Search Results (451)

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: Metabolic syndrome (MS) is a major public health concern linked to an elevated risk of type 2 diabetes and cardiovascular disease. Simple, reliable screening tools are needed for early identification, especially in working populations. Objective: To compare the diagnostic accuracy of body mass index (BMI), waist-to-height ratio (WtHR), triglyceride–glucose index (TyG), and waist–triglyceride index (WTI) for detecting MS based on NCEP ATP III and IDF criteria in a large cohort of Spanish workers. Methods: This cross-sectional study analyzed data from 386,924 Spanish workers. MS was diagnosed using NCEP ATP III and IDF definitions. The four indexes were evaluated by sex using a receiver operating characteristic (ROC) curve analysis. Area under the curve (AUC), optimal cut-off points, and Youden’s index were calculated. Results: TyG and WTI had the highest AUC values in men (0.911 and 0.901, respectively) for NCEP ATP III-defined MS, while WtHR and WTI achieved the best performance in women (0.955 and 0.953, respectively). WtHR outperformed BMI in all subgroups. Optimal cut-off values were identified according to sex and the definition of MS: TyG (8.95 men, 8.51 women), WtHR (0.54 men, 0.51 women), and WTI (170.6 men, 96.5 women), supporting their practical implementation in occupational health programs. All indexes showed significant discriminatory capacity (p < 0.001). Conclusions: TyG, WtHR, and WTI are more effective than BMI in detecting MS among Spanish workers, with sex-specific patterns. Their ease of use and diagnostic strength support their adoption in occupational health programs for early cardiometabolic risk detection. Full article

Background/Objectives: Childhood obesity represents a growing public health concern. It is closely associated with obstructive sleep apnoea (OSA), which impairs nocturnal breathing and significantly affects neurocognitive and cardiovascular health. This review aims to analyse differences in fat distribution, anthropometric parameters, and instrumental assessments of paediatric OSA compared to adult OSA to improve the diagnostic characterisation of obese children. Methods: narrative review. Results: While adenotonsillar hypertrophy (ATH) remains a primary cause of paediatric OSA, the increasing prevalence of obesity has introduced distinct pathophysiological mechanisms, including fat accumulation around the pharynx, reduced respiratory muscle tone, and systemic inflammation. Children exhibit different fat distribution patterns compared to adults, with a greater proportion of subcutaneous fat relative to visceral fat. Nevertheless, cervical and abdominal adiposity are crucial in increasing upper airway collapsibility. Recent evidence highlights the predictive value of anthropometric and body composition indicators such as neck circumference (NC), neck-to-height ratio (NHR), neck-to-waist ratio (NWR), fat-to-muscle ratio (FMR), and the neck-to-abdominal-fat percentage ratio (NAF%). In addition, ultrasound assessment of lateral pharyngeal wall (LPW) thickness and abdominal fat distribution provides clinically relevant information regarding anatomical contributions to OSA severity. Among imaging modalities, dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and air displacement plethysmography (ADP) have proven valuable tools for evaluating body fat distribution. Conclusions: Despite advances in the topic, a validated predictive model that integrates these parameters is still lacking in clinical practice. Polysomnography (PSG) remains the gold standard for diagnosis; however, its limited accessibility underscores the need for complementary tools to prioritise the identification of children at high risk. A multimodal approach integrating clinical, anthropometric, and imaging data could support the early identification and personalised management of paediatric OSA in obesity. Full article

