The “athlete’s heart” represents a physiological condition consequent to long-term adaptation to sport-specific training loads. Cardiac imaging is a pivotal tool in the assessment of athletes. The study of the autonomic nervous system (ANS) using heart rate variability is becoming increasingly popular in sports fields, given its fundamental role in cardiovascular adaptation to exercise. Unfortunately, many barriers limit the clinical use of this methodology. In this observational study of 330 elite athletes, we used a composite index of ANS control (ANSI), designed to overcome pitfalls, following the hypothesis that studying the ANS could help address cardiac adaptation to high-volume training. In athletes subdivided into three groups considering the level (LOW/HIGH) of combined static/dynamic exercise and the presence [+]/absence [−] of left ventricular hypertrophy (LVH), we found that ANSI showed a progressive increase (LOW: 38.2 ± 27.6%; HIGH-LVH [−]: 52.1 ± 27.2%; HIGH-LVH [+]: 64.4 ± 24.9%, J-T test p < 0.001), with significant differences between all groups considered (p < 0.001). After adjustment and within the HIGH group, ANSI showed the strongest association with LVH and the highest explanatory power among autonomic variables. In conclusion, ANSI was able to differentiate elite athletes characterized by different cardiac remodeling and workloads (as suggested by different sport disciplines), corroborating the hypothesis for a wider use of ANS evaluation in the sports field.

Background/Objectives: Lifestyle Modification Programs (LMPs) based on exercise and nutrition aim to prevent/manage chronic diseases and foster well-being. However, moving LMPs from research to medical practice can be challenging, as programs must be both effective and feasible. The primary goal of this study was to assess cardiorespiratory fitness (CRF) changes according to an LMP, measured through VO2max, as a key indicator of health outcomes and intervention efficacy. Methods: In this single-arm intervention study, 100 subjects were enrolled; per-protocol analysis of main parameters was performed on 85 participants (15 were excluded due to medical/technical reasons). A feasible intervention program (of low resource intensity with only two physician/patient encounters) provided personalized exercise prescription, optimized nutritional habits based on the Mediterranean diet and Healthy Eating Plate principles, and supported behaviour change. We assessed CRF through VO2max, a key indicator of health outcomes and intervention efficacy. We also analyzed, using regression analysis, the relationship between VO2max (the gold-standard measure of CRF) and METSpeak, a simpler, feasible parameter of CRF derived from Exercise Stress Testing. Body composition (BC) and AHA diet score were also measured at baseline and post-6-month intervention. Statistical analyses included paired comparisons and multivariable regression to explore factors influencing CRF changes. Results: Analysis on the primary outcome, VO2max, was performed according to the intention-to-treat principle and per-protocol. This feasible protocol resulted in a significant increase in VO2max, improvements in fat-free mass, and a reduction in fat mass. Overall, 42.4% of participants achieved an improvement of ≥1 MET, a change previously associated with reduced mortality risk. Older participants tend to experience smaller improvements in VO2max. Conclusions: Although observing an improvement in CRF and BC following an LMP is not surprising, the strength of the study is to show the feasibility of implementing an effective, feasible LMP into clinical routine, supporting the integration of such programs into clinical practice.

Background/Objectives: Cardiorespiratory fitness (CRF), measured as VO2peak during cardiopulmonary exercise testing (CPX), represents a fundamental marker of cardiovascular health. Heart Rate Variability (HRV) assesses cardiac autonomic regulation (CAR) non-invasively, though technical issues limit clinical use. Combining CRF and CAR may provide complementary information on cardiovascular and autonomic function. We examined the relationship between CRF and HRV using a composite autonomic index, the Autonomic Nervous System Index (ANSI), which incorporates multiple HRV variables accounting for age/sex-related influences. Methods: This cross-sectional study involved 200 adults undergoing preventive health evaluation without overt cardiometabolic disease. CRF was expressed as VO2peak and as VO2peak percentile from the FRIEND registry. CAR was assessed at rest using HRV. Results: We observed significant correlations between VO2peak and several HRV variables, with ANSI showing the strongest association (r = 0.457, p < 0.001). In simple regressions, ANSI was linked to VO2peak (R2 = 0.175, p < 0.001) and VO2peak percentile (R2 = 0.209, p < 0.001). In multiple regression, several autonomic variables were retained for VO2peak, whereas ANSI was the only autonomic variable retained for VO2peak percentile. This association remained significant after adjustment for age, sex, smoking, and anthropometric measures. Trend analyses (p < 0.001) and ordinal regression analyses (p < 0.001) further substantiated these findings. A 10-point increase in ANSI corresponded to an OR of 1.39 for belonging to a higher CRF percentile category. Conclusions: Multiple HRV indices were associated with CRF, with ANSI showing the strongest association. These findings highlight the potential of ANSI as a simple, integrated measure of CAR in individuals with different levels of CRF.

