Search Results (430)

Background: Sleep quality (SQ) and physical activity (PA) are among the strongest behavioral determinants of healthy aging, while dietary behavior and psychological factors act as complementary modulators of these relationships. Although each domain has been studied extensively, their combined influence on subjective life expectancy (SLE)—an individual’s perceived likelihood of living to an advanced age—remains largely unexplored. Methods: This narrative review synthesizes evidence from sleep science, exercise physiology, behavioral medicine, and psychological aging. Literature published between January 2015 and 15 December 2025 was examined across PubMed, Scopus, and Web of Science using integrative keyword strategies. Studies addressing SQ, PA, circadian rhythms, psychological health, SLE, or aging-related outcomes were included. Results: The review identifies several converging pathways linking sleep and PA to aging trajectories. Sleep architecture, circadian stability, metabolic regulation, inflammatory balance, and autonomic function represent key biological mechanisms. PA contributes through improvements in mitochondrial efficiency, VO₂max, muscle metabolism, and anti-inflammatory signaling (IL-6 as a myokine). Across studies, both sleep and PA strongly influence psychological health, health perception, and future-oriented expectations, within a broader lifestyle context supported by nutritional status and dietary quality. SLE emerges as a central psychological mediator that shapes motivation, adherence to health behaviors, and long-term health outcomes. Contextual moderators—including age, gender, socioeconomic status, cultural norms, and wearable technology engagement—further influence these relationships. Conclusions: SQ and PA form the core behavioral components of a dynamic system that is further shaped by dietary behavior and psychological well-being and centered on SLE. Our proposed integrative model positions SLE as a key psychological link between lifestyle behaviors and longevity. This framework is hypothesis-generating and requires empirical validation through future longitudinal and interventional studies, underscoring the need for multidomain research integrating behavioral, biological, nutritional and psychological indicators of aging. Full article

Background/Objectives: This study aimed to describe changes in physical performance and nutritional status among frail adults at risk of falls receiving muscle-targeted oral nutritional supplementation (MT-ONS) as part of routine clinical care. Methods: A prospective, open-label, single-centre, uncontrolled, descriptive study was conducted in a real-world clinical setting. Patients ≥ 70 years attending an outpatient fall clinic were consecutively recruited and assessed at baseline and after at least 90 days of MT-ONS (100% whey protein enriched with leucine and vitamin D), provided as part of a comprehensive care plan including exercise recommendations, medication review, and home adaptation advice. Sociodemographic, physical performance [Short Physical Performance Battery (SPPB)], nutritional status [Mini Nutritional Assessment-Short Form, (MNA^®-SF)], walking ability [Functional Ambulation Categories (FACs)], number of falls, muscle strength (dynamometry), body composition (Tanita), health-related quality-of-life (SF-12), functional capacity (Barthel Index), and adherence data were collected. Statistics analyses were descriptive and exploratory. Results: Twenty-six participants were assessed (58% women, age: 82.1 ± 5.4 years). Mean SPPB score increased from 7.3 (±3.6) to 8.0 (±4.0) (p = 0.3). At baseline, 35% were malnourished, 42% at risk of malnutrition, and 23% well-nourished. After ≥90 days of MT-ONS, 4% were malnourished, 54% at risk, and 42% well-nourished. The number of falls decreased from 1.2 falls/month (±0.9) to 0.2 falls/month (±0.3, p < 0.0001). Favourable changes in physical performance were positively correlated with improvements in nutritional status (p = 0.03). Adherence was high (92%), largely attributed to pleasant taste (71%) and smell (58%) and positive health perceptions (58%). Conclusions: In routine clinical practice, frail adults at risk of falls who received MT-ONS, 100% whey protein enriched with leucine and vitamin D for ≥90 days, as part of a comprehensive care plan improved their physical performance and nutritional status and reduced the number of falls. These findings should be interpreted as preliminary. Full article

