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Background: Heart failure (HF) imposes limitations due to severe dyspnea and fatigue, which are often linked to diminished exercise tolerance, potentially influenced by compromised microvascular density, blood flow, and muscle strength. Myofascial release techniques (MRT) have demonstrated the capacity to enhance blood flow by reducing fascial tension., Purpose: To assess the impact of incorporating MRT into Circuit Resistance Training (CRT) in comparison to an unsupervised home-based rehabilitation (RUHB) program on exercise tolerance (ET), muscle strength (MS), quality of life (QoL), and depression in patients with HF., Methods: A randomized clinical trial involved HF patients with reduced ejection fraction (HFrEF, ejection fraction <50%) and NYHA classes II-IV. Participants were randomly assigned to either CRT (performing 2 circuits of 8 exercises thrice a week for three months) or CRT+MRT (receiving a combination of CRT and 6 MRT interventions once a week). Assessments included cardiopulmonary exercise tests (CPET) to measure ET, MS evaluated through One Repetition Maximum (1RM), QoL using the Minnesota Living with HF Questionnaire (MLwHFQ), and Depression through the Beck Depression Inventory (BDI) conducted before and after the interventions., Results: Thirty-eight patients (14 in CRT, 14 in CRT+MRT, and 10 in RUHB), with a mean age of 55 years and 50% male, completed the study. After 12 weeks, only the CRT group displayed a significant effect in certain ET variables VO2 peak [baseline 12 (9-15) vs post 16 (11-19) ml/kg/min, p<0.05], VO2peak (ml/min) [baseline 848 (640-1056) vs post 1103 (852-1355) p<0.05], VE/VCO2 slope [baseline 34 (27-41) vs post 31 (27-36) p<0.05] and VO2/HRpeak [baseline 7 (5-9) vs post 11 (8-14) p<0.05]. There were significant decreases in the ΔMLwHFQ in the CRT group vs. RUHB (p<0.001) and CRT+MRT group vs. RUHB (p<0.001), demonstrating improved quality of life after 12 weeks in CRT and CRT+MRT groups., Conclusion: Our findings suggest that CRT alone is sufficient to enhance cardiorespiratory function and muscle capacity, improve the quality of life, and alleviate depression in individuals with HF., Competing Interests: NO authors have competing interests., (Copyright: © 2024 Thomaz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: School physical education is an important population-level health intervention for improving youth fitness. This study estimated the impact of New York City's PE Works program - which included providing PE teachers, training for classroom teachers, and administrative/ teacher support for PE - on student cardiorespiratory fitness as measured by the FitnessGram's 15-meter PACER test for aerobic capacity., Methods: This longitudinal study (2014/15-2018/19) includes 581 elementary schools (n = 315,999 4th /5th -grade students; 84% non-white; 74% who qualify for free or reduced-price meals, a proxy for socioeconomic status). We apply the parametric g-formula to address schools' time-varying exposure to intervention components and time-varying confounding., Results: After four years of staggered PE Works implementation, 49.7% of students/school (95% CI: 42.6%, 54.2%) met age/sex-specific Healthy Fitness Zone (HFZ) aerobic capacity standards set by the FitnessGram. Had PE Works not been implemented, we estimate 45.7% (95% CI: 36.9%, 52.1%) would have met aerobic capacity HFZ standards. Had PE Works been fully implemented in all schools from the program's inception, we estimate 57.4% (95% CI: 49.1%, 63.3%) would have met aerobic capacity HFZ standards. Adding a PE teacher, alone, had the largest impact (6.4% (95% CI: 1.0, 12.0) increase)., Conclusion: PE Works positively impacted student cardiorespiratory fitness. Mandating and funding multicomponent PE programs is an important public health intervention to increase children's cardiorespiratory fitness., Competing Interests: Declarations Ethics approval and consent to participate Informed consent for parents/guardians of participants under the age of 16 was not required as this was a secondary data analysis using de-identified school-level data. Study procedures, including a waiver for consent to participate, were approved by UC Berkeley’s Committee for the Protection of Human Subjects (#202009 − 13643) and NYCDOE’s Institutional Review Board (#3788). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: To investigate the physical activity (PA) intensity associated with cardiometabolic health when considering the mediating role of cardiorespiratory fitness (CRF)., Methods: A subsample of males and females aged 50-64 years from the cross-sectional Swedish CArdioPulmonary bioImage Study was investigated. PA was measured by accelerometry and CRF by a submaximal cycle test. Cardiometabolic risk factors, including waist circumference, systolic blood pressure, high-density lipoprotein, triglycerides and glycated haemoglobin, were combined to a composite score. A mediation model by partial least squares structural equation modelling was used to analyse the role of CRF in the association between PA and the composite score., Results: The cohort included 4185 persons (51.9% female) with a mean age of 57.2 years. CRF mediated 82% of the association between PA and the composite score. The analysis of PA patterns revealed that moderate intensity PA explained most of the variation in the composite score, while vigorous intensity PA explained most of the variation in CRF. When including both PA and CRF as predictors of the composite score, the importance of vigorous intensity increased., Conclusion: The highly interconnected role of CRF in the association between PA and cardiometabolic health suggests limited direct effects of PA on cardiometabolic health beyond its impact on CRF. The findings highlight the importance of sufficient PA intensity for the association with CRF, which in turn is linked to better cardiometabolic health., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Cardiorespiratory fitness (CRF) is a stronger predictor of mortality than traditional risk factors and is a neglected vital sign of health. Enhanced fitness is a cornerstone in diabetes management and is most often delivered concurrently with pharmacological agents, which can have an opposing impact, as has been reported with metformin. Considering the rapid evolution of diabetes medications with improved cardiovascular outcomes, such as glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors, it is of importance to consider the influence of these vis-a-vis effects on CRF., Materials and Methods: Combining the words glucagon-like peptide-1 receptor agonists and sodium glucose cotransporter-2 inhibitors with cardiorespiratory fitness, an online search was done using PubMed, Embase, Scopus, Web of Science, Scientific Electronic Library Online, and Cochrane., Results: There were only a few randomized controlled studies that included CRF, and the results were mostly neutral. A handful of smaller studies detected improved CRF using sodium glucose cotransporter-2 inhibitors in patients with congestive heart failure., Conclusions: Since CRF is a superior prognosticator for cardiovascular outcomes and both medications can cause lean muscle mass loss, the current review highlights the paucity of relevant interactive analysis., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

The decline in fitness levels among children and adolescents underscores the urgent need for effective exercise interventions. Aerobic endurance training (ET) and resistance training (RT) are vital for physical development in this demographic. This study employs multivariate and network meta-analysis (NMA) to assess the impact of concurrent training (CT), which integrates both ET and RT, on youth physical fitness. The objective is to identify the distinct advantages of CT over either ET or RT alone, emphasizing demographic and training-specific variables. A systematic literature review of publications from 1980 onward was conducted through ISI Web of Science, PubMed/MEDLINE, and SPORTDiscus databases, adhering to the PICOS criteria for study selection. Data were analyzed using univariate, multivariate, and network meta-analyses in Stata 17.0, focusing on cardiorespiratory fitness and muscular strength. The methodological quality and risk of bias were evaluated using the PEDro scale and Egger's test, along with sensitivity analyses and meta-regression to explore heterogeneity and publication bias. This analysis included 36 studies with 2658 participants (mean age: 14.32 ± 2.29 years) from an initial 11 074 publications, indicating low bias risk (PEDro scores ≥ 6). Univariate meta-analysis showed no significant differences in maximal oxygen uptake (VO 2 max) between CT and ET (standardized mean difference [SMD] = 0.01; 95% confidence interval [CI]: -0.23 to 0.25; p = 0.93). In contrast, CT significantly improved countermovement jump (CMJ) compared to RT alone (SMD = 0.19; 95% CI: 0.01-0.36; p = 0.04). Multivariate analysis confirmed notable enhancements in endurance and explosiveness for CT compared to ET or RT. NMA indicated significant improvements in lower limb strength, CMJ, and VO 2 max across interventions compared to controls, with the consecutive resistance training followed by ET (CRE) group yielding the most significant CMJ improvement (SMD = 0.27; 95% CI: 0.07-0.47). Isolated RT showed the highest lower limb strength improvement (SUCRA score 80.1%), while CRE excelled in CMJ advancements (SUCRA score 93.4%), and the CRED group (alternating ET and RT) led in VO 2 max improvements (SUCRA score 81.6%). Furthermore, high-intensity interval training (HIIT) significantly enhanced VO 2 max compared to team sports. This meta-analysis emphasizes the effectiveness of CT in improving muscle power and VO 2 max in children and adolescents, surpassing isolated ET or RT, and advocates for integrating ET and RT to optimize physical performance. Future research should explore the mechanisms underlying these enhancements. Trial Registration: PROSPERO registration number CRD42022368452., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The study aimed to establish the test-retest reliability of detrended fluctuation analysis of heart rate variability (DFA-α1) based exercise intensity thresholds, assess its agreement with ventilatory- and lactate-derived thresholds and the moderating effect of sex and cardiorespiratory fitness (CRF) on the agreement. Intensity thresholds for thirty-seven participants (17 females) based on blood lactate (LT 1 /LT 2 ), gas-exchange (VT 1 /VT 2 ) and DFA-α1 (αTh 1 /αTh 2 ) were assessed. Heart rate (HR) at αTh 1 and αTh 2 showed good test-retest reliability (coefficient of variation [CV] < 6%), and moderate to high agreement with LTs ( r  = 0.40 - 0.57) and VTs ( r  = 0.61 - 0.66) respectively. Mixed effects models indicated bias magnitude depended on CRF, with DFA-α1 overestimating thresholds versus VTs for lower fitness levels (speed at VT 1 <8.5 km⋅hr -1 ), while underestimating for higher fitness levels (speed at VT 2 >15 km⋅hr -1 ; VO 2max >55 mL·kg -1 ·min -1 ). Controlling for CRF, sex significantly affected bias magnitude only at first threshold, with males having higher mean bias (+2.41 bpm) than females (-1.26 bpm). DFA-α1 thresholds are practical and reliable intensity measures, however it is unclear if they accurately represent LTs/VTs from the observed limits of agreement and unexplained variance. To optimise DFA-α1 threshold estimation across different populations, bias should be corrected based on sex and CRF.