This tutorial presents a step-by-step guide on how to use an adult-oriented wearable (Fitbit) to collect and analyze activity and cardiovascular data in a pediatric population of school-aged children with obesity. After outlining the current landscape of commercial wearables for adults and children, the tutorial illustrates the distinct considerations required for accurate pediatric monitoring, especially for cardiovascular metrics and derived features. The text provides a clinical application, highlighting how data from these devices were gathered and integrated with standard clinical measurements (ie, 1 week of monitoring with the wearable compared with the 6-minute walk test). The tutorial also discusses potential correlations, which should be interpreted as exploratory, given the small sample size (n=16), as well as limitations and future perspectives on using wearables for long-term pediatric monitoring of school-aged children, aiming to inform clinicians, researchers, and other stakeholders about the additional considerations that are needed to use wearables designed for adults to monitor this age group.

[This corrects the article DOI: 10.3389/fspor.2024.1422222.].

Background/Objectives: The workplace represents an ideal context for applying policies to foster a healthy lifestyle, guaranteeing advantages both to the individual and the company. Nevertheless, motivation to change one’s lifestyle remains an issue. This study aimed to determine subjects’ most valued intentions toward lifestyle changes and the target actions to improve lifestyles that they would be willing to invest in economically, information which might help design effective intervention programs. Methods: Classification trees were applied to 2762 employees/ex-employees (55.09 ± 13.80 years; 1107 females and 1655 males) of several Italian companies who voluntarily filled out an anonymous questionnaire on lifestyles (inquiring about, e.g., exercise, nutrition, smoking, and stress) to unveil specific subject typologies that are more likely associated with, e.g., manifesting a specific intention toward lifestyle changes and choosing the two most popular target actions resulting from the survey. Results: The main lifestyle aspect that respondents desired to improve was to become more physically active, and the most preferred tools chosen to improve their lifestyle were the possibility of having a medical specialist consultant to prescribe a tailored lifestyle program and buying a gym/swimming pool membership. Conclusions: This observational study might help tailor worksite health promotion and insurance services offered to employees, initiatives that may play an important role in fostering health/well-being and preventing chronic diseases in the more general population, especially in healthy or young subjects who are more prone to change their behavior if immediate benefits are seen instead of only advantages in the future.

Fibromyalgia (FM) is a chronic syndrome characterised by widespread pain, high prevalence, and a significant impact on quality of life. Despite extensive research, its pathogenesis and treatment remain only partially understood, driving continued investigation throughout 2024. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system has been linked to chronic stress responses and neuroinflammation, with neuroimaging and preclinical studies confirming altered pain and stress processing. Low-grade inflammation and metabolic disturbances, including cytokine imbalance and increased adipose tissue infiltration, further exacerbate symptoms. Alterations in the gut microbiota contribute to immune and emotional dysregulation. MRI studies continue to reveal brain changes that differentiate FM from other chronic pain disorders. Multi-omics approaches, including transcriptomic and metabolomic analyses, show promise as diagnostic biomarkers. Mitochondrial dysfunction also emerges as a key factor, since impaired energy metabolism seems to correlate with symptom severity. From a clinical perspective, recent studies have explored under-recognised aspects of FM, such as sexual and cognitive dysfunction, the role of gender, environmental exposures, and the disease's impact on relationships and family life. The differential diagnosis of FM and long COVID has ignited discussion about potential shared mechanisms. Conversely, residual pain in inflammatory diseases remains insufficiently addressed. Therapeutically, non-pharmacological strategies, particularly physical activity and psychosocial interventions, remain fundamental. Emerging areas such as non-invasive neuromodulation, psychedelic therapies, and the integration of technologies like virtual reality and artificial intelligence are opening new frontiers in treatment, patient care, and research. These advances underscore the multifactorial nature of FM and the need for personalised, interdisciplinary approaches.