This pilot study examined the feasibility, usability, and physiological effects of a high-intensity exercise program delivered through immersive virtual reality (IVR) in adults with Down syndrome (DS). Twenty participants (mean age: 29.85 ± 9.37 years) completed a 12-week intervention using the FitXR exergame on Meta Quest 3, with two sessions per week. Usability, safety, and personal experiences were assessed via the System Usability Scale (SUS), Simulator Sickness Questionnaire (SSQ), and Game Experience Questionnaire (GEQ), while body composition and strength were measured using bioelectrical impedance analysis and standardized tests (handgrip dynamometry, Five Sit-to-Stand Test). Results indicated excellent usability (SUS: 92.88–95.03/100), minimal cybersickness (SSQ: 2.12 → 1.98/48), and high adherence (90%). Positive experiences increased significantly, with no negative experiences reported. Lower-limb strength has been considered as a primary outcome, which has shown to improve significantly (p = 0.018; Cohen’s d = 0.89), whereas upper-limb strength and body composition changes were minimal. These findings suggest that IVR-based exercise is a safe, engaging, and feasible strategy for promoting physical activity and enhancing functional strength in adults with DS. Further controlled trials with longer duration and nutritional strategies are warranted to optimize body composition outcomes. Full article

Background/Objectives: Self-care is central to chronic illness management and is particularly relevant in osteoporosis to prevent complications and improve quality of life. Grounded in Riegel’s middle-range theory of self-care of chronic illness, the study sought to understand the contextual, emotional, and structural influences shaping self-care in people living with osteoporosis. Aim: The aim of this study was to explore patient-reported barriers and facilitators to self-care behaviors among individuals living with osteoporosis. Methods: A qualitative descriptive design was conducted using in-depth, semi-structured interviews with 20 patients with osteoporosis recruited via convenience sampling. Data were coded deductively and analyzed using Mayring’s qualitative content analysis with a deductive approach. Results: Participants identified several factors related to both barriers and facilitators of self-care behaviors. Four barrier sub-themes emerged: ineffective coping strategies, difficulties in osteoporosis management, inadequate physical activity, and ineffective self-efficacy. Six facilitator sub-themes were identified: self-care management strategies, osteoporosis management after a fracture, osteoporosis control, osteoporosis treatment, exercise, and confidence in one’s ability. Main barriers included fear of falling, ineffective self-efficacy, and poor care continuity, whereas key facilitators included support networks, motivation, and tailored care. Conclusions: Self-care behaviors in individuals with osteoporosis are influenced by emotional, contextual, and structural factors. Person-centered interventions integrating emotional and educational components may strengthen patients’ engagement and enhance self-care behaviors in osteoporosis. Identifying barriers and facilitators enables nurses to design empathetic, tailored strategies that enhance empowerment and disease management. Understanding these factors can improve autonomy for patients and adherence, promoting long-term health outcomes across clinical and community settings. Full article

Background: Metabolic syndrome, a clinical condition defined by central obesity, impaired glucose regulation, elevated blood pressure, hypertriglyceridemia, and low high-density lipoprotein cholesterol across the lifespan, is now a major public health issue typically managed with lifestyle, behavioral, and dietary recommendations. However, “one-size-fits-all” recommendations often yield modest, heterogeneous responses and poor long-term adherence, creating a clinical need for more targeted and implementable preventive and therapeutic strategies. Objective: To synthesize evidence on how the gut microbiome can inform precision nutrition and exercise approaches for metabolic syndrome prevention and management, and to evaluate readiness for clinical translation. Key findings: The gut microbiome may influence cardiometabolic risk through microbe-derived metabolites and pathways involving short-chain fatty acids, bile acid signaling, gut barrier integrity, and low-grade systemic inflammation. Diet quality (e.g., Mediterranean-style patterns, higher fermentable fiber, or lower ultra-processed food intake) consistently relates to more favorable microbial functions, and intervention studies show that high-fiber/prebiotic strategies can improve glycemic control alongside microbiome shifts. Physical exercise can also modulate microbial diversity and metabolic outputs, although effects are typically subtle and may depend on baseline adiposity and sustained adherence. Emerging “microbiome-informed” personalization, especially algorithms predicting postprandial glycemic responses, has improved short-term glycemic outcomes compared with standard advice in controlled trials. Targeted microbiome-directed approaches (e.g., Akkermansia muciniphila-based supplementation and fecal microbiota transplantation) provide proof-of-concept signals, but durability and scalability remain key limitations. Conclusions: Microbiome-informed personalization is a promising next step beyond generic guidelines, with potential to improve adherence and durable metabolic outcomes. Clinical implementation will require standardized measurement, rigorous external validation on clinically meaningful endpoints, interpretable decision support, and equity-focused evaluation across diverse populations. Full article