OBJECTIVE: To determine if current exercise interventions were effective at improving physical activity (PA) levels and/or cardiorespiratory fitness (CRF) in postpartum women. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: CINAHL, Embase, Medline, PsycINFO, and SPORTDiscus were searched from inception to March 2024. STUDY SELECTION CRITERIA: Participants : postpartum women; intervention : exercise; control : standard care; outcomes : PA levels and/or CRF. DATA SYNTHESIS: Random effects meta-analysis using standardized mean differences (SMDs). Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) and Risk of Bias in Non-Randomized Studies - Intervention (ROBINS-I). RESULTS: A total of 6041 studies were screened, and 29 were eligible for inclusion. Nineteen studies with adequate control data included outcomes related to PA levels (n = 12) or CRF (n = 7) and were pooled in meta-analyses. There was a small to moderate improvement in CRF (SMD, 0.65; 95% CI [confidence interval]: 0.20, 1.10; I 2 = 61%). There was no improvement in PA levels (SMD, -0.13; 95% CI: -0.53, 0.26; I 2 = 90%). Frequency, intensity, type, and time of the exercise interventions varied. Twenty-three studies were at high or serious risk of bias. CONCLUSIONS: Postpartum exercise interventions may improve CRF but have an unclear effect on PA levels. Despite numerous exercise interventions to improve health outcomes postpartum, parameters were inconsistent. J Orthop Sports Phys Ther 2024;54(11):687-701. Epub 9 October 2024. doi:10.2519/jospt.2024.12666 .

There is growing interest in identifying the mechanisms underpinning the effects of physical activity on executive functions (e.g. inhibitory control, cognitive flexibility) in children. Our study examined cardiorespiratory fitness, muscular fitness, and motor competence as potential mediators of this relationship. The study used baseline data from the Learning to Lead (L2L) cluster randomised controlled trial. In total, 675 children (7-11 years, 49.5% girls) completed measures of moderate-to-vigorous physical activity (MVPA), cardiorespiratory fitness, muscular fitness, motor competence, and executive functions. Structural equation modelling was used to examine the potential mediating roles of cardiorespiratory fitness, muscular fitness, and motor competence in the cross-sectional association between MVPA and executive functions. Cardiorespiratory fitness ( β  = 0.06, SE = 0.021, p  = 0.004) partially mediated the association between MVPA and cognitive flexibility. Muscular fitness was a significant mediator of the association between MVPA and both inhibitory control ( β  = 0.03, SE = 0.014, p  = 0.027) and cognitive flexibility ( β  = 0.06, SE = 0.021, p  = 0.005). No significant mediated effects were found for motor competence. Our findings suggest cardiorespiratory and muscular fitness (but not motor competence) mediate the association between physical activity and executive functions in children.

Background: Monitoring health-related physical fitness (HRPF) may benefit proactive Inflammatory Bowel Disease (IBD) management. However, knowledge regarding HRPF in patients with IBD is limited and gold standard tests are impractical for widespread use, necessitating simpler methods., Aim: This study evaluated the criterion validity of screening tools and field-based tests compared to gold standard tests for HRPF in patients with IBD., Methods: Adult patients with IBD completed screening tools, field-based tests, and gold standard tests for HRPF. Criterion validity was examined through (intraclass) correlation coefficients and Bland-Altman plots. Predictive capacity of the screening tools was examined with receiver operating curve analysis., Results: Among 53 included patients, screening tools demonstrated poor-to-moderate validity compared to the cardiopulmonary exercise test (CPET) for cardiorespiratory fitness. Very strong correlations were found for four-site skinfold thickness and multi-frequency bioimpedance analysis (BIA) with deuterium oxide dilution for body fat percentage (ICC = 0.90, ICC = 0.93), and between the steep ramp test and CPET (r = 0.95) for cardiorespiratory fitness. The steep ramp test also correlated strongly with isokinetic quadriceps (r > 0.75) and hamstring (r > 0.74) strength. Hand-held dynamometry and the sit-to-stand test showed strong correlations with hamstring strength (r > 0.80, r > 0.76). Negligible correlations were found for field-based tests compared to isokinetic quadriceps and hamstring endurance., Conclusions: Four-site skinfold thickness and BIA showed good agreement with the gold standard for body fat measurement. The steep ramp test demonstrated strong correlations with the gold standard tests for cardiorespiratory fitness and quadriceps and hamstring strength, while hand-held dynamometry and the sit-to-stand test showed strong correlations with hamstring strength., Competing Interests: Declarations Conflict of interest Daisy M.A.E. Jonkers reports grant from the public-private partnership grants of Dutch Top Institute of Food and Nutrition (TIFN), Top Knowledge Institute (TKI) Agri&Food and Health Holland, by the Carbokinetics program as part of the NWO-CCC Partnership Program, by Organic A2BV/Mothersfinest BV and, EU/FP7 SysmedIBD/305564, BIOM/305479 and Character/305676, H2020 DISCOvERIE/848228, all outside the submitted work. Marieke J. Pierik reports grants and non-financial support from Falk Pharma, grants from European commission, grants from ZONMW (Dutch national research fund), grants and non-financial support from Takeda, grants and non-financial support from Johnson and Johnson, grants and non-financial support from Abbvie, non-financial support from Ferring, non-financial support from Immunodiagnostics, non-financial support from MSD, all outside the submitted work. Laurents P.S. Stassen serves on the advisory board of Diagnostic Green Gmbh and has served as a speaker and received research support from Takeda, outside the submitted work. For the remaining authors none were declared. Ethical approval This study was conducted in compliance with the Declaration of Helsinki and was approved by the Medical Ethical Committee of the Maastricht University Medical Center + (registration no. 22–012). Consent to participate Informed consent was obtained from all individual participants included in the study., (© 2024. The Author(s).)

There are known sex differences in cardiorespiratory fitness (CRF). Little is known about the impact of pubertal blockade with a gonadotropin-releasing hormone agonist (GnRHa) followed by hormone therapy on CRF for transgender adolescents. We aimed to 1 ) determine the effect of GnRHa monotherapy on CRF and mitochondrial function and associations with metabolomic profiles and 2 ) evaluate changes after 1 and 12 mo of testosterone therapy among transgender adolescents. Participants assigned female at birth ( n = 19, baseline age of 15.0 ± 1.0 yr) from two groups: GnRHa + ( n = 8) and GnRHa - ( n = 11) were examined at baseline and 1- and 12-mo post-testosterone therapy in a longitudinal observational study to assess cardiorespiratory fitness, mitochondrial respiration, and metabolic profile. Fasted morning labs included assessment of metabolomics and peripheral blood mononuclear cell mitochondrial respiration and degree of mitochondrial coupling (respiratory control ratio, RCR). A graded cycle ergometer test was performed. Baseline differences were evaluated between groups. Changes were compared with mixed linear regression models evaluating time (baseline, 1 mo, and 12 mo), group (GnRHa treatment yes/no), and their interaction. At baseline GnRHa + individuals had higher relative V̇o 2peak (30.1 ± 4.83 vs. 25.24 ± 4.47 mL/kg/min, P = 0.042) than GnRHa - individuals. In regression models, GnRHa + individuals had a significant increase in peak watts ( P = 0.011) and total exercise time ( P = 0.005) after 12 mo of testosterone ( P = 0.012) but not GnRHa - individuals. GnRHa + individuals have significantly higher RCR under carbohydrate ( P = 0.0007) and lipid ( P = 0.0002) conditions than GnRHa + individuals. Pretreatment with GnRHa positively influences peak CRF and mitochondrial respiration in adolescent transgender males undergoing testosterone therapy. NEW & NOTEWORTHY This study demonstrates differences in exercise capacity and mitochondrial respiration at baseline based on whether or not individuals had feminizing puberty blocked. Individuals who had puberty blocked had greater improvements in cardiopulmonary exercise testing parameters after 12 mo of testosterone than those who went through feminizing puberty.

Background: Little is known about the cardiorespiratory fitness (CRF)-cardiometabolic risk relationship in Latin American pediatric populations across different age/sex groups, especially when considering the potential effects of adiposity on the association. We evaluated cross-sectional associations between VO 2max and cardiometabolic risk variables (CMRV), and verified whether the associations were independent of adiposity markers in school-aged children and adolescents from Cali, Colombia., Methods: The sample consisted of 1206 children aged 5-17 years. CMRV were fasting glucose, HDL and LDL cholesterol, triglycerides, systolic, and diastolic pressure. Logistic regressions were conducted for associations of age/sex-specific tertiles of VO 2max with age/sex-specific highest tertiles of CMRV (except HDL-C, lowest tertile) and a CMR cluster (> 2 CMRV in extreme tertiles), adjusting for socioeconomic stratum, and adiposity markers (BMI, body fat percentage, and waist circumference)., Results: Overweight/obesity ranged from 15% to 18% with no difference by sex. In children aged 5-11 years, high VO 2max (highest tertile vs. lowest) was inversely associated with the CMR cluster [Odds ratio (95% confidence interval): 0.18 (0.06-0.47), p < 0.05] independently of adjustment for any adiposity marker in boys but not in girls. In the age group of 12-17 years, there were initially significant VO 2max - CMR cluster and VO 2max - CMRV associations but attenuated by adiposity adjustment. In girls, high VO 2max was inversely associated with high systolic blood pressure regardless of adjustment for adiposity markers., Conclusion: VO 2max is inversely associated with cardiometabolic risk, but adiposity influences the association. The adiposity-independent association among younger boys requires further research. Interventions to tackle cardiometabolic risk in childhood may primarily focus on reducing excess adiposity, and secondarily on improvement of CRF., (© 2024 Wiley Periodicals LLC.)

