Sleep has been identified as an important factor influencing performance, as well as sex and chronotype. The study aimed to investigate: (I) sleep changes in tennis season periods; (II) sleep influence on balance and lower-limb strength; (III) sex and chronotype influences. Participants filled out a questionnaire to evaluate their chronotype. Sleep habits, balance, and lower limbs strength were evaluated in two season periods: off- and in-season. Forty percent of participants worsened their sleep duration from off- to in-season. Based on this, two groups were made: the worsened sleep group (WSG) and the improved sleep group (ISG). The WSG showed a decrease in balance performance across all test conditions. This was evidenced by significantly higher Sway Path Length (SPL) and Sway Average Speed ​​(SAS) values in double-leg stance (DLS) both with eyes open (EO) and eyes closed (EC) (p range from 0.043 to < 0.001), as well as in single-leg stance (SLS) (p range from 0.018 to 0.010) from off-season to in-season period. Furthermore, gender-specific differences were also observed. Females had significantly worse SPL and SAS values ​​in right SLS (p ≤ 0.043), while males significantly increased SAS in DLS with EO (p = 0.044), and SPL, SAS, and Sway Ellipse Area (SEA), in DLS with EC (p ≤ 0.018). No sleep effects were found in jumping performance. Evening types showed the lowest SEA in left SLS than the other chronotypes, and at in-season compared to off-season (all p < 0.001). Sleep remains a critical determinant of performance. Indeed, a reduction in sleep quantity was associated with a significant decline in balance performance, while no effect on jumping performance was observed. The strength of this association may be affected by athletes’ transition from off-season to in-season. This study suggests that individual factors such as sex and chronotype can influence these associations. These results offer valuable insights that require further investigations.

Background/Objectives: Anorexia nervosa (AN) is a severe psychiatric disorder characterized by energy restriction and associated with profound metabolic and body composition alterations. The loss of Body Cell Mass (BCM) leads to impaired muscle strength and functional capacity. Traditional monitoring based on body mass index (BMI, kg/m2) and weight primarily captures quantitative recovery, failing to reflect early qualitative metabolic and functional restoration. This study evaluated the longitudinal associations between improvements in physical performance and metabolic and structural recovery during intensive rehabilitation. Methods: A prospective longitudinal study was conducted on 21 AN patients undergoing a four-month intensive nutritional and functional rehabilitation program at Villa Miralago. Anthropometry, BIVA-derived parameters, indirect calorimetry and physical performance tests were assessed at baseline (T0), 2 months (T1) and 4 months (T2). Longitudinal associations were explored using Generalized Estimating Equations (GEE). Results: Improvements in functional performance (KPI-SUSS) were significantly associated with metabolic recovery, with a positive association with resting metabolic rate (β = +0.3635; p = 0.0088), indicating early metabolic reactivation before full structural reconstruction. Grip strength (KPI-grip) was significantly associated with cellular integrity (Xc β = +0.4129; p = 0.0088) and with favorable fluid redistribution (↑ intracellular water percentage (ICWp), ↓ extracellular water percentage (ECWp)). Structural recovery markers (Fat-Free Mass (FFM, kg), Fat-Free Mass Index (FFMI, kg/m2), BCM) increased significantly over time, confirming a time-dependent restoration of metabolically active mass. Fat mass (FM, kg) and fat mass percentage (FMp) were positively associated with functional improvement, although this effect attenuated longitudinally. These findings support strength performance as a sensitive functional indicator longitudinally associated with qualitative metabolic and cellular recovery. Conclusions: Muscle strength and functional performance tests are simple, non-invasive and cost-effective tools longitudinally associated with metabolic and structural normalization in AN. Their integration into clinical practice may enable the monitoring of meaningful recovery, personalized rehabilitation strategies and improving long-term outcomes.

