Neuromuscular assessments are commonly used to monitor athletes and inform decisions regarding readiness to train and compete. However, the extent to which changes in neuromuscular performance may influence subsequent training or match-play outputs remains unclear, limiting their practical utility. Accordingly, further investigation is required to determine whether these assessments capture neuromuscular changes that meaningfully influence subsequent physical output. This study aimed to examine the acute relationship between changes in pretraining isometric strength and subsequent physical training outputs during preseason in professional Australian Rules football (ARF) players. Prospective longitudinal observational study. Forty-two professional ARF players were monitored across a 12-week preseason. Pretraining lower-limb isometric strength was assessed via dynamometry (knee flexion [KNEEFLEX] and hip adduction [HIPADD]), with subsequent linear running and change of direction outputs quantified during training using global navigation satellite system devices with integrated triaxial accelerometers. Linear mixed models were used to examine whether changes in pretraining strength from baseline were associated with subsequent training outputs. Analyses revealed that changes in pretraining KNEEFLEX strength from baseline were significantly associated with subsequent running intensity (m min−1) at > 70
Accumulating evidence suggests that physical exercise can favorably modulate the tumor microenvironment (TME) and enhance the efficacy of cancer immunotherapies. Exercise has been shown to modulate the immune environment to promote infiltration and function of cell types that confer anti-tumor effects. These effects counteract several mechanisms of immune evasion within the TME that limit the effectiveness of immune checkpoint blockade, particularly therapies targeting PD-1 and PD-L1. Preclinical models demonstrate that exercise not only enhances anti-tumor immune responses, but also sensitizes tumors to checkpoint inhibitors, resulting in improved tumor control. Mechanistically, these benefits appear to be mediated through enhanced cytokine signaling, metabolic reprogramming of immune cells, and alterations in chemokine gradients that facilitate immune cell trafficking. This review summarizes current insights into how exercise impacts tumor biology and immunity and discusses the emerging rationale for integrating structured physical activity into immunotherapeutic regimens. While clinical evidence remains limited, ongoing studies will be critical to determining the translational relevance of these findings across cancer types and patient populations.
For a valid one-repetition maximum (1RM) prediction via load–velocity (LV) relationships, high reliability and accuracy must be assumed. Since individual study results indicate ambivalent prediction, this systematic review and meta-analysis was designed to provide a updated and comprehensive overview, extending knowledge about the validity and reliability of commercially available velocity sensors in Part I and the validity and reliability of velocity-based 1RM prediction models in Part II. A systematic literature search was conducted in PubMed/MEDLINE, Web of Science, and Scopus. Validity and/or reliability studies or velocity-based 1RM prediction evaluations were included. Methodological quality was assessed using adapted COSMIN. The analysis was performed for intraclass correlation coefficient (ICC), Lin’s concordance correlation coefficient (CCC), and Pearson’s correlation coefficient (r). The review was preregistered in PROSPERO (CRD42025634595). Sixty-three studies were included for sensor validity and reliability and 38 for 1RM prediction models. Part I: Velocity sensors demonstrated good-to-excellent pooled validity and device agreement (ICC = 0.91–0.92 [0.83–0.97]; k = 55 and 439, respectively); intra- and inter-day reliability were classified as good to excellent with ICC = 0.90–0.91 [0.85–0.95] (k = 228 and 608, respectively), with sensor technology moderating the results. However, substantial heterogeneity and wide ranges of study-level estimates indicated considerable variability across moderators, linear position transducer (LPT) generally showing more consistent performance than inertial measurement units (IMU). Part II: Velocity-based 1RM prediction showed ICCs = 0.90 [0.83–0.94] (k = 124) and ICC = 0.91 [0.72–0.98] (k = 9); for reliability and validity, respectively. Commercial velocity sensors generally provide high relative validity and reliability. Results varied depending on exercise complexity, intensity, sensor technology, and modeling approach. While velocity-based 1RM prediction demonstrated high average validity, large heterogeneity in lower body exercises significantly biased the results. Furthermore, the dearth of measurement error and agreement analyses prohibits final conclusions. Therefore, velocity-based monitoring and 1RM prediction require cautious interpretation, as sensor- and exercise-specific evidence remains limited.
