Search Results (272)

Background: Sulfur-containing amino acids (SCAAs) are essential for fetal growth and development, but their metabolism during pregnancy remains poorly understood, with conflicting reports regarding the effect of exercise training. This study investigates the effects of physical activity (PA) interventions on maternal plasma concentrations of SCAAs and their associations with neonatal outcomes. Methods: The FitMum randomized controlled trial included 220 healthy, inactive, pregnant women enrolled before gestation age (GA) 15+0 weeks. Participants were randomized to supervised exercise training (EXE), motivational counseling on PA (MOT), or standard care (CON). This secondary analysis includes all participants with an eligible blood sample (n = 214). Maternal plasma concentrations of SCAAs were measured at four time points (GA ≤15+0, 28+0-6, 34+0-6, and delivery), and umbilical cord venous plasma was measured at delivery. Results: Longitudinally, maternal methionine and taurine concentrations decreased significantly (p < 0.001 for both) during pregnancy, while total cysteine (tCys) concentrations increased (p < 0.001). At GA 28+0-6 weeks, methionine concentrations were significantly higher in EXE (p = 0.031) and MOT (p = 0.006) groups compared to CON, and tCys was higher in the MOT group (p = 0.017) versus CON. Maternal taurine was positively associated with birth weight (p = 0.034) and birth weight/placental weight ratio (p = 0.010), while maternal tCys was negatively associated with head circumference (p < 0.001). Additionally, increased moderate-to-vigorous intensity physical activity (MVPA) was associated with a smaller maternal–umbilical venous difference for methionine (p = 0.025), suggesting enhanced placental transport. Conclusions: Pregnancy significantly alters maternal metabolism of SCAAs. PA interventions may modulate maternal methionine and tCys concentrations, and our results suggest that maternal taurine status is linked to offspring birth weight, highlighting the potential of PA to influence key nutrients required for fetal development. Full article

Background/Objectives: Food allergy prevention is no longer understood as the simple avoidance of allergenic foods. The first 1000 days (from conception to, approximately, 24 months of age) include prenatal, perinatal and postnatal windows in which diet, epithelial barrier integrity, microbial ecology, immune maturation and family-level implementation interact. This narrative review was developed as a Commission-proposed SIAIP-oriented clinical framework, rather than a formal guideline or consensus statement. Evidence from guidelines, systematic reviews, randomised trials, birth cohorts and mechanistic studies was organised by developmental window and interpreted according to endpoint validity, confounding, feasibility and clinical readiness. Prenatal factors include maternal allergen non-avoidance, whole-diet quality, micronutrient and fatty acid status, antibiotic exposure, environmental context and maternal microbiome. Perinatal factors include mode of delivery, intrapartum and neonatal antibiotics, gestational maturity, early colonisation, breastfeeding initiation and routine vaccination. Postnatal factors include eczema, skin barrier inflammation, the timing and regularity of allergen introduction, breastfeeding management, infant diet diversity, siblings, daycare, pets, smoke and pollution, physical activity and equitable implementation. The strongest actionable evidence remains eczema-linked risk recognition and timely, sustained oral exposure to peanut and well-cooked egg. Maternal and environmental factors are clinically important, but many are contextual rather than prescriptive; they should guide non-restrictive, non-blaming counselling rather than deterministic risk labelling. Full article

