Search Results (118)

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

Memory function is susceptible to decline with age, stress, and neurological diseases, highlighting the importance of exploring effective and sustainable strategies to enhance memory consolidation. Epinephrine plays a key role in memory consolidation; acute, moderate elevations enhance memory, while chronic high levels are inhibitory. Given the limitations of pharmacological interventions, this study aims to investigate exercise as a non-pharmacological means to promote post-learning memory consolidation by inducing acute epinephrine release, focusing on its mechanisms and optimized implementation strategies. This narrative review systematically reviews evidence from neurophysiology, molecular biology, and behavioral experiments and finds that exercise can safely and controllably activate the sympathetic–adrenal system, leading to a rapid rise in epinephrine. The release kinetics align highly with the critical time window for memory consolidation. Moderate-intensity aerobic exercise implemented within 30 min post-learning can significantly improve memory retention. The mechanisms involve not only epinephrine enhancing synaptic plasticity and LTP by activating hippocampal β-adrenergic receptors, but also synergistic effects across multiple systems, such as promoting osteocalcin signaling, upregulating BDNF expression, inducing neurogenesis, and optimizing cerebral metabolism and blood flow. Evidence suggests that exercise, as a non-pharmacological intervention, significantly enhances post-learning memory consolidation through the precise modulation of epinephrine release and multi-system synergy, offering both high efficacy and safety. Future research should focus on developing precise exercise prescriptions based on individual characteristics and leveraging wearable devices and digital technologies to improve intervention adherence and applicability, promoting its widespread use in educational and clinical settings. 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

Background/Objectives: Secondary stroke prevention is a cornerstone of long-term recovery and healthy aging among older adults, yet adherence to preventive strategies remains suboptimal. This global systematic review aimed to synthesize evidence from randomized controlled trials evaluating interventions that support sustained secondary prevention in older adults after stroke. Methods: A systematic search of PubMed and Scopus databases was conducted up to April 2025, following PRISMA 2020 guidelines and registered in PROSPERO (CRD420251177501). Eligible studies included randomized controlled trials targeting adults aged 60 years or older and assessing pharmacological, behavioral, educational, rehabilitative, or technology-assisted interventions for stroke recurrence prevention. Data were narratively synthesized due to study heterogeneity, and methodological quality was appraised using the Cochrane RoB 2 tool. Results: Seventeen randomized trials involving approximately 17,000 participants met the inclusion criteria. Multicomponent programs integrating medication management, behavioral education, exercise, cognitive rehabilitation, and digital support consistently improved adherence, vascular risk control, and quality of life. Pharmacological strategies alone showed limited or transient benefits, underscoring the importance of patient education and sustained follow-up. Common barriers included low motivation, cognitive decline, and technological challenges, while key facilitators were personalized education, multidisciplinary coordination, and culturally adapted implementation. Conclusions: Effective secondary stroke prevention in older adults depends on integrated, person-centered models that combine education, behavioral reinforcement, and technology-assisted monitoring. Structured, continuous educational programs, embedded within rehabilitation and primary care, emerge as the most promising pathway to improve adherence, reduce recurrence, and promote active, autonomous aging. Full article