Ambient air pollution impairs respiratory and cardiovascular function during exercise, yet evidence on its effects across the full spectrum of endurance performance remains limited. To quantify the association between race-day ambient air pollution and marathon finishing time across six World Marathon Majors, and to determine whether effects vary by sex, age group, and performance level. We analysed 2,756,553 net finishing times from six World Marathon Majors (Berlin, Boston, Chicago, London, New York City, and Tokyo) for editions held between 2010 and 2024. Race-day nitrogen dioxide (NO₂) and fine particulate matter (PM₂.₅) concentrations were obtained from the Copernicus Atmosphere Monitoring Service (CAMS) global reanalysis dataset. Linear mixed-effects models with random intercepts for each of 75 marathon–year events estimated pollution effects on finishing time, adjusting for heat index, wind speed, and temporal trends. Stratified analyses were conducted among 1,815,188 runners with available age data. Of the pollutants examined, NO₂ showed the stronger association with finishing time. Each 1 µg/m3 increase was associated with 1.43 min slower finishing time in men (95
The proliferation of consumer-grade digital health technologies has expanded physiological data collection beyond clinical and laboratory settings. In high-performance sport, these devices offer genuine utility for monitoring sleep, cardiac activity, and recovery. However, their widespread adoption has outpaced frameworks for responsible implementation. This perspective introduces orthometria, derived from ortho- (correct) and -metria (to measure), to describe the counterproductive fixation on digital health metrics collected via commercially available health technology. Orthometria is not proposed as a clinical phenomenon but as a behavioural descriptor for when the collection and review of any physiological metric obtained using a digital health device creates anxiety or has a negative effect on well-being or performance. The construct is introduced not to sensationalise potential risks or deter technology use, but to facilitate clearer discussion, monitoring, and responsible, effective implementation. Drawing on Kolb's Experiential Learning Theory, a five-stage framework is proposed for the responsible implementation of digital health technology in high-performance sport. Future research should explore framework efficacy, validate an orthometria-specific psychometric scale, and examine which metric types most influence athlete behaviour.
Advanced footwear technology (AFT) generally improves running economy (RE) measures on average by 4
Abstract Background In view of new evidence revealing a mechanical and nociceptive role of the thoracolumbar fascia (TLF), it has been suggested to be involved in low back pain. Objective To compare characteristics of the TLF in low back pain (LBP) patients and asymptomatic controls. Methods Two independent investigators performed a systematic literature search using PubMed, Web of Science, Science Direct, Cochrane Library, and Google Scholar. Imaging studies (ultrasound/MRI) investigating the morphology and mechanics of the TLF in LBP patients and controls were included. We used robust variance estimation to pool (a) the standardized mean differences (SMD) between both groups and (b) the correlation between TLF characteristics and subjective pain ratings in LBP patients. Results A total of 14 trials with moderate-to-high methodological quality (5.1 ± 1.2 points on the JBI critical appraisal checklist) were identified. Relative to asymptomatic controls, the LBP patients displayed a higher thickness (SMD: 0.64, 95% CI 0.41 to 0.88, p = < .001, 12 studies), stiffness (SMD: 0.82, 95% CI 0.34 to 1.31, p = .018, 3 studies), and echogenicity (SMD 0.43, 95% CI 0.16 to 0.70, p = .02, 3 studies) of the TLF. No effect was found for fascial layers sliding (SMD: − 0.05, 95% CI − 5.82 to 5.71, p = .92, 2 studies), although both studies of this comparison found significant (opposite) difference to controls. TLF thickening correlated with higher pain ratings. Conclusion The TLF of patients with LBP is thickened, stiffened and more echogenic when compared to controls, while the role of shear mobility is unclear. As we additionally found associations of TLF characteristics with pain ratings, future research addressing the predictive value of these markers is warranted.
