Search Results (183)

Background and Objective: Maximal oxygen uptake (VO₂max) is a fundamental indicator of cardiorespiratory fitness in sports medicine, essential for athletic profiling and training prescription. However, traditional direct measurements require exhaustive physical testing, which induces considerable physiological stress, limits testing frequency, and increases the risk of injury. To address this problem, this study aimed to eliminate the need for exhaustive protocols by developing a highly precise, non-invasive digital prediction model for VO₂max utilizing readily available anthropometric data and acute metabolic biomarkers (blood glucose and lactate kinetics). Methods: To overcome the limitations of a small initial empirical sample (n = 16) and prevent model overfitting, the original dataset was statistically augmented to create a robust synthetic cohort (n = 200) using Multivariate Normal Distribution and k-Nearest Neighbors (k-NN) algorithms. Three different machine learning models (Multiple Linear Regression [MLR], Random Forest [RF], and Support Vector Regression [SVR]) were trained using such parameters as sex, height, weight, baseline/pre-exercise, and net (Δ) glucose and lactate concentrations. Evaluation of the performance of the models included tenfold cross-validation and Bland–Altman analysis as a measure of clinical agreement. Results: Among the three algorithms used, the highest correlation coefficient (R² = 0.939) was observed for SVR, along with the lowest error metrics (RMSE = 1.442 mL/kg/min, MAPE = 2.78%). Moreover, SVR showed remarkable performance in predicting VO₂max of female (R² = 0.890) and male (R² = 0.702) athletes separately. Also, Bland–Altman analysis proved almost zero-bias estimation with 95% limits of agreement ranging between −4.40 and 4.43 mL/kg/min. In order to bypass the black-box problem of complex algorithms for practical application in the field, the MLR model was used for the development of the Beta-Weighted Lacto-Glycemic Equation (β-LGE). Conclusions: In this work, a unique dual-model approach was introduced, with the SVR algorithm serving as a high-performance backend of a digital tool for sport technologists and Beta-Weighted LGE providing a practical calculation formula for coaches. This innovative approach allowed for a completely non-exhaustive profiling of an athlete’s VO₂max using only minimally invasive metabolic measurements. Full article

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency characterized by sudden cardiorespiratory collapse, disseminated intravascular coagulation (DIC), and a high case-fatality rate. Because no confirmatory test exists, the diagnosis remains clinical and one of exclusion. We report a case of presumed AFE in a 39-year-old primigravida with uterine myomas, obesity, and chronic hypertension who underwent an elective primary cesarean delivery under spinal anesthesia. During manipulation of the placenta, the patient developed abrupt cardiovascular collapse requiring cardiopulmonary resuscitation, with return of spontaneous circulation followed by profound coagulopathy and refractory uterine atony. Management included goal-directed transfusion within a massive transfusion protocol, uterotonic therapy, a failed B-Lynch suture, supracervical hysterectomy, and a subsequent right oophorectomy for an ovarian-vein hemorrhage identified on imaging. Laboratory studies demonstrated an overt consumptive coagulopathy consistent with the International Society on Thrombosis and Haemostasis (ISTH) criteria, while a normal serum tryptase argued against an anaphylactic mechanism. The neonate was delivered in good condition (Apgar scores 9, 10, and 10 at 1, 5, and 10 min; umbilical-artery pH 7.38) and required no neonatal intensive care. The mother achieved full hemodynamic and neurological recovery. This case illustrates that survival from presumed AFE is achievable through early recognition, high-quality resuscitation, prompt correction of coagulopathy, and decisive surgical hemostasis, and it highlights the diagnostic reasoning required to distinguish AFE from its principal differential diagnoses. Full article

