Search Results (475)

Background: Cardiometabolic risk in adolescents represents a growing public health concern that is closely linked to modifiable factors such as physical fitness. Traditional statistical approaches often fail to capture complex, nonlinear relationships among anthropometric and fitness-related variables. Objective: To develop and evaluate supervised machine learning algorithms, including artificial neural networks and ensemble methods, for classifying cardiometabolic risk levels among Chilean adolescents based on standardized physical fitness assessments. Methods: A cross-sectional analysis was conducted using a large representative sample of school-aged adolescents. Field-based physical fitness tests, such as cardiorespiratory fitness (in terms of estimated maximal oxygen consumption [VO_2max]), muscular strength (push-ups), and explosive power (horizontal jump) testing, were used as input variables. A cardiometabolic risk index was derived using international criteria. Various supervised machine learning models were trained and compared regarding accuracy, F1 score, recall, and area under the receiver operating characteristic curve (AUC-ROC). Results: Among all the models tested, the gradient boosting classifier achieved the best overall performance, with an accuracy of 77.0%, an F1 score of 67.3%, and the highest AUC-ROC (0.601). These results indicate a strong balance between sensitivity and specificity in classifying adolescents at cardiometabolic risk. Horizontal jumps and push-ups emerged as the most influential predictive variables. Conclusions: Gradient boosting proved to be the most effective model for predicting cardiometabolic risk based on physical fitness data. This approach offers a practical, data-driven tool for early risk detection in adolescent populations and may support scalable screening efforts in educational and clinical settings. Full article

Volunteer firefighters often have lower cardiorespiratory fitness (CRF) and less access to health monitoring and fitness programs than career firefighters, yet few studies explore how individual and departmental factors influence their CRF. This study assessed associations between CRF and both firefighter-level (e.g., years of service, firefighting calls, and firefighter rank) and department-level (e.g., department characteristics and fitness infrastructure) factors among volunteer firefighters. Surveys were administered to United States volunteer firefighters and departments, capturing CRF and related characteristics. CRF was analyzed as both a continuous and categorical variable (≤8, >8–<10, 10–<12, ≥12 METs) using bivariate analyses and mixed effects linear and logistic regression. Among 569 incumbent volunteer firefighters from 41 departments, 79.9% did not meet the recommended 12 METs threshold. Only 56.8% of departments provided routine physical exams; 35.1% had a wellness coordinator or committee; and 40.5% offered fitness resources. More years of service were associated with lower CRF and reduced odds of meeting the 12 METs benchmark, while more frequent training and responding to more calls were associated with better CRF. These findings highlight individual and structural challenges for CRF in volunteer fire service, underscoring the need for targeted fitness support to protect firefighter health and community safety. Full article

This study presents an approach based on machine learning (ML) techniques to analyze the relationship between emergency room (ER) admissions for cardiorespiratory diseases (CRDs) and environmental factors. The aim of this study is the development and verification of an interpretable machine learning framework applied to environmental and health data to assess the relationship between environmental factors and daily emergency room admissions for cardiorespiratory diseases. The model’s predictive accuracy was evaluated by comparing simulated values with observed historical data, thereby identifying the most influential environmental variables and critical exposure thresholds. This approach supports public health surveillance and healthcare resource management optimization. The health and environmental data, collected through meteorological sensors and air quality monitoring stations, cover eleven years (2013–2023), including meteorological conditions and atmospheric pollutants. Four ML models were compared, with XGBoost showing the best predictive performance (R² = 0.901; MAE = 0.047). A 10-fold cross-validation was applied to improve reliability. Global model interpretability was assessed using SHAP, which highlighted that high levels of carbon monoxide and relative humidity, low atmospheric pressure, and mild temperatures are associated with an increase in CRD cases. The local analysis was further refined using LIME, whose application—followed by experimental verification—allowed for the identification of the critical thresholds beyond which a significant increase in the risk of hospital admission (above the 95th percentile) was observed: CO > 0.84 mg/m³, P_atm ≤ 1006.81 hPa, Tavg ≤ 17.19 °C, and RH > 70.33%. The findings emphasize the potential of interpretable ML models as tools for both epidemiological analysis and prevention support, offering a valuable framework for integrating environmental surveillance with healthcare planning. Full article