Background: Q&A corpora generated through university student–AI mental health support tools may reveal how physical activity (PA) and psychosocial themes are represented in support-oriented text. However, the absence of individual-level demographic metadata and the pooling of prompt and response fields limit attribution of any expression to a particular speaker, and the corpus describes a specific student population rather than a general or clinical one. Objective: This exploratory study described PA-, sport-, physical education (PE)-, body-, lifestyle-, and emotion-related patterns in a large corpus of university student–AI mental health exchanges collected through an institutional counselling platform. Methods: This study analysed 209,715 paired prompt–response records as combined exchange-level units using a BERTopic-based computational text-mining workflow. The full corpus was used for the main 18-topic model and overlapping dictionary analyses. After secondary data-quality filtering, 178,062 eligible exchanges formed the sampling frame from which a systematic sample of 10,000 exchanges was drawn for a separate complementary BERTopic and scenario-mapping analysis. The workflow used Qdrant/bge-small-zh-v1.5 embeddings, NFKC normalisation, an archived stop-word list, UMAP (n_neighbors = 15, n_components = 5, min_dist = 0.0, cosine metric, seed = 42), HDBSCAN (min_cluster_size = 300, min_samples = 10, Euclidean metric, EOM), c-TF-IDF topic representations, overlapping dictionary screens, and stability testing across seeds 42, 52, and 62. Results: A student/school/family-context lexical screen matched 83,215 exchanges (39.68%), and a broad PA/body/lifestyle screen matched 82,464 exchanges (39.32%). These overlapping indicators describe topical co-occurrence and do not establish PA behaviour or which party to the exchange produced a given term. Eighteen corpus-level themes were retained. In the 10,000-exchange analysis, 13.11% of exchanges matched a narrow movement-related expression screen, with the highest within-topic rate in the sample topic labelled emotional outburst and relaxation regulation (51.09%). Conclusions: The findings describe exchange-level lexical and topic patterns in student–AI interactions rather than actual PA behaviour, intervention delivery, clinical efficacy, or population prevalence, and they do not identify which party introduced the language. The mapping to autonomy, competence, relatedness, and emotional regulation is a post hoc interpretive lens, offered as a hypothesis to inform future, prospectively validated design work in PE and digital mental health support rather than as a demonstrated result. Full article

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual incretin therapies have significantly advanced obesity management by facilitating clinically significant weight loss and enhancing cardiometabolic outcomes. Nevertheless, their growing application calls for careful consideration of nutritional and behavioural factors, including decreased dietary intake, gastrointestinal symptoms, loss of lean mass, micronutrient deficiencies, and potential weight regain following treatment cessation. Methods: This narrative review synthesises evidence from clinical trials, observational studies, reviews, professional guidelines, and MBS nutrition protocols to evaluate the role of structured dietetic care in adults receiving GLP-1 RAs or related incretin-based therapies for weight management. MBS pathways provide a comparative framework for investigating how established principles of nutritional assessment, monitoring, and dietetic follow-up may inform pharmacological treatments of obesity. Results: The literature indicates that pharmacological weight-loss treatments should not be administered solely as prescription-based treatments. Structured dietetic care can facilitate nutritional assessment, personalised dietary interventions, the management of gastrointestinal symptoms, protein optimisation, behavioural counselling, physical activity support, and long-term weight maintenance. MBS pathways illustrate the role of dietitians in pre-, peri-, and post-major weight-loss interventions through assessment, guidance on supplementation, dietary progression, biochemical monitoring, and long-term maintenance. Although these principles require adaptation rather than direct application to GLP-1 RA pathways, they offer a valuable system for integrating dietitians into comprehensive obesity pharmacotherapy. Conclusions: Structured dietetic care should be regarded as a fundamental component of the pharmacological management of obesity, especially as GLP-1 RAs and incretin-based therapies become more prevalent. Dietitians are well positioned to help optimise nutritional adequacy, preserve lean mass, manage gastrointestinal symptoms, and support sustained weight maintenance. Future research should investigate effective models for delivering dietetic care alongside incretin-based therapies, including strategies to identify patients who need more intensive support. Full article