Background: Digital exclusion is a validated risk factor for cognitive decline in older adults. Digital interventions exhibit high dropout rates due to low digital literacy, technology anxiety, and limited adaptation to individual states, resulting in limited real-world transfer. Objective: This protocol aims to present the CTC Framework (Coach–Teacher–Companion), a tri-agent generative AI system proposed for exploring the feasibility of adaptive cognitive interventions in older adults with existing digital access. The protocol provides technical architecture, feasibility-stage implementation procedures, and methodological and ethical guidelines to assist clinicians in safely applying AI-based cognitive interventions in clinical research settings. Methods: The framework integrates three AI agents (Coach, Teacher, and Companion) designed to provide behavioral, cognitive, and emotional support. The system is designed to embed cognitive exercises in daily activities, monitor emotional states, and incorporate accessibility features for age-related limitations. Implementation safeguards include digital literacy assessment (MDPQ-16), technology anxiety monitoring (CARS), emotional safety protocols, and data privacy protections. The protocol specifies a six-week feasibility study (n$=14$, MMSE 18–25) to evaluate usability (System Usability Scale, primary outcome), user experience (UEQ-S), psychological needs satisfaction (BPNS), emotional safety (PANAS), adherence, and preliminary cognitive outcomes (MMSE, TMT-A/B, Digit Span). Conclusions: The CTC Framework is designed to provide methodological and ethical safeguards for clinical implementation, including standardized procedures for digital literacy assessment, technology anxiety management, emotional safety monitoring, and data privacy protections. Empirical validation of the framework’s feasibility and efficacy is required through future studies. Full article

Background/Objectives: This systematic review aimed to evaluate the effectiveness and feasibility of “exercise snacks,” brief, intermittent bouts of physical activity designed to interrupt prolonged sedentary behavior. The review synthesized findings across metabolic, cardiovascular, cognitive, and functional health domains to identify consistent patterns of benefit and determine their practical applicability across populations. Methods: A total of 26 studies met inclusion criteria, encompassing diverse populations such as healthy adults, older adults, and individuals with obesity, type 2 diabetes, or PCOS. Following the PRISMA 2020 guidelines, comprehensive searches were conducted across PubMed, Scopus, Web of Science, and CINAHL databases for studies published between 2012 and 2025. Eligible studies included randomized controlled trials, crossover trials, and feasibility studies assessing health outcomes following exercise snack interventions in adults. Data were extracted using standardized protocols, and methodological quality was evaluated using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale. Narrative synthesis was prioritized due to intervention heterogeneity. Results: Exercise snacks consistently improved postprandial glucose, insulin, and triglyceride responses, reduced blood pressure, preserved endothelial and cerebral blood flow, and enhanced cardiorespiratory fitness. Older adults demonstrated significant gains in lower-limb strength and mobility. Emerging evidence also indicated improvements in mood, fatigue, and cognitive performance. Feasibility trials confirmed high acceptability and adherence across settings and age groups. Conclusions: Exercise snacking represents a time-efficient, feasible, and evidence-based strategy to mitigate the health risks of sedentary behavior. By incorporating brief, frequent activity bouts into daily routines, individuals can achieve meaningful benefits in metabolic regulation, cardiovascular health, physical function, and cognitive well-being. Future research should refine optimal protocols and explore long-term sustainability across varied populations. Full article

Background: The COVID-19 pandemic has substantially altered lifestyle behaviors, potentially affecting cardiovascular health. This study examined changes in lifestyle behaviors—specifically physical activity, smoking, and alcohol consumption—and cardiovascular disease (CVD) risk factors before and after the pandemic using nationally representative data from Korea. Methods: Data were obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2016 to 2023. Weighted analyses were conducted to ensure national representativeness. Descriptive and inferential statistics (t-tests, ANOVA, and correlation analyses) were used to compare health behaviors and CVD risk factors between pre-pandemic (2016–2019) and post-pandemic (2020–2023) periods. Results: Adherence to aerobic physical activity declined from 45.5% before the pandemic to 42.1% after the pandemic, and resistance exercise participation also decreased (p < 0.05). Average sedentary time increased from 8.1 ± 3.5 to 8.7 ± 3.4 h/day. Body mass index (BMI) increased from 23.9 ± 3.7 to 24.1 ± 3.5 kg/m², and triglyceride levels similarly increased (p < 0.05). In contrast, smoking prevalence decreased from 17.2% to 16.5%, and the average number of cigarettes smoked per day declined from 13 to 11–12. Alcohol intake per occasion also decreased significantly after the pandemic (p < 0.05). However, lipid indicators such as total cholesterol and LDL-C tended to be higher in the post-pandemic period, indicating unfavorable changes rather than improvement. Correlation analyses further showed that heavy drinking was associated with higher BMI, glucose, and triglyceride levels, whereas moderate drinking showed more favorable metabolic profiles. Conclusions: The COVID-19 pandemic exerted mixed effects on lifestyle behaviors and cardiovascular risk factors among Korean adults. While reductions in physical activity and increases in sedentary time may elevate long-term health risks, concurrent decreases in smoking and alcohol intake could have mitigated some negative outcomes. Nevertheless, adverse changes in lipid profiles—including increases in LDL-C, total cholesterol, and triglycerides—suggest that metabolic health worsened overall after the pandemic. These findings underscore the urgent need for tailored public health strategies to promote balanced lifestyle behaviors and mitigate cardiovascular risks in the post-pandemic era. Full article