Introduction: Cancer-related cognitive impairment (CRCI) is a significant but often neglected issue for breast cancer survivors that reduces their quality of life. Physical exercise and cognitive training have emerged as promising strategies for CRCI; however, evidence regarding its effectiveness is still unknown. A recently developed motor-cognitive training (dual-tasks) is proposed to examine its efficacy on executive function, physical fitness, emotional symptomatology, and important muscle-brain crosstalk biomarkers., Methods: The BRAINonFIT study is a randomised, controlled, longitudinal (20 weeks), three-arm, parallel study with a follow-up phase (12 weeks). Breast cancer survivors (stage I-IIIA) with completed chemotherapy are recruited from QuirónSalud Hospital in Seville. Principal outcomes are executive functions, measured by the Trail Making Test, Stroop and Digit Span Backwards; physical fitness, assessed by muscle strength, cardiorespiratory fitness, and body composition; and several muscle-brain biomarkers analysed by immunoenzymatic assay (ELISA). Secondary endpoints are memory function, intelligence, learning ability, self-reported cognitive function, and emotional symptomatology. Assessments take place after the enrolment (baseline; T 1 ), after completing the interventions (5 months after baseline; T 2 ), and after completing the follow-up period (8 months after baseline; T 3 )., Discussion: Given the importance of improving care for breast cancer survivors, this study will provide preliminary evidence for the effectiveness of cognitive-motor training (dual task) as a therapeutic strategy to improve CRCI. Moreover, addressing muscle-brain crosstalk by representative biomarkers will help to elucidate the underlying mechanisms by which this intervention may beneficially impact CRCI., Clinicaltrials: gov: NCT06073717., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

The aim of this study was to examine the moderating role of cardiorespiratory fitness (CRF) between the relationship of cardiometabolic risk factors and adiponectin in adolescents. This is a cross-sectional study conducted with 255 adolescents of both sexes, aged 11 to 17 years. Anthropometric and biochemical parameters such as body mass, height, fat mass (FM), fat-free mass, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, insulin, adiponectin, systolic blood pressure, diastolic blood pressure, and peak oxygen consumption (VO2peak) were measured. Body mass index z-score (BMI-z), tri-ponderal mass index (TMI), homeostasis model assessment insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and age peak height velocity were calculated. The moderation analyses were tested using linear regression models. Interaction was observed with low CRF, indicating that those who achieved more than 2.27 (BMI-z), 2.18 (TMI), 2.10 (FM), 2.57 (insulin), 2.65 (HOMA-IR), and 2.81 (QUICKI) in L·min-1 on the CRF test may experience reduced risks in cardiometabolic risk factors., Conclusion: The deleterious effects attributed to excess adiposity and unfavorable changes related to insulin resistance and sensitivity may be attenuated by CRF., What Is Known: • Adiponectin, a protein derived from adipose tissue, may play a role as a potential marker of protection and predictor of cardiometabolic disorders and its relationship with cardiorespiratory fitness is controversial., What Is New: • The deleterious effects attributed to overweight and unfavorable changes related to insulin resistance and sensitivity may be attenuated by high cardiorespiratory fitness in adolescents., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Physiological fitness, encompassing cardiorespiratory fitness (CRF) and body composition, are important markers of overall health, functional capacity, and quality of life in general and clinical populations. Characterizing fitness is important for the development of tailored interventions and strategies to optimize well-being across the spectrum of disability in multiple sclerosis (MS). While existing research has explored fitness in people with mild-to-moderate disability, there is a scarcity of data in people with advanced MS (Expanded Disability Severity Scale, EDSS≥7.0)., Objective: To characterize CRF and body composition and their associations with fatigue, quality of life, and function in individuals with advanced MS., Methods: Participants (n=18, mean age=60.7 years-old, median EDSS=7.5) underwent a cardiopulmonary exercise test and dual-energy X-ray absorptiometry scanning. Main outcomes included peak volume of oxygen uptake (V̇O 2peak ) and whole and regional body fat, lean mass, bone mineral content, and bone density. Symptoms of fatigue (Modified Fatigue Impact Scale, MFIS), quality of life (29-item MS Impact Scale, MSIS-29), and daily function (Late-Life Function and Disability Instrument, LLFDI) were collected., Results: Participants exhibited notably low CRF levels (V̇O 2peak =9.8 mL/min/kg) and poor body composition (lower lean mass, bone mineral content and density) compared to previous studies in the general population and in individuals with MS with lower disability. V̇O 2peak was most consistently associated with function in daily life (LLFDI scores, r s ≥0.637, p≤0.004)., Conclusion: These findings reinforce the potential importance of physiological fitness to preserve function in people with advanced MS., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest related to this manuscript., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: To assess the association between cardiorespiratory fitness (CRF) and COVID-19-related health outcomes including mortality, hospitalization, and mechanical ventilation., Patients and Methods: In a retrospective analysis of 750,302 patients included in the Exercise Testing and Health Outcomes Study, we identified 23,140 who had a positive result on COVID-19 testing between March 2020 and September 2021 and underwent a maximal exercise test in the Veterans Affairs Health Care System between October 1, 1999 to September 3, 2020. The association between CRF and risk for severe COVID-19 outcomes, including mortality, hospitalization due to COVID-19, and need for intubation was assessed after adjustment for 15 covariates. Patients were stratified into 5 age-specific CRF categories (Least-Fit, Low-Fit, Moderate-Fit, Fit, and High-Fit), based on peak metabolic equivalents achieved., Results: During a median of follow-up of 100 days, 1643 of the 23,140 patients (7.1%) died, 4995 (21.6%) were hospitalized, and 927 (4.0%) required intubation for COVID-19-related reasons. When compared with the Least-Fit patients (referent), the Low-Fit, Moderate-Fit, Fit, and High-Fit patients had hazard ratios for mortality of 0.82 (95% CI, 0.72 to 0.93), 0.73 (95% CI, 0.63 to 0.86), 0.61 (95% CI, 0.53 to 0.72), and 0.54 (95% CI, 0.45 to 0.65), respectively. Patients who were more fit also had substantially lower need for hospital admissions and intubation. Similar patterns were observed for elderly patients and subgroups with comorbidities including hypertension, diabetes, cardiovascular disease, and chronic kidney disease; for each of these conditions, those in the High-Fit category had mortality rates that were roughly half those in the Low-Fit category., Conclusion: Among patients positive for COVID-19, higher CRF had a favorable impact on survival, need for hospitalization, and need for intubation regardless of age, body mass index, or the presence of comorbidities., (Copyright © 2024 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Aim: Poor cardiorespiratory fitness has been suggested to increase the risk of chronic diseases in obesity. We investigated the ability of key variables from cardiopulmonary exercise testing (CPET) to predict all-cause mortality in an obese cohort., Methods: The sample included 469 participants of both sexes (mean age 40 ± 13 years) who underwent a CPET for clinical reasons between 1 March 2009 and 1 December 2023. All-cause mortality was the prognostic endpoint. A receiver operating characteristic analysis was performed to establish optimal cut-points for CPET variables. Kaplan-Meier and Cox regression analyses were used to determine the association between CPET variables and all-cause mortality., Results: There were 46 deaths during a mean follow-up period of 69 ± 48 months, resulting in an annual mortality rate of 2%. Despite the sample being made up of mostly women (70%), there were more deaths in men (18 vs. 6%, p < 0.001).The optimal thresholds for discrimination of survival were as follows: (a) peak oxygen uptake (pVO 2 ) ≤16 mL/kg/min; (b) minute ventilation/carbon dioxide production (V E /VCO 2 ) slope ≥31; (c) ventilatory power ≤5.8 mmHg; and (d) circulatory power ≤2980 mmHg/mL O 2 /min. Kaplan-Meier survival plots revealed a significant positive association between lower pVO 2 , circulatory power and ventilatory power values and survival (log-rank, p < 0.001) and higher mortality for men than women. Adjusted Cox regression models showed that a pVO 2 ≤16 mL/kg/min had a 20-fold higher risk of mortality when compared with >16 mL/kg/min., Conclusion: Given the strong association of VO 2 , ventilatory efficiency, circulatory and ventilatory power with all-cause mortality, our findings support the notion that poorer cardiorespiratory fitness is associated with a poor prognosis in patients with obesity., (© 2024 John Wiley & Sons Ltd.)

Aims: To investigate the relationship between cardiorespiratory fitness (CRF) and liver fat content (LFC) in community-based participants and highlight their relationship in people with different body mass indices (BMIs)., Materials and Methods: Using UK Biobank data, CRF was estimated with bicycle ergometer fitness testing and was evaluated based on physical work capacity at 75% maximum heart rate (PWC 75% ). LFC was quantified through liver proton density fat fraction (PDFF) on magnetic resonance imaging. Multivariate linear regression models were used to analyse the associations of CRF and BMI with absolute reduction and percentage change in PDFF (%)., Results: In total, 5765 participants with a mean age of 55.57 years and a median (range) follow-up of 10.7 (4.0-17.7) years were included. Compared with the lowest PWC 75% tertile, the absolute reduction and percentage change in PDFF in the highest PWC 75% tertile were -0.450 (95% confidence interval [CI] -0.699 to -0.192) and -4.152 (95% CI -6.044 to -2.104), respectively. These associations were independent of BMI, and individuals with obesity and normal weight had the largest absolute reduction and percentage change in LFC, respectively (p for interaction <0.001). Joint analysis showed that PWC 75% and BMI had a negative dose-response relationship with PDFF. These associations were consistent in different sex and age subgroups (p for interaction >0.05)., Conclusions: There was a significant negative association between CRF and LFC, and this association was independent of BMI. The results of this study strongly recommend improving CRF to mitigate LFC., (© 2024 John Wiley & Sons Ltd.)

Purpose: To investigate the effects of an 8-wk AHIIT-DWR intervention compared with land-based HIT training (LHIIT) on cardiometabolic health, cognitive, and psychological outcomes in inactive elderly women., Methods: Seventy inactive elderly women aged 60 yr or above were randomly assigned into two groups: AHIIT-DWR and LHIIT. The AHIIT-DWR group engaged in DWR sessions comprising 30 min of interval training, consisting of ten 2-min exercise bouts at 80%-90% of their maximal heart rate (HR max ), with 1-min active recovery at 70% HR max between bouts, for two sessions per week, for 8 wk. The LHIIT group performed treadmill running at the same intensity., Results: Both groups showed similar cardiovascular fitness, maximal aerobic capacity (V̇O 2max ), HR max , and RER improvement ( P > 0.05), whereas AHIIT-DWR showed a significant improvement in aerobic capacity minute ventilation (V̇E), metabolic equivalents (METs), and O 2 pulse ( P < 0.05) over the 8-wk intervention. Both AHIIT-DWR and LHIIT significantly decreased triglycerides, total cholesterol, HDL, and LDL postintervention ( P < 0.05). No significant group differences were observed for cognitive function assessed by MMSE and MOCA ( P > 0.05). Both groups showed similar enjoyment levels, self-efficacy scores, and high adherence rates (>90%)., Conclusions: Our study suggests that AHIIT-DWR can elicit a similar improvement in cardiorespiratory health, metabolic blood markers, cognitive function assessed by MMSE and MOCA, and psychological responses as LHIIT in inactive elderly women., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine.)