Background: Approximately half of U.S. adults have ≥1 cardiovascular disease (CVD) risk factors. Exercise is universally recommended as a first-line lifestyle therapy to prevent and treat CVD. Objective: We will conduct a feasibility and pilot efficacy randomized controlled trial to test the usability and user satisfaction of an evidence-based digital health tool we developed for physicians—the Prioritizes Personalizes Prescribes EXercise algorithm (P3-EX)—to treat patients with CVD risk factors (ClinicalTrials.gov: NCT07238556). Methods: We will recruit 24 physicians who do not prescribe written exercise prescriptions (ExRx) from two local CT hospitals. Physicians will recruit two patients each (N = 48); both patients must have CVD risk factors. Each physician will deliver a P3-EX ExRx to one patient (n = 24) and the Physical Activity Vital Sign ExRx to the other patient (n = 24) in a random sequence crossover design. Physicians and patients will rate the feasibility and acceptability of each ExRx method using validated questionnaires. Patients will perform their ExRx for 12 weeks and complete an exercise diary to monitor exercise adherence with weekly virtual oversight by Research Assistants. Before and after the exercise intervention, we will measure patient CVD risk factors and physical activity levels via accelerometry. Results: This trial has received Institutional Review Board approval (E-HHC-2025-0198) and will begin in January 2026, with findings published in 2027. Conclusions: This protocol provides the scientific rationale and methodology to test P3-EX within a real-world clinical setting, to inform the feasibility of using P3-EX as a digital health support tool by physicians, and preliminary efficacy of P3-EX to improve patient cardiovascular health and physical activity levels. Full article

Background: Eating disorders are increasingly diagnosed in young women, particularly during adolescence. The recently described Anorexic Readiness Syndrome (ARS) is more common than full-blown anorexia. It has been identified in female athletes engaging in disciplines focusing on the aesthetics of the body, in women involved in recreational exercise and in those who are not physically active but strive to achieve the “perfect” figure. The study aimed to assess the severity and prevalence of ARS in women regularly engaging in body-shaping physical activity. Methods: The study included 659 women aged ≥ 14 years who engaged in regular body-shaping physical activity, provided informed consent to participate in the study (in the case of minors, also the consent of a parent or legal guardian), and had no diagnosed chronic diseases. The level of ARS was assessed using a questionnaire measuring attitudes toward food, supplemented with a specially designed survey consisting of 32 questions and a personal data form. Based on the frequency of body-shaping physical activity, participants were divided into two groups: the study group comprised women exercising ≥ 3 times per week (n = 301), while women exercising < 3 times per week constituted the control group (n = 358). The analyses examined the relationships between ARS, frequency of body-shaping physical activity, BMI, and menstrual irregularities. Results: Medium or high ARS level was identified in over 96% (n = 637) of the respondents. The level of ARS was significantly related to the allocation into the group (p = 0.034) and the weekly hours of physical activity (p = 0.011 in the control group; p = 0.020 in the study group). There was a correlation between ARS and menstrual irregularities (p = 0.001). Weak but significant correlations were identified for awareness of eating disorders (V = 0.20; p = 0.001), adherence to a special diet (V = 0.18; p < 0.001) and self-assessed health (V = 0.18; p < 0.001). Conclusions: Higher ARS levels were observed in women reporting greater weekly physical activity. No significant associations were found between ARS and body mass index or body weight. Medium and high ARS levels were significantly associated with self-reported menstrual disturbances, while most participants with elevated ARS were unaware of disordered eating risk. Full article