The incidence of sports-related concussion (SRC) in rugby has been rising in recent years. The Head Injury Assessment (HIA) protocol, used to manage SRC, is limited by its reliance on subjective symptom reporting. Blood biomarkers such as glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1) and S100B could serve as complementary objective tools for SRC management. A prospective cohort study was conducted in a French elite professional rugby team (Association Montferrandaise Clermont Auvergne Sports, Association Sportive Montferrandaise Clermont Auvergne). A total of 68 professional rugby players were followed from September 2022 to June 2024. During this study period, 23 SRC episodes with blood samples collected according to the HIA protocol were included. S100B baseline levels remained stable across the season in control players. For GFAP and UCH-L1, all baseline values were consistently below the measurable range limits (GFAP < 30 ng/L and UCH-L1 < 200 ng/L). At 2 h post-match (in the absence of SRC), both S100B and UCH-L1 levels increased significantly and were positively correlated with contact frequency, whereas GFAP levels showed no significant change at this early timepoint. At the 36-h post-match follow-up, concentrations of all three biomarkers had returned to baseline, supporting the use of this timepoint within the validated HIA protocol. At 36 h following SRC, UCH-L1 concentrations remained below the quantifiable range, suggesting that earlier sampling may be required to capture post-injury changes for this biomarker. At this timepoint, an increase in S100B of ≥ 15
The debate over whether beginning a sport early and specializing in it promotes athletic success in adulthood has been the subject of academic discussion for decades. Current evidence suggests the opposite. Multisport participation during youth and a later start in the primary sport may positively influence athletic success in adulthood, although the effects on youth athletes remain inconclusive. However, youth sports performance and developmental potential are central to success in talent selection processes, which decisively shape athletes’ subsequent talent development. Therefore, this study aimed to determine the handball training age and prevalence rates of sport specialization in talented female U15 and male U16 handball players and to examine their associations with the attained selection tier. In addition, the years of practice in other sports (i.e., depth), the number of other sports (i.e., breadth), and the type of other sports were compared between selection tiers. The vast majority of female (92.8
The high relapse rate in methamphetamine (MA) use disorder (MUD) highlights limitations in current treatment approaches. MA disrupts neural circuits underlying reward processing and executive control, inducing maladaptive neuroplastic changes that reinforce compulsive drug-seeking behaviors. We propose a core pathology of MUD that lies in the dysregulation of metaplasticity, pathological alterations in the rules that govern synaptic plasticity. This dysregulation lowers the threshold for strengthening drug-related cues while simultaneously blunting plastic responses to adaptive, non-drug stimuli. This review posits that exercise may interrupt the MA addiction cycle through three interrelated metaplasticity-regulating mechanisms: a threshold recalibration mechanism whereby exercise synergistically lowers the threshold for adaptive learning across molecular (e.g., brain-derived neurotrophic factor–N-methyl-D-aspartic acid receptor signaling), neural circuit (prefrontal–striatal pathways), and large-scale brain network levels (default mode network–central executive network interactions). A competitive resource reallocation mechanism, in which exercise, acting as a natural reward, competes with drug cues for plasticity-related neural resources (e.g., dopamine D2 receptor availability), thereby weakening the dominance of drug-associated representations. This is a self-reinforcing mechanism, through which exercise enhances neural sensitivity to subsequent therapeutic interventions. The metaplasticity dysregulation framework integrates evidence spanning molecular and cellular processes, neural circuits and brain networks, and peripheral–central regulatory pathways (including the gut–brain axis). The framework suggests that exercise shifts the rules of neural plasticity away from pathological drug cue dominance toward adaptive processing of natural rewards, providing a strong neurobiological rationale for incorporating exercise into comprehensive MUD treatment strategies.
CART (combined aerobic and resistance training) has shown important results in exercise-based cardiovascular rehabilitation. However, there are little data concerning the effects of CART on the exercise capacity, muscle strength, health-related quality of life (HRQoL), and mortality of coronary heart disease (CHD) patients. Therefore, the aim of this study was to analyze the published randomized controlled trials (RCTs) that investigated the effects of CART on exercise capacity [peak oxygen consumption (peak VO2) and 6-min walking distance (6MWD)], muscle strength [1-repetition maximum (1-RM), peak torque and handgrip strength], HRQoL, and mortality in patients with CHD. We search for references in MEDLINE/PubMed, Scopus, Cochrane Central Register of Controlled Trials, and EMBASE databases to find RCTs that evaluated the effects of CART for CHD. Mean difference (MD), standardized mean difference (SMD), risk ratio (RR), and 95