Background: Recent advances in childhood cancer treatment and increased survival rates have led to a growing number of adolescents and young adults (AYAs) who are survivors of childhood cancer (CCSs). This study aimed to examine health status, health-related quality of life (HRQoL), and social outcomes in AYA CCSs. Methods: Sixty-two AYAs who were CCSs (treated within the same tertiary Pediatric Hematology–Oncology Department in Crete, Greece) were enrolled in the study. Self-reported HRQoL was assessed using the Short-Form Health Survey (SF-36). Sixty-five never-ill peers constituted the control group. Results: CCSs reach adolescence and young adulthood without significant deviations in HRQoL from their healthy peers. The presence and severity of late effects were significantly correlated with lower scores in physical health. The cancer type seems to play a pivotal role: Langerhans cell histiocytosis survivors displayed significantly lower scores in mental health, and brain tumor survivors scored substantially lower scores in physical functioning. Acute lymphoblastic leukemia survivors reported the highest scores in mental health. Age at diagnosis of neoplasia was negatively correlated with physical functioning. No significant sex differences were identified. Adherence to multiple healthy lifestyle behaviors (regular exercise, abstaining from alcohol consumption and smoking, and using sun protection) and active employment were correlated with significantly higher scores in mental health. Conclusions: Appropriate therapy and regular follow-up after treatment have led to improved clinical and social outcomes, as assessed by CCSs. More efforts are needed to increase awareness of avoiding harmful behaviors that raise the risk of late effects in this specific group. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), have become the leading causes of chronic liver disease worldwide, with increasing rates of cirrhosis, hepatocellular carcinoma, and cardiovascular complications. Pathogenesis involves a complex interplay of dietary excess, sedentary lifestyle, insulin resistance, adipose tissue dysfunction, and alterations in the gut microbiome, which collectively lead to hepatocellular stress, inflammation, and fibrogenesis. Despite ongoing advances in pharmacotherapy, lifestyle intervention remains the cornerstone of management. Evidence shows that sustained weight loss of ≥5% reduces hepatic steatosis, ≥7% improves necroinflammation, and ≥10% stabilizes or reverses fibrosis. Dietary strategies, including Mediterranean-style patterns, high-protein approaches, and intermittent fasting, have been shown to be effective in improving insulin sensitivity and reducing intrahepatic triglycerides. Exercise interventions, focusing on both aerobic fitness and resistance training, enhance metabolic flexibility and combat sarcopenia, thereby improving hepatic and systemic outcomes. Equally important are behavioral support, digital health tools, and multidisciplinary approaches that enhance adherence and address barriers such as socioeconomic disparities, limited access, and patient engagement issues. Personalized nutrition plans, integrating physical activity, and ongoing support for behavioral change are essential for long-term disease management. This review synthesizes current evidence on the roles of macronutrients, micronutrients, dietary quality, physical activity, and adjunctive behavioral strategies in managing MASLD. By translating mechanistic insights into practical, evidence-based recommendations, we aim to provide clinicians, dietitians, and exercise professionals with effective frameworks to slow disease progression and improve outcomes across diverse patient populations. Full article