Objective: To compare the cardiovascular risk and physical fitness, according to type of school in a national sample of Chilean school students., Methods: A total of 7,218 students participated, who completed all the national tests of the National System for Measuring the Quality of Education, which included physical fitness and anthropometric tests. The results were compared according to the type of educational establishment and anthropometric indicators were considered. Physical fitness was measured by lower extremity strength, abdominal strength, upper extremity strength, trunk flexibility, exertional heart rate, and cardiorespiratory fitness. Body mass index, heart rate, and waist-to-height ratio were analyzed as predictors of cardiovascular risk., Results: There were differences according to the type of establishment in the predictors of cardiovascular risk (p < 0.05). Differences were also found in the physical fitness tests evaluated (p < 0.01). Students in private schools (PSC) and subsidized schools (SC) had lower levels of cardiovascular risk and higher levels of physical fitness than public schools (PS) and schools with delegated administration (DA)., Conclusions: In conclusion, students in educational establishments with a higher socioeconomic level have lower levels of cardiovascular risk and better physical fitness than students in public establishments. The authors suggest considering specific school interventions to mitigate cardiovascular risk and improve physical fitness among this vulnerable population. To this end, future studies should analyze the characteristics of physical activity and nutritional habits in schools to determine the factors that affect the results., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Editora Ltda.)

Objective: Previously, we have found increased carotid-to-femoral pulse wave velocity (cfPWV) among shift workers compared to day workers in industry, and a decline in maximal oxygen uptake (V̇O 2max ) in all 86 workers., Methods: Utilizing all available measurements in 2018, 2021, and 2022, this study investigated associations between V̇O 2max and measures of arterial stiffness. Using a mixed model approach, we analyzed the cross-sectional association between all V̇O 2max (outcome) and measures of arterial stiffness (covariates)., Results: We observed a significant association between V̇O 2max and cfPWV of -1.59 (95% confidence interval [CI], -3.03 to -0.16), and between augmentation pressure (AP) and augmentation index (Aix) of -0.32 (95% CI, -0.58 to -0.06) and -0.12 (95% CI, -0.23 to -0.005), respectively., Conclusions: We found a significant negative association between cardiorespiratory fitness and measures of arterial stiffness. The former and present results pose challenges for shift workers' future macrovascular and microvascular health., Competing Interests: Skogstad, Skare, Mamen, Zardin, and Sirnes have no relationships/conditions/circumstances that present potential conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Purpose: Cardiopulmonary exercise testing (CPET) is considered the gold standard for assessing cardiorespiratory fitness. To ensure consistent performance of each test, it is necessary to adapt the power increase of the test protocol to the physical characteristics of each individual. This study aimed to use machine learning models to determine individualized ramp protocols based on non-exercise features. We hypothesized that machine learning models will predict peak oxygen uptake ( V ˙ O 2peak ) and peak power output (PPO) more accurately than conventional multiple linear regression (MLR)., Methods: The cross-sectional study was conducted with 274 (♀168, ♂106) participants who performed CPET on a cycle ergometer. Machine learning models and multiple linear regression were used to predict V ˙ O 2peak and PPO using non-exercise features. The accuracy of the models was compared using criteria such as root mean square error (RMSE). Shapley additive explanation (SHAP) was applied to determine the feature importance., Results: The most accurate machine learning model was the random forest (RMSE: 6.52 ml/kg/min [95% CI 5.21-8.17]) for V ˙ O 2peak prediction and the gradient boosting regression (RMSE: 43watts [95% CI 35-52]) for PPO prediction. Compared to the MLR, the machine learning models reduced the RMSE by up to 28% and 22% for prediction of V ˙ O 2peak and PPO, respectively. Furthermore, SHAP ranked body composition data such as skeletal muscle mass and extracellular water as the most impactful features., Conclusion: Machine learning models predict V ˙ O 2peak and PPO more accurately than MLR and can be used to individualize CPET protocols. Features that provide information about the participant's body composition contribute most to the improvement of these predictions., Trial Registration Number: DRKS00031401 (6 March 2023, retrospectively registered)., (© 2024. The Author(s).)

Objective: We recently demonstrated that upper-body rowing exercise (UBROW) improved aerobic fitness in individuals with spinal cord injury (SCI), with no effect on traditional cardiometabolic risk factors. Here, we tested the hypothesis that the exercise-induced increase in aerobic fitness was maintained at 6-month (6M) follow-up. Design: Six-month follow-up. Setting: University/hospital. Participants: Seventeen wheelchair-dependent participants with SCI. Interventions: 12-week of exercise training (UBROW) or control (CON). Outcome Measures: Aerobic fitness (PO peak and V̇O 2peak ), body composition, blood pressure, and blood biomarkers of cardiometabolic risk were assessed at 6M follow-up and compared to baseline (BL) and immediately post-intervention (12-week). Minutes of mild, moderate, and heavy intensity leisure time physical activity (LTPA) were assessed by self-report. Results: Fourteen participants returned at 6M follow-up (CON, n  = 6; UBROW, n  = 8). In UBROW, PO peak (median (Q1-Q3)) increased from BL (70 W (37-84)) to 12-week (77 W (58-109), P = 0.01) and 6M follow-up (81 W (51-96), P = 0.01), with no difference between 12-week and 6M follow-up (P = 0.21). Similarly, V̇O 2peak increased from BL (15.4 ml/kg/min (10.5-19.4)) to 12-week (16.6 ml/kg/min (12.8-21.3), P = 0.01) with no difference between 12-week and 6M follow-up (16.3 ml/kg/min (12.9-19.7), P = 0.74). No differences were found in CON for either PO peak (P = 0.22) or V̇O 2peak (P = 0.27). There were no changes over time in traditional cardiometabolic risk factors or for minutes of different LTPA intensities. Conclusion: We demonstrate that improvements in aerobic fitness are maintained for at least six months after completion of a 12-week exercise intervention, supporting the use of periodic exercise interventions to boost aerobic fitness level in individuals with SCI. Trial registration: ClinicalTrials.gov identifier: NCT04390087..

This systematic review and meta-analysis aimed to examine the influence of aerobic training (AT) versus resistance training (RT) on cardiorespiratory fitness and body composition in middle-aged to older adults. Four electronic databases including PubMed, Scopus, Cochrane CENTRAL, and web of science, as well as reference lists of included randomized controlled trials (RCTs) were searched from inception to April 2024. Data were pooled by the inverse-variance method and reported as mean differences (MDs) with 95 % confidence intervals (CIs). Thirty-eight RCTs, with a pooled sample of 1682 participants, met our inclusion criteria. Meta-analysis revealed that AT significantly improved VO 2max / peak (MD = 1.80, 95 % CI: 0.96 to 2.64, p < 0.0001) and 6-MWT (MD = 18.58, 95 % CI: 10.38 to 26.78, p < 0.00001), and significantly decreased body mass (MD = -1.23, 95 % CI: -1.98 to -0.47, p = 0.001) versus RT. However, changes in lean body mass favored RT over AT. Moreover, changes in VO 2max / peak and 6-MWT following AT were significant among both healthy and unhealthy participants, or men and women, after medium-term (< 24 weeks) and long-term (≥ 24 weeks) interventions, and among participants aged ≤65 and >65. Our results propose that AT should be considered an efficient approach to improving cardiorespiratory fitness and overall body composition with aging, particularly in terms of VO2max and 6-MWT performance. However, for improvements in lean body mass, RT may be more beneficial. Therefore, a combination of AT and RT might be optimal for comprehensive fitness and body composition improvements with aging., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Providing an overview of the clinimetric properties of the steep ramp test (SRT)-a short-term maximal exercise test-to assess cardiorespiratory fitness (CRF), describing its underlying physiological responses, and summarizing its applications in current clinical and research practice., Data Sources: MEDLINE (through PubMed), CINAHL Complete, Cochrane Library, EMBASE, and PsycINFO were searched for studies published up to July 2023, using keywords for SRT and CRF., Study Selection: Eligible studies involved the SRT as research subject or measurement instrument and were available as full text articles in English or Dutch., Data Extraction: Two independent assessors performed data extraction. Data addressing clinimetric properties, physiological responses, and applications of the SRT were tabulated., Data Synthesis: In total, 370 studies were found, of which 39 were included in this study. In several healthy and patient populations, correlation coefficients between the work rate at peak exercise (WR peak ) attained at the SRT and oxygen uptake at peak exercise during cardiopulmonary exercise testing (CPET) ranged from .771-.958 (criterion validity). Repeated measurements showed intraclass correlation coefficients ranging from .908-.996 for WR peak attained with the first and second SRT (test-retest reliability). Physiological parameters, like heart rate and minute ventilation at peak exercise, indicated that the SRT puts a lower burden on the cardiopulmonary system compared to CPET. The SRT is mostly used to assess CRF, among others as part of preoperative risk assessment, and to personalize interval training intensity., Conclusions: The SRT is a practical short-term maximal exercise test that is valid for CRF assessment and to monitor changes in CRF over time in various healthy and patient populations. Its clinimetric properties and potential applications make the SRT of interest for a widespread implementation of CRF assessment in clinical and research practice and for personalizing training intensity and monitoring longitudinal changes in CRF., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Platelets are key mediators in cardiovascular disease (CVD). Low cardiorespiratory fitness (CRF) is a risk factor for CVD. The purpose of our study was to assess if CRF associates with platelet function., Methods: Platelet assays and cardiopulmonary exercise testing were conducted in the Framingham Heart Study ( N = 3014). Linear mixed effects models estimated associations between CRF (assessed by peak oxygen uptake [V̇O 2 ]) and multiple platelet reactivity assays. Models were adjusted for multiple medications, risk factors, relatedness, and prevalent CVD., Results: Nineteen associations passed the significance threshold in the fully adjusted models, all indicating higher CRF associated with decreased platelet reactivity. Significant traits spanned multiple platelet agonists. Strongest associations were observed in multiplate whole blood testing after TRAP-6 (e.g., velocity, beta = -0.563, 95% CI = -0.735 to -0.391, P = 1.38E-10), ADP (e.g., velocity, beta = -0.514, 95% CI = -0.681 to -0348, P = 1.41E-09), collagen (e.g., velocity, beta = -0.387, 95% CI = -0.549 to -0.224, P = 3.01E-06), ristocetin (e.g., AUC, beta = -0.365, 95% CI = -0.522 to -0.208, P = 5.17E-06) and arachidonic acid stimulation of platelets (e.g., velocity, beta = -0.298, 95% CI = -0.435 to -0.162, P = 3.39E-04), and light transmission aggregometry (LTA) after ristocetin stimulation (e.g., max aggregation, beta = -0.362, 95% CI = -0.540 to -0.184, P = 6.64E-05). One trait passed significance threshold in the aspirin subsample (LTA ristocetin primary slope, beta = -0.733, 95% CI = -1.134 to -0.333, P = 3.30E-04) and another in a model including von Willebrand Factor levels as a covariate (U46619, a thromboxane receptor mimetic, AUC in the Optimul assay, beta = -0.36, 95% CI = -0.551 to -0.168, P = 2.35E-04). No strong interactions were observed between the associations and sex, age, or body mass index in formal interaction analyses., Conclusions: Our findings build on past work that shows CRF to be associated with reduced CVD by suggesting decreased platelet reactivity may play a mechanistic role. We found significant associations with multiple platelet agonists, indicating higher CRF may globally inhibit platelets; however, given multiple strong associations after TRAP-6 and ADP stimulation, PAR-1 and purinergic signaling may be most heavily involved. This is notable because each of these receptor pathways are tied to anticoagulant (DOAC/thrombin inhibitors) and antiplatelet therapies (P2Y12/PAR1/PAR4 inhibitors) for CVD prevention., (Copyright © 2024 by the American College of Sports Medicine.)