Background: Shift work and chronotype may influence dietary habits, physical activity, and eating behaviors. However, research examining the combined associations of shift work and chronotype with these behaviors in women is limited. This study examined these associations, together with anthropometric outcomes, among women attending an obesity counseling center. Methods: A cross-sectional study included 190 women aged 18–64 years (mean age: 33.31 ± 7.87 years) attending an obesity counseling center in Istanbul. Sociodemographic data, dietary habits, work schedules and behavioral data were collected using structured questionnaires, whereas anthropometric measurements were obtained using standardized procedures. Chronotype, physical activity, and eating behaviors were assessed using the Morningness–Eveningness Questionnaire (MEQ), International Physical Activity Questionnaire (IPAQ), and Dutch Eating Behavior Questionnaire (DEBQ). Statistical analyses included chi-square tests, parametric-nonparametric group comparisons, and multivariable linear and logistic regression models. Results: Compared to fixed-schedule workers, shift workers had more frequent meals (77.9% vs. 59.6%; p = 0.007, V = 0.195) and breakfast (51.2% vs. 16.3%; p < 0.001,V = 0.371) skipping. Participants with obesity had higher emotional eating, external eating, total DEBQ, and total meal-number values than the other BMI groups. Chronotype scores varied according to age, smoking, alcohol consumption and occupational factors, but were not directly correlated with anthropometric measurements. Conclusions: Shift work was associated with irregular eating habits and altered eating behaviors. These findings should be interpreted with caution because the cross-sectional, single-center design limits causal inference and generalizability. To better understand the relationship between chronotype, lifestyle, and obesity-related behaviors, as well as to develop effective interventions, larger prospective studies are needed. Full article

Background/Objectives: Incretin-based pharmacotherapies are the most effective non-surgical treatments for obesity to date, yet 85% of patients discontinue within the second year of real-world use. No established framework exists for managing this post-cessation transition. This narrative review evaluates the evidence for structured exercise to mitigate physiological rebound and support long-term weight management following discontinuation. Methods: A narrative review was conducted per Assessment of Narrative Review Articles (SANRA) guidelines using PubMed, Scopus, and Web of Science from January 2005 through to June 2026. Results: Post-cessation weight regain averages 5.6 kg within one year and is observationally associated with dose-dependent cardiometabolic worsening. Lean mass losses averaging 6–7 kg and reductions in bone mineral density are seen during active treatment, creating a metabolically unfavorable state at cessation compounded by fat-preferential regain. Exercise and pharmacotherapy generate fundamentally different body composition outcomes. Exercise preserves lean mass, bone density, cardiorespiratory fitness, and insulin sensitivity, while pharmacotherapy alone does not, with downstream implications for resting metabolic rate and post-cessation rebound. Controlled trial data show exercise initiated during incretin treatment is associated with significantly less weight regain, greater sustained weight loss, and maintained physical activity levels one year after medication and supervised program end. This evidence derives from a single liraglutide-based trial and may not generalize directly to semaglutide, tirzepatide, or next-generation agents. Real-world data associate exercise counseling with durable weight loss after discontinuation. Conclusions: No randomized controlled trial has directly evaluated exercise at pharmacotherapy cessation; conclusions are based on post-treatment extension, real-world observational, and mechanistic evidence. Combined aerobic and resistance training is a biologically plausible, low-risk adjunct to incretin-based pharmacotherapies. Resistance training, adequate dietary protein, and individualized clinical screening are likely important components pending direct evidence from post-cessation trials. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) and arterial hypertension (AH) frequently coexist and are major risk factors for cardiovascular disease (CVD) and chronic kidney disease. Although the Mediterranean diet (MeDi) is widely recommended in cardiometabolic management, longitudinal real-world evidence regarding dietary adherence, body composition, and the role of continuous dietitian-led follow-up remains limited. Methods: This three-year prospective observational study included 158 adults with T2DM and AH treated at the Outpatient Clinic for Clinical Nutrition, University Hospital Centre Split, Croatia. Body composition was assessed using multi-frequency bioelectrical impedance analysis, dietary adherence using the Mediterranean Diet Serving Score (MDSS), and renal and metabolic parameters using standard laboratory methods. Participants were stratified according to attendance at scheduled dietitian-led follow-up visits. Results: Significant reductions were observed in body weight, body mass index (BMI), waist circumference, muscle mass, skeletal muscle index, and phase angle (PhA) during follow-up (all p < 0.001). Lipid profile improved, with reductions in total cholesterol and low-density lipoprotein levels and an increase in high-density lipoprotein concentrations. In contrast, renal function declined, as evidenced by increased creatinine and urea levels and decreased estimated glomerular filtration rate (eGFR). CVD incidence increased significantly during follow-up (p < 0.001). Although overall adherence to the MeDi improved, only 17.8% of participants achieved high adherence. Participants attending regular dietitian-led follow-up demonstrated significantly higher MDSS scores, greater adherence to the MeDi, and higher phase angle values compared with participants without regular follow-up. Conclusions: Adults with T2DM and AH demonstrated partial enhancement of MeDi adherence over three years; although the lipid profile also improved, this could not be attributed to diet and may largely reflect pharmacological treatment. These changes were accompanied by progressive muscle mass loss, declining renal function, and increased cardiovascular burden. Continuous dietitian-led follow-up was associated with superior dietary quality and better nutritional status, supporting the importance of individualized, multidisciplinary approaches integrating sustained nutritional counselling, lean mass preservation, and structured physical activity in long-term cardiometabolic care. Full article