Background/Introduction: Psychological inflexibility, which includes experiential avoidance, is a transdiagnostic process associated with multiple mental health issues in adolescence. Physical fitness (PF) has shown benefits for mental well-being, yet its specific relationship with psychological inflexibility remains understudied, particularly among youth. Objectives: To examine the association between components of PF and psychological inflexibility, measured by the Acceptance and Action Questionnaire-II (AAQ-II), in a representative sample of Spanish adolescents. Methods: A cross-sectional analysis was conducted using data from 631 adolescents (aged 12–17) participating in the Eating Healthy and Daily Life Activities (EHDLA) study. PF was assessed by the Assessing the Levels of PHysical Activity and Fitness (ALPHA-Fit) Test Battery (cardiorespiratory fitness, muscular strength, agility, and flexibility). Psychological inflexibility was measured using the AAQ-II. Generalized linear models (GLMs) were used to evaluate associations, adjusting for age, sex, body mass index, socioeconomic status, physical activity, sedentary behavior, sleep duration, and energy intake. Results: Unadjusted analyses showed weak but significant associations between psychological inflexibility and performance in the 20 m shuttle run test (p = 0.002), the 4 × 10 shuttle run test (p = 0.005), and the sit-and-reach test (p < 0.001). However, after adjusting for covariates, none of the PF components maintained a statistically significant association with the AAQ-II scores. Conclusions: In this adolescent sample, PF components were not independently associated with psychological inflexibility after adjustment for key confounders. These findings suggest that, while PF may contribute to general well-being, it is not a primary determinant of psychological inflexibility. Further longitudinal and intervention studies are needed to clarify the mechanisms linking physical and psychological health in youth. Full article

Physical activity, particularly when practiced in natural settings, has well-established benefits for overall health, sleep, and body composition. These effects are especially important for postmenopausal women, although research specifically targeting this population remains limited. The study evaluated a 16-week multicomponent outdoor exercise program (cardiorespiratory, strength, balance, coordination, and flexibility training) in postmenopausal women, consisting of three 60 min sessions per week. Participants were non-randomly assigned to an experimental group (EG, n = 55) and a control group (CG, n = 20). Measurements were taken at baseline and after 16 weeks, including body composition, sleep (duration and quality), and connection with nature. No significant differences were observed between groups at baseline. After the intervention, the EG and CG presented significant differences (p ≤ 0.01) in the rates of change in body mass, fat mass (FM; −9.26% and −1.21%, respectively), and visceral fat level (VFL; −13.46 points and −3.80 points). These differences were also observed for the sleep fragmentation index (p ≤ 0.01), but not for connection with nature. A significant interaction effect (p < 0.01) of time × group was observed for %FM, VFL, and appendicular skeletal muscle mass. Exercise duration had an effect (p = 0.043) on participants’ personal and affective identification with nature, and the time × group × medication interaction significantly influenced sleep efficiency (p = 0.034). The exercise program proved effective in reducing total and central adiposity levels; however, it did not lead to improvements in sleep duration, sleep quality, or connection with nature. Full article

Cardiorespiratory fitness is a predictor of long-term health, traditionally assessed through structured exercise protocols that require maximal effort and controlled laboratory conditions. These protocols, while clinically validated, are often inaccessible, physically demanding, and unsuitable for unsupervised monitoring. This study proposes a non-invasive, unsupervised alternative—predicting the heart rate a person would reach after completing the step test, using wearable data collected during natural daily activities. Ground truth post-exercise heart rate was obtained through the Queens College Step Test, which is a submaximal protocol widely used in fitness settings. Separately, wearable sensors recorded heart rate (HR), blood oxygen saturation, and motion data during a protocol of lifestyle tasks spanning a range of intensities. Two machine learning models were developed—a Human Activity Recognition (HAR) model that classified daily activities from inertial data with 96.93% accuracy, and a regression model that estimated post step test HR using motion features, physiological trends, and demographic context. The regression model achieved an average root mean squared error (RMSE) of 5.13 beats per minute (bpm) and a mean absolute error (MAE) of 4.37 bpm. These findings demonstrate the potential of test-free methods to estimate standardized test outcomes from daily activity data, offering an accessible pathway to infer cardiorespiratory fitness. Full article