Introduction: Overuse musculoskeletal injuries (MSKI) remain a significant medical challenge in military personnel undergoing military training courses; further understanding of the biological process leading to overuse MSKI development and biological signatures for injury risk are warranted. The purpose of this study was to determine the association between overuse MSKI occurrence and physiological characteristics of allostatic load characterized as maladaptive biological responses to chronic stress measured by wearable devices in US Marine Corps officer candidates during a 10-wk training course., Methods: Devices recorded energy expenditure (EE), daytime heart rate (HR), sleeping HR, and sleep architecture (time and percentage of deep, light, rapid eye movement sleep, awake time, total sleep). Flux was calculated as the raw or absolute difference in the average value for that day or night and the day or night beforehand. Linear mixed-effect model analysis accounting for cardiorespiratory fitness assessed the association between overuse MSKI occurrence and device metrics ( α = 0.05)., Results: Sixty-nine participants (23 females) were included. Twenty-one participants (eight females) sustained overuse MSKI. Overuse MSKI occurrence in male participants was positively associated with daytime HR ( β = 5.316, P = 0.008), sleeping HR ( β = 2.708, P = 0.032), relative EE ( β = 8.968, P = 0.001), absolute flux in relative EE ( β = 2.994, P = 0.002), absolute EE ( β = 626.830, P = 0.001), and absolute flux in absolute EE ( β = 204.062, P = 0.004). Overuse MSKI occurrence in female participants was positively associated with relative EE ( β = 5.955, P = 0.026), deep sleep time ( β = 0.664, P < 0.001), and percent deep sleep ( β = 12.564, P < 0.001) and negatively associated with absolute flux in sleeping HR ( β = -0.660, P = 0.009)., Conclusions: Overuse MSKI occurrences were associated with physiological characteristics of allostatic load, including chronically elevated HR and EE and greater time in restorative sleep stages, which may serve as biological signatures for overuse MSKI risk., (Copyright © 2024 by the American College of Sports Medicine.)

The aim of the study was to verify whether selected somatic parameters and components of body composition were significant predictors of cardiorespiratory fitness (CRF) among a potentially healthy Polish population of adolescents aged 11-14 years. The cross-sectional study was conducted on a group of 375 subjects (164 girls, and 211 boys). A 20 m shuttle run test (20 m SRT) was used to assess CRF. The total number of rounds was taken into account. Basic somatic parameters were measured: body mass (BM), body height (BH), waist circumference (WC), hip circumference (HC), body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), and body composition components: body fat percentage (FM%), fat mass (FM kg), total body water (TBW), fat-free mass (FFM). Statistical analyses included basic statistical measures (mean and standard deviation) and Spearman rank correlation coefficient. Multiple linear regression analysis was performed to detect significant predictors of CRF. In each proposed model, the dependent variable was the number of rounds, and the independent variables were selected somatic parameters and components of body composition. More than half (65%) of the subjects had an average or lower level of CRF, and 35% of the population presented a good or above good level of CRF. The study showed a statistically significant negative correlation between BM, FM%, FM kg, HC, WC, BMI, WHR, WHtR and the number of laps in the total sample. The strongest correlation in the group of girls was noted for age (r = 0.34) and in the group of boys for FM% (r = - 0.52 ). Each regression model presented proved to be statistically significant, and the significant predictors of CRF in the group of girls were age ( R 2 = 16%) and FM% ( R 2 = 6%). In the group of boys, the significant predictors of CRF were WHtR ( R 2 = 8%) and age ( R 2 = 2%). Estimating body fat distribution is useful in assessing cardiorespiratory fitness, and this in turn indicates its usefulness in preventive screening of school-aged adolescents., (© 2024. The Author(s).)

Objective: The course of cognitive aging is influenced by multiple health factors. This cross-sectional study investigated the interactive relations between body mass index (BMI), maximum oxygen consumption (VO2max), and sex on neuropsychological outcomes in community-dwelling predominantly older adults., Methods: Participants were 164 healthy adults [M (SD) = 64.6 (12.5) years, 56% men, 87% white] who participated in an investigation of cardiovascular risk factors and brain health. Multivariable regression analysis, adjusted for age, education, ethnicity, smoking, alcohol consumption, and depression, examined the interactive relations of BMI, VO2max, and sex to multiple neuropsychological outcomes., Results: Significant BMI*VO2max*sex interactions for Grooved Pegboard dominant (p = .019) and nondominant (p = .005) hands revealed that men with lower VO2max (l/min) displayed worse performance with each hand as BMI increased (p's < .02). A significant BMI*sex interaction for Logical Memory-Delayed Recall (p = .036) (after adjustment for blood glucose) showed that men, but not women, with higher BMI demonstrated worse performance (p = .036). Lastly, significant main effects indicated that lower VO2max was related to poorer logical memory, and higher BMI was associated with poorer Trail Making B and Stroop interference scores (p's < .05)., Conclusions: Among men, higher cardiorespiratory fitness may protect against the negative impact of greater BMI on manual dexterity and motor speed, making VO2max a target for intervention. Higher BMI is further associated with poorer executive function and verbal memory (in men), and lower VO2max is associated with poorer verbal memory., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To compare the effects of aerobic training combined with muscle strength training (hereafter referred to as combined training) to aerobic training alone on cardiovascular disease risk indicators in patients with coronary artery disease (CAD)., Design: Systematic review with meta-analysis., Data Sources: MEDLINE, Embase, CINAHL, SPORTDiscus, Scopus, trial registries and grey literature sources were searched in February 2024., Eligibility Criteria: Randomised clinical trials comparing the effects of ≥4 weeks of combined training and aerobic training alone on at least one of the following outcomes: cardiorespiratory fitness (CRF), anthropometric and haemodynamic measures and cardiometabolic blood biomarkers in patients with CAD., Results: Of 13 246 studies screened, 23 were included (N=916). Combined training was more effective in increasing CRF (standard mean difference (SMD) 0.26, 95% CI 0.02 to 0.49, p=0.03) and lean body mass (mean difference (MD) 0.78 kg, 95% CI 0.39 kg to 1.17 kg, p<0.001), and reducing per cent body fat (MD -2.2%, 95% CI -3.5% to -0.9%, p=0.001) compared with aerobic training alone. There were no differences in the cardiometabolic biomarkers between the groups. Our subgroup analyses showed that combined training increases CRF more than aerobic training alone when muscle strength training was added to aerobic training without compromising aerobic training volume (SMD 0.36, 95% CI 0.05 to 0.68, p=0.02)., Conclusion: Combined training had greater effects on CRF and body composition than aerobic training alone in patients with CAD. To promote an increase in CRF in patients with CAD, muscle strength training should be added to aerobic training without reducing aerobic exercise volume., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: This study aimed to study the potential effects of oxaliplatin-based chemotherapy on cardiorespiratory fitness, handgrip strength (HGS), body composition, and quality of life (QoL) of stages III-IV colorectal cancer (CRC) patients before the first cycle (T0) and after the last cycle of systemic adjuvant/neoadjuvant chemotherapy (T1)., Methods: Cardiorespiratory fitness, HGS, body composition, and QoL were evaluated with the six-minute walk test (6MWT), hydraulic hand dynamometer, body composition analyzer, and Functional Assessment of Cancer Therapy-Colon (FACT-C) questionnaire in both T0 and T1, respectively., Results: Twenty-eight CRC patients were included in this study. The total walked distance (TWD) was found to be decreased from T0 to T1 (499.72 m vs. 488.56 m); however, this change was not significant (z = -.706, p = 0.48). Type of chemotherapy whether adjuvant or neoadjuvant also showed no significant effect on TWD (z = -.1.372, p = .17 vs z = -1.180, p = .238, respectively). The QoL was significantly decreased (T0 = 118.35 vs T1 = 110.77, t = 2.176,p = 0.05). The TWD was significantly correlated with the physical well-being (PWB) subscale of FACT-C (r = .64, p = 0.001) as well as with HGS (r = .46, p = .018) in T0. After controlling for age, type of chemotherapy, and type of regimen, the HGS did not show a significant difference from T0 to T1 (F(1,23) = 1.557, p = .22, ηp 2  = .06). However, the effect of time x gender showed significant difference from T0 to T1 (F(1,23) = 4.906, p = .037, ηp 2  = .17)., Conclusion: This study showed the decreased QoL and physical well-being of CRC patients who underwent oxaliplatin-based treatment. In addition, the gender effect of decreased HGS should be considered further when planning an oncological rehabilitation program., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To investigate the impact of chemoradiotherapy on the physical fitness of patients with oesophageal cancer, and the clinical factors influencing it., Method: A total of 67 participants successfully completed the study, with 18 of them engaging in supervised, in-hospital aerobic training at moderate intensity for a minimum of 20 sessions. Cardiopulmonary exercise testing, hand grip strength, body composition assessed via bioelectrical impedance analysis, patient-generated subjective global assessment, albumin, and the Functional Oral Intake Scale (FOIS) were evaluated before chemoradiotherapy and 6-8 weeks after its completion., Result: Among the participants, cardiopulmonary fitness, hand grip strength, and phase angle of BC-BIA declined during chemoradiotherapy. Before and after chemoradiotherapy, V̇O2peak was 19.6 ± 4.4 and 17.4 ± 3.9 mL/min/kg respectively. The improvement in FOIS during chemoradiotherapy showed a positive correlation with changes in aerobic capacity. Additionally, exercise training was associated with attenuating the decline in aerobic capacity., Conclusion: Physical fitness deteriorated in patients with oesophageal cancer following chemoradiotherapy. Improvement in dysphagia helps maintain aerobic capacity. Additionally, exercise training has the potential to mitigate the decline. This discovery can serve as a reference for enhancing holistic care for patients with oesophageal cancer.