Ageing is a multidimensional concept related to the progressive decline in physiological functions. The decrease of physical autonomy due to the ageing process leads to frailty, which in turn is associated with disability and comorbidity. Ageing represents the primary risk factor for chronic degenerative diseases, especially involving cardiovascular, metabolic, respiratory, and osteoarticular systems, determining the decrease in activities and quality of daily life. Regular physical activity can significantly reduce the risk of chronic degenerative diseases, moderate or severe functional limitations, and premature death in older adults. In light of the relationship between ageing, sedentary lifestyle, disability, comorbidity, and physical activity, a clear need emerges within the health system. Better control on the territory of pathologies related to ageing with the management of clinical and care complexity, multidimensional and multi-professional evaluation of the elderly complex and fragile patient, also through the definition of specific outpatient packages for pathology that allow the simplification of the evaluation process. There is a need for integration between local services, hospitals, and social assistance services. Aim of this review is to highlight the importance of the multidimensional approach is essential to be able to classify the complex elderly patient according to a multi-professional vision aimed at evaluating comorbidities and frailties, including sarcopenia, nutritional deficits, functional capacity, and planning a personalized and monitored motor training program, to improve motor, metabolic, cardiovascular and respiratory functions. In addition, developing an integrated hospital-community-care services management program to follow up with patients post-care is crucial.

Background:A healthy lifestyle is currently considered a pillar in the prevention/treatment of chronic non-communicable diseases in both adulthood and childhood. Notably, it is also a prominent tool for fostering wellbeing and managing stress, particularly at a young age when these two lifestyle components play a fundamental role in determining present and future health. Purpose:This study aimed to evaluate the link between stress perception and lifestyle habits, particularly exercise and sleep in children/adolescents and their parents, using a simple anonymous questionnaire. Methods:Members of 50 families filled out a simple ad hoc anonymous questionnaire on lifestyle habits (exercise, sleep, nutrition, etc.) and stress/health/performance perceptions. The questionnaire was based on standardized instruments (International Physical Activity Questionnaire and the American Heart Association Healthy Diet Score), including objective indicators such as exercise volume and self-developed ordinal evaluation scales ranging from 0 to 10 that assessed subjective perceptions (e.g., health, stress, and performance). Anthropometric, systolic and diastolic arterial pressures, and heart rate data were also collected. Results:In children/adolescents, stress perception negatively correlated with the volume of moderate-vigorous exercise and time dedicated to sleep. The latter also correlated positively with the perception of health and academic performance and negatively with perception of fatigue, somatic symptoms, and systolic arterial pressure percentiles. When considering data from all the family members, we also observed interesting significant correlations between parents' exercise habits, parents' perceptions of health, and parents' perceptions of somatic symptoms and the perception of stress reported by their children, respectively. Conclusion:In this observational study, exercise and good sleep hygiene represent important tools to counteract stress perception in youth, fostering present and future wellbeing and health. The collection of lifestyle data using a simple questionnaire with simple clinical parameters may offer an opportunity to construct an immediate picture of family members' lifestyles, which may motivate parents and institutions to focus on improvement of lifestyle components (in particular, exercise and good sleep) instead of only focusing on traditional risk factors (such as dyslipidaemia, obesity, hypertension, and smoking) to foster present wellbeing in children/adolescents and prevent chronic non-communicable diseases.

Background/Objectives: Childhood/youth are ideally the best periods to teach healthy behaviors; unfortunately, children/adolescents are frequently characterized by unhealthy lifestyles and reduced well-being. Lifestyle improvement early in life may play a fundamental role in determining present health, preventing many chronic diseases, and fostering well-being. Having a clear picture of the lifestyle characteristics of a group can help institutions and schools define effective educational and intervention strategies. This observational study aims to examine whether information collected from children and adolescents about their lifestyles and perceptions of well-being could help identify particular groups that deserve specific interventions, implemented by the school, to improve their overall health. Methods: After administering a simple lifestyle/well-being questionnaire to 225 children/adolescents at an Italian school complex, we investigated the relationships between lifestyles and perceptions of well-being by constructing statistical indicators through nonlinear principal component analysis. Then, we defined lifestyle typologies based on lifestyle indicators and studied the distribution of the well-being indicator across such typologies, also adjusting for sex and age effects. Results: The study shows that lifestyle worsens with age (p < 0.001) and influences overall well-being perception. We identified four lifestyle typologies by combining two indicators of sedentary behavior and sleep, and of quality of nutrition and the volume of physical activity. The healthier the lifestyle, the better the overall well-being perception is (represented by the indicator that includes the perceived quality of health, sleep, and academic performance) (p = 0.005). Conclusions: Tailored educational/intervention strategies that consider specific groups’ characteristics, rather than general counseling, might be more effective at improving health/well-being.

