Background Lung resection is the gold standard and the most effective curative treatment for lung cancer, especially in early-stage non-small cell lung cancer, improving long-term survival and quality of life. The growing body of evidence from randomized controlled trials supports the efficacy of prehabilitation in reducing both the incidence and severity of postoperative pulmonary complications and shortening the length of hospital stay. Objective The general objective is to compare the effects of a single education session with different prehabilitation programs in patients undergoing lung resection surgery. Methods Two hundred lung cancer patients who are going to be submitted to a lung resection surgery will be randomized into: (1) Inspiratory Muscle Training Group (n = 50), Expiratory Muscle Training Group (n = 50), Global Exercise Training Group (n = 50), and Control Group (n = 50). All patients will receive a single session in-person education session and written information regarding healthy habits to follow before, during, and after hospital discharge, and those from the IMT-G, EMT-G, and GET-G will start their 2-week prehabilitation interventions at ULS São João. Patients will be evaluated at baseline, after completing the prehabilitation program (post-intervention assessment), and 30 days post-discharge (follow-up assessment). Discussion Despite diverse intervention strategies, prehabilitation consistently proves effective in bolstering patients' functional capacity. It may also help strengthen the respiratory muscles, which in turn affect lung function and cough effectiveness after thoracic surgery. This randomized trial has been designed to compare different prehabilitation programs and analyze their inherent costs.

To investigate, in adults with coronary artery disease (CAD), (i) the comparative effectiveness of aerobic exercise interventions differing in intensity and/or pattern—low-, moderate- and high-intensity continuous training (LICT, MICT, HICT) and high-intensity interval training (HIIT)—versus usual care or no exercise, and (ii) the relative effectiveness of continuous versus interval modalities, on peak oxygen uptake (VO₂peak), health-related quality of life (HRQoL), and mortality. MEDLINE (PubMed), CENTRAL, EMBASE, PEDro, and Google Scholar were searched from inception to June 2026, with grey-literature sources and reference-list screening, without language restrictions. Randomized trials were eligible per our PICO strategy. Population: adults with CAD; Intervention: aerobic exercise classified by intensity following the European Association of Preventive Cardiology; comparator: another aerobic intensity, usual care (cardiac rehabilitation without structured aerobic prescription), or control (no intervention); outcomes: VO₂peak (primary), HRQoL and mortality (secondary). Two reviewers independently extracted data and appraised methodological quality (PEDro); risk of bias for the certainty assessment used RoB 2 within CINeMA. 78 trials (6287 participants) were included; 58 (3171 participants) contributed to VO₂peak, 7 (553) to HRQoL and 13 (2,563) to mortality. For VO₂peak versus usual care, HIIT (MD = 3.92 mL/kg/min, 95

Boxing-based training has emerged as a multicomponent exercise modality for aging populations; however, its implementation characteristics and health-related outcomes remain heterogeneous and insufficiently synthesized. This scoping review aimed to systematically map and critically characterize the application of structured boxing-based training in middle-aged and older adults, focusing on intervention characteristics, feasibility, and reported health-related outcomes. This scoping review was conducted in accordance with the Joanna Briggs Institute framework and reported following PRISMA-ScR guidelines. Databases were searched from inception to June 2025, and weekly search alerts were monitored until October 25, 2025. A comprehensive search was performed across 15 electronic databases and gray literature sources from inception to June 2025, followed by weekly monitoring of search alerts until October 25, 2025. Studies involving individuals aged ≥45 years undergoing structured boxing-based training were included. Data extraction focused on intervention characteristics, adherence, acceptability, and health-related outcomes. A total of 49 studies involving 1,033 participants were included. Most interventions were conducted in clinical populations, particularly individuals with Parkinson’s disease, while evidence in healthy aging populations was limited. Interventions were predominantly non-contact and varied substantially in frequency, duration, and structure. Balance, mobility, and gait were the most frequently assessed outcomes. Overall, adherence and acceptability were high when reported. Boxing-based training appears to be a feasible and well-accepted intervention in aging populations, particularly in clinical settings; however, substantial heterogeneity in intervention design limits comparability. Future research should prioritize standardization of protocols and expand investigation into non-clinical populations.