Sex-specific differences in the prevalence of sarcopenia, dynapenia, and the impact of obesity on muscle strength and quality in patients with chronic kidney disease (CKD) remain underexplored. Background/Objectives: In this cross-sectional study, 78 adults with stage 5 CKD undergoing thrice-weekly maintenance hemodialysis in Brazil (44 men, 34 women; mean ± SD age = 57.55 ± 4.06 years) were assessed. Anthropometry (BMI, waist circumference, waist-to-height ratio), dual-energy X-ray absorptiometry, circulating IL-6, Timed Up and Go, handgrip strength (Jamar ^® dynamometer), and muscle quality index (MQI = handgrip/BMI) were obtained. Dynapenia (handgrip < 27 kg men and < 16 kg women) and sarcopenia (1.0 kg/kg for men and 0.56 kg/kg for women) were classified using EWGSOP2-2018 and FNIH thresholds. Results: Compared with reference values, men showed markedly reduced muscle strength and muscle quality (men: handgrip 21.3 ± 5.1 kg; MQI 0.80 ± 0.23 AU) than women. Also, men were 5.1 times more likely to present with dynapenia (88.6%; 95% CI 2.28–11.60) and 3.15 times more likely to present with sarcopenia (75.0%; 95% CI 1.88–5.30) than women. Waist circumference, waist-to-height ratio, BMI, and body fat % correlated inversely with MQI in both sexes (p ≤ 0.01) and with handgrip strength in men (p ≤ 0.01) but not in women. Conclusions: Among hemodialysis patients, men exhibit a substantially higher burden of dynapenia and sarcopenia than women and excess adiposity is independently associated with poorer muscle quality in both sexes. These findings highlight the need for sex-specific screening cut-offs and integrated strategies targeting both muscle dysfunction and central obesity in CKD management. Full article

Background: Currently, there is a lack of data regarding the reliability of different anthropometric, instrumental, and biochemical indexes in detecting metabolic syndrome (MetS) in pediatric patients with Prader–Willi syndrome (PWS). Therefore, this study aimed to compare the accuracy of different indices to identify the simplest and most accurate predictor of MetS in this at-risk population. Methods: We conducted a multicenter study involving 124 children and adolescents with PWS (61 males and 63 females), aged 13.6 ± 3.7 years. For each participant, we assessed all components of MetS, defined according to either the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study or the International Diabetes Federation (IDF) criteria, based on age. The following indexes were calculated: Body Mass Index (BMI), BMI standard deviation score (BMI-SDS), tri-ponderal mass index, body mass fat index, fat mass index, fat-free mass index, body shape index, visceral adiposity index, waist-to-height ratio, cardiometabolic index, total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, and triglycerides/HDL-C (TG/HDL-C) ratio. Results: MetS was identified in 24 subjects (9 females and 15 males), representing 19.4% of the sample. When comparing the receiver operating characteristic (ROC) curves, the TG/HDL-C ratio and cardiometabolic index demonstrated significantly better performance than the other indices in detecting MetS, with no difference between the two. As a result, we focused on the TG/HDL-C ratio since it is the simplest measure, requiring no additional anthropometric data compared to the cardiometabolic index. Additionally, applying age- and gender-specific thresholds can further improve its accuracy. Conclusions: The TG/HDL-C ratio, which requires only two standard biochemical markers, provides the same accuracy as more complex indexes in detecting MetS in children and adolescents with PWS, making it the optimal predictor for MetS in this population. Full article

Background: Childhood and adolescent obesity often coexist with micronutrient deficiencies and metabolic alterations, particularly in marginalized communities. Objectives: This cross-sectional study evaluated the biochemical, anthropometric, and dietary characteristics of 55 children and adolescents (ages 4–13) from Tlaltizapán, Mexico, to identify the early metabolic risk factors associated with excess weight. Methods: Nutritional intake was assessed through six-day dietary recalls and analyzed for adequacy against the national reference values. Anthropometric and biochemical indicators—including the BMI-for-age Z-score, waist-to-height ratio (WHtR), lipid profile, and plasma amino acid levels—were stratified by age and weight status. Results: Overall, 36.4% of participants were overweight or obese. Alarmingly, 89.4% of children and 94.1% of adolescents had low HDL levels, regardless of their BMIs. Several participants with a normal BMI showed elevated WHtR, triceps skinfold, and plasma branched-chain amino acids, suggesting hidden metabolic risks. The dietary analysis revealed an excess intake of sugars, proteins, and fats, alongside insufficient fiber, vitamins, and minerals. The adolescents had poorer adherence to dietary recommendations than children. Conclusions: These findings underscore the limitations of BMI alone and support the use of WHtR, skinfolds, and biochemical markers to detect preclinical obesity. Urgent, targeted nutritional strategies are needed in semi-rural areas to address the double burden of obesity and undernutrition. Full article