Abstract Background Athletes with diabetes increasingly participate in endurance running, benefiting from physiological adaptations and technological advances like continuous glucose monitoring (CGM) for glycemic control. So far, no comprehensive review summarizing the current knowledge has been performed. Objective To identify the prevalence of long-distance runners with diabetes, their performance, methods used for blood glucose monitoring and glycemic control. Methods PubMed, Medline Ovid, Scopus, SPORTDiscus, Cochrane databases, CINAHL, and Web of Science were systematically searched until April 2024 using key terms related to long-distance running and diabetes. An updated search applying the identical strategy was conducted on May 3rd, 2026, to capture subsequently published literature. This study included original research articles, case reports, and case studies published in English or German in peer-reviewed journals, utilizing both quantitative and qualitative methodologies. Eligibility criteria encompassed runners with a confirmed diagnosis of diabetes mellitus, irrespective of type, who participated in endurance events of at least half-marathon distance, including half-marathons, marathons, ultra-marathons, and other ultra-endurance competitions. Patients with prediabetic state, gestational diabetes, or after pancreatic islet-cell transplantation were excluded. For quality assessment, we used the Joanna Briggs Institute of Analytical Cross-Sectional Studies or the Joanna Briggs Institute of Analytical Case Report critical appraisal tool. Results A total of 656 studies were identified, with 22 meeting the inclusion criteria, comprising 99 runners with diabetes (99.0% Type 1, 1.0% Type 2 diabetes mellitus). Among them, 50.0% used CGM, 27.2% had an insulin pump, 63.6% administered insulin via multiple daily injections, and the method of insulin application was not specified in 7.0% of runners. The weighted mean HbA 1c was 7.4% (95% CI 6.9–8.1). Time-in-range varied by race distance: 40–100% for half-marathoners, 51.6% for marathoners, and 47–73% for ultra-marathoners. No cases of symptomatic hypoglycemia were observed during the races. However, asymptomatic late-onset hypoglycemia (occurring 6–15 h post-exercise) was reported in 27 runners. The most common insulin adjustment strategy before competitive races was a 50–80% reduction of basal insulin. Conclusion Despite limited research, evidence suggests that with proper preparation and multidisciplinary support, athletes with diabetes can safely participate in endurance events, including ultra-marathons, while maintaining stable glycemic control. Trial Registration : PROSPERO—CRD42024539281.
Abstract Background Clinical guidelines and practice increasingly endorse physical activity interventions for individuals with neurodevelopmental disorders. However, because monitoring and reporting of potential intervention-related harms are often incomplete, the current evidence base regarding safety remains limited. Methods A systematic search of PubMed, Web of Science, Scopus, the Cochrane Library, and EBSCO was conducted on November 11, 2025, followed by three rounds of supplementary snowball searching completed on November 20, 2025. Eligible studies were randomized controlled trials of physical activity interventions in populations with neurodevelopmental disorders. Following prespecified procedures recommended by the CONSORT-Harms extension and the Cochrane Handbook for Systematic Reviews of Interventions, we characterized adverse event monitoring and reporting practices across studies, summarized reasons for participant withdrawal, and considered the potential safety signals these reasons might indicate. Random-effects meta-analyses estimated the relative risk of adverse events for physical activity interventions versus non-exercise controls, and potential moderators were examined via subgroup and meta-regression analyses. Results Among the 41,852 deduplicated records, 309 randomized controlled trials were included, comprising 322 study arms and 13,228 participants with neurodevelopmental disorders. None of the included trials fully complied with CONSORT-Harms recommendations for systematic harm monitoring and reporting. Only 58 trials described adverse event monitoring, mostly using passive, non-prespecified procedures; among those reporting results, approximately one quarter reported at least one adverse event or adverse effect, most commonly intervention-induced delayed-onset muscle soreness, mild pain or irritation, and related psychological discomfort. Among the 201 studies that reported reasons for participant withdrawal, 38 statements were too vague to determine the event characteristics. Sixteen studies reported adverse events (e.g., health problems and emotional discomfort); however, because none used a systematic adjudication procedure, attributing these events to the intervention was difficult. Forty-five studies met the inclusion criteria for meta-analysis. The pooled analysis indicated that physical activity interventions did not significantly increase the risk of reported adverse events (RR = 1.14; 95% CI 0.67–1.94). However, trials with prespecified monitoring procedures had a significantly higher risk estimate (RR = 4.32, 95% CI 1.36–13.68). Conclusions Existing reported results suggest that these interventions do not significantly increase the overall risk of adverse events. However, the strength of this conclusion is limited by widespread systematic underreporting in the original studies and by substantial heterogeneity in methods used to monitor, identify, and assess harms. In contrast, studies that implemented prespecified adverse event monitoring procedures were generally able to identify and report adverse events more comprehensively, rather than indicating that these trials carry a genuinely higher risk. Future research should establish and implement standardized procedures for adverse event monitoring and reporting, standardize procedures for adjudicating and attributing reasons for withdrawal, and systematically report key variables related to intervention implementation and descriptive adverse event data to strengthen the credibility of benefit–risk assessments of physical activity interventions in this population.