Prolonged sitting is a key risk factor for cardiovascular disease, partly due to its cumulative endothelial dysfunction. Although physical activity may mitigate the deleterious effects of sitting time, the relationship between habitual physical activity levels and sitting-induced endothelial impairment remains unclear. Thus, we aimed to examine the association between sitting-induced endothelial dysfunction and habitual physical activity in healthy adults. This quasi-experimental pre-post study evaluated 15 healthy adults exposed to 3 hours of uninterrupted sitting. Baseline and post-intervention measurements of calf circumference (CC) and flow-mediated dilation (FMD) of the superficial femoral artery were taken. Physical activity was assessed via the long International Physical Activity Questionnaire (IPAQ). Endothelial function significantly decreased after sitting (ΔFMD = -2.15%, d=1.56), and CC significantly increased (ΔCC = +1.24 cm, d=0.74). An inverse correlation was found between total moderate-to-vigorous physical activity (MVPA) and ΔFMD (ρ = -0.57, p < 0.05). The linear mixed model showed that prolonged sitting effects on ΔFMD were significantly moderated by baseline MVPA level (Time×MVPA interaction: F(1,12) = 7.69, p = 0.017). Prolonged sitting acutely impairs endothelial function and promotes lower-limb fluid accumulation. Habitual MVPA may attenuate the adverse vascular impact of acute sitting, reinforcing its importance for vascular health.

Objectives To compare and investigate agreement across diagnostic instruments in detecting impairment in the domains of intrinsic capacity (IC). Design Cross-sectional descriptive design. Setting and participants: The study was conducted with 205 community-dwelling older adults (ages 60–96; mean: 71.3 ± 7.9 years). Measurements IC was assessed across five domains, using multiple diagnostic instruments for each domain: cognition [Mini-Mental State Examination (education-adjusted versus raw score of 26 points) and a cognitive battery]; mobility (Short Physical Performance Battery, gait speed test, chair stand test, and Timed Up and Go test); vitality (Mini Nutritional Assessment, handgrip strength, body mass index, and self-reported unintentional weight loss); psychological well-being (Geriatric Depression Scale, Center for Epidemiologic Studies Depression Scale, and self-reported of mental health diagnosis or use of antidepressant or anxiolytic medications); and sensory function (whisper voice test, Snellen chart, and self-reported hearing or visual impairment). McNemar’s test and Cochran’s Q-test were used to compare the detection of impairment in IC domains. Cohen’s Kappa and Fleiss’ Kappa tests were used to measure the level of agreement across diagnostic instruments. Results Detection of impairment in each IC domain varied substantially across diagnostic instruments. Moderate agreement was found in the diagnostic instruments for mobility (K = 0.64) and hearing (K = 0.69; agreement = 88.8%). Conclusions Diagnostic instruments substantially influence the detection of impairment on IC. Moderate agreement was found for mobility and hearing measures, underscoring the urgent need for harmonized assessment protocols and highlighting the critical impact of instrument selection on estimating the prevalence of impairment on IC.