Physical and mental health are receiving increasing attention among university students. This study aims to evaluate the relationship between physical activity level, chronotype, and sleep quality in influencing physical and mental health in a sample of 691 active Italian university students. Participants completed the GSL-TPAQ, MEQ, PSQI, and SF-12 questionnaires and were divided into three categories based on physical activity level (low, medium, high). A three-way ANCOVA assessed the main effects of physical activity, chronotype, and sleep quality on physical and mental health. A moderated mediation model tested whether sleep quality mediated the relationship between chronotype and health, and whether physical activity moderated the effect of sleep quality on health. A three-way ANCOVA revealed that high physical activity, morningness, and good sleep quality were associated with better mental health. Specifically, students with high physical activity reported higher mental health (43.23 ± 8.97 a.u.) than those with low activity (40.65 ± 10.21 a.u.; p < 0.05). Morning-types reported better mental health (43.6 ± 9 a.u.) compared to evening-types (39.08 ± 10.05 a.u.; p < 0.001), and good sleepers scored significantly higher on mental health (43.64 ± 9.04 a.u.) than bad sleepers (37.7 ± 9.68 a.u.; p < 0.001). Good sleepers also had better physical health (52.55 ± 5.32 a.u.) than bad sleepers (50.14 ± 5.97 a.u.; p < 0.001). A moderated mediation model confirmed that sleep quality mediated the relationship between chronotype and mental health (indirect effect: B = –0.08, 95

Inadequate sleep quality is a significant risk factor for overweight and obesity, which in turn may predispose individuals to adverse health outcomes. The aim of the present study was to evaluate the moderating effect of physical activity on the relationship between sleep quality and BMI in adults with overweight and obesity. In the current cross-sectional study, 589 white European participants (mean age 50 ± 12.2 years; 65% women; mean BMI 31.4 ± 5.5 kg/m2) were recruited from the International Center for the Assessment of Nutritional Status in Italy between October 2021 and July 2022. They completed the Godin–Shephard Leisure Time Physical Activity Questionnaire and the Pittsburgh Sleep Quality Index. The significant moderation model analysis performed on the entire sample [F(3, 585) = 4.4, p = 0.0045, r = 0.15, r2 = 0.02] found a statistically significant association between sleep quality and BMI (β = −0.16, p = 0.05), between physical activity and BMI (β = −0.08, p = 0.0018), and between the interaction of sleep quality and physical activity and BMI (β = 0.01, p = 0.01), particularly for physical activity values equal or higher than 49 Leisure Score Index (p = 0.004). The moderation analysis revealed a significant effect of physical activity on the relationship between sleep quality and BMI; better sleep quality was associated with lower BMI in individuals with higher levels of physical activity. The present findings suggest new aspects relating to the effect of physical activity in the relationship between sleep quality and overweight/obesity. Therefore, focusing on maintaining adequate levels of physical activity may represent an effective complementary strategy.

University students face several lifestyle-related health risk factors, including low physical activity levels, inadequate sleep quality and duration, and poor diet quality, which can contribute to compromised health. This study explores (i) the effect of physical activity levels and being bachelor’s or master’s students on sleep quality, adherence to the Mediterranean diet and health and (ii) how these factors may influence health outcomes in a sample of Italian university students. 436 sports science students answered an online survey assessing physical activity (GSL-TPAQ), sleep quality (PSQI), daytime sleepiness (ESS), Mediterranean diet adherence (KIDMED), and health status (SF-12). Master’s students reported better sleep quality (p = 0.046) and less daytime sleepiness (p = 0.025) than bachelor’s. Independently of graduation state, students in the highest activity tertile reported better mental health than those in the lowest (p = 0.003) and medium tertiles (p = 0.013). Regression analyses identified poor sleep quality as a significant predictor of worse physical (β = − 0.2, p = 0.001) and mental health (β = − 0.35, p < 0.001); Mediterranean diet adherence (β = 0.09, p < 0.048) was associated with better physical health, while higher physical activity (β = − 0.14, p = 0.001) and being master’s students (β = − 0.12, p < 0.01) were predictors of better mental health. Even in a sample of highly active and good sleeper students, physical activity and sleep quality appear as critical factors in determining physical and mental health, underlying the necessity of interventions for university students’ lifestyles.