Background and Objectives: Overweight and obesity among medical students represent significant public health concerns as unhealthy weight status during medical training may affect future health and professional counseling practices. Understanding the factors associated with BMI categories may help inform future university-based health promotion strategies. This study aimed to assess the prevalence of overweight and obesity and examine sociodemographic, lifestyle, and dietary factors associated with BMI categories among medical students. Methods: This cross-sectional study was conducted among medical students at the College of Medicine, King Faisal University, between December 2025 and January 2026. Students were selected using proportionate stratified random sampling according to academic year and gender. Of the 422 students invited to participate, 382 students completed the study questionnaire and anthropometric assessment, yielding a response rate of 90.5%. Height and weight were measured in person using calibrated equipment. Data on demographic characteristics, lifestyle habits, dietary patterns, smoking, sleep, and physical activity were collected through a structured face-to-face questionnaire. Multinomial logistic regression analysis was performed to examine factors associated with BMI categories, using normal weight as the reference category. Results: A total of 382 medical students were included, with a median age of 21 years. The prevalence of overweight was 19.9%, and the prevalence of obesity was 14.1%, resulting in a combined overweight and obesity prevalence of 34.0%. In the adjusted multinomial logistic regression model, male gender was associated with being overweight compared with having normal weight (aRRR = 2.71, 95% CI: 1.22–5.98). Obesity showed associations with below-average financial status (aRRR = 13.53, 95% CI: 1.98–92.22), current smoking (aRRR = 17.00, 95% CI: 2.50–115.47), soft drink intake of 2–3 times/week (aRRR = 4.57, 95% CI: 1.13–18.49), and lower physical activity, including no activity (aRRR = 11.61, 95% CI: 2.07–65.01), rare activity (aRRR = 7.54, 95% CI: 2.21–25.80), and physical activity several times/month (aRRR = 5.86, 95% CI: 1.78–19.31). Always eating breakfast was associated with overweight (aRRR = 2.23, 95% CI: 1.05–4.73). Several adjusted estimates had wide confidence intervals, indicating limited precision. Conclusions: Overweight and obesity were common among medical students at King Faisal University and were associated with several sociodemographic, lifestyle, and dietary variables. Because of the cross-sectional design and the imprecision of some adjusted estimates, these findings should be interpreted as associations rather than causal relationships. Future longitudinal and multicenter studies using validated lifestyle measures are recommended to clarify temporal relationships and guide university-based health promotion strategies. Full article