Metabolic syndrome (MetS) and its associated cardiometabolic phenotypes significantly contribute to the global burden of cardiovascular disease (CVD), especially in individuals with type 2 diabetes mellitus (T2DM) and prediabetes. This study aimed to explore the association between cardiometabolic phenotypes—specifically, metabolically unhealthy normal weight (MUHNW) and metabolically unhealthy obese (MUHO)—and various cardiovascular risk indices including the triglyceride-glucose (TyG) index and its derivatives, the atherogenic index of plasma (AIP), the cardiometabolic index (CMI), and the cardiac risk ratio (CRR). A total of 300 participants were evaluated (100 with prediabetes and 200 with T2DM). Anthropometric, biochemical, and lifestyle parameters were assessed and stratified across phenotypes. The results demonstrated that cardiovascular risk indices were significantly elevated in the MUHO compared to MUHNW phenotypes, with T2DM patients consistently exhibiting higher risk profiles than their prediabetic counterparts. TyG-derived indices showed strong correlations with BMI, waist–hip ratio (WHR), waist–height ratio (WHtR), and body fat percentage (%BF). The findings suggest that cardiometabolic phenotypes are more strongly associated with elevated cardiometabolic risk indices than body weight alone. These indices may enhance early risk stratification and intervention efforts. The study investigates the association of cardiometabolic phenotypes with surrogate cardiovascular risk indices, not direct CVD outcomes, However, the cross-sectional design and population homogeneity limit the generalizability of the results and preclude causal inference. Full article

Background/Objectives: The prevalence of metabolic syndrome (MetS) among youth is rising, and the increase is closely linked to unhealthy lifestyle patterns. This study aimed to determine the prevalence of MetS among University of Rijeka students and investigate its associations with dietary habits, physical activity, gender, and faculty type (health and non-health faculties). Methods: A cross-sectional study conducted from September 2024 to March 2025 involved 217 randomly selected students from 16 faculties. The validated questionnaires Mediterranean Diet Adherence Screener (MEDAS) and International Physical Activity Questionnaire Short Form (IPAQ-SF), as well as a general data questionnaire, were used alongside anthropometric (height, weight, waist circumference) and biochemical measurements (fasting plasma glucose, triglycerides, HDL cholesterol). MetS was diagnosed using a combination of International Diabetes Federation (IDF) criteria and Polish Experts Consensus (2022) criteria. Statistical analyses included descriptive statistics, t-tests, ANOVA, Spearman’s correlation, and multivariate logistic regression. Results: MetS was identified in 5.5% of students. Significant risk factors included obesity (body mass index, BMI, p < 0.05), low physical activity (IPAQ-SF, p < 0.05), elevated blood pressure (p < 0.01), high triglyceride levels (p < 0.05), and increased waist-to-height ratio (WHtR, p < 0.01). Female students reported lower physical activity than males (p < 0.05), while students from non-health faculties had lower adherence to the Mediterranean diet (MEDAS, p < 0.05) and reduced physical activity (p < 0.05). Higher adherence to the Mediterranean diet correlated with lower BMI and triglyceride levels (p < 0.05), whereas lower adherence was associated with reduced physical activity (Spearman’s r = −0.35, p < 0.01). Logistic regression with WHR as the dependent variable showed waist circumference (WC) as the strongest predictor (OR = 45.925, 95% CI: 5.238–402.666, p = 0.001), followed by triglycerides (OR = 3.395, 95% CI: 1.322–8.718, p = 0.011). BMI was inversely associated with WHR (OR = 0.068, 95% CI: 0.006–0.780, p = 0.031). HDL cholesterol, systolic and diastolic blood pressure, and fasting glucose were not significant predictors (p > 0.05), indicating limited predictive power in this model. Conclusions: The 5.5% MetS prevalence underscores the need for targeted interventions promoting Mediterranean diet adherence and physical activity, particularly among non-health faculty students and females. Longitudinal studies are warranted to assess intervention efficacy. Full article