Background: Chronic stress in childhood and adolescence leads to excessive cortisol secretion, adipokines production and obesity with all the negative mental and physical effects on the health of individuals and adulthood. Objectives: The aim of the present non-randomized controlled trial was to investigate the effect of a stress management protocol with diaphragmatic breathing (DB) and physiotherapy exercise on stress, body composition, cardiorespiratory and metabolic markers of children and adolescents with morbid obesity. Methods: The study included 31 children and adolescents (5–18 years old) with morbid obesity (22 in the intervention arm and 9 controls). All participants completed anxiety questionnaires and a self-perception scale. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), blood pressure (BP) and SpO₂ were measured. Fasting glucose, uric acid, triglycerides, HbA1c, (AST/SGOT), (ALT/SGPT), HDL, LDL, insulin, ACTH, cortisol, HOMA-IR, 17-OH, S-DHEA, SHBG were assessed, and anthropometric measurements were also performed. Results: In the intervention group, 4 months after the treatment, an improvement was noted in the BMI, BMI z-score, waist-to-height ratio, FEV1, SpO₂, pulse and systolic BP. HDL increased, ALT/SGPT and insulin resistance improved. Positive changes were observed in temporary and permanent stress and self-esteem of children in the intervention group, including anxiety, self-perception, physical appearance, etc. Conclusions: A combined exercise and DB protocol has a positive effect on stress, by improving body composition, reducing insulin resistance, and ameliorating physical and mental health and quality of life of pediatric patients with morbid obesity. Full article

Background/Objectives: Cardiorespiratory fitness (CRF) is of great interest in children and adolescents. Due to the limited availability of cardiopulmonary exercise testing, simple and reliable alternatives are needed. A stair climbing test (SCT) for the assessment of CRF developed at the Department of Pediatric Cardiology of the LMU University Hospital in Munich showed a strong correlation with VO₂max. The aim of this study is to prove its feasibility in a non-clinical setting and to analyse its results in a larger study population. Methods: During the “Hand aufs Herz” study, a comprehensive cardiovascular examination was carried out on 922 pupils and siblings (13.2 ± 7.8 years) at a high school in Bavaria. The SCT was performed to evaluate CRF: participants had to run up and down a total of four floors (14.8 m) as quickly as possible without skipping steps or holding on to the banister. Absolute time has been normalized over the standard height of 12 m to allow comparisons with different settings. An SCT Index was calculated to adjust results to the different weights of participants and the exact height of the staircase. Results: The SCT proved to be easily feasible and safe in non-clinical contexts. Out of 922 participants, 13 (1.4%) were not able to perform the test, and 3 (0.3%) had to interrupt it following fatigue or stumbling. A total of 827 participants aged from 9 to 17 years (13.1 ± 2.1 years, 45.8% girls) had a mean absolute SCT time of 53.4 ± 6.2 s and 43.3 ± 5.1 s when normalized over 12 m. Conclusions: The SCT represents a simple, cost- and time-saving test that allows a rapid and solid assessment of cardiorespiratory fitness in children and adolescents. We could demonstrate that it is safe and feasible in non-clinical contexts. Its short duration and universal applicability are valuable advantages that could facilitate the establishment of a repetitive cardiovascular screening in the pediatric population, particularly in outpatient departments or settings with low-resource systems. Full article

Children and adolescents with type 1 diabetes (T1D) often experience abnormalities in bone health. Studies have consistently demonstrated that youth with T1D have lower bone mineral density (BMD) compared to their healthy peers. Additionally, children with T1D show impaired bone microarchitecture and reduced bone turnover. These factors collectively contribute to an increased risk of fractures across the life span of this population. To optimize bone accrual and reduce fracture risk, several strategies can be employed during childhood and adolescence. First, maintaining good glycemic control is critical, as poor glycemic control has been associated with lower BMD and an increased risk of fractures. Second, specific nutritional recommendations can help improve bone health, including a balanced diet, adequate calcium and vitamin D intake, and careful monitoring of both macronutrient and micronutrient intake. Third, regular physical activity plays a vital role. A systematic review and meta-analysis have shown that youth with T1D are generally less physically active, more sedentary, and have lower cardiorespiratory fitness levels than their non-diabetic peers. This review emphasizes targeted strategies aimed at optimizing skeletal health in the pediatric population with T1D, with a particular focus on the critical roles of glycemic control, nutritional adequacy, and regular physical activity. These modifiable factors may contribute to the reduction of fracture risk across the life span in individuals with T1D. Full article