This study aims to assess the impact of an 8-week multidisciplinary intervention on the physical and psychosocial health in active women over 55 years old, paying attention to the need of supervision. Eighty-one women were assessed for pelvic floor strength (using PERFECT’s guidelines), body composition and satisfaction with life, and later blindly assigned to a supervised or reduced-supervision pelvic floor exercise program (i.e., therapeutic exercises guided by a professional, twice a week, or identical exercises performed at home). All of them received six additional educational sessions together, interspersed along the program, for nutritional and psychological counseling. Twenty-eight women of 36 [66.50 (4.68) years] in the supervised group, and another 20 of 34 [64.65 (5.12) years] (reduced-supervision) ended the intervention. Although both groups improved in all four dimensions of pelvic floor muscle strength, with endurance showing differences between-groups. Completion rate was lower in the reduced-supervision group (58.8% vs. 77.7%). Lack of motivation was their main reason to leave. No significant changes were found in body composition or life satisfaction. However, the results suggest that comparable pelvic floor strength benefits can be achieved with fewer resources when health awareness is emphasized. Ongoing supervision appears important to minimize dropout in these sensitive interventions. Multidisciplinary, movement-based programs show strong potential for public health promotion in older women. Pelvic floor training should be incorporated into preventive care for this population and supervised or follow-up formats seem essential to support adherence and long-term effectiveness. Full article

Perimenopause is a complex, multidimensional biopsychosocial transition characterized by endocrine fluctuations that interact with psychological vulnerabilities, sleep disturbances, and physical symptoms, significantly impacting women’s health-related quality of life (HRQoL). While hormonal therapies remain a viable option, there is an increasing demand for acceptable and accessible non-pharmacological interventions. This structured narrative review synthesizes recent randomized controlled trial (RCT) evidence evaluating integrative non-pharmacological interventions for mental health and HRQoL during the menopausal transition. A structured search was performed in MEDLINE via PubMed, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) for RCTs published between 1 January 2021 and 30 June 2026. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale: Nineteen RCTs met the eligibility criteria and were categorized into five domains: (i) lifestyle and structured exercise interventions, (ii) psychological, educational, and coaching-based interventions, (iii) mind–body and meditative movement interventions, (iv) acupuncture and traditional technique-based interventions, and (v) herbal and nutraceutical interventions. Overall, physical activity, Mediterranean- or DASH-oriented dietary counseling, cognitive behavioral therapy (CBT), health coaching, mindfulness-based stress reduction (MBSR), yoga, and Tai Chi were associated with favorable findings for depressive and anxiety symptoms, perceived stress, insomnia, sexual functioning, and menopause-specific quality of life. Acupuncture, moxibustion, and specific nutraceuticals yielded positive but highly heterogeneous or formulation-specific outcomes. The breadth of reported effects appeared to vary according to comparator selection, with broader findings generally observed against inactive controls than against active or sham comparators. Current evidence supports integrating tailored non-pharmacological strategies within patient-centered perimenopausal care. However, substantial heterogeneity in perimenopause definitions, small sample sizes, high attrition in select trials, and a lack of long-term follow-up limit generalizable conclusions. Future research requires standardized staging, active comparative-effectiveness designs, and implementation evaluation within multidisciplinary healthcare settings. Full article

Background/Objectives: The global incidence of neuroendocrine tumors (NETs) is steadily rising. While modifiable lifestyle factors impact oncological outcomes, the interplay between dietary habits, orthorexia nervosa (ON) tendencies, physical activity levels (PAL), and body image in NET survivors remains poorly understood. Methods: A cross-sectional study was conducted on a convenience sample of 61 patients with NETs. Validated evaluation tools included the PREDIMED questionnaire for Mediterranean Diet (MD) adherence, the GPAQ for PAL, and the ORTO-15 questionnaire for ON risk. Body image satisfaction and comprehensive clinical features were also assessed. Results: Most participants (75.4%) demonstrated moderate MD adherence. Body image dissatisfaction (32.8%) was significantly associated with a higher BMI (28.86 vs. 24.93 kg/m², p < 0.01) and reduced PAL (660.0 vs. 1680.0 MET-min/week, p = 0.021, pFDR = 0.042). Notably, moderate MD adherence was linked to a higher orthorexic risk (corresponding to lower ORTO-15 scores) compared to low adherence (p = 0.032, pFDR = 0.078). Somatostatin analog therapy showed no detrimental impact on behavioral parameters (p > 0.05). Conclusions: These findings highlight specific vulnerabilities in NET patients: body image dissatisfaction correlates with higher BMI and lower physical activity, while moderate Mediterranean Diet adherence associates with orthorexic risk, which is localized and was not independent in multivariate analysis. Targeted nutritional and physical activity interventions should be integrated into multidisciplinary NET care. Full article