Sleep efficiency is a widely used indicator of sleep quality in actigraphy studies. Nevertheless, it is a composite metric integrating data derived from actigraphic recordings alongside information about bedtime and wake-up time, typically obtained from self-reported sleep logs. The aim of this report is to propose a novel sleep efficiency index, denoted as core sleep efficiency, that relies solely on actigraphic data and focuses on the quality of sleep after its onset. Using a database of actigraphic recordings obtained in 40 young subjects (22 ± 3 yrs, Mean±SD) and in 45 middle-aged subjects (63 ± 11 yrs, Mean±SD), we evaluated the interrelationship between the two metrics of sleep efficiency and investigated the extent of their correlation with other crucial actigraphic indicators of sleep quality, such as sleep onset latency, fragmentation index and mean activity score. We provided evidence suggesting that the novel index may be suitable for specifically assessing the quality of sleep once it has begun. We propose that the newly introduced core sleep efficiency has the potential to serve as a valuable adjunct to the classic sleep efficiency, thus enriching the parametric characterisation of sleep obtained through actigraphy.

BackgroundIn modern society, achieving high-quality sleep is increasingly challenging. We conducted a study to explore the potential benefits of daytime physical activity and balneotherapy, including mud application and thermal-water bathing, on sleep quality.MethodsTo assess daytime physical activity and sleep parameters, we actigraphically monitored 127 healthy participants (34.6% male, average age 64.61 ± 0.89 years) during a one-week stay at a spa resort, where they received mud application and thermal-water bathings.ResultsParticipants were divided into three groups based on the timing of mud application. Those receiving mud application before 8:30 a.m. tended to have shorter sleep durations compared to those with later application, especially if it occurred before 7:45 a.m. However, mud application did not significantly affect sleep quality. Three-way ANCOVA revealed a significant effect of daytime physical activity on delta Sleep Efficiency, but post-hoc tests were insignificant. Furthermore, analyzing the duration of daily thermal-water bathings, individuals bathing for over 75 min per day experienced a noteworthy improvement in sleep quality, particularly in terms of delta Sleep Efficiency (2.15 ± 0.9% vs. −0.34 ± 0.31%, p = 0.007).ConclusionOur findings suggest that extended thermal-water bathing may enhance objective aspects of sleep quality. Since balneotherapy is mainly prescribed for individuals with musculoskeletal pathologies or psychological disorders, these findings may encourage doctors to recommend bathing in thermal water also to healthy subjects. Future researchers need to investigate the role of daytime physical activity in depth.

Social jetlag (SJL), resulting from misalignment between biological rhythms and social schedules, has emerged as a prevalent phenomenon in modern society, particularly among young athletes. However, the effect of SJL on performance is poorly studied. Jump and dynamic balance are two key skills in volleyball, as the first allows the player to perform better both during the offense and defense phase, and the second is fundamental in landing and in injury prevention. Therefore, our aim was to investigate the effect of SJL on jump skill performance and balance in female volleyball players. Thirty female volleyball players (mean age: 17.3 ± 0.88 years) participated in the study. SJL was assessed using the Munich ChronoType Questionnaire (MCTQ), integrated with Jankowsky's sleep-corrected formula. Jump skill performance was evaluated using a standardized jump test, the Vertec Jump Test, while balance was assessed with the Y Balance Test. The tests were performed at 09:00 a.m. and at 06:00 p.m. The results revealed that players with greater SJL exhibited decreased jump performance, characterized by lower vertical jump height (p = 0.02). Furthermore, players with lower SJL showed the typical difference between morning and afternoon performance (p = 0.001), demonstrating their synchronization between biological rhythms and social commitments, while no statistically significant difference between the two sessions was shown in players with higher SJL. Regarding balance, no significant association with SJL was found, but the morning session yielded lower results than the afternoon one (p = 0.01). These findings highlight the detrimental impact of SJL on jump skill performance, underscoring the importance of optimizing sleep-wake schedules and circadian alignment to enhance athletic performance. Future research should explore targeted interventions, such as sleep hygiene education, to minimize social jetlag and promote optimal performance in adolescent athletes.