Background/Objectives: In the context of active ageing, functional assessment is key to preserving autonomy in older women. The six-minute walk test (6MWT) is a practical tool for estimating general health, but its results can be influenced by various factors. This study analysed cardiorespiratory variations during the 6MWT in older women according to their physical activity level and age-related variables such as pain, sarcopenia, frailty, and motivation to exercise. Methods: A total of 163 older women with musculoskeletal pain, but without cardiac or respiratory conditions, were classified into groups with high (HPA), moderate (MPA), and low (LPA) physical activity. During the 6MWT, heart rate (HR), dyspnoea, and oxygen saturation (SpO₂) were recorded. Pain, sarcopenia, frailty, and motivation to exercise were also assessed. A repeated-measures multivariate analysis of (co)variance (RM-MANCOVA) was performed. Results: The results showed differences in HR depending on the level of physical activity, conditioned by sarcopenia (p < 0.05) and walked distance (p < 0.001), and in dyspnoea conditioned by pain perception (p < 0.01) and social (p < 0.001) and psychological (p < 0.05) motivation to exercise. There were also differences in SpO₂ depending on the level of physical activity (p < 0.0001). There were differences between the HPA group and both the MPA and LPA group, which had higher HR, higher dyspnoea, and lower SpO₂ when undergoing the 6MWT test. Conclusions: To accurately interpret 6MWT results in older adult women, it is essential to consider physical activity level, perceived pain, sarcopenia, and motivation to exercise, as these factors influence HR, dyspnoea, and SpO₂. These variables should guide physical activity recommendations for healthy ageing. Full article

By-products from winemaking, such as grape pomace, grape seeds, grape skins, or extracts made from them, represent a cost-effective and sustainable bioresource. These by-products are a source of polyphenolic compounds, plant fibers and—in the case of seeds—essential fatty acids with various health-promoting effects for livestock. Numerous studies involving fast-growing broiler breeds—which often suffer from metabolic inflammation and oxidative stress due to disproportionate breast muscle growth leading to issues like cardiorespiratory insufficiency—indicate that supplementing feed with grape by-products improves performance, particularly weight gain and feed efficiency. This literature review demonstrates that the performance-enhancing effects of grape by-products in fast-growing broiler breeds can be attributed to various mechanisms such as improved nutrient digestibility, a positive influence on intestinal morphology and integrity, the favorable modulation of the microbial community in the gut, the inhibition of oxidative stress or the enhancement of the antioxidant defense system, and the stimulation of the immune response. Full article

Background/Objectives: High-intensity interval training (HIIT) can optimize recovery by complementing the low cardiovascular fitness intensities typically achieved in stroke rehabilitation programs. Skating exercise is an HIIT workout developed based on ice skating movements, and we investigated the effects of this exercise on the cardiorespiratory fitness of elderly patients with minor stroke. Methods: Participants aged 65 or older with a National Institutes of Health Stroke Scale score of 3 or lower were recruited. This study was designed as a randomized controlled trial, in which the intervention group engaged in skating exercises following HIIT, while the control group underwent moderate-intensity continuous training (MICT). Both groups of participants performed either HIIT or MICT for 20 min per day, four times a week, over three months. Results: A total of 34 elderly patients with minor stroke were recruited, with an average age of 70.7 years. For three months, no fall-down injuries or adverse cardiovascular or cerebrovascular events were reported among patients undergoing HIIT or MICT. Both the intervention and control groups showed significant increases in the measures of aerobic capacity after the intervention. However, the patients in the intervention group exhibited significantly greater improvements in peak oxygen uptake, ventilatory threshold, and peak MET (p = 0.005, p = 0.002, and p = 0.024, respectively). Additionally, the Berg Balance Scale (BBS) scores and the skeletal muscle mass index showed significantly greater enhancements in the intervention group compared to the control group (p = 0.032 and p = 0.032). Conclusions: In conclusion, skating exercise could be a safe and effective HIIT protocol for elderly people who have experienced a minor stroke. Full article