Research suggests that overweight/obese adults (BMI ≥ 25 kg/m²) have an elevated risk of cognitive decline. Although exercise is recommended to improve both physical and cognitive health, adherence is often low in this population. Virtual reality (VR) is an emerging strategy that may enhance exercise engagement. This pilot study compared the effects of traditional (TRAD) cycling and VR-based exercise on cognitive performance and prefrontal cortex (PFC) oxygenation (O₂Hb). Eleven adults (M = 6, F = 5; BMI: 31.1 ± 2.8 kg/m²; VO_2max: 30.4 ± 5.7 mL/kg/min) completed a VO_2max test and two 16 min moderate-intensity cycling sessions (TRAD, VR) on separate days, each followed by a Stroop task (four rounds of 30 trials). Exercise intensity did not differ between conditions (TRAD: %HRmax 73.9 ± 4.2, RPE 12.9 ± 1.5, BLa⁻ 2.5 ± 1.3; VR: %HRmax 74.0 ± 5.6, RPE 12.7 ± 1.4, BLa⁻ 2.7 ± 1.7). Stroop accuracy was similar between conditions; however, response time was faster post-TRAD in round two (p = 0.005) and round three (p = 0.004). No significant differences in PFC O₂Hb were observed. These preliminary results suggest that both TRAD cycling and VR-based exercise are feasible modes of moderate-intensity exercise in overweight/obese adults, with largely comparable post-exercise cognitive outcomes. Larger, counterbalanced studies are warranted. Full article

Background/Objectives: Recent preclinical studies suggest that acute exercise induces immune modulation, enhances tumor blood perfusion, and is associated with reduced tumor growth. Adding exercise to immunochemotherapy treatment (ICT) has been proposed as a strategy to increase treatment effectiveness. The ERICA trial (NCT04676009) aimed to assess the feasibility of acute aerobic exercise performed immediately before the administration of ICT in patients with metastatic non-small cell lung cancer (mNSCLC) and to explore hypothesis-generating outcomes related to physical fitness and patient-reported outcomes. Methods: Newly diagnosed mNSCLC patients were randomly assigned (2:1) to the exercise or control group. The exercise intervention included supervised acute exercise before each of four ICT cycles plus a 3-month home-based walking program with an activity tracker and step goals. The feasibility of the exercise protocol was assessed through adherence, acceptability, tolerability, and safety. Clinical, physical, and patient-reported outcomes were assessed at baseline and after 3 months. Results: Twenty-six patients (mean age 60.6 years; SD 10.65) participated, with an 87.5% acceptance rate. In the exercise group (n = 17), 80.9% of participants completed the acute exercise sessions, with a median interval of 38 min [IQR, 20–60] between exercise and ICT. No exercise-related adverse effects were reported. After 3 months, 60% of participants in the exercise group were classified as active and maintained their step goals. Self-reported measures suggest that maintaining physical fitness is favorable for reducing fatigue and insomnia, and therefore improving quality of life. Conclusions: Acute exercise performed immediately before each ICT administration in patients with mNSCLC appears feasible and safe. Full article

Despite being key partners in the supportive care of the cancer patient, family caregivers are often inadequately prepared for or supported to take on this critical role, subsequently putting their own wellbeing at risk and, by extension, that of the patient. Exercise interventions show promise in mitigating caregiver burden and improving health outcomes for both caregivers and patients; however, the interrelationship between family caregiver and care recipient has gone largely unexplored. Thus, we conducted a single-group pilot study to examine the feasibility and preliminary effectiveness of a 12-week dyadic exercise intervention. Of the 27 caregiver–patient dyads who consented, 21 (77.8%) completed the study, with participants completing an average of 23.1 (96.3%) of the prescribed exercise sessions, suggesting good adherence and study retention. All participants reported higher post-intervention levels of strenuous physical activity (p = 0.017), improved sit-to-stand repetitions (p = 0.004), and social functioning (p = 0.030) compared to baseline. Of note, caregivers reported higher post-intervention scores on the burden in relationship subscale of the Zarit Burden Interview relative to baseline (p = 0.043), suggesting an increase in perceived caregiver burden following the intervention. Overall, dyadic exercise interventions appear feasible and may confer certain physical and psychosocial benefits for both family caregivers and care recipients. However, such programs may also unintentionally exacerbate certain aspects of caregiver burden. Future research should aim to identify factors within dyadic exercise interventions that may contribute to increased caregiver burden, as well as strategies to help mitigate these effects. Full article