University students are commonly described as having worsened sleep quality, especially when inactive and Evening-type (E-type) subjects. This study aimed to examine the interactions between physical activity and chronotype on sleep quality among a sample of active Sports Science university students. In November 2019, 433 participants (mean age: 19.7 & PLUSMN; 1.56 years; 70% males) completed the Pittsburgh Sleep Quality Index, the Godin-Shepard Leisure-Time Physical Activity Questionnaire (tertiles categorisation), and the Morningness-Eveningness Questionnaire. Females and E-type slept significantly worse than males and Neither-(N-types) and Morning-types (M-types), respectively. However, there were no significant differences in sleep quality based on physical activity levels. The three-way ANOVA revealed that sleep quality in N- and E-types appeared to be independent of physical activity, whereas M-types showed an improvement in sleep classification with increased physical activity. Moderation analysis indicated that physical activity significantly moderated the relationship between chronotypes and sleep quality. Specifically, M-types demonstrated a more pronounced improvement in sleep quality with increasing physical activity compared to the other chronotypes. In conclusion, M-type university students derived the greatest benefits from physical activity in improving sleep quality. Conversely, physical activity seemed to have a limited impact on sleep quality among active E-type university students.

Actigraphic parameters can provide indication of people's sleep quality during their daily lives. However, there is a need for clear guidelines on the understanding of the different actigraphic parameters. The present study aims to propose a conceptual and theoretical framework for known actigraphic-derived parameters, which is able to describe the alternation between rest and wake phases during the nocturnal sleep, explaining their main characteristics and interrelations that can be replicated in future studies. Forty Sport Sciences students at the University of Milan (20 males; mean age +/- SD, 22 +/- 3 y) completed the validated Italian version of Morningness-Eveningness Questionnaire (MEQ) and wore an actigraph (Motion Watch 8 (R), Cambridge Neurotechnology, Cambridge, UK) for seven days. A framework was developed to depict the interactions between the actigraphic parameters and how they objectively describe sleep, according to which the parameters are organized into three different functional blocks related to different aspects of sleep. Correlations analyses were conducted to explore the relationships among the primary actigraphic parameters within and across the functional blocks. The proposed framework is a purely theoretical construct that provides a simple interpretation of known actigraphic parameters guiding researchers and practitioners in the use of these parameters either for research or clinical purposes.

Background: Men are more likely than women to have subthreshold overeating disorders. Lifestyle plays a role as a determinant, while chronotype is an emerging factor. Chronotype explains the natural preferences of wakefulness and activity throughout the day: evening chronotypes (E-Types), those most productive in the evening, have been linked with unhealthy dietary patterns and a higher propensity to substance addiction than morning types (M-Types). Methods: We carried out a cross-sectional study on 750 overweight or obese adults (70% females, 48 ± 10 years, BMI 31.7 ± 5.8 kg/m2). The Binge-Eating Scale, the Yale Food Addiction Scale 2.0 (YFAS 2.0), the reduced Morningness-Eveningness Questionnaire (rMEQ), and the MEDAS questionnaire were used to assess binge eating, food addiction, chronotype, and adherence to the Mediterranean diet, respectively. Results: No differences in BES binge-eating and FA food-addiction scores occurred between chronotypes, but we found significant interactions between sex × rMEQ score. While women showed the same prevalence for binge eating and food addiction across all chronotypes, binge eating and food addiction risk increased with reducing rMEQ score in men, indicating that being male and E-Type increases the risk association of binge eating and/or food addiction prevalence. Conclusions: chronotype is associated with binge eating and food addiction in men, emphasizing the link between chronobiology and sex differences as determinants in appetite and eating behaviour dysregulation and in overweight and obesity.

Impaired sleep and low daily activity levels increase the risk of developing metabolic syndrome (MS). Metformin (MET), an insulin sensitizer drug, is effective in regressing MS and has been recently studied as an adjuvant agent for managing sleep disorders. The present study aimed to assess whether 1,700 mg/day of MET treatment modifies sleep and daily activity levels in people with MS evaluated by Rest-Activity circadian Rhythm (RAR), which is the expression of 24 h of spontaneous activity parameters. A total of 133 subjects with MS, randomized into the MET (n = 65) or placebo (PLA, n = 68) group, underwent a clinical/anthropometric examination and carried out a continuous 7-day actigraphic monitoring to investigate sleep and RAR parameters at baseline and after 1 year of intervention. After 1 year of intervention, 105 subjects were analyzed. The MET group showed greater anthropometric and metabolic improvements compared with placebo, with a significant reduction in weight (p = 0.01), body mass index (p = 0.01), waist circumference (p = 0.03), and glucose (p < 0.001). With regard to sleep parameters, the MET group showed a significant increase in actual sleep time (p = 0.01) and sleep efficiency (p = 0.04) compared with placebo. There were no significant changes reported in the RAR parameters. Our study suggests that MET might be used as an adjuvant treatment for sleep disorders in people with MS.