Objective: With the emergence of the COVID-19 virus, there was a widespread infection rate among college campuses, creating a need to understand the impact of COVID-19 infection on the health and wellbeing of adolescents. The aim of this study was to examine COVID-19 incidence and cardiorespiratory fitness (CRF) among undergraduate students in the 2 years post-COVID-19 pandemic lock-down., Participants: Participants ( n  = 151) included undergraduate college freshmen students during the 2021-2022 and 2022-2023 academic years., Methods: A series of annual surveys ( n  = 151) and laboratory measures among a sub-sample of participants ( n  = 28) were conducted to assess COVID-19 incidence, CRF, anthropometrics, and physical activity (PA)., Results: Over half of participants self-reported COVID-19 infection (59%), "good" or better CRF, a healthy body mass index (BMI), and 25% met PA recommendations. Nearly a quarter, (24%) perceived a negative impact of COVID-19 on their CRF and although not statistically significant, participants who contracted COVID-19 had 46% lower odds of having a positive perception of CRF than those who did not contract COVID-19 before. However, students who were more physically active were more likely to perceive a negative impact of COVID-19 incidence on their CRF ( p  = 0.035)., Conclusion: Although no relationship was detected between COVID-19 and CRF, those who perceived a negative impact of COVID-19 on their CRF reported engaging in more physical activity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Alvaro, Levers, Barberio, Jin, Stranieri and Sacheck.)

Objectives: To examine the safety of cardiorespiratory fitness (CRF) assessment and training in the early sub-acute phase of recovery (≤3 months) following moderate-to-extremely severe traumatic brain injury (TBI)., Methods: A systematic review was completed in accordance with the PRISMA guidelines. Studies investigating adults and adolescents ≥15 years with moderate-to-extremely severe TBI were considered for inclusion. The methodological quality of the included studies was evaluated according to the McMaster Guidelines for Critical Review Form - Quantitative Studies., Results: Eleven studies with a total of 380 participants were included in the review. Adverse events (AEs) and symptom monitoring were poorly reported. Only four studies reported on the occurrence of AEs, with a total of eight AEs reported. Three of the reported AEs were concussion-like symptoms with no further exercise-induced symptom exacerbation reported. No serious AEs were reported., Conclusion: There is no evidence to suggest that CRF assessment and training is unsafe in the early sub-acute phase of recovery following moderate-to-extremely severe TBI. However, despite the low AE and symptom exacerbation rates identified, a timeframe for safe commencement was unable to be established due to poor reporting and/or monitoring of exercise-induced symptoms and AEs in the current literature.

Background: Health literacy is a core public health issue in relation to children and adolescents associated with multiple health behaviours and health outcomes. The aim of the study is to test the direct associations between health literacy, physical activity behaviour, health outcomes of body composition and cardiorespiratory fitness among Slovak adolescents and possible indirect effect of health literacy on health outcomes of body composition and cardiorespiratory fitness mediated by adolescents' physical activity behaviour., Methods: Data from the Slovak Health Behaviour in School-aged Children (HBSC) study conducted in 2022 were used. For the purposes of this study, a subsample of the adolescents (n = 508; mean age = 14.50; SD = 0.82; 54.3% boys) which provided HBSC questionnaire data on health literacy, moderate-to-vigorous physical activity and vigorous physical activity and participated in body composition (InBody 230) and cardiorespiratory fitness (20-m shuttle run test) measurements. Data were analysed using linear regression analysis., Results: The findings showed that higher health literacy of the adolescents was directly associated with higher frequency of physical activity represented by moderate-to-vigorous physical activity and vigorous physical activity and only with the visceral fat area in the crude model. Furthermore, there was an indirect effect of health literacy on cardiorespiratory fitness and most of the body composition variables (except the Body Mass Index) which was mediated by physical activity of the respondents., Conclusions: Health literacy is indirectly associated to body composition and cardiorespiratory fitness through higher frequency of physical activity. It seems that health literacy as cognitive and social competencies need behavioural components to be involved in the proposed causal pathway between health literacy and health outcomes. Our findings may contribute to the process of creating a framework for future health literacy interventions in adolescents., (© 2024. The Author(s).)

Background: Post-COVID-19 Syndrome (PCS) entails a spectrum of symptoms, including fatigue, reduced physical performance, dyspnea, cognitive impairment, and psychological distress. Given the effectiveness of exercise-based rehabilitation for PCS, this study examined the efficacy of rehabilitation for PCS patients, focusing on sex-specific differences., Methods: Prospective cohort study during inpatient rehabilitation. Cardiopulmonary exercise testing and spirometry were performed at admission and discharge. Questionnaires were used to assess fatigue, health-related quality of life, wellbeing, and workability for up to 6 months., Results: 145 patients (36% female, 47.1 ± 12.7 years; 64% male, 52.0 ± 9.1 years; p = 0.018) were referred to rehabilitation 262.0 ± 128.8 days after infection (female, 285.5 ± 140.6 days; male, 248.8 ± 112.0 days; p = 0.110). Lead symptoms included fatigue/exercise intolerance (81.4%), shortness of breath (74.5%), and cognitive dysfunction (52.4%). Women presented with higher relative baseline exercise capacity (82.0 ± 14.3%) than males (68.8 ± 13.3%, p < 0.001), but showed greater improvement in submaximal workload (p = 0.026). Men exhibited higher values for FEV1, FEV1/VC, PEF, and MEF and lower VC at baseline (p ≤ 0.038), while FEV1/VC improvement more in women (p = 0.027). Higher baseline fatigue and lower wellbeing was detected in women and correlated with impaired pulmonary function (p < 0.05). Disease perception including fatigue, health-related quality of life, wellbeing and workability improved with rehabilitation for up to six-month., Conclusions: Rehabilitation improves cardiopulmonary fitness, pulmonary function and disease burden in women and men with long-term PCS. Women with PCS may benefit from intensified respiratory muscle training. Clinical assessment should include cardiopulmonary exercise testing and pulmonary function tests and fatigue assessments for all PCS patients to document limitations and tailor therapeutical strategies., (© 2024. The Author(s).)

Peak oxygen pulse (O 2 P peak ) is an important index of cardiorespiratory fitness (CRF). The FRIEND database is a global source of reference values for CRF. However, no reference equation is tailored for endurance athletes (EA) to predict O 2 P peak . Here, we adjusted the well-established FRIEND equation for O 2 P peak to the characteristics of the EA population. 32 (34.0%) female EA and 62 (66.0%) male well-trained EA underwent maximal cardiopulmonary exercise test on a treadmill. V̇O 2max was 4.5 ± 0.5 L min -1 in males and 3.1 ± 0.4 L min -1 in females. O 2 P peak was 23.6 ± 2.8 mL beat -1 and 16.4 ± 2.0 mL beat -1 for males and females, respectively. Firstly, we externally validated the original FRIEND equation. Secondly, using multiple linear regression, we adjusted the FRIEND equation for O 2 P peak to the population of EA. The original FRIEND equation underestimated O 2 P peak for 2.9 ± 2.9 mL beat -1 (P < .001) in males and 2.2 ± 2.1 mL beat -1 (P < .001) in females. The updated equation was 1.36 + 1.07 (23.2 · 0.09 · age - 6.6 [if female]). The new equation explained 62% of the variance and significantly predicted O 2 P peak (R 2  = 0.62, β = 0.78, P < .001). The error of the EA-adjusted model was 0.1 ± 2.9 mL beat -1 (P = .82) and 0.2 ± 2.1 mL beat -1 (P = .65) for males and females respectively. Recalibration of the original FRIEND equation significantly enhances its accuracy among EA. The error of the EA-adjusted model was negligible. A new recalibrated equation should be used to predict O 2 P peak in the population of EA., (© 2024. The Author(s).)