The assessment of cardiac autonomic regulation (CAR) with non-invasive techniques, such as heart rate variability (HRV), might be of practical interest in elite sports, considering its importance in determining training. We studied 117 soccer players (74 male and 43 female) from three First Division European soccer teams. We used a ranked Autonomic Nervous System Index (ANSI, resulting from the combination of multivariate statistical methodologies applied to HRV-derived indices) to assess CAR. We hypothesized that ANSI might differentiate playing positions, considering goalkeepers, defenders, midfielders, and forwards. We also assessed the perception of somatic symptoms and stress. We observed in male athletes that ANSI was significantly greater in males as compared to females (p < 0.001), being higher in midfielders and defenders (p = 0.035), who usually sustain the greatest external load. Interestingly, this result was not observed in female athletes, who, instead, reported a significantly higher perception of somatic symptoms (p = 0.018) and stress (p = 0.049), the latter being particularly high in midfielders and forwards (p = 0.045). This approach might represent a convenient model to study the effects of long-term physical exercise on CAR in soccer, even to unveil possible differences due to sex, different playing positions characterized by distinct exercise routines, or stress perception.

The aims of this study are to evaluate the effectiveness of an online supervised training program in modulating lipid and glucose metabolism in children with obesity and to investigate the possible role of the 6-minute walking test (6MWT) as a predictor of metabolic improvement. A total of 35 Caucasian children with obesity (aged 8-13) were enrolled in the study and tested before (T0) and after (T1) a 12-week online supervised exercise training protocol: cardiovascular fitness (by means of 6MWT), metabolic biochemical profile, lifestyle (with ad hoc questionnaires focusing on physical activity, nutrition, sedentariness, sleep hours and quality, health perception) and Cardiac Autonomic Regulation (CAR) were assessed. Spearman correlations between the variations in the studied outcomes were explored. After intervention, the distance covered during 6MWT significantly increased (p < 0.001), and nutrition quality improved slightly but significantly (p = 0.03). The improvement in the 6MWT performance was shown to be significantly correlatee with the reduction of insulin levels (r = -0.455; p = 0.02), HOMA-IR Index (r = -0.452; p = 0.02), total cholesterol values (r = -0.549; p = 0.004) and Atherogenic Index of Plasma (AIP) (r = 0.422; p = 0.04). Moreover, there was a significant correlation between the improvement in 6MWT and health perception (r = 0.578; p = 0.002). We observed that the improvement in the 6MWT performance correlates with better metabolic profile after exercise training in children with obesity suggesting the goodness of this simple test on unveil changes in pathogenetic processes underlying obesity.

Background/Objectives: Cardiorespiratory fitness (CRF) represents a strong and consistent predictor of mortality among adults. It is ideally expressed as the maximum or peak rate of oxygen consumption per kilogram of body mass (VO2max) determined by the cardiopulmonary exercise test (CPX). Variance in CRF is mainly attributable to genetics and physical training; nevertheless, strong behavioral and socioeconomic confounders need to be considered. Among those, psychosocial stress may play an important role. Some papers show an association between low CRF and chronic stress conditions; nevertheless, CRF is generally estimated by indirect assessment and not directly measured by CPX. Methods: CRF was directly assessed by performing a CPX in 145 consecutive subjects (56 male, 89 female) (age 19-65 years) who attended our Exercise Medicine unit for health check-ups. Weekly total volume of physical activity (PA) was evaluated using a validated questionnaire (IPAQ); perceptions of stress, fatigue, and somatic symptoms were assessed using a self-administered questionnaire. Results: VO2max was negatively correlated with perception of stress (p = 0.03), fatigue (p < 0.001), and somatic symptoms (p < 0.001); as expected, it was positively correlated with the weekly volume of PA (p < 0.001). This link was further evidenced by the observation that subjects who did not meet the PA goals as indicated by WHO guidelines presented a higher perception of stress, fatigue, and symptoms, as compared to physically active subjects. Conclusions: This direct link might, on the one hand, corroborate the role of exercise as a tool to manage stress and, on the other hand, focus on the role of stress as a possible determinant of CRF.