People can be classified into three chronotypes (CT): morning-type (M-type), Neither-type (N-type) and Evening-type (E-type). M-types perform better in the morning, E-types in the evening. It seems that bad sleep worsens physical performance. The impact of sleep and CT on specific sports and populations is unclear. Therefore, we wanted to assess agility, strength and endurance in young soccer players in relation to their sleep and chronotype. 58 players (13–19 years) were recruited. Sleep and CT were assessed by questionnaires. The physical trial was performed at 8:30 a.m. and 6:00 p.m., and included three tests to determine agility, strength and endurance. The sample was classified by CT as M-types (n = 11), N-types (n = 29) and E-types (n = 18). Furthermore, they were categorized as people with Good Sleep/Wake quality (GSW, n = 28) and people with Bad Sleep/Wake quality (BSW, n = 30). Comparing the three CTs in the aerobic test, M-types performed better in the morning (p = 0.01), while E-types in the evening (p < 0.001). GSW performed better than BSW (p = 0.019) in the aerobic test in the p.m. session. These results underline the difference in aerobic power between M-and E-types during the morning and evening session; moreover, they show a difference in p.m. aerobic performance according to sleep quality.

Glucose and insulin follow circadian-mediated metabolic profiles. Accumulating evidence has demonstrated significant associations between circadian disruption-related lifestyles and an increased risk of type 2 diabetes typical of Evening-types (E-types), more active in the last part of the day, compared to Morning-types (M-types). However, few studies have examined the contribution of chronotype to abnormalities of glucose profile considering both lifestyle factors and body composition. We conducted a cross-sectional study on 575 adults (71% females, 48.5±12.8 years, BMI 29.3±6.0 kg/m2) with no endocrine diseases and no consumption of medications affecting endocrine function. Chronotype was assessed through the reduced Morningness-Eveningness Questionnaire (rMEQ), glycemia, insulinemia and HbA1c plasma levels HOMA-IR were estimated. Anthropometric parameters were collected and abdominal fat distribution was measured by ultrasonography. Smoking and physical activity habits were collected by a medical history and adherence to Mediterranean diet was assessed by MEDAS questionnaire. Logistic regression models were used to investigate the association between glycemia, insulinemia and chronotype. Sex, age, BMI, total body fat, visceral and subcutaneous fat, physical activity, smoking habits and MEDAS were included in all models. Insulin levels were significantly higher in the E-Types compared to M-Types. We did not find a significant interaction between chronotype, glycemia and HbA1c, however insulin and HOMA-IR decreased with increasing rMEQ score and morningness, indicating that E-Types have +5,6 and +1,4 points of insulinemia and HOMA-IR, respectively, compared to M-Types (β=−0.28 [−0.5; −0.1], p=0.003; β=−0.07 [−0,12; −0,02], p=0.005). Chronotype is independently associated with abnormalities in insulin profile, pointing to the importance of understanding the mechanisms underlying the impact of circadian disruption on glucose metabolism, which may contribute to improved glycemic control. Disclosure R.De amicis: None. A.Battezzati: None. A.Foppiani: None. A.Leone: None. L.Galasso: None. A.Montaruli: None. E.Roveda: None. L.Castelli: None. F.Esposito: None. S.Bertoli: None. Funding Italian National Recovery and Resilience Plan Mission 4 Component 2 Investment 1.3 - Call for Proposals (341) of 15 March 2022 of Italian Ministry of University and Research funded by the European Union - NextGenerationEU (PE00000003) Concession Decree (1550) of 11 October 2022 adopted by the Italian Ministry of University and Research (CUP D93C22000890001)

