Search Results (1,006)

Excess adiposity increases cardiovascular and cardiometabolic risks, while aquatic exercise may reduce mechanical barriers to participation. This systematic review and meta-analysis examined aquatic exercise training in individuals with overweight or obesity. PubMed, Web of Science, and the Cochrane Library were searched through to June 2026. Eight randomized controlled trials involving 295 participants were included. Random-effects meta-analyses showed increased VO₂ max (MD 3.70 mL·kg⁻¹·min⁻¹, 95% CI 2.49–4.90; p < 0.001) and lower resting heart rate (MD −1.47 beats/min, 95% CI −2.73 to −0.21), systolic blood pressure (MD −4.50 mmHg, 95% CI −7.05 to −1.94), diastolic blood pressure (MD −2.17 mmHg, 95% CI −4.11 to −0.22), triglycerides (MD −15.75 mg/dL, 95% CI −23.12 to −8.39), and fasting glucose (MD −7.82 mg/dL, 95% CI −12.48 to −3.16). No significant pooled effects were observed for total cholesterol, HDL cholesterol, LDL cholesterol, BMI, or body fat percentage. Evidence certainty ranged from low to very low. Aquatic exercise may improve selected cardiovascular and metabolic outcomes, although small samples and heterogeneity limit confidence. Future research must focus on high-quality RCTs to further confirm these findings. PROSPERO: CRD420261340445. Full article

Obesity care increasingly requires outcomes that extend beyond total body weight. Although weight reduction remains clinically meaningful, the scale alone does not indicate whether fat mass, lean tissue, muscle quality, strength, mobility, or physiological reserve have changed in a favorable direction. This narrative review examines the combined role of higher-protein dietary strategies and concurrent exercise in adults with obesity, with emphasis on body composition, metabolic health, and physical function. Higher-protein dietary strategies may support satiety, improve the tolerability of energy restriction in some patients, and attenuate lean-tissue loss during weight reduction, while evidence for superior long-term weight loss remains inconsistent. Exercise provides complementary stimuli to protein-focused nutrition: resistance training supports strength, muscle function, and lean-tissue preservation, while aerobic and interval-based training contribute to cardiorespiratory fitness, regional adiposity reduction, and selected cardiometabolic adaptations. Concurrent training offers a practical framework for integrating these stimuli, with value primarily as multidomain coverage rather than as evidence of universal superiority over other modalities. The main rationale for combining protein adequacy with exercise is preservation of usable physical function during weight loss, particularly in older adults, patients with sarcopenic-obesity risk, and individuals undergoing rapid pharmacological or surgical weight reduction. Overall, the available evidence is most consistent with viewing higher-protein nutrition and structured exercise as complementary strategies for improving the quality of weight loss, rather than as a single protocol for maximizing scale-weight reduction. Longer pragmatic trials are needed to clarify phenotype-specific responses, feasible protein targets, exercise progression, monitoring strategies, and functional outcomes. Full article

Background/Objectives: Postural stability is considered a key component of motor development during early childhood; however, its specific association with different components of physical fitness in preschool children remains insufficiently explored. This study aimed to evaluate the association between postural stability and physical fitness components in preschool children. Methods: A cross-sectional study was conducted in 134 preschool children. Physical fitness was assessed through lower-limb muscular strength (standing long jump), speed/agility (4 × 10 m shuttle run), cardiorespiratory fitness (20 m shuttle run), and flexibility (sit-and-reach test). Object-control skills and postural stability were evaluated using selected tasks from the Movement Assessment Battery for Children-2. Composite indices were created for object-control skills and postural stability. Multiple linear regression analyses were performed adjusting for age, sex, body mass index (BMI), and object-control skills. Additional analyses included ANCOVA by postural stability tertiles and sensitivity analyses using HC3 robust standard errors, exclusion of influential observations, and bootstrap resampling. Results: Greater postural stability was independently associated with better lower-limb muscular strength (B = 9.49; 95% CI: 4.39–14.60; p ≤ 0.001) and cardiorespiratory fitness (B = 0.27; 95% CI: 0.06–0.49; p = 0.014). An association with speed/agility was observed in the primary model but lost statistical significance in sensitivity analyses. No significant association was found with flexibility. ANCOVA analyses confirmed significant differences across postural stability tertiles for lower-limb muscular strength (p = 0.033) and cardiorespiratory fitness (p = 0.011). Sensitivity analyses supported the robustness of the associations for lower-limb muscular strength and cardiorespiratory fitness. Conclusions: Greater postural stability was consistently associated with better lower-limb muscular strength and cardiorespiratory fitness in preschool children. These findings suggest that postural stability is associated with selected components of physical fitness during early childhood. Longitudinal and intervention studies are needed to clarify the direction and potential implications of these associations. Full article