Background Remote methods may help older adults improve their physical function, but understanding the perspectives of experts who deliver this care is critical. This modified Delphi process aimed to develop expert consensus on effectiveness, feasibility and implementation of remote assessment and management of physical function in older adults. Methods This online Delphi process included experts involved in supporting older adults to maintain or improve their health. The Round 1 survey presented 33 Delphi statements assessed using an 11-point Likert scale (0-10; ≥7 indicated agreement). Statements with strong (≥80%), moderate (50-<80%) and low (<50%) agreement were accepted, revised, or rejected, respectively. Revised statements were presented in Round 2, and accepted statements were consolidated into key messages. Results In total, 108 respondents (67% female; mean [SD] age 41.4 [10.9] years) from 16 countries (five continents) completed Round 1. Fourteen statements were accepted (88-100% agreement) and 10 were rejected (8-39% agreement). The remaining nine statements (52-69% agreement) were revised, and two new statements were developed for Round 2, which was completed by 89 (82%) respondents. Five Round 2 statements were accepted (82-93% agreement). Seven key messages were developed from 19 accepted statements, highlighting that remote care should be accessible to older adults with requisite capabilities, is feasible for older adults and health professionals with adequate support and training, and requires guidelines, policies, and further research to support wider adoption. Conclusions The findings of this Delphi process can inform the implementation of remote care approaches for assessing and managing physical function in older adults.

Objectives: To investigate the association between sedentary behavior and functional disability in instrumental activities of daily living among older adults, and to determine the accuracy and optimal cutoff point of sedentary behavior for the discrimination of functional disability. Methods: This is a population-based, cross-sectional epidemiological survey of 318 older adults (mean age: 74.6 +/- 9.7 years old) from Northeastern Brazil. Functional disability in instrumental activities of daily living was assessed using the Lawton scale (presence or absence). Sedentary behavior time was quantified using the International Physical Activity Questionnaire. Results: The prevalence of functional disability was 59.7% (women: 68.5%; men: 48.5%; P = 0.001). The median sedentary behavior time was 4.7 h/day. Each 1 h/day increase in sedentary behavior was associated with a 4% increase in the likelihood of functional disability in women (PR: 1.04; 95% CI: 1.01-1.07). Furthermore, in women, sedentary behavior demonstrated an accuracy of 0.61 (95% CI: 0.530.68), a sensitivity of 23%, and a specificity of 100% (optimal cutoff point: 7.5 h/day). Conclusion: Sedentary behavior was positively associated with functional disability in instrumental activities of daily living in women but not in men. Additionally, sedentary behavior showed accuracy in discriminating functional disability in women, with the optimal cutoff point identified at 7.5 h/day.

Background/Objectives: this study evaluated the effects of a 12-week multicomponent training (MCT) program combined with multiprofessional interventions (nutritional and psychoeducational) on body composition, lipid profiles, fasting glucose levels, and arterial stiffness in Brazilian older women stratified by nutritional status. Methods: thirty-six older women, who were classified as normal weight (n = 8; mean age: 69.2 ± 7.2 years), overweight (n = 13; mean age: 72.1 ± 5.3 years), or obese (n = 15; mean age: 70.3 ± 4.6 years), were included in the study. The outcomes included body fat percentage (BFP), visceral fat level, fat-free mass (FFM), fasting glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and arterial stiffness, as determined by pulse wave velocity (PWV). Results: BFP was reduced in all groups (p < 0.001), but in the overweight and obese groups, these decreases were greater. Visceral fat level decreased significantly in all groups (p < 0.001), with greater decreases in the obese group compared with the normal weight and overweight groups (p < 0.001), and greater reductions in the normal weight group compared to the overweight group (p < 0.05). A significant reduction in PWV was observed only in the overweight group (p < 0.05), while greater improvements were observed in the overweight group compared to the normal weight group (p < 0.05) in FFM, lipid profiles, and fasting glucose. Conclusions: an MCT combined with multiprofessional intervention effectively reduced BFP and arterial stiffness in Brazilian older women with excess adiposity.