Background: This study checked whether vitamin D (Vit-D) supplementation improves the efficacy of resistance training (RT) in terms of increasing muscle strength and lean body mass (LBM), and influencing cardiorespiratory fitness (VO 2 max) in Vit-D-deficient middle-aged healthy men., Methods: Participants ( n = 28) were quasi-randomly assigned to one of two groups, which, in a double-blind manner, supplemented their diet daily with either Vit-D (8000 IU; VD) or placebo (PLC) during participation in a 12-week supervised RT program., Results: During the intervention, serum Vit-D concentrations increased 2.6-fold ( p < 0.001) in the VD group, while no changes occurred in the PLC group. Muscle strength gains ( p < 0.001) as measured in seven exercises performed on RT equipment and increases ( p < 0.001) in LBM were similar in the two groups. Total fat mass, percent total fat, and percent android fat decreased ( p < 0.05) to a similar extent in both groups, but there was no change in VO 2 max in either group., Conclusions: In conclusion, in healthy Vit-D-insufficient middle-aged men engaged in resistance training, Vit-D supplementation increases serum 25(OH)D levels but does not enhance gains in muscle strength and LBM, or decreases in fat mass and fat percentage, and does not affect cardiorespiratory fitness.

The aim of the study is to investigate the association of cardiorespiratory fitness (CRF) and muscular strength indicators with gray matter volume (GMV) and to study whether fitness-related regions of GMV are associated to executive function (EF) in cognitively normal older adults. Ninety-one cognitively normal older adults (71.69 ± 3.91 years; 57.14% females) participated in this study from the AGUEDA trial. CRF was measured by a 2-km walking test and a 6-min walking test. Muscular strength was measured by handgrip, biceps curl, squats, and isokinetic strength tests. T1-weigthed images were obtained through a magnetic resonance scan. GMV was determined by voxel-based morphometric analysis. Standardized EF tests were performed. CRF did not show any positive association with GMV. Handgrip strength was positively associated with GMV (p < 0.001) in nine regions (β from 0.6 to 0.8 and k from 106 to 1927) and knee extension strength in three regions (β from 0.4 to 0.5 and k from 76 to 2776). Squats strength was negatively associated with GMV (p < 0.001) in two regions (β = -0.3, k = 1102 and k = 152) and the 2-km walking test in one region (β = -0.4, k = 99). Only handgrip strength-related GMV was associated with cognitive flexibility (p = 0.039, β = 0.215) and spatial working memory (p < 0.03, β 0.247-0.317), but not with EF score (p > 0.05). Muscular strength, but no CRF, may be positively related to GMV in cortical and subcortical regions, with implications for specific cognitive domains rather than the overall EF score. Specifically, handgrip strength was the indicator most associated with higher GMV, while squats strength and CRF were negatively related to GMV. ClinicalTrials.gov identifier: NCT05186090., (© 2024 The Author(s). Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

The current study was conducted at Ali-Ul-Murtaza Department of Rehabilitation Sciences, Muhammad Institute of Medical and Allied Sciences, Multan, Pakistan, from October to December 2022 to explore the correlation of body mass index with cardiometabolic and cardiorespiratory parameters in 393 male and female healthcare professionals, including physiotherapists, pharmacists and medical laboratory technicians, aged 22- 40 years. The evaluation was on the basis of the Physical Activity Readiness Questionnaire, body mass index, lipid profile, body fat and correlation of blood pressure, temperature, oxygen saturation, respiration rate and heart rate with cardiorespiratory fitness assessed through shuttle-run test, step test and treadmill test. Data was analysed using SPSS 25. Of the 393 subjects, 140(35.62) were underweight, 140(35.62) were overweight and 113(28.75) were obese. Of the total, 153(38.93) were pleased with their general health, while 240(61.06) had a history of cardiovascular and metabolic conditions. There was a highly significant correlation between lipid profiles and the subjects' quality of life (p<0.05).

Job strain is a major concern in the workplace. Work-related stress is an increasing challenge worldwide as it is the leading cause of long-term sickness absences, disability pensions and lower productivity. Rarely studied simultaneously, both leisure-time physical activity (LTPA) and physical fitness (PF), which comprises cardiorespiratory fitness (CRF) and muscular fitness (MF), may have potential in preventing and managing job strain. The current study aimed to investigate whether LTPA, CRF and MF predict perceived job strain. In addition, the study examines reverse associations, that is, whether job strain predicts LTPA, CRF and MF. We used longitudinal population-based data from a Northern Finland birth cohort of 1966 (n = 5363) to analyse LTPA, CRF and MF as well as job strain and its components, job demands and job control, at age 31 years (1997) and 46 years (2012). Leisure-time physical activity was measured with a self-reported questionnaire whereas CRF and MF were measured as part of clinical examination. Linear regression analyses were used to analyse the data. In both men (n = 2548) and women (n = 2815), higher baseline MF predicted lower job strain and job demands 15 years later. In women, higher baseline total LTPA predicted higher job demands, whereas in men, higher CRF predicted lower job strain and higher job control. These associations remained significant, also when adjusted for education and occupational status. In the analyses on reverse associations, higher job control and higher job demands were linked to higher leisure-time moderate-to-vigorous physical activity (MVPA) and total LTPA 15 years later among both men and women, except for the association between job demands and total LTPA among women. These associations remained significant after adjustment for education and occupational status, except for the association of job control with MVPA and total LTPA among men. The association of higher job demands and total LTPA became significant in women. We conclude that LTPA and PF seem beneficial in preventing and managing job strain., (© 2024 The Author(s). Stress and Health published by John Wiley & Sons Ltd.)

Introduction: The study aimed to investigate to what extent acute endurance exercise, especially eccentric exercise and cardiorespiratory fitness, affects the metabolic profile of CD4 + cells., Methods: Fifteen male, healthy adults aged between 20 and 33 yr with a maximal oxygen uptake (V̇O 2max ) between 44 and 63 mL·kg -1 ·min -1 performed a downhill run (DR) and a level run (LR) for 45 min at 70% of their V̇O 2max on a treadmill in a crossover design. Blood samples were taken before (T0), directly after (T1), 3 h after (T3), and 24 h (T24) after each exercise for analyzing leukocyte numbers and cytokine levels. Isolated CD4 + cells were incubated for 4 h in autologous resting versus 3 h after exercise serum (T3 DR and T3 LR), and subsequently, cellular respiration, transcriptomic, and metabolomics profiles were measured., Results: The systemic immune inflammation index increased significantly after DR and LR at T1 and T3 ( P < 0.001). In contrast, the transcriptomic and metabolic profile of CD4 + cells showed no significant alterations after incubation in T3 exercise serum. However, cardiorespiratory fitness positively correlated with the maximal mitochondrial respiration in CD4 + cells after incubation with T3 LR serum ( r = 0.617, P = 0.033) and with gene expression of oxidative phosphorylation and levels of different metabolites. Similarly, V̇O 2max was associated with an anti-inflammatory profile on RNA level. Lower lactate, methylmalonic acid, and d -gluconic acid levels were found in CD4 + cells of participants with a high V̇O 2max ( P < 0.001)., Conclusions: Acute exercise leads to a mild proinflammatory milieu with only small changes in the metabolic homeostasis of CD4 + cells. High cardiorespiratory fitness is associated with a metabolic shift to oxidative phosphorylation in CD4 + cells. Functional relevance of this metabolic shift needs to be further investigated., (Copyright © 2024 by the American College of Sports Medicine.)

Background: Studies have shown a positive relationship between cardiorespiratory fitness (CRF) and executive functioning in older adults. Although this relationship has been well established, there seems to be a gap in the literature on the role of sex differences concerning CRF and executive functions. The current study aimed to assess the effect of sex in the relationship between CRF and cognition in older adults by stratifying the results to examine effects in males and females., Methods: Ninety-six older adults (61 females) gave their written, informed consent to participate in this cross-sectional study. All participants underwent a maximal continuous graded exercise test on a cycle ergometer to assess their maximal oxygen uptake (VO2max) and a computerized Stroop task (naming, inhibition, and switching) to assess their executive functions. According to VO2max test results and the American College of Sports Medicine's guidelines, females and males were classified into higher-fit and lower-fit groups. A general linear model and estimated marginal means analyses were applied., Results: Results showed no significant differences in the naming, inhibition and switching performance tests between male and female older adults (P>0.05)., Conclusions: Based on the observed positive relationship between CRF and executive functioning, the data of the current study supports the idea that aerobic exercise, which typically increases CRF, is well-situated to improve executive functioning in older adults, irrespective of sex.

Background: The therapeutic effects of exercise have prompted calls for it to be embedded into standard asthma care, but evidence informing the optimal exercise intensity is lacking., Objective: This study aimed to compare the effects of moderate- and vigorous-intensity aerobic exercise training on asthma outcomes and inflammation., Methods: This was a 12-week randomized controlled trial in 46 adults with asthma randomized to either (1) 45-minute moderate-intensity exercise training 3 times/wk, (2) 30-minute vigorous-intensity exercise training 3 times/wk, or (3) the control group. Asthma-related quality of life (AQLQ), asthma control (ACQ), cardiorespiratory fitness, body composition, and airway and systemic inflammation were assessed before and after the intervention., Results: Forty-one participants completed the study (89% retention). The moderate-intensity group had a statistically and clinically significant improvement in AQLQ (0.63 [0.33-0.93], P < .001) and ACQ (-0.51 [-0.83 to -0.19], P = .003) relative to control. The vigorous-intensity group had a statistically, but not clinically, significant improvement in AQLQ (0.46 [0.14-0.80], P = .007) and ACQ (-0.36 [-0.69 to -0.02], P = .040) relative to control. After moderate-intensity training, there was a reduction in sputum macrophage (-1341 [-2491 to -191] × 10 4 /mL, P = .024) and lymphocyte (-114 [-220 to -8] × 10 4 /mL, P = .036) counts relative to control. A reduction in android fat mass, but not a change in fitness, was associated with improved AQLQ (r s  = -0.341, P = .030) and reduced sputum IL-6 (r s  = 0.422, P = .013)., Conclusions: Our findings suggest that both moderate-intensity and vigorous-intensity aerobic exercise training are associated with improvements in clinical asthma outcomes and, therefore, both intensities could be recommended as an adjuvant asthma therapy., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Muscle strength and cardiorespiratory fitness are important components of physical fitness and are important for the physical and mental health development of university students. However, obesity is also an important factor affecting physical fitness, and there are few studies on how body mass index (BMI), which reflects obesity, is associated with muscle strength and cardiorespiratory fitness among Chinese university students. Therefore, this study analyzed the association between BMI and muscle strength and cardiorespiratory fitness among Chinese university students in order to provide a reference and basis for promoting the development of physical fitness among Chinese university students., Methods: A stratified whole-group sampling method was used to test physical fitness items in 27 973 (15 527 boys, 55.51%) university students in 800 first- to fourth-year university classes in Anhui, Fujian, Xinjiang, Shanghai, and Jiangxi, China. The physical fitness items included height, weight, standing long jump, 1000 m running (boys), and 800 m running (girls) items. Curvilinear regression analysis was used to analyze the correlations that existed between BMI and standing long jump and VO 2max ., Results: The BMI of Chinese 19-22 years old university students was (21.14 ± 2.92) kg/m 2 . The mean standing long jump score was (197.31 ± 34.07) cm. In general, the BMI reached the highest point of 207.92 cm when the BMI was 26.25 kg/m 2 , and then showed a decreasing trend with the increase of BMI. The overall relationship between BMI and vertical jump showed an inverted "U"-shaped curve. In terms of VO 2max , the overall trend of VO 2max increased gradually with the increase of BMI, and when BMI reached 40 kg/m 2 , VO 2max was 4.34 L-kg -1 -min -1 ., Conclusion: Chinese university students showed an inverted "U" curve relationship between BMI and standing long jump in general, while VO 2max showed a gradual increase with increasing BMI. Compared with the cardiorespiratory fitness of Chinese university students, the effect of BMI changes on muscle strength was greater., (© 2024 Wiley Periodicals LLC.)