Aims The frequent occurrence of sudden death as the sentinel event in the long QT syndrome (LQTS) forces the search for still asymptomatic patients. We tested our hypothesis that complete fusion of the T and P waves (TP-fusion) at peak exercise might be a marker of likely LQTS. Methods and results A maximal exercise stress test, off-therapy, was performed by healthy athletes and genotype-positive LQTS patients. TP-fusion had to be complete in all precordial leads except V1. The study population (n = 578) included 310 healthy athletes (all with QTc <430 ms) and 268 LQTS patients. To deal only with clear-cut phenotypes, 64 athletes and 70 patients with incomplete TP-fusion were excluded. TP-fusion was present in 2% of controls and in 22% (P < 0.001) of the 198 LQTS patients. By limiting the analysis to subjects below age 25 (n = 262), the prevalence of TP-fusion increased to 3% in healthy athletes and to 32% in LQTS (P < 0.001). TP-fusion depends on the combination of QTc prolongation and fast heart rates; either alone is not sufficient. The appearance of TP-fusion predicted an 88% probability of being affected by LQTS. Importantly, of the 44 LQTS patients with TP-fusion, 24 (55%) had a borderline/normal baseline QTc (<460 ms). Conclusion TP-fusion, a qualitative trait more easily assessable at peak exercise than QTc prolongation, especially outside referral centres, unmasks a high probability of LQTS, even in subjects with normal baseline QTc. Further clinical assessment and genetic screening allow life-saving prophylactic therapy.

BACKGROUND: Workplace barriers to physical activity (PA) and sedentary work contribute to obesity. Workplace lifestyle interventions are needed to reduce sedentary behavior. OBJECTIVE: The study evaluates the effects of a self-monitoring PA protocol plus diet on general health of workers with obesity. METHODS: Thirty-nine workers affected by obesity were enrolled in this pilot intervention study. Monthly and daily PA diary, six-minute walking test (6MWT), Short Form-36 health survey (SF-36), and Global Physical Activity Questionnaire (GPAQ) results were evaluated prior (T0) and at the end of the study (T1). A personalized low-calorie diet based on the Mediterranean diet model was also implemented. Participants followed the protocol from one to three months depending on the date of recruitment. RESULTS: Significant improvements in SF36 and GPAQ scores were recorded, along with reductions in sedentary activity, weight, and BMI (p < 0.001). 6MWT significantly increased from 462.5 [412.5–500] m at T0 to 500 [462.5–550] m at T1 (p < 0.001). A multiple linear regression analysis to investigate the impact of selected covariates (PA, body weight reduction, and sedentary time) on the 6MWT was significant in men. CONCLUSIONS: PA self-monitoring protocols and diets are effective and sustainable for workplace interventions. PA should be part of daily medical practice and occupational physicians should encourage behavioral changes in workers.

Objective. To evaluate the role of exercise in the management of fibromyalgia syndrome (FM) by addressing its complex pathogenesis involving central sensitisation, autonomic dysfunction, inflammation, and neurological irregularities, and examining how exercise impacts symptom exacerbation caused by external stressors and comorbid conditions. Methods. This review synthesises evidence from current literature focusing on the benefits of structured and personalised exercise programmes in FM management. It discusses the importance of specifying exercise type, intensity, frequency, duration, and progression tailored to individual patient needs and clinical objectives. Results. Regular physical activity effectively mitigates core aetiopathogenetic mechanisms of FM and improves associated conditions such as stress and obesity. It also provides benefits for preventing other chronic diseases, enhancing well-being, and promoting healthy ageing. Structured and personalised exercise programmes that start with a low-demand protocol and gradually increase exercise volume are most beneficial, by improving patient compliance and reducing the risk of adverse effects. Conclusion. Effective management of FM requires a patient-centred approach integrating both pharmacological and non-pharmacological treatments, with exercise playing a pivotal role. Personalised exercise prescriptions that consider FM patients' specific needs and limitations are crucial for optimising treatment outcomes and enhancing quality of life.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)