Saliva was used as non-invasive alternative to blood for diagnosing pathophysiological conditions. This study aimed to assess changes in protein profile in people with obesity after bariatric surgery and to assess the impact of exercise on these changes. The saliva proteome was determined from two-dimensional gels of twenty adults (ten people with normal weight and ten people with obesity). The effects of bariatric surgery and exercise were assessed. A decrease in body weight, body mass index, and waist-to-height ratio was observed after bariatric surgery. Low levels of carbonic anhydrase VI (CA-VI), short palate, lung, and nasal epithelium clone 2 (SPLUNC2), and haptoglobin were observed. One month after bariatric surgery, spots of haptoglobin and SPLUNC2 increased, although one CA-VI spot decreased. Zn-alpha-2 glycoprotein, immunoglobulin chains, and actin-related protein-3, which are high in people with obesity, decreased 1 month after bariatric surgery. Five months after bariatric surgery, the most significant change was the amylase decrease. The exercise-induced changes in salivary proteins increased SPLUNC, CA-VI, type S cystatins, actin cytoplasmic 1, and zinc alpha-2 glycoprotein levels and decrease Ig kappa chain C region and Rab GDP dissociation inhibitor beta. It can be concluded that the salivary proteins change between people with normal weight vs. patients with obesity, as well as after bariatric surgery and exercise programmes. Salivary proteins may be useful biomarkers in non-invasive samples for monitoring and assessing the impact of interventions on people with obesity. Full article

Background/Objectives: Obesity is a major contributor to cardiovascular disease, yet traditional risk assessment methods may overlook behavioral and circadian influences that modulate metabolic health. Chronotype, physical activity, sleep quality, eating speed, and breakfast habits have been increasingly associated with cardiometabolic outcomes. This study aims to evaluate the associations between these behavioral factors and both anthropometric and biochemical markers of cardiovascular risk among obese candidates for bariatric surgery. Methods: A cross-sectional study was conducted in a sample of 286 obese adults (78.3% females, mean 44.3 years, SD = 10.8, mean BMI = 42.5 kg/m², SD = 6.2) followed at a central Portuguese hospital. Chronotype (reduced Morningness–Eveningness Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), physical activity (Godin–Shephard Questionnaire), eating speed, and breakfast skipping were assessed. Cardiovascular risk markers included waist-to-hip ratio (WHR), waist-to-height ratio, A Body Shape Index (ABSI), Body Roundness Index, atherogenic index of plasma (AIP), triglyceride–glucose index (TyG), and homeostatic model assessment for insulin resistance (HOMA-IR). Results: Men exhibited significantly higher WHR, ABSI, HOMA-IR, TyG, and AIP. Eveningness was associated with higher insulin (r = −0.168, p = 0.006) and HOMA-IR (r = −0.156, p = 0.011). Poor sleep quality was associated with higher body fat mass (r = 0.151, p = 0.013), total cholesterol (r = 0.169, p = 0.005) and LDL cholesterol (r = 0.132, p = 0.030). Faster eating speed was associated with a higher waist circumference (r = 0.123, p = 0.038) and skeletal muscle mass (r = 0.160, p = 0.009). Conclusions: Male sex, evening chronotype, and poor sleep quality were associated with more adverse cardiometabolic profiles in individuals with severe obesity. These findings support the integration of behavioral and circadian factors into cardiovascular risk assessment strategies. Full article