Background: Neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and Down syndrome (DS) are associated with cognitive, behavioral, motor, and functional impairments that may negatively affect daily functioning and quality of life. Aquatic exercise has emerged as a potential complementary intervention due to its unique physical and sensory characteristics. Objective: To analyze the available evidence regarding aquatic exercise as a complementary intervention for individuals with ADHD, ASD, and DS, considering its potential effects on cognitive, behavioral, motor, and functional outcomes. Methods: A narrative review was conducted using studies identified in PubMed, Scopus, and Web of Science between November 2025 and February 2026. Experimental and quasi-experimental designs, including case studies, evaluating aquatic exercise interventions in individuals with ADHD, ASD, or DS were included. Results: Twenty-two studies were analyzed (ADHD = 7, ASD = 10, DS = 5). In ADHD, aquatic exercise was associated with improvements in inhibitory control, attention, cognitive flexibility, behavioral regulation, academic performance, and cardiorespiratory fitness. In ASD, the main benefits included improvements in balance, motor coordination, aquatic skills, social interaction, communication, adaptive behavior, and behavioral regulation, particularly in Halliwick-based interventions. In DS, positive effects were mainly observed in aerobic capacity, muscular strength, body composition, balance, functional physical fitness, and motor autonomy. Across studies, interventions commonly involved 2–3 weekly sessions lasting 30–90 min over 6–36 weeks. Conclusions: Aquatic exercise appears to be a promising complementary intervention for individuals with ADHD, ASD, and DS, with potential benefits across cognitive, behavioral, motor, and functional domains. Although the available evidence is heterogeneous and methodological limitations remain, aquatic exercise may represent a valuable component of interdisciplinary intervention and adapted physical activity programs. Full article

Ice hockey represents a sport with predominantly anaerobic efforts best reflected by repeated sprint ability (RSA) testing (5 × 5 s with 10 s recovery). A controversy persists about the usefulness of VO₂max laboratory testing for the assessment of ice hockey players. The purpose of this study was to evaluate the relationship between laboratory-measured VO_2max and RSA simulated on a supine ergometer and tested on ice. Elite male hockey players (n = 64) were tested in the laboratory (VO_2max and RSA). RSA testing was performed by a modified Wingate test (5 × 5 s sprints with 10 s recovery). In 28 athletes RSA was assessed during on-ice testing (five maximal skating sprints between the goal and the blue line). The decrease in performance was assessed by fatigue indices. In the laboratory setting, VO₂max correlated significantly with maximum workloads of the second, third, fourth and fifth bouts with increasing correlation strength (r = 0.26, p = 0.02; r = 0.48, p < 0.001; r = 0.57, p < 0.001; and r = 0.60, p < 0.001) and with fatigue indices—the percentage workload decrement index (r = 0.44, p < 0.001) and percentage maximum average workload decrement (%) (r = 0.38, p = 0.002). In addition, VO₂max correlated with lactate levels after 10 min of recovery (r = 0.31, p = 0.01). There was no correlation between VO₂max and on-ice testing results. Moreover, the results of RSA measured in the laboratory and on ice did not show any correlation. The lack of relationship between laboratory and on-ice testing further challenges the usefulness of bicycle ergometry laboratory testing in ice hockey. Full article

Background: Binge eating (BE) is frequently associated with negative emotional states, obesity, and physical inactivity. Although yoga may improve binge eating and emotional symptoms, its effects on physical fitness remain unclear. In contrast, high-intensity interval training (HIIT) has been demonstrated to effectively enhance physical fitness. This study compared the effects of low-volume HIIT (LV-HIIT), high-volume HIIT (HV-HIIT), and yoga on binge eating, negative emotional states, and physical fitness in female college students with binge eating. Methods: Fifty-five physically inactive female college students with binge eating (BES ≥ 18) were randomly assigned to LV-HIIT (n = 19), HV-HIIT (n = 18), or yoga (n = 18) for 8 weeks. The Binge Eating Scale (BES), Depression Anxiety Stress Scale-21 (DASS-21), body fat percentage, waist circumference, and maximal oxygen uptake (VO2max) were assessed before and after the intervention. Data were analyzed using intention-to-treat linear mixed models, with per-protocol repeated-measures ANOVA as a supplementary analysis. Results: After 8 weeks of intervention, significant improvements over time were observed across all groups in binge eating, negative emotional states, and cardiorespiratory fitness (all p < 0.05). Waist circumference and body fat percentage did not change significantly in the ITT analysis. No significant time × group interaction effects were detected for any outcome (all p > 0.05), indicating that the improvements did not differ significantly among the LV-HIIT, HV-HIIT, and yoga groups. Conclusions: An 8-week intervention of LV-HIIT, HV-HIIT, and yoga was associated with improvements in binge eating behaviors, negative emotional states, and VO2max in inactive young women with binge eating, with no evidence of differential efficacy between interventions. LV-HIIT may be promising because of its shorter duration and higher adherence; however, this requires confirmation in larger trials. Full article