Concussion is a common but serious health concern among athlete and military populations. To improve understanding of concussion, the NCAA and U.S. Department of Defense established the Concussion Assessment, Research, and Education (CARE) Consortium, which collected comprehensive baseline assessment data from collegiate athletes and military service academy members. In this study, we used baseline assessments collected in service academy cadets and midshipmen to estimate the likelihood of concussion in the following academic year. Using eXtreme Gradient Boosting, we determined how the predictive accuracy of baseline assessments changes over the first year after testing and compared concussion risk prediction across two sub-populations (varsity/club sport athletes and intramural cadets) and two injury mechanisms (concussions occurring during military training/physical education classes versus sports-related concussions). Exploratory analyses also identified and ranked the most influential variables contributing to risk prediction, offering insights that could guide future risk assessment and prevention efforts. The analytic dataset included 16,642 participants from four U.S. military academies between the 2015–2016 and 2019–2020 academic years after data preprocessing. We used eXtreme Gradient Boosting to predict concussion risk using baseline variables collected within the same academic year. Prediction accuracy decreased as time passed since the baseline assessment both in the overall model and within each sub-population and injury mechanism model, with the overall prediction dropping from 0.68 to less than 0.64. Concussion predictions were more accurate for intramural cadets and for injuries sustained during military training or physical education, compared to varsity/club sport athletes and sports-related concussions. Given the significant time and resource investment required to conduct baseline concussion testing, baseline assessments being used to predict concussion risk should be performed as close to time periods of greatest risk as possible. Future research is needed to develop streamlined population- and injury mechanism-specific predictive models using a smaller set of key baseline measures to facilitate more frequent baseline testing to optimize risk prediction.
Distinct brain activity in anterior cruciate ligament (ACL) patients has been reported, yet comprehensive evidence on neural differences during movement and the potential impact on motor performance remains limited. This review aimed to synthesize evidence on cortical activity during motor tasks in ACL patients compared to healthy controls and explored the potential impact on motor performance. A scoping review was conducted in accordance with the Joanna Briggs Institute methodological guidance for scoping reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews. Eligible literature was searched in PubMed, Embase, SPORTDiscus, and Web of Science from inception to December 31, 2025, and included primary research assessing brain activity during voluntary motor tasks in ACL patients compared to controls. Out of 233 identified records, 25 were included, with 15 utilizing electroencephalography, 8 functional magnetic resonance imaging, and 2 functional near-infrared spectroscopy assessing a total of 416 ACL patients on study level. 21 studies reported significant between-group differences in brain activity, demonstrating increased activity in frontal and visual processing regions but inconsistent findings for motor and parietal cortices. Additionally, 14 records described behavioral data alongside neuroimaging results, of which 10 found no significant differences and 4 reported impaired motor performance. Distinct patterns of brain activity were demonstrated in ACL patients compared to healthy controls, predominantly depicting increased recruitment of neural resources within the cognitive and visual network. Despite some evidence reporting associated impaired motor performance, the relationship between cortical alterations and motor performance remains hypothetical. Future research should incorporate paradigms including visual and cognitive dual-tasks to explore the relationship between brain activity and behavioral outcomes.
Long-chain omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) support cardiovascular health; however, athletes often exhibit Omega-3 Index (O3I) levels below 8
Prior research has shown that mental fatigue, induced by prolonged cognitive loads, negatively impacts subjective and behavioral variables. A currently unanswered question is whether the susceptibility to mental fatigue (i.e., how much mental fatigue a person experiences and how much it affects performance) can be classified as a state or a trait characteristic, or combination of both. Therefore, a follow-up measurement of a large-scale experimental study was conducted to assess the temporal robustness of mental fatigue susceptibility. Twenty-five participants (10♀; 31 ± 8 y) finished a familiarization, intervention (Stroop task) and control (documentary) trial on two separate occasions (i.e., baseline and follow-up) approximately one year apart. Subjective (i.e., subjective feeling of mental fatigue (MVAS) and the rating of perceived exertion (RPE)) and behavioral (i.e., GoNoGo task reaction time and distance covered during a cycling time trial) outcomes were selected for further analysis. Temporal robustness was analyzed by comparing mixed linear models between baseline and follow-up, and performing intraclass correlation coefficients (ICC) on the condition differences between baseline and follow-up. The influence of the Stroop task on the time trial performance revealed fair temporal robustness (ICC = 0.448, p = 0.011), while also showing a diminishing effect