Background: Endobronchial tumors represent a heterogeneous spectrum of benign and malignant histopathological types. Selecting the optimal surgical strategy remains a multidisciplinary challenge. This study evaluates how the integration of spirometry, DLCO, and CPET can objectively stratify cardiorespiratory risk and guide surgical decision-making regarding resection type, postoperative complications, and perioperative mortality. Methods: A single-center, retrospective study was conducted between 2020 and 2025, evaluating an initial screening cohort of 93 patients with endobronchial masses. Following multidisciplinary tumor board review based on functional and anatomical criteria, 36 patients were excluded from major resection due to extensive disease or prohibitive functional risk, while 57 underwent tailored surgical interventions, including sleeve resections, lobectomies, bilobectomies, and pneumonectomies. Preoperative evaluation included spirometry, DLCO, cardiological assessment, CT, and autofluorescence bronchoscopy (AFB). Results: Spearman correlation analysis demonstrated that advanced age and higher ASA scores significantly correlated with reduced preoperative DLCO (p < 0.0001). The overall postoperative morbidity rate was 36.84% (n = 21) and perioperative mortality was 5.26% (n = 3). Stratified analysis by surgical magnitude demonstrated a significant escalation in overall complication rates from parenchymal-sparing sleeve resections (17.6%, 95% CI: 3.8% to 43.4%) to standard lobectomies (40.7%, 95% CI: 22.4% to 61.2%), bilobectomies (50.0%, 95% CI: 15.7% to 84.3%), and radical pneumonectomies (60.0%, 95% CI: 14.7% to 94.7%; p = 0.042). Severe morbidity (Clavien–Dindo Grade III–IV) was significantly lower in the sleeve resection subgroup (5.8%) compared to pneumonectomies (40.0%, p = 0.015). Fatal outcomes occurred exclusively following major resections and were attributable to ARDS and acute cardiovascular events. Conclusions: A multi-parametric preoperative protocol provides an informative framework for risk stratification in endobronchial tumor surgery, helping to describe baseline reserves and explore post-resection trends. However, the anatomical and hemodynamic magnitude of radical pneumonectomy constitutes an independent risk modifier that cannot be fully captured by preoperative functional testing alone, highlighting the exploratory nature of these single-center retrospective observations rather than a definitive algorithmic validation. 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

Exogenous ketone supplementation has emerged as a potential ergogenic strategy for trained and physically active individuals, prompting increasing research into its effects on exercise performance and metabolism. This systematic review evaluated the effects of ketone supplementation on athletic performance, metabolic variables, and physiological responses in trained and physically active populations. Searches were conducted in EBSCOhost, PubMed, and Web of Science following PRISMA 2020 guidelines. Peer-reviewed controlled studies published between 2018 and December 2025 were included. Twenty-six studies met the eligibility criteria. Ketone supplementation consistently increased circulating β-hydroxybutyrate concentrations and modified glucose, lactate, and acid–base balance. Effects on exercise performance were heterogeneous, with some studies reporting improvements in time-trial performance and cognitive function, whereas others found no benefit or even impaired performance. Co-ingestion with sodium bicarbonate attenuated metabolic acidosis and occasionally enhanced performance outcomes. Ketone supplementation also influenced cardiorespiratory responses and fluid regulation, and may promote muscular angiogenesis during periods of training overload. Overall, current evidence remains heterogeneous and does not support definitive conclusions regarding ergogenic efficacy, which appears to depend on exercise intensity, participant characteristics, supplementation protocols, and co-ingestion strategies. Full article