Regular endurance exercise is consistently associated with lower cardiovascular mortality, a favorable cardiometabolic profile, and superior cardiorespiratory fitness. However, coronary imaging studies in master endurance athletes have raised a clinically relevant paradox: despite a low burden of conventional risk factors, some athletes—particularly older men with high lifetime exercise exposure—show a greater prevalence of coronary artery calcium and subclinical coronary plaque than sedentary or less active controls. This observation has challenged the long-standing assumption that high-volume endurance exercise is uniformly protective against coronary artery disease. A binary interpretation of this literature is inadequate. Coronary flow reserve and ischemic threshold may remain adequate in some athletes, although this concept is supported by limited functional and outcome data. Based on experimental vascular biology and indirect human evidence, repetitive high-flow states during endurance exercise generate sustained laminar shear stress, cyclic wall strain, and marked increases in coronary blood flow, thereby activating endothelial mechanotransduction pathways and influencing vascular smooth muscle cell behavior, extracellular matrix remodeling, and calcification biology. These adaptations may culminate in positive arterial remodeling, luminal enlargement, and, in some individuals, a predominantly calcified plaque phenotype. Importantly, structural remodeling does not necessarily equate to functional impairment. In selected athletes, when outward remodeling and endothelial responsiveness are preserved, coronary flow reserve and ischemic threshold may remain adequate, although this concept remains supported by limited functional and outcome data. This narrative review integrates the clinical imaging literature with current concepts in vascular mechanobiology to propose that coronary remodeling in endurance athletes exists along an adaptive–maladaptive continuum shaped by cumulative exercise load, aging, sex, conventional risk factors, and biological susceptibility. This framework may help clinicians interpret CAC/CCTA findings in athletes more appropriately and avoid equating plaque burden with equivalent functional or prognostic significance. Full article

Weekend cyclists are individuals who engage in vigorous physical activity only on weekends, as opposed to those who exercise regularly during the week. Research suggests that concentrating physical training on one or two days may benefit heart health and metabolism, similar to exercising regularly. However, it remains unclear whether weekend cyclists exhibit similar adaptations in metabolic, performance, and muscle oxygenation markers. The aim of this study is to compare cardiorespiratory fitness, body composition, cardiometabolic risk markers, muscle strength, and muscle oxygenation between cyclists who concentrated training on weekends and cyclists who distributed training across three or more days per week. In this study, we used an analytical, observational, non-experimental design that recruited 28 cyclists, divided into weekend cyclists (n = 14) and regular cyclists (n = 14). Body composition, blood tests, lower body strength, aerobic capacity, and muscle oxygen saturation were assessed. Results: Weekend cyclists exhibited lower VO₂max (36.7 ± 3.9 vs. 48.9 ± 6.3 mL·kg⁻¹·min⁻¹), lower knee extension strength (3.16 ± 0.57 vs. 4.42 ± 0.83 Nm·kg⁻¹), and reduced ΔSmO₂ responses during exercise compared with regular cyclists (all p < 0.05). In addition, weekend cyclists presented higher body fat percentage (25.9 ± 3.8 vs. 17.2 ± 4.2%), greater waist circumference (90.5 ± 4.3 vs. 83.6 ± 5.1 cm), and lower HDL cholesterol levels (54.2 ± 8.4 vs. 64.1 ± 11.0 mg/dL). In conclusion, weekend cyclists have lower cardiorespiratory fitness, muscular strength, and reduced ΔSmO₂ responses during incremental exercise, along with higher levels of visceral fat and triglycerides, compared to those who train three or more days a week. The distribution and frequency of training within their workout plans were associated with differences in cardiorespiratory fitness and cardiometabolic markers. Full article