Background: Health-related quality of life is a key indicator of well-being that integrates physical, emotional, and social dimensions. Identifying its determinants during childhood and adolescence is essential to guide effective health promotion strategies. Objective: To analyze the association between health-related quality of life and demographic, anthropometric, biochemical, lifestyle, and environmental variables in school-aged children and adolescents. Methods: A cross-sectional study was conducted during the 2023–2024 academic year in northeastern Spain. A total of 571 children and adolescents participated in the study (mean age = 11.64 ± 1.64 years), of whom 254 were girls (44.48%). Health-related quality of life was assessed using the Revised Children’s Quality of Life Questionnaire (KINDL-R), a validated instrument for assessing perceived well-being in pediatric populations. Independent variables included waist-to-height ratio, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, adherence to the Mediterranean diet, weekly physical activity, sleep quality, and residential context (i.e., large urban areas, small urban areas, and municipalities). Multiple linear regression analysis was performed to explore the associations. Results: Older age was associated with lower health-related quality of life (β = −1.07; 95% CI: −1.61 to −0.53; p < 0.001). In contrast, better adherence to the Mediterranean diet (β = 0.72; 95% CI: 0.09 to 1.37; p = 0.023), better sleep quality (b = −2.48; p < 0.001), and participants living in cities and large urban areas reported compared to those in municipalities were associated with higher HRQoL (p < 0.05), with moderate effect sizes. No significant associations were found for sex, waist-to-height ratio, cholesterol levels, or physical activity. Conclusions: This study highlights the importance of adopting a multidimensional approach to promote health-related quality of life in young populations, addressing dietary habits, sleep quality, and environmental factors within health promotion strategies. Full article

Background/Objectives: The eating window concept has been understudied in children, with no reports from Austria. This study explored meal timing and its association with obesity-related variables in a sample of Viennese schoolchildren. The effect of a healthy intervention on obesity variables according to the daily eating window was assessed. Methods: The EDDY study included 138 third-grade students from three Vienna schools. Baseline meal timing was assessed using self-administered questionnaires, and the daily eating window—the time between the first and last meal—was calculated and categorized into tertiles. Anthropometric and body fat measurements were taken at baseline and after 21 months. Baseline outcomes were compared between children with long (LEW; 3rd tertile) and short (SEW; 1st tertile) eating windows using adjusted linear regression analysis. Longitudinal changes were analyzed using mixed models for repeated measures. Results: The median age was 7.9 years, and 26.8% were classified with overweight/obesity. The children’s eating window spanned 11:40 h, from 7:00 to 19:00. More than half (52.2%) reported fasting 1–2 h before bed. Children had four daily meals; 16.4% skipped breakfast, while 51.5% ate it regularly. Meal timing variables did not differ by weight status. Children with a LEW (≥12:05 h) had lower BMI-SDS (−0.66) and fat mass index (−1.06) than those with a SEW (≤11:05 h). No longitudinal changes in BMI-SDS, fat mass index, or waist-to-height ratio were observed across eating window tertiles following the intervention. Conclusions: In a non-representative sample of Viennese children, the eating window ranged from 9:30 to 13:30 h, similar to Austrian adults but differing from other Western European countries. Full article

Background and Objectives: This study aimed to evaluate the impact of myoinositol (MYO) and α-lipoic acid (ALA) supplementation on hormonal and metabolic markers in women diagnosed with polycystic ovary syndrome (PCOS). Materials and Methods: A retrospective case–control study was conducted with 58 women aged between 18–40 years who met the Rotterdam criteria for PCOS. The case group (n = 29) received MYO (2000 mg/day) and ALA (400 mg/day) supplements, while the control group (n = 29) did not receive any treatment. Data on the subjects’ anthropometric measures, glycemic indices, sex hormones, and lipid profiles were collected. Results: The results demonstrated that, following three months of MYO + ALA supplementation, the case group exhibited steady body weight (p = 0.484) and BMI (p = 0.405), whereas the control group demonstrated a significant increase in both (p = 0.029; p = 0.026, respectively). A stratified analysis based on BMI, waist circumference, and waist-to-height ratio revealed that HbA1c (%) was significantly lower in the “normal” subgroup compared to the “risky” subgroup within the case group (p < 0.05). Although the mean HbA1c, insulin, and HOMA-IR values were comparable between the two groups, the LH/FSH ratio significantly increased in the control group (p = 0.010). No significant differences were observed in the lipid profiles between the two groups; however, LDL levels decreased significantly in the case group (p = 0.024). Across all classifications, the “normal” subgroup consistently exhibited lower HbA1c and TG/HDL ratios than the “risky” subgroup. Conclusions: Adding MYO + ALA supplementation to standard PCOS treatment may offer metabolic benefits, particularly in maintaining glycemic control, body weight, and BMI. Supplementation also reduces LDL. Full article