Background: Lipedema is a chronic disorder of subcutaneous adipose tissue characterized by symmetrical fat accumulation in the extremities, pain, and orthostatic edema. Objectives: This study aimed to assess whether high-resolution cutaneous ultrasound can detect measurable tissue-level changes in subcutaneous tissue over six months. Methods: A retrospective, single-center, real-world longitudinal observational cohort study was conducted in 60 women with lipedema followed at three timepoints (baseline, 3 months, 6 months). High-resolution ultrasound (18–20 MHz) measured subcutaneous and dermal thickness at standardized anatomical sites. Results: All primary ultrasound parameters decreased significantly over six months of conservative multicomponent management, which included individualized nutritional counseling and physical activity. Medial proximal thigh subcutaneous thickness declined by 18.7% (48.2 to 39.2 mm; p < 0.001). Edema prevalence fell from 100% to 55.0%. Echogenicity improved significantly between 3 and 6 months, suggesting a delayed structural remodelling effect distinct from early volumetric reduction. Ultrasound reductions were inversely correlated with weight loss, suggesting that ultrasound captures tissue-level information not fully reflected by anthropometric measures alone. Conclusions: Standardized cutaneous high-resolution ultrasound detected consistent tissue-level modifications over six months of routine clinical follow-up, capturing changes beyond anthropometric measures and representing a candidate monitoring tool warranting evaluation in controlled study designs. Full article

Background: Sedentary behavior is a major modifiable risk factor for chronic metabolic disorders, particularly type 2 diabetes mellitus (T2DM). Despite recommendations promoting regular physical activity (PA), adherence remains low. DIA/01 is a multidisciplinary study designed to promote healthy lifestyles for the prevention and management of T2DM, supporting healthcare systems. Methods: A total of 123 adults with T2DM diagnosed will be enrolled at the Diabetes Center of the University Hospital of Perugia throughout 2025. Inclusion criteria are age 25–80 years, ability to walk independently, being inactive, and BMI 18.5–40 kg/m². Exclusion criteria include severe cardiovascular, central nervous system, or musculoskeletal diseases contraindicating PA. Participants will be randomized into three groups: (1) standard care (SC); (2) SC plus theoretical PA counseling (TCPA); and (3) SC plus TCPA plus a 3-month supervised mixed exercise program. The assessment, conducted at baseline and at 6 and 12 months, includes total weekly PA (WPA) time, using IPAQ-SF and actigraphy. Moreover, glycated hemoglobin, sedentary time (ST), functional capacity, body composition, cardiometabolic risk factors, dietary adherence, perceived barriers and willingness to initiate PA, readiness to change, health-related quality of life, and sleep quality will be studied. This study is registered in the Clinical Trials Registry on 13 May 2026, with the identifier NCT07583355. Conclusions: Participants in groups (2) and (3) are expected to show greater improvements in WPA, reductions in ST, and favorable changes in metabolic and functional outcomes compared with SC. This approach may support long-term engagement in regular PA and contribute to improving the clinical management of T2DM. Full article

