FB versus W. Children rated the FB as more likable across all time points (p < 0.05). Net fluid balance was better with FB at 60, 70, 85, 135, and 145 min (p < 0.05), though not different at the 3 h mark. Urine volume was higher with FB (727 ± 291 mL) than with W (400 ± 293 mL; p < 0.05). Urine osmolality was significantly higher in the W trial at 120 and 180 min (p < 0.05). Conclusions: A flavored, low-sugar beverage enhanced ad libitum fluid intake and improved hydration markers compared to water during exercise in the heat, supporting its potential as a practical rehydration strategy for children. Full article
(This article belongs to the Section Pediatric Nutrition)
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29 pages, 5277 KB  
Article
DualHet-YOLO: A Dual-Backbone Heterogeneous YOLO Network for Inspection Robots to Recognize Yellow-Feathered Chicken Behavior in Floor-Raised House
by Yaobo Zhang, Linwei Chen, Hongfei Chen, Tao Liu, Jinlin Liu, Qiuhong Zhang, Mingduo Yan, Kaiyue Zhao, Shixiu Zhang and Xiuguo Zou
Agriculture 2025, 15(14), 1504; https://doi.org/10.3390/agriculture15141504 - 12 Jul 2025
Cited by 4 | Viewed by 1327
Abstract
The behavior of floor-raised chickens is closely linked to their health status and environmental comfort. As a type of broiler chicken with special behaviors, understanding the daily actions of yellow-feathered chickens is crucial for accurately checking their health and improving breeding practices. Addressing [...] Read more.
The behavior of floor-raised chickens is closely linked to their health status and environmental comfort. As a type of broiler chicken with special behaviors, understanding the daily actions of yellow-feathered chickens is crucial for accurately checking their health and improving breeding practices. Addressing the challenges of high computational complexity and insufficient detection accuracy in existing floor-raised chicken behavior recognition models, a lightweight behavior recognition model was proposed for floor-raised yellow-feathered chickens, based on a Dual-Backbone Heterogeneous YOLO Network. Firstly, DualHet-YOLO enhances the feature extraction capability of floor-raised chicken images through a dual-path feature map extraction architecture and optimizes the localization and classification of multi-scale targets using a TriAxis Unified Detection Head. Secondly, a Proportional Scale IoU loss function is introduced that improves regression accuracy. Finally, a lightweight structure Eff-HetKConv was designed, significantly reducing model parameters and computational complexity. Experiments on a private floor-raised chicken behavior dataset show that, compared with the baseline YOLOv11 model, the DualHet-YOLO model increases the mAP for recognizing five behaviors—pecking, resting, walking, dead, and inactive—from 77.5% to 84.1%. Meanwhile, it reduces model parameters by 14.6% and computational complexity by 29.2%, achieving a synergistic optimization of accuracy and efficiency. This approach provides an effective solution for lightweight object detection in poultry behavior recognition. Full article
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