Periodontal disease is a chronic inflammatory condition that extends beyond the oral cavity and is increasingly recognized as a significant contributor to cardiovascular disease, the leading cause of global mortality. Systemic inflammation serves as the key link between the two, with elevated biomarkers such as C-reactive protein and interleukin-6 observed in individuals with PD, driving endothelial dysfunction and atherogenesis. Epidemiological and mechanistic studies consistently demonstrate that PD not only heightens the risk of major adverse cardiovascular events but is also independently associated with increased all-cause and cardiovascular mortality. In parallel, emerging research underscores the protective role of regular physical activity and improved cardiorespiratory fitness, which attenuate systemic inflammation and may reduce the burden of both PD and CVD. This review integrates current evidence on the shared inflammatory mechanisms linking PD and CVD, highlights the systemic impact of poor oral health, and advocates for incorporating exercise-based interventions and oral health assessments into comprehensive cardiovascular risk management. A multidisciplinary approach—bridging cardiology, dentistry, and preventive medicine—may offer a novel strategy to reduce inflammation-driven morbidity and mortality. Full article

Lyme borreliosis (LB), caused by Borrelia burgdorferi sensu lato (s.l.) and babesiosis, caused by Babesia divergens and Babesia venatorum, are both transmitted by the ixodid tick Ixodes ricinus. Although these diseases coexist in Spain and other European regions, no studies have been carried out to assess the impact on the health of patients exposed to both causative pathogens. This retrospective study, conducted in Asturias in northwestern Spain between 2015 and 2017, analyzed the possible complications arising from exposure to these pathogens. To this end, the epidemiological, clinical and analytical features of two groups of a cohort of 120 LB patients exposed to one or two of the pathogens were compared. The cohort comprised 73 patients who had only been infected with Bo. burgdorferi s.l. (Bb group) and 47 patients who were seropositive for Ba. divergens/venatorum in addition to being infected with Bo. burgdorferi s.l. (BbBdv group). The results showed that LB patients who had also been exposed to infection with Babesia spp. (BbBdv group) had significantly more cardiorespiratory symptoms, in particular dyspnea and first- and second-degree atrioventricular (AV) blocks, compared to those who had been infected with Bo. burgdorferi s.l. alone (Bb group). No relevant differences in other symptoms, epidemiological factors or analytical tests were observed between the two groups. Full article

Background: Individuals with neuromuscular diseases (NMDs) have low physical activity levels and an increased risk of cardiovascular and pulmonary diseases. Respiratory gas kinetics obtained during cardiopulmonary exercise testing (CPET) may provide valuable insights into disease mechanisms and cardiorespiratory fitness in individuals with NMD. Recovery from exercise is an important marker of exercise performance and overall physical health, and impaired recovery is strongly associated with poor health outcomes. This study evaluates recovery metrics in individuals with NMD after performing maximal exertion during CPET. Methods: A total of 34 individuals with NMD and 15 healthy volunteers were recruited for the study. CPET was performed using a wearable metabolic system and a wheelchair-accessible total body trainer to peak exertion. Recovery metrics assessed were (i) the time to reach 50% O₂ recovery compared with peak exercise and (ii) the ratios of ventilation and respiratory gases between peak exercise and the highest values observed during recovery (overshoot). Results: The NMD group had a significantly longer time to reach 50% O₂ recovery (T1/2 VO₂: 105 ± 43.4 vs. 76 ± 36.4 s, p = 0.02), lower respiratory overshoot (17.1 ± 13.0% vs. 28.8 ± 9.03%), and lower ventilation/VO₂ (31.9 ± 28.3 vs. 52.2 ± 23.5) compared to the control group. Conclusions: This study observes significantly impaired recovery metrics following peak exercise in individuals with NMD compared to controls. These insights may improve the understanding of exercise recovery and mechanics, thus improving prognostication and optimizing exercise prescriptions for individuals with NMD. Full article