The aim of the present study is to explore the potential association between sleep quality and physical activity (PA) in women carriers of BRCA1/2 mutations. 63 women completed the Pittsburgh Sleep Quality Index (PSQI) and Godin Shepard Leisure-Time Physical Activity Questionnaire (GSL-TPAQ) and were included in the present cross-sectional analysis. Globally, women showed a PSQI score of 7.0 ± 3.6 and a GSL-TPAQ score of 22.8 ± 18.3. Good sleepers (PSQI score ≤ 5) showed significantly higher PA levels compared to bad sleepers (PSQI score > 5) . Women in the higher tertile of GSL-TPAQ total score (≥ 27 METs/week) have a prevalence ratio (PR) of being a good sleeper of 2.85 (1.25–6.52, 95% confidence intervals) compared to women in the lower tertile (≤ 11 METs/week). These results were consistent in BRCA1 and BRCA2 women. Considering each single question of PA intensity, the PR of being a good sleeper by unit of increase of MET/week was higher and significant in women engaged in strenuous and moderate intensity PA. These results suggests a direct association between PA and sleep quality in women carriers of BRCA mutations.

Balneotherapy and exercise are potential factors influencing sleep through several physiological pathways and relaxing effects. This review aims to assess whether balneotherapy can improve sleep quality in concomitance or not with exercise. The research was conducted on Medline, Scopus, PubMed, Web of Science, and Cochrane Library databases. The current review followed PRISMA reporting guidelines and involves twenty-one articles grouped into four sections based on the characteristics of the balneotherapy protocol: 1.a Balneotherapy-thermal water immersion alone (five studies); 1.b Balneotherapy-thermal water immersion with other spa treatments (six studies); 2.a Balneotherapy and physical exercise-balneotherapy and out-of-the-pool physical exercise (eight studies); 2.b Balneotherapy and physical exercise-balneotherapy and in-pool physical exercise (three studies). Apart from healthy or sub-healthy subjects, patients recruited in the studies were affected by fibromyalgia, ankylosing spondylitis, osteoarthritis, musculoskeletal pain, subacute supraspinatus tendinopathy, and mental disorders. Duration, number of sessions, and study protocols are very different from each other. Only one study objectively evaluated sleep, whereas the others used subjective sleep assessment methods. Eight studies considered sleep as a primary outcome and ten as secondary. Sixteen out of twenty-one studies described improvements in self-perceived sleep quality. Thus, balneotherapy associated with other spa treatments and physical exercise seems to be effective in improving self-perceived sleep quality. However, the miscellany of treatments makes it difficult to discern the isolated effects of balneotherapy and physical exercise. Future studies should consider using an objective sleep assessment method and describing the pathways and physiological mechanisms that could provoke sleep changes during balneotherapy treatments.

Physical performance could be negatively affected by sleep deficiency and fatigue. The present study assesses the role of sleep quality, fatigue and motivation on cardiovascular performance (VO2peak, Wmax, and HRmax) in a sample of active young subjects. The current study is a cross-sectional design. Ninety-six university students (males 54.2%; 21.5 ± 2.9 yrs) completed an incremental exercise test on a bicycle ergometer. Sleep, fatigue, and motivation were assessed with the Pittsburgh Sleep Quality Index and two visual analogue scales, respectively. Differences in VO2peak, Wmax, HRmax, self-perceived fatigue and motivation were compared between good and bad sleepers and sleep duration >/<7.5 h, while regression analysis defined the predictors of VO2peak, Wmax, and HRmax. In the male sample, good and bad sleepers' differences were significant only for self-perceived fatigue (p = 0.04). The female sample showed no statistically significant differences between good and bad sleepers and different sleep durations. In the male sample, linear regression analysis showed a significant inverse correlation between Wmax and the PSQI score (-0.4, p = 0.004). The stepwise regression model indicated that sleep (β = -0.3, p = 0.02) was a significant predictor of VO2peak in males accounting for 20% of the variance, whereas physical performance seems more affected by fatigue (β = -0.4, p = 0.03) in females. In conclusion, chronic inadequate and self-reported sleep quality seems to be one of the factors compromising cardiovascular performance in males.