Background: Given that true exercise response variation on cardiorespiratory fitness in adults with coronary heart disease (CHD) is not known, this study addressed this gap. Methods: Randomized controlled trials (RCTs) comparing continuous aerobic exercise (CAE) to controls in adults ≥18 years of age with CHD were included. The primary outcome was exercise-associated inter-individual response differences (IIRDs) in cardiorespiratory fitness (VO_2peak in ml·kg⁻¹·min⁻¹). Using the inverse variance heterogeneity (IVhet) model, a standard deviation of individual response difference (SD_ir) meta-analysis was conducted. Ninety-five percent confidence intervals (CIs) and prediction intervals (PIs) were calculated. Results: Twenty-eight RCTs representing 1383 participants (725 CAE, 658 control) were included. Statistically significant and clinically important improvements (≥1.0 mL·kg⁻¹·min⁻¹) were observed for VO_2peak as a result of CAE ($\overline{X}$, 3.6, 95% CI, 2.8 to 4.4 mL·kg⁻¹·min⁻¹, p < 0.001), but no statistically significant or clinically important IIRD based on the SD_ir were found ($\overline{X}$, 0.9, 95% CI, −1.5 to 2.0 mL·kg⁻¹·min⁻¹; 95% PI, −2.4 to 2.7). Based on GRADE, the strength of evidence was of low certainty. Conclusions: There is low certainty evidence that CAE results in statistically significant and clinically important improvements in VO_2peak in adults with CHD, but no exercise-associated IIRD was observed once properly accounted for. Full article

High-intensity functional concurrent training (HIFCT) has emerged as a form of training characterized by constantly varied functional movements adapted to individual fitness levels. Previous studies have reported positive effects on muscular strength, cardiorespiratory fitness, body composition, and psychological well-being; however, evidence regarding HIFCT interventions in school-aged children remains limited. Therefore, the aim of the present study protocol is to evaluate the effects of an 8-week HIFCT programme on muscular strength, cardiorespiratory fitness, body composition, anxiety, stress, and self-esteem in children aged 10–12 years. Physical fitness, anthropometric variables, and psychological outcomes will be assessed before and after the intervention using validated field-based tests and questionnaires. This study may provide novel evidence regarding the feasibility, safety, and potential effects of HIFCT programmes in the school setting. The study protocol was registered at ClinicalTrials.gov (NCT07552844) and approved by the Córdoba Research Ethics Committee (IMIBIC, Córdoba, Spain; protocol code SICEIA-2025-000408). Full article

Objectives: We aimed to systematically review and meta-analyze the impact of COVID-19 infection on cardiorespiratory fitness (CRF): (1) within-athlete (the same participants before and after infection), and (2) between-athlete (infected vs. healthy reference participants). Methods: In this systematic review (PROSPERO Registry: CRD42024540430) we included observational studies enrolling recreational or competitive athletes ≥18 years old with laboratory confirmation of SARS-CoV-2 infection. The primary outcome was change in relative maximal oxygen uptake (VO_2max). Secondary outcomes included changes in absolute VO_2max, maximal ventilation (VE_max), and maximal heart rate (HR_max). We searched Embase, PubMed, Medline, Scopus, and Web of Science up to August 9th, 2025. Risk of bias was assessed with the JBI critical appraisal tool. Meta-analyses were performed with a random-effects model. Results: Twelve studies enrolling a total of 1595 participants met the eligibility criteria. COVID-19 infection was associated with lower relative VO_2max (MD = −1.83 mL·kg⁻¹·min⁻¹; 95%CI [−3.16, −0.49]; p = 0.007; I² = 54%) and absolute VO_2max (MD = −0.15 L·min⁻¹; 95%CI [−0.29, −0.01]; p = 0.03; I² = 0%). COVID-19 infection was associated with lower VE_max (MD = −7.99 L·min⁻¹; 95%CI [−12.94, −3.04]; p = 0.002; I² = 0%) but not with HR_max (MD = −0.34 bpm; 95%CI [−1.54, 0.86]; p = 0.58; I² = 0%). High heterogeneity of included studies was addressed with subgroup analyses. The risk of bias in most studies was high. The certainty of evidence was very low for each outcome. Conclusions: COVID-19 infection in athletes was associated with reduced VO_2max and VE_max. The relationships were highly dependent on the quality of the studies. CRF and athlete profile should be considered when making shared decisions regarding safe return to sport after infection. Full article