of mental fatigue in follow-up compared to baseline. The influence of mental fatigue on RPE values was significant at baseline (β = 2.85, p = 0.022), and showed a trend towards significance at follow-up (β = 2.22, p = 0.058). GoNoGo reaction time showed limited consistency between baseline and follow-up, while there was a small significant correlation after the intervention/control task for the MVAS (ICC = 0.336, p = 0.047). There were no other significant correlations between condition differences. Our findings favor a state-like interpretation of mental fatigue susceptibility. The results highlight the importance of RPE in driving the negative influence of mental fatigue on physical performance, while also confirming the discrepancy in subjective and behavioral quantification of mental fatigue. Future research is necessary to further investigate this phenomenon, ideally focusing on the additional influence of external features such as weather and occupational cognitive demands on mental fatigue susceptibility. Trial registration Clinicaltrials.gov, NCT05576935, registered 1st of July 2022, https://clinicaltrials.gov/study/NCT05576935?term=NCT05576935 rank=1
Abstract Background Understanding differences in non-game performance indicators—spanning physical, motor, technical, tactical, and psychological domains—may assist athlete profiling and monitoring in youth basketball. However, comparatively little is known about whether standardised psychological measures differentiate competitive standards in youth basketball. Objectives This study aimed to quantify mean differences in non-game performance indicators between elite and sub-elite South Australian youth basketball players using a quantitative cross-sectional design. Methods All South Australian under-16 and under-18 Division 1 and 2 district basketball players were invited to participate. A total of 174 players (n = 98 [56%] male), including 125 elite and 49 sub-elite players, were assessed. Non-game performance indicators included anthropometric, physical fitness, movement skill, and psychological measures. Generalised linear models adjusted for age, sex, and biological maturation were used to quantify differences between elite and sub-elite players. Differences in means were expressed as partial eta-squared (η 2 ) effect sizes. Results After adjustment, elite players demonstrated significantly higher confidence (η 2 = 0.138), instrumental leadership (η 2 = 0.123), competitiveness (η 2 = 0.120), and body mass (η 2 = 0.074) compared to sub-elite players. Conclusions Significant psychological and anthropometric differences exist between elite and sub-elite youth basketball players. These findings support the inclusion of psychological assessment within multidimensional athlete profiling and monitoring frameworks, although longitudinal studies are required to establish their predictive value for future playing success.
A paradigm shift has emerged regarding exercise participation in patients with hypertrophic cardiomyopathy (HCM), with recent studies suggesting that structured training may improve functional capacity and cardiopulmonary responses. However, the effects of structured exercise interventions in HCM have not been comprehensively synthesized. The main objective was to determine the effect of exercise training on bodyweight, functional capacity, echocardiography, blood pressure, heart rate (HR), double product, and NT-proBNP in HCM patients. Randomized controlled trials (RCTs) and non-randomized individualized endurance and concurrent training interventions including cardiopulmonary exercise test and echocardiographic measures in adult (≥ 18 years) obstructive and non-obstructive HCM patients were extracted from PubMed, Web of Science, and Cochrane in December 2025. Random-effects meta-analyses and meta-regressions were performed, and risk of bias was assessed using the ROBINS-I V2 tool for internal validity. Data from 8 studies (3 RCTs) with 205 low to moderate risk patients showed that training significantly (all p < 0.05) increased [mean (95 Exercise training is emerging as a promising therapeutic strategy for individuals with hypertrophic cardiomyopathy (HCM). This study systematically reviewed and analyzed evidence from eight clinical trials including 205 low to moderate risk patients with obstructive and non-obstructive phenotypes. Importantly, all interventions were individualized, guided, and followed up by the researchers and no adverse events were reported in these cohorts. The available evidence suggests that structured exercise programs are associated with meaningful improvements in multiple areas of health. Participants showed increased functional capacity, reflected by higher peak oxygen consumption (pVO2) and longer exercise time. These increases were significantly higher compared to control groups consisting in usual care, and similar between endurance-only and concurrent endurance + resistance training interventions. Exercise training was also associated with improved heart rate responses during physical activity, including higher peak values, greater reserve, and lower resting heart rate. Importantly, no adverse structural or functional changes in heart imaging were observed, confirming that short to mid-term exercise programs were not associated with adverse changes in cardiac morphology in HCM. Moreover, a small between-group reduction in maximal wall thickness ( 1 mm) was observed compared to usual care. Overall, structured exercise programs lasting approximately 2–3 months or longer may be sufficient to induce positive adaptations. These findings support the emerging role of individualized exercise as a potential component of HCM management in selected patients, while more research on longer programs and greater cohorts is warranted.