Background: This systematic review evaluates clinical trials on spinal cord injury (SCI) physical therapy interventions. The objective is to assess the impact of contemporary physical therapy interventions on patients’ functional parameters and recovery outcomes, based on the literature published in the preceding six years. Methods: Inclusion and Exclusion Criteria: Eligible studies included randomized controlled trials (RCTs) and clinical trials involving adult participants with SCI who received physiotherapy interventions. Studies published more than six years ago or those not involving physiotherapy as a primary intervention were excluded. Data Synthesis and Presentation: Results were synthesized qualitatively. Due to substantial clinical and methodological heterogeneity across the included trials, a meta-analysis was not performed, and findings are based entirely on qualitative synthesis. Main outcomes were categorized into primary (muscle strength, walking ability, balance, activities of daily living [ADL]) and secondary outcomes (cardio-respiratory function, mental health, pain management) and are presented in order of the number of supporting studies. Results: Study Numbers and Characteristics: Of 181 records initially identified, 23 studies (all high-quality clinical trials/RCTs; mean PEDro score 7.2) were ultimately included in the review. Main Outcomes and Direction of Effect: The included studies generally reported positive effects of physiotherapy interventions on several functional and physiological outcomes. Statistically significant improvements favoring the physical therapy groups were reported for balance (7 studies), ADLs (4 studies), and respiratory function (6 studies) across the clinical spectrum. Conversely, positive outcomes in muscle strength (12 studies) and gait/walking ability (7 studies) were predominantly localized within motor-incomplete cohorts. Cardiovascular function outcomes (5 studies) remained inconsistent, while secondary psychological metrics and formal mental health parameters (6 studies) showed no statistically significant changes between groups. Discussion: Limitations of the Evidence: The primary limitation identified across the included evidence is the substantial heterogeneity in the specific physical therapy intervention protocols utilized across trials, which limits direct comparison. Interpretation and Implications: Current evidence suggests that tailored physical therapy interventions play an important role in driving functional adaptations and managing specific physiological complications in adult SCI populations. The principal implication of these findings is that, while physical therapy is potentially effective, findings must be interpreted with caution due to protocol diversity, and further high-quality, standardized research is urgently required to establish uniform clinical guidelines. Other: Funding Source: This systematic review received no specific grant or primary funding from any agency in the public, commercial, or not-for-profit sectors. 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

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

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: Intermittent Hypoxic–Hyperoxic Training (IHHT) induces physiological adaptations. While its efficacy in athletic performance remains debated, IHHT improves health markers in pathological and geriatric populations. This Exploratory Pilot Study aimed to explore the safety and feasibility of two IHHT protocols through preliminary responses. Methods: Twelve healthy volunteers completed a 4-week intervention (two sessions/week, 45 min/session) combining IHHT simultaneously during low-intensity exercise. The study compared a Training Group (TG: 30 min hypoxia, 7.5 min normoxia, 7.5 min hyperoxia) with a Conditioning Group (CG: 15 min hypoxia, 22.5 min normoxia, 7.5 min hyperoxia). Outcomes assessed included cardiorespiratory parameters, Acute Mountain Sickness symptoms, Perceived Exertion, a comprehensive biochemical panel, systemic inflammation, oxidative stress, and renal status. Results: Both protocols were well-tolerated. The TG exhibited significantly greater oxygen desaturation than the CG (p = 0.048). Moreover, the CG demonstrated a significantly attenuated increase in Interleukin-6 (p = 0.021) compared to the TG. Additionally, preliminary variations highlighted an interesting reduction in lipid parameters (TC, LDL, and Apo A1/B ratios) in both groups, although these did not reach statistical significance after FDR correction. Conclusions: While both protocols proved feasible and safe, a more balanced hyperoxic-to-hypoxic exposure (CG) showed better acute physiological tolerability, attenuating cardiovascular strain and mitigating systemic pro-inflammatory responses compared to the unbalanced exposure (TG). Finally, the preliminary variations observed in lipid parameters provide a rationale that warrants further controlled investigations. Full article

Background/Objectives: Stroke is a leading cause of long-term disability worldwide and is frequently associated with reduced cardiorespiratory fitness, impaired functional capacity, and cognitive decline. High-intensity interval training (HIIT) has emerged as a promising rehabilitation strategy; however, its effects across multiple domains remain unclear. This systematic review and meta-analysis aimed to evaluate the effects of HIIT on cardiorespiratory fitness, cognitive function, and functional capacity in adults with stroke. Methods: A systematic search was conducted in PubMed, Scopus, CINAHL, and Web of Science up to April 2026. Randomized controlled trials involving HIIT interventions in adults with stroke were included. Outcomes of interest were cardiorespiratory fitness (VO₂peak), functional capacity (gait speed, walking distance, mobility, and balance), and cognitive function. Pooled effect sizes were calculated using a random-effects model. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated with the Cochrane RoB-2 tool. Results: In total, 17 studies (n = 809 participants) were included, with 12 contributing to the meta-analysis. HIIT significantly improved cardiorespiratory fitness (SMD = −0.849; p = 0.005), gait speed (SMD = 0.693; p = 0.014), walking distance (SMD = 0.604; p < 0.001), functional mobility (SMD = −0.711; p = 0.027), balance (SMD = 2.447; p = 0.002), and cognitive function (SMD = 1.741; p < 0.001). However, substantial heterogeneity was observed across most outcomes. Conclusions: HIIT appears to be an effective intervention for improving cardiorespiratory fitness, functional capacity, and cognitive performance in individuals with stroke. Nevertheless, the variability across studies suggests that its effectiveness is context-dependent. Further research is needed to standardize protocols and determine optimal implementation strategies. Full article