Metformin and aerobic exercise are routinely co-prescribed in the management of metabolic syndrome, yet evidence regarding their interaction on cardiorespiratory fitness and substrate oxidation adaptations remains inconsistent. This study aimed to investigate the effects of combined metformin and aerobic training on peak oxygen uptake (VO₂peak), maximal fat oxidation (MFO), submaximal substrate utilization, and perceived exertion in metformin-naïve adults with metabolic syndrome. In this randomized, placebo-controlled trial, 24 metformin-naïve adults with metabolic syndrome were allocated to receive either metformin (1000 mg/day; MET-EX) or a matched placebo (PLA-EX) combined with supervised aerobic training (5 sessions/week, 60% VO₂peak, 500 kcal/session) for five weeks; 22 participants (n = 11 per group) completed the protocol. VO₂peak, MFO, fat and carbohydrate oxidation, energy expenditure, and rating of perceived exertion (Borg 6–20) were assessed before and after the intervention. The absolute VO₂peak gain was modestly attenuated in MET-EX relative to PLA-EX (group × time interaction p = 0.042; +0.11 vs. +0.26 L·min⁻¹), whereas the interaction for relative VO₂peak did not reach significance (p = 0.088). In contrast, MFO increased substantially more in MET-EX than in PLA-EX (+0.13 vs. +0.04 g·min⁻¹; p = 0.001), accompanied by greater fat oxidation, energy expenditure, and perceived exertion during moderate-to-high submaximal exercise intensities. Moreover, VO₂peak improvement was negatively correlated with age exclusively in MET-EX (r = −0.87, p < 0.001). These findings suggest that metformin induces a dissociated adaptation profile during aerobic training in metabolic syndrome, characterized by enhanced lipid oxidation alongside attenuated cardiorespiratory adaptations and greater perceived effort, particularly in older individuals. Full article

Cardiorespiratory fitness is a key indicator of overall health, yet its assessment still largely depends on structured protocols such as cardiopulmonary exercise testing (CPET), which require specialized equipment, trained personnel, and controlled laboratory conditions that limit accessibility. Wearable sensing technologies offer a practical alternative by continuously capturing physiological and biomechanical signals during daily life. However, most wearable-based approaches remain constrained by activity-specific modeling, structured exercise protocols, or prolonged monitoring periods, limiting generalization across real-world behaviors. This work presents an activity-independent machine learning framework for estimating VO₂max from short-duration multimodal wearable signals acquired during semi-structured real-world daily activities. The proposed two-stage framework first estimates the metabolic equivalent of task (MET) as a continuous representation of activity intensity, then integrates this estimate with physiological, biomechanical, and demographic features to predict subject-level VO₂max. By decoupling physiological demand from explicit activity labels, the framework improves robustness to unseen activities while preserving physiological interpretability. Evaluation under the Leave-One-Subject-Out validation protocol demonstrates that short-duration wearable-derived signals encode meaningful information related to inter-subject differences in cardiorespiratory fitness. These findings support the feasibility of activity-independent, wearable-based fitness estimation and provide a practical foundation for scalable preventive health monitoring in everyday life. Full article

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

Background/Objectives. Increasing evidence suggests that nutrition and sport participation may positively influence cognitive functioning, readiness for learning, and academic achievement during adolescence. However, limited research has investigated the combined effects of structured breakfast programs and cognitively oriented sport-based interventions implemented in real school settings. The present study aimed to examine the associations between participation in an integrated school-based program consisting of structured breakfast and morning sport sessions and executive functions, physiological well-being, school engagement, and academic achievement in adolescent students. Methods. A 16-week quasi-experimental pre–post study with class-based allocation was conducted in a secondary school in Southern Italy. A total of 110 students aged 14–16 years participated in the study. The experimental group, comprising 55 students, participated in a structured breakfast program combined with cognitively oriented morning sport-based sessions conducted three times per week for 40 min before regular lessons, whereas the control group continued ordinary school activities. Cognitive assessment included the Stroop Color and Word Test and the Digit Span Test in both forward and backward conditions. Physiological measures included body mass index, resting heart rate, and the 20 m shuttle run test. Nutritional habits, school engagement, and academic achievement were also evaluated through questionnaires and school records. Results. Compared with the control group, students participating in the integrated program showed more favorable changes in selective attention, inhibitory control, working memory performance, cardiorespiratory fitness, breakfast habits, and school engagement over the study period. Moderate positive changes in academic achievement were also observed, whereas no substantial anthropometric changes emerged during the study period. Conclusions. The findings suggest that participation in an integrated school-based program combining structured nutrition and cognitively oriented sport activities was associated with improvements in cognitive functioning, healthy habits, and academic outcomes during adolescence. These findings highlight the potential value of multidimensional educational approaches integrating health promotion and learning processes within school environments. Full article