Purpose: to investigate the effects of a physical exercise (PE) program, supported by wearable technology (WT), in children with drug-resistant epilepsy (DRE)., Methods: 29 children with DRE were randomized to experimental (EG) and control (CG) groups. To encourage PE, the EG performed one hour of aerobic activity three days a week for six months, outside the school setting. Compliance was monitored using activity wristbands, with data reported weekly by parents. Health-related quality of life (HRQoL), seizure frequency, physical activity (PA), physical fitness (musculoskeletal, motor, and Cardiorespiratory Fitness), and body composition, were assessed at baseline, at three and six months., Results: Seizure frequency in the last six months evolved from 10.5 seizures/week at baseline, to 4.5 at the end of the study in the EG, and from 5.2 seizures/week to one in the CG. Significant differences were found in weekly hours-PE (η2= 0.49); motor fitness (η2= 0.08); Cardiorespiratory Fitness (η2= 0.19); weight (η2= 0.003); Triceps skinfold thickness (η2= 0.05); lower limb muscular strength (η2= 0.03); HRQoL (η2= 0.02); and PA (η2= 0.22). Post-hoc ANOVA revealed that EG improved significantly (p < 0.05) between baseline and six months. Negative correlations were observed between PA and seizure frequency., Conclusion: Supported by WT, children with DRE increased the weekly hours of PE at three and six months, with no increase in seizure frequency. Our study provides evidence of the effectiveness of PE for improving HRQoL., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Despite evidence that aerobic exercise benefits the aging brain, in particular the hippocampus and memory, controlled clinical trials have not comprehensively evaluated effects of aerobic exercise training on human memory in older adults. The central goal of this study was to determine chronic effects of moderate-to-vigorous intensity aerobic exercise on the hippocampus and memory in non-demented, inactive adults ages 55-80 years. We determine effects of aerobic exercise training with a 6-month randomized controlled trial (RCT) comparing 150 min/week of home-based, light intensity exercise with progressive moderate-to-vigorous intensity aerobic exercise. For the first time in a large trial, we examined temporal mechanisms by determining if individual differences in the rapid, immediate effects of moderate intensity exercise on hippocampal-cortical connectivity predict chronic training-related changes over months in connectivity and memory. We examined physiological mechanisms by testing the extent to which chronic training-related changes in cardiorespiratory fitness are a critical factor to memory benefits. The Exercise Effects on Brain Connectivity and Learning from Minutes to Months (Brain-EXTEND) trial is conceptually innovative with advanced measures of hippocampal-dependent learning and memory processes combined with novel capture of the physiological changes, genetic components, and molecular changes induced by aerobic exercise that change hippocampal-cortical connectivity. Given that hippocampal connectivity deteriorates with Alzheimer's and aerobic exercise may contribute to reduced risk of Alzheimer's, our results could lead to an understanding of the physiological mechanisms and moderators by which aerobic exercise reduces risk of this devastating and costly disease., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aim : (I) to verify if there are sex differences in respiratory function, respiratory muscle strength, and effort limitation in individuals recovered from severe acute COVID-19 30 months after the initial infection, and (II) to evaluate the influence of length of stay on cardiorespiratory capacity among men and women. Methods : Cross-sectional observational multicentric study with participants from five Brazilian states (São Paulo, Amazonas, Minas Gerais, Bahia, and Brasília). We assessed lung function and respiratory muscle strength by maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and cardiorespiratory fitness by cardiopulmonary exercise test (CPET). Results : 86 individuals were stratified by sex (48 women and 38 men). Females had significantly longer hospitalization for acute COVID-19 ( p < 0.05) and showed a marked reduction in MIP (cmH 2 O and % predicted). Regarding the CPET, women presented lower V˙O 2 % predicted, O 2 pulse, and oxygen uptake efficiency slope (OUES, % predicted) ( p < 0.05). In addition, women also had greater abnormal combinations between RER < 1.10, OUES < 80% predicted, VE/VVM < 15% [3 (6.2%)] and V˙O 2 % predicted < 80%, V˙E/V˙CO 2 slope and V˙O 2 /workload < 8.4 mL/min/W [8 (17%)]. The regression analysis showed a significant influence of age, length of hospitalization (< and >10 days), and FEV 1 /FVC (%) on the V˙O 2 peak (mL·kg -1 ·min -1 ). Secondarily, we found that women hospitalized for more than 10 days had worse O 2 pulse ( p = 0.03), OUES % predicted ( p < 0.001), and worse V˙O 2 % predicted ( p < 0.009). Conclusion : Women exhibited more pronounced impairments in several key indicators of cardiopulmonary function 30 months post-infection.

Background: Little is known on how the substitution of time spent in sedentary behavior (SB) patterns with time spent in physical activity impacts cardiovascular risk factors during adolescence. The study aimed to investigate how the substitution of time spent in SB and sedentary bouts with time spent in different physical activity intensities was associated with longitudinal changes in cardiovascular risk factors in analyses stratified by sex., Methods: This is a prospective cohort study with a mean follow-up period of 3.2 (±0.34) years, involving 109 (60 girls and 49 boys) Brazilian adolescents. Body mass index, waist circumference, and cardiorespiratory fitness were the cardiovascular risk factors considered. A cardiovascular risk score was calculated. Sedentary bouts, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were measured by accelerometers. Multivariate linear regression models adopting the isotemporal substitution were used to analyze the association between substitution of 10 minutes per day of sedentary bouts with LPA and MVPA and risk factors. All analyses considered 5% significance levels., Results: Substitutions of SB, short and long bouts, with MVPA were associated with higher cardiorespiratory fitness in boys (β = 0.077; 95% confidence interval, 0.001 to 0.55; β = 0.076; 95% confidence interval, 0.003 to 0.154; and β = 0.084; 95% confidence interval, 0.001 to 0.167, respectively). No associations were observed when analyses involved substitution of sedentary bouts with LPA, adiposity, cardiovascular risk score, and girls., Conclusions: Substituting SB bouts with MVPA appears to favorably influence changes of cardiorespiratory fitness in boys during adolescence. Greater benefits appear to occur when longer sedentary bouts are substituted by MVPA.

Cardiovascular disease (CVD) risk factors are frequently reported among firefighters, yet no studies have compared these factors between male and female firefighters, specifically from a low- to middle-income country (LMIC). This study aimed to determine the prevalence of CVD risk factors and their relationship with cardiorespiratory fitness (VO 2max ) in 254 active career firefighters (mean age: 42.6 ± 7.8 years). The assessments included anthropometry, blood pressure, blood glucose, cholesterol, triglycerides, and VO 2max . The results indicated that 48.0% and 51.8% of females and males were pre-hypertensive, respectively. Hypertension was identified in 15.8% of the firefighters. According to body mass index (BMI), 37.3% of males and 25% of females were found to be overweight, while an additional 44.9% of males and 45.7% of females were classified as obese. Only 17.3% of males and 18.2% of females were found to be of normal weight. These findings were corroborated by categories of central obesity using waist circumference (WC), which were 47.7% for males and 41.6% for females. Low HDL-C was found in 95.2% of males and 86.4% of females, with 28.3% of males also having elevated triglyceride levels (TG). VO 2max was "excellent" in 48.8% of males and 12.6% of females, though it had no significant association with most CVD risk factors. The only notable link was a small correlation between VO 2max and triglycerides (r = -0.215; p = 0.001). These findings suggest that while cardiorespiratory fitness may have no impact, additional factors likely contribute to the cardiovascular health of firefighters, necessitating the need for comprehensive health and fitness programmes.

Cerebral blood flow (CBF) and arterial transit time (ATT), markers of brain vascular health, worsen with age. The primary aim of this cross-sectional study was to identify modifiable determinants of CBF and ATT in healthy older adults ( n = 78, aged 60-81 years). Associations between cardiorespiratory fitness and CBF or ATT were of particular interest because the impact of cardiorespiratory fitness is not clear within existing literature. Secondly, this study assessed whether CBF or ATT relate to cognitive function in older adults. Multiple post-labelling delay pseudo-continuous arterial spin labelling estimated resting CBF and ATT in grey matter. Results from multiple linear regressions found higher BMI was associated with lower global CBF (β = -0.35, P = 0.008) and a longer global ATT (β = 0.30, P = 0.017), global ATT lengthened with increasing age (β = 0.43, P = 0.004), and higher cardiorespiratory fitness was associated with longer ATT in parietal (β = 0.44, P = 0.004) and occipital (β = 0.45, P = 0.003) regions. Global or regional CBF or ATT were not associated with processing speed, working memory, or attention. In conclusion, preventing excessive weight gain may help attenuate age-related declines in brain vascular health. ATT may be more sensitive to age-related decline than CBF, and therefore useful for early detection and management of cerebrovascular impairment. Finally, cardiorespiratory fitness appears to have little effect on CBF but may induce longer ATT in specific regions.