Purpose: The current study tested the hypothesis that a bodyweight training (BWT) protocol with a higher weekly time commitment and training volume would produce greater improvements in cardiorespiratory fitness compared to lower time commitment/volume BWT protocols. Methods: Fifty-eight (n = 21 males; n = 37 females) recreationally active, healthy, young adults were randomized to either a 16 (TAB, n = 20), 27 (5BX, n = 19), or 90 min/week (AMRAP, n = 19) BWT protocol for 6 weeks. Peak work rate (WRpeak) was measured pre- and post-intervention using a cycle ergometer graded exercise test. VO₂peak was estimated (eVO₂peak) using a simple linear regression of WRpeak and VO₂peak generated from a previous study (n = 26; 13M/13F). Results: TAB and 5BX yielded non-inferior improvements in eVO₂peak. The 95% confidence intervals of the mean difference in change did not cross our non-inferiority margin of −2.6 mL/kg/min (TAB—AMRAP = 95% CI = −1.16 to 2.07; 5BX—AMRAP 95% CI = −0.29 to 2.89). Conclusions: Our results suggest that 16 and 27 min/week of minimalist BWT yields non-inferior improvements in CRF compared to 90 min/week and provides evidence supporting the efficacy of low-volume BWT protocols compared to higher volume protocols. The study was registered on Open Science Framework on 29 May 2023 (OSF registration). Full article

Adolescence is a critical window for health behavior consolidation, yet the combined influence of physical activity level (PAL) and the body mass index (BMI) on aerobic capacity remains understudied, especially in transitioning periurban environments. This study examined the association between PAL, BMI, and aerobic capacity in adolescents from Montería, Colombia. A cross-sectional study was conducted among 112 adolescents (aged 12–17 years). Aerobic capacity was assessed using the 20 m shuttle run test (Course Navette), and PAL was measured via the validated Assessment of Physical Activity Levels Questionnaire (APALQ), following standard fitness assessment protocols. Multivariable linear regression models were utilized to estimate independent associations, adjusting for age and sex. The multivariable model was significant (F = 8.45; p < 0.001), explaining 21% of the variance in aerobic capacity (adjusted R² = 0.21). PAL was positively and independently associated with aerobic capacity (B = 0.22; 95% CI: 0.05–0.38; p = 0.010), regardless of BMI. While age showed a positive association (B = 0.09; p = 0.032) and sex was inversely associated (B = −0.39; p < 0.001), BMI did not emerge as an independent predictor in the adjusted model (B = −0.04; p = 0.080). Aerobic capacity in adolescents is more consistently explained by behavioral factors (what they “do”) than by anthropometric status (what they “weigh”). These findings support a paradigm shift in pediatric public health, prioritizing high-intensity movement overweight control to improve cardiorespiratory fitness in transitioning urban territories. Full article

Cardiac rehabilitation (CR) is strongly recommended in secondary cardiovascular prevention; indeed, in patients after cardiac surgery or with coronary artery disease or heart failure, this intervention is recommended to decrease mortality, morbidity, and disability, and to improve quality of life and cardiorespiratory fitness. Moreover, each step of the cardiovascular continuum denotes a potential risk factor for the progression of cognitive frailty; this interaction is highly prevalent, affecting approximately one-third of all patients in cardiology settings. For these reasons, CR should consider the patient’s cognitive domain; however, cognitive assessment is still rarely integrated into standard CR protocols. Therefore, this comprehensive review presents current evidence and recent updates on the interaction between CR and cognitive impairment, focusing on physiological mechanisms, core components, benefits, and strategies for implementing CR in patients with cognitive frailty to optimize recovery and prognosis. Full article