Aim: Insulin resistance (IR) and hyperglycemia have been associated with increased risk of heart failure (HF) in patients with and without diabetes. Global longitudinel strain (GLS) has been shown to be superior in the detection of left ventricular (LV) systolic dysfunction when compared to ejection fraction (EF). In this study, we aimed to assess GLS in relation to IR and pre-diabetes. Method: All participants underwent an echocardiography to assess LV systolic function using GLS. IR was evaluated using homeostatic model assessment for IR (HOMA-IR), and the participants were divided into tertiles based on their HOMA-IR values. An oral glucose tolerance test (OGTT) was performed to divide participants into normal glucose tolerance (NGT) and pre-diabetes. A multivariable linear regression model was used to assess GLS in relation to IR and glycemic groups. Results: In total, 359 men without significant coronary artery disease (CAD) and without diabetes were enrolled. Participants in the higher HOMA-IR tertile had significantly reduced GLS when compared with participants in the lower HOMA-IR tertile (−17.9% vs. −18.7%, p < 0.01). A significant trend was observed towards reduced GLS with increasing HOMA-IR tertile (p-trend 0.005). However, in the multivariable regression model, only waist-to-height-ratio (WH) (β 7.1 [95% CI 3.1–11.1, p = 0.001) remained significantly associated with GLS, whereas HOMA-IR tertile and pre-diabetes were not. Conclusions: In asymptomatic elderly men with no diabetes or CAD, neither IR nor pre-diabetes was associated with GLS in the adjusted regression model. Increased WH seems to be associated with reduced systolic function by GLS measurement. Full article

Objectives: Type 1 diabetes is characterized by hyperglycemic episodes influenced by diet, sleep quality, chronotype, and physical activity, among others. While aerobic exercise is known to improve glycemic control, its effect on blood glucose regulation remains underexplored. Thus, this case study aimed to evaluate the effects of a prolonged and differentiated indoor and outdoor exercise intervention on glycemic control in an individual with type 1 diabetes. Methods: The participant (age: 23 years; weight: 95 kg; height: 1.90 m; Body Mass Index: 26.3 kg/m²; waist to hip ratio: 0.98; basal metabolic rate: 2015 kcal; Heart Rate Maximum (HRmax): 197 beats·min⁻¹) completed two outdoor (~3800 m) and two indoor sessions with self-selected speed, in the initial 2 min stage, at a 0% grade slope. The grade increased by 2% at each stage during the uphill phase until reaching volitional fatigue, followed by a 2% decrease at each stage during the downhill phase until returning to a 0% grade. Blood pressure was assessed before and after each session. Daily nutrition intake, insulin intake, and blood glucose were continuously monitored. Dietary adherence (PREvención con DIeta MEDiterránea), sleep quality (Pittsburgh Sleep Quality Index), chronotype (Morningness–Eveningness Questionnaire), and physical activity levels (International Physical Activity Questionnaire) were assessed before each session. The Physical Activity Enjoyment Scale was used to measure enjoyment after each session. Results: The sessions were completed in ~44 and ~39 min with the participant achieving 84% (outdoor) and 96% (indoor) of their theoretical HRmax. The intervention resulted in glycemic improvements, with time spent in hyperglycemia (>250 mg/dL) decreasing from 56.46% to 0%, while time in the normal range (70–180 mg/dL) increased to 63.96%. A 47% reduction in insulin units showed that insulin sensitivity also improved. Conclusions: Despite differences in intensity, indoor and outdoor activities yielded comparable benefits, with outdoor activities being perceived as more enjoyable (outdoor: 28.5 ± 0.7; indoor: 24.0 ± 5.6) and positively impacting glycemic control, thus supporting the need for tailored strategies in diabetes management. Full article