Background: This randomized controlled trial aimed to evaluate the effects of a school physician-led counseling intervention on total cholesterol (TC) levels, adherence to the Mediterranean diet, physical activity, and sedentary behavior in children aged 6–7 years with elevated cholesterol levels in a Mediterranean setting. Methods: A one-year randomized controlled study was conducted among children aged 6–7 years with elevated TC levels, excluding those with familial hypercholesterolemia (FH). Participants were randomly assigned to either a control group (n = 38) or an intervention group (n = 39). All participants received standard care consisting of educational materials and baseline counseling, while the intervention group additionally participated in three structured follow-up counseling sessions conducted by school physicians during the one-year study period. Counseling focused on Mediterranean dietary habits, implementation of basic dietary principles in cases of elevated TC levels, promotion of physical activity, and reduction in sedentary behavior. TC levels were measured at baseline and at the end of the study. Dietary habits, physical activity, and sedentary behavior were assessed using validated questionnaires. For the primary outcome, a descriptive change-from-baseline analysis, unadjusted mean difference, the approximate 95% confidence interval, and Cohen’s d effect size were calculated. Results: At baseline, no significant differences in TC levels were observed between groups (p = 0.852). After the intervention, mean TC levels were lower in the intervention group than in the control group (4.977 ± 0.414 mmol/L vs. 5.137 ± 0.410 mmol/L); however, the between-group difference did not reach statistical significance (p = 0.089). The unadjusted mean difference at follow-up was −0.160 mmol/L, with an approximate 95% confidence interval from −0.35 to 0.03 and a small-to-moderate effect size in favor of the intervention group (Cohen’s d = −0.39). Descriptive change-from-baseline analysis showed a greater mean reduction in TC in the intervention group than in the control group (−0.364 mmol/L vs. −0.195 mmol/L). A statistically significant improvement in adherence to the Mediterranean diet was observed in the intervention group compared with the control group (p < 0.001). Favorable changes were also observed in several physical activity and sedentary behavior variables, including participation in organized physical activity, walking and running activities, and reduced television viewing and video gaming time. Given the exploratory nature of behavioral analyses and the number of physical activity and sedentary behavior outcomes examined, these findings should be interpreted cautiously. Conclusions: The school physician-led counseling intervention did not result in a statistically significant between-group difference in TC levels after one year, although the direction and magnitude of change favored the intervention group. The intervention was associated with improved adherence to the Mediterranean diet and favorable exploratory lifestyle-related behavioral changes. Nevertheless, the findings should be interpreted cautiously in light of the relatively small sample size, non-significant primary outcome, and exploratory nature of behavioral analyses. Full article

Background: Return to play (RTP) after total hip arthroplasty (THA) is increasingly expected by younger and more physically active patients. Current activity recommendations remain heterogeneous and are largely derived from expert opinion and indirect biomechanical modelling approaches, rather than direct in vivo biomechanical evidence. The aim of this article is to systematically map and synthesize the evidence from instrumented hip implant studies and to clarify how direct in vivo telemetry data can inform RTP counselling after THA. Methods: A scoping review was conducted according to a predefined Open Science Framework protocol and reported following PRISMA-ScR guidelines. MEDLINE (PubMed) and Scopus were searched from inception. Peer-reviewed clinical studies reporting direct in vivo biomechanical measurements obtained from instrumented hip implants were included. Conference proceedings, technical notes, reviews, and in vitro or computational-only studies were excluded. Data were extracted and synthesized descriptively according to activity domain, biomechanical variables, and implant technology. Results: Fifty studies met the inclusion criteria. Early investigations established feasibility and evolved from wired strain-gauge systems to fully implantable telemetric prostheses capable of measuring three-dimensional forces, moments, and friction-related parameters. Across cohorts, level walking consistently produced peak hip contact forces of approximately 2–3 times body weight, serving as a clinically meaningful reference loading envelope. Several recreational activities—including cycling, aquatic exercise, Nordic walking, and most gym-machine exercises—generally remained within or close to this range when performed with controlled technique. In contrast, certain rehabilitation tasks, forward-bent postures, lifting maneuvers, and perturbation events generated loads equal to or exceeding those observed during walking. Importantly, frictional moments and load direction showed substantial variability and may be more relevant to implant fixation than peak force magnitude alone. Conclusions: Instrumented hip implants provide objective biomechanical benchmarks that support principle-based and individualized RTP counselling, grounded in directly measured mechanical exposure rather than sport classification alone. Full article