Background: The worldwide prevalence of obesity in children and adolescents quadrupled in the past decades, becoming a public health priority. Following the recommendation by the Italian Minister of Health, the Emilia-Romagna Region started a community-based program aimed at reducing pediatric overweight through children and family behavioral counseling on nutrition and physical activity. Methods: Children with excess weight, aged 2–17 years, and without severe diseases were visited five times by a multidisciplinary team, who provided dietary advice, exercise plans, and psychosocial support, according to Italian guidelines. The outcomes were the median pre–post change in Δ₃₀BMI (distance between children’s BMI and age- and sex-specific obesity threshold values) and the proportion of children who moved to a lower weight class. Logistic regression was used to identify potential predictors of weight improvement. Results: Up to March 2025, 1331 participants completed the follow-up. In total, 17.5% of the children showed an improvement in weight class, and 32.5% had a reduction of more than one unit of Δ₃₀BMI. The program was significantly and substantially more effective among the children with obesity at baseline (overweight vs. obese children adjusted odds ratio—aOR—of weight class improvement: 0.28; p < 0.001), older than eight years (9–11 years vs. 2–8 years children aOR: 1.41; p < 0.05), who adhered to breakfast recommendations (aOR: 1.60; p < 0.01) and had no obese parents (≥1 vs. 0 obese parents aOR: 0.62; p < 0.05). Conclusions: The multidisciplinary model was associated with an overall positive impact on the weight status of the enrolled children. Given the varying response, however, in order to maximize cost-effectiveness, future programs could be reserved for children with obesity, older than eight years. Further randomized research is needed to investigate the efficacy of this intervention in different settings and on late clinical endpoints. Full article

Research on food-related behaviors has increasingly focused on orthorexia nervosa, but the underlying mechanisms are not fully understood, especially with the rise of new types of healthy foods. This study examines the associations between orthorexic tendencies, as measured by the Orthorexia Nervosa Inventory and ORTO-R, and scores on the Food Neophobias Scale, attitudes toward novel foods, body shape concerns, as assessed by the Body Shape Questionnaire, and drive for muscularity, training adherence, and anabolic steroid use, as measured by the Drive for Muscularity Scale. A total of 306 participants (68.3% female; Mage = 35.4 years, SD = 13.7), who were at least 18 old and fluent in Italian, took part in an online, anonymous data collection. The results revealed mixed associations between ON and the perceived attractiveness or intention to consume novel foods. In contrast, no relationship was found between orthorexia and food neophobia. Additionally, orthorexic dimensions were correlated with greater body shape dissatisfaction (r-scores ranging from 0.44 to 0.52, p < 0.001) and a drive for muscularity (r-scores ranging from 0.43 to 0.57, p < 0.001). Notably, orthorexic scores showed significant positive correlations with thoughts about anabolic steroid use (r-scores ranging from 0.26 to 0.60, p < 0.001) and training adherence (r-scores ranging from 0.39 to 0.53, p < 0.001) in a subsample of people who regularly exercise. Of examined the predictors, body shape concerns and thoughts about anabolic steroid use (ß ranging from 0.21 to 0.55, and R² ranging from 0.43 to 0.57, p < 0.001) were the most robust predictors of orthorexic tendencies. Overall, the findings highlight the complex relationships between orthorexic tendencies, perceptions, and attitudes, as well as body-related concerns, while also providing new insights into their connection to novel foods. Full article