This narrative review explores the impact of diet and physical exercise both as a risk factor of central nervous system inflammatory diseases, but more importantly as potential adjunctive disease modifiers in Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum Disorders (NMOSD), and Myelin Oligodendrocyte Glycoprotein (MOG) antibody-associated disease (MOGAD). The majority of evidence relies on MS preclinical and clinical studies, but preclinical studies also support the benefit of lifestyle intervention in NMOSD and MOGAD. In MS, adherence to healthy diets (particularly Mediterranean and MIND diets) could lead to a milder disease course with reduced relapse rates, while structured exercise from early disease stages promotes neuroprotection by upregulating neurotrophic factors and preserving brain volume, possibly impacting disease progression. The ketogenic diet and intermittent caloric restriction also showed promising results. Physical activity, including both aerobic training and resistance training, emerges as a potential disease-modifying strategy by promoting neuroprotection, reducing inflammation, and supporting functional and cognitive outcomes, particularly when implemented early in the disease course. A synergistic approach alongside disease-modifying treatments (DMTs) would further positively modulate core pathological processes. Evidence for NMOSD and MOGAD warrants further investigation. We highlight that integrating personalized lifestyle strategies would be beneficial from the early stages. However, future large-scale, standardized trials are required to fully confirm the neuroprotective potential of diet and exercise across the entire spectrum of CNS disorders. Full article

Background: Physical exercise (PE) has emerged as a promising intervention for depressive disorder (DD), yet its efficacy and optimal implementation remain under investigation. Objective: To thoroughly assess the effectiveness of supervised PE as a conventional intervention for adults with DD. Methods: A comprehensive literature search was conducted across PubMed/MEDLINE, EBSCOhost, Ovid, Web of Science, and Scopus. Randomized controlled trials (RCTs) published between 2010–2025 involving adults with DD without other comorbidities under supervised exercise interventions were selected. Methodological rigor was ensured through two independent reviewers and adherence to PRISMA 2020 guidelines. The influence of moderating variables [total work performed (workload) and the instrument used to evaluate DD (instrument)] was analyzed using meta-regression. The pooled effect size was estimated using both frequentist and Bayesian meta-analyses. Results: From 15,542 screened records, 20 RCTs were selected. Workload and instrument account for 60% and 15% of the variance in the effect size, respectively. Both frequentist and Bayesian meta-analyses showed that supervised PE reduces depressive symptoms (standardized mean difference = 0.82; 95% CI: 0.54–1.11; I² = 76%, and 0.61; 95% CI: −0.06–0.95; I² = 51, respectively). Conclusions: PE could be a valuable complementary intervention to reduce depressive symptoms in adults with depression. PROSPERO (CRD420251121919). Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most prevalent chronic liver disorder among children and adolescents, mirroring the rise in pediatric obesity. The Mediterranean diet (MD) has demonstrated anti-inflammatory, antioxidant, and beneficial effects on different health outcomes across different life stages. The MD’s effect has been explored in adult MASLD, but there is limited information on the pediatric population. However, evidence on pediatric MASLD should be explored given its rising prevalence. Therefore, the aim of this review is to collect human studies assessing the effect of MD interventions on pediatric MASLD, focusing on key pathophysiological mechanisms. It also examines other interventions, including specific energy/macronutrient prescriptions, nutrition education or counseling, and physical activity components. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted using terms related to the Mediterranean diet, nutrition education, physical activity, pediatrics, and MASLD/NAFLD. Pre-determined inclusion and exclusion criteria were used to collect eligible studies to be included in the review. Study quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Screening, data extraction, and appraisal were performed independently, with discrepancies resolved through discussion, and the findings were synthesized qualitatively. Results: This review synthesizes findings from eight human studies evaluating the impact of the MD, alone or integrated with structured exercise and nutrition education, on pediatric MASLD. Interventions consistently demonstrated reductions in hepatic steatosis, liver stiffness, and fibrosis markers, alongside improvements in inflammatory cytokines, oxidative stress defenses, and liver enzymes. The MD also enhanced lipid and glycemic profiles, lowering triglycerides, total cholesterol, and insulin resistance indices. Nutrition education and family-centered approaches improved adherence, while structured, enjoyable physical activity enhanced outcomes and long-term sustainability. Conclusions: Collectively, the MD, particularly when combined with exercise and tailored education, offers a safe, effective, and comprehensive lifestyle intervention for pediatric MASLD. Nonetheless, current evidence remains limited by small sample sizes, heterogeneity in protocols, and short follow-ups. Larger, multicenter randomized trials with standardized designs are needed to establish best practices and long-term efficacy. Full article