Background: Type 2 Diabetes Mellitus (T2DM) is a growing global health concern, closely linked to modifiable lifestyle factors. Emerging evidence suggests that religious principles can shape behaviors that promote physical and mental well-being. Objective: This study explores how adherence to a lifestyle rooted in Seventh-Day Adventist beliefs may influence the risk of developing T2DM. Methods: This study is of a non-experimental quantitative design with a cross-sectional and explanatory scope. The sample consisted of 303 participants (adults who had been active Seventh-Day Adventist Church, SDA, members for the past 3 years), selected by non-probabilistic convenience sampling. Data were collected using the Adventist Lifestyle questionnaire (eight dimensions) and the FINDRISC scale. The non-parametric statistics, Rho Spearman, and ordinal logistic regression analysis were used. Results: The results showed that lifestyle levels based on religious principles significantly predicted the risk of developing T2DM (X² = 100.34, p < 0.05). The model explained approximately 31% of the variance in T2DM risk (R² = 0.31), indicating a moderate association between lifestyle and risk. Specifically, individuals with lower (less healthy) lifestyle scores had a significantly higher likelihood of being classified in higher risk categories for T2DM. It was also observed that there is a significant relationship between the risk of developing T2DM and the following dimensions: Rest (rho = −0.16, p < 0.05), exercise (rho = −0.13, p < 0.05), temperance (rho = −0.19, p < 0.05), nutrition (rho = −0.66, p < 0.05) and spirituality (rho = −0.57, p < 0.05). Conclusions: A healthier lifestyle promoted by religious principles, such as the SDA, reduces the risk of developing T2DM. A stronger correlation was perceived between nutrition and spirituality since these practices are related to a low risk of developing the disease. Full article

Introduction: The main purpose of this study was to test a hierarchical model of motivation that integrates Achievement Goal Theory and Self-Determination Theory to explain and predict exercise adherence. Method: In total, 2180 exercisers (1020 female, 1160 male) aged between 18 and 60 years, from different gyms and health clubs, completed several scales validated in exercise settings, regarding perceived motivational climate, basic psychological need satisfaction, behavioral regulation, and exercise adherence. For the last measure, weekly computer access to a control system over a 6-month period before and after data collection was consulted. Results: Through structural equation models (SEM), it was verified that (1) task-involving climate positively predicted basic psychological needs. In turn, the satisfaction of these needs predicted autonomous motivation, which led to a positive prediction of adherence; (2) a small variation in exercise adherence was explained by the motivational model under analysis. Nevertheless, models significantly improved their analytical power when past adherence was inserted in the model increasing the explained variance in future behavior from 9.2% to 64%. Conclusions: In conclusion, autonomous motivation can predict people’s exercise adherence, and past behavior increases that predictive effect. The present study brings scientific evidence to the popular saying “tell me what you’ve done and, and I’ll predict what you’ll do”. Full article

Despite recent advances in the treatment of obesity, lifestyle medicine remains foundational to the treatment of individuals with obesity, regardless of the modality chosen by the patient with the guidance of the clinician they are working with, including in conjunction with, as appropriate, anti-obesity medications and metabolic surgery. Lifestyle medicine involves the use of diet, exercise, sleep, stress, and other lifestyle modalities in the treatment of disease. Clinicians and health systems should, after a patient-centered discussion with the patient, do their best to ensure access to lifestyle treatments. Gold standard guidelines recommend intensive, multicomponent lifestyle change programs for obesity treatments with evidence-based diet and exercise counseling and established, theoretically driven behavior change components. Clinicians treating obesity should be aware of their own biases, make efforts to reduce stigmatizing experiences in their practice, and address weight stigma in their treatment plans as needed. A variety of dietary patterns can be used to support patients with obesity, and clinicians should make evidence-based but patient-centered recommendations that aim to maximize adherence. Diet and exercise can play an important role in reducing the side effects of treatment and optimizing outcomes in weight loss, attenuating the effects of metabolic adaptation, and weight maintenance. Exercise should be increased gradually to reduce injury with a goal of 200–300 min (approximately 3.3–5 h) of moderate to vigorous intensity exercise per week to maximize weight maintenance effects with exercise prescriptions customized to patients risks. A variety of practice models can be leveraged along with the use of an interdisciplinary team to provide lifestyle medicine care for those with obesity. Full article