Cancer remains a leading global cause of morbidity and mortality. Modifiable lifestyle factors, including avoidance of tobacco use and excessive ultraviolet radiation, healthy dietary patterns, regular physical activity, and weight management, play key roles in prevention and care. This narrative review synthesizes evidence on lifestyle-based interventions influencing cancer risk, treatment tolerance, and survivorship. A literature search was conducted in PubMed and Scopus, supplemented by manual screening via Google Scholar. The time frame (2001–2025) was selected to reflect evidence produced within the modern era of molecular oncology and contemporary lifestyle medicine research. Eligible publications addressed carcinogen exposure (tobacco, alcohol, ultraviolet radiation), diet and nutritional strategies, physical activity, sedentary behavior, obesity, metabolic health, complementary therapies, and cancer outcomes. Evidence indicates that reducing exposure to tobacco and ultraviolet radiation remains central to cancer prevention. Adherence to predominantly plant-based diets, regular physical activity, and maintenance of healthy body weight are consistently associated with lower incidence of several cancers, including breast, colorectal, and liver cancer. Nutritional strategies such as caloric restriction, ketogenic diets, and fasting-mimicking diets show promise in improving treatment efficacy and quality of life. Complementary and mind–body therapies may alleviate treatment-related symptoms, although high-quality evidence on long-term safety and effectiveness is limited. Integrating lifestyle medicine into oncology offers a cost-effective, sustainable strategy to reduce cancer burden and enhance survivorship. Comprehensive programs combining carcinogen avoidance, dietary regulation, structured exercise, and effective radiation risk mitigation may extend healthspan, improve treatment tolerance, and help prevent recurrence. Full article

Objective: To evaluate the effect of Physitrack^® on jump performance in handball players through performance, kinematic, and kinetic variables. Material and Methods: A pilot, randomized clinical trial was conducted with male handball players (n = 28). Participants were allocated to either an intervention group (IG), which completed a specific jump-training program, or a control group (CG), which followed a general strengthening program. Both programs were delivered via Physitrack^® over an 8-week period. Vertical jump variables were assessed using force platforms (Hawkin Dynamics^®), along with adherence questionnaires, the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ), and the System Usability Scale (SUS). Results: Both groups showed significant improvements in jump height, flight time, and peak velocity (p < 0.05), without differences between groups. The IG, additionally, demonstrated improvements not statistically significant in the modified Reactive Strength Index (mRSI), Rate of Force Development (RFD), and power. Mean adherence was moderate, slightly higher in the IG (52.13% vs. 48.98%), with no significant differences between groups (p = 0.74). Physitrack^® received an excellent usability rating (SUS: 83.3/100) and good satisfaction (TSUQ: 3.68/5). These findings should be interpreted with caution given the pilot nature of the study and the limited sample size, which restrict statistical power and the generalizability of results. Conclusions: Physitrack^® is a feasible tool for prescribing home-based exercises and is well rated by users. It does not directly improve adherence but facilitates the implementation of effective programs although the content of the program has a greater influence on performance improvements than the platform itself. Full article