Abstract This cross‐sectional study examined associations between postmenopausal stage (early and late), arterial stiffness, and cardiorespiratory fitness. A total of 125 postmenopausal women (58.07 ± 6.61 years) underwent carotid‐femoral pulse wave velocity assessment (SphygmoCor, Atcor). A subset of 96 women (57.20 ± 6.42 years) completed an estimated maximal oxygen uptake testing, using a Monark Ergomedic 839E cycle ergometer. Multiple stepwise regressions identified predictors of arterial stiffness and cardiorespiratory fitness. Compared with late postmenopause, early postmenopausal women showed lower arterial stiffness (−0.71 ± 0.29 m/s, p = 0.02) and systolic blood pressure (−6.40 ± 3.06 mmHg, p = 0.04), indicating a relative difference within postmenopause. Early postmenopause also showed higher cardiorespiratory fitness levels than late postmenopause. Moreover, body fat percentage was inversely associated with cardiorespiratory fitness in +1c substage, and visceral fat level displayed inverse associations with cardiorespiratory fitness in late postmenopause. In the +1a substage, hormone therapy was positively associated with cardiorespiratory fitness in exploratory model. Within postmenopause, early postmenopause showed lower arterial stiffness and systolic blood pressure than late postmenopause, and blood pressure and adiposity emerged as key correlates of vascular stiffness and fitness. While causal inference is precluded by the cross‐sectional design, the results support stage‐targeted strategies emphasizing BP control, body‐composition management, and exercise to help preserve vascular and functional health in women after menopause.

To explore the relationship between varying durations of sedentary time (ST) in hours per day and multimorbidity, while considering covariates such as non-compliance to moderate to vigorous physical activity (MVPA) recommendations, age, sex, and smoking in middle-aged and older adults. Data from the first wave (2015–2016) of the nationally-representative Brazilian Longitudinal Study of Aging (ELSI-Brazil) were analyzed. Ordinary regression analysis was utilized to assess the odds ratio for individuals with varying daily ST durations concerning the escalation in the number of diseases while accounting for covariates such as failure to meet MVPA recommendations, age, sex, and smoking status. A cohort of 7,314 individuals aged 50–105 years (56,3

AIM:To investigate the effects of an 8-weeks of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) program on ventricular-arterial coupling (VAC) in young women with obesity. METHODS:Twenty-four obese women completed an 8-week supervised aerobic training program (3 sessions/week) assigned to either HIIT (n = 11) or MICT (n = 13). The HIIT protocol involved four 4-min bouts at 85%-95% of the maximum heart rate (HRmax), while the MICT consisted of continuous walking/running for 41 min at 65%-75% of HRmax. VAC was assessed using two methods: (1) the ratio of pulse wave velocity to global longitudinal strain (PWV/GLS), and (2) the ratio of arterial to ventricular elastance (Ea/Ees). RESULTS:Both HIIT (-0.35 ± 0.01 to -0.31 ± 0.05 m/s%; p = 0.005) and MICT (-0.35 ± 0.01 to -0.30 ± 0.05 m/s%; p = 0.003) significantly improved the PWV/GLS ratio. However, only HIIT led to a significant reduction in the Ea/Ees ratio (0.88 ± 0.07 to 0.80 ± 0.09 mmHg/mL; p = 0.024), with a significant correlation between relative changes in PWV/GLS and Ea/Ees ratio (r = 0.749; p = 0.008). CONCLUSIONS:Both HIIT and MICT improved VAC as assessed by PWV/GLS ratio in young obese women. In contrast, elastance-derived improvements (Ea/Ees) were observed only following HIIT. These findings suggest that PWV/GLS may serve as a more sensitive and integrative marker for detecting exercise-induced improvements in VAC.

Introduction: Physical exercise is essential for maintaining functionality and independence in later life. However, the specific benefits of boxing as a form of exercise remain unclear. Objective: To describe the protocol of Boxing4Ageing, a program designed to compare the effects of boxing (BT) and multicomponent training (MT) on cognitive performance, brain activity, physical fitness, and fall risk in community-dwelling older adults in Portugal. Methodology: This quasi-experimental study protocol will include participants aged ≥60, assigned to one of three groups: BT, MT, or a control group (CG). The exercise programs will run for 24 weeks, with two weekly sessions. CG participants will maintain their usual activities. Assessments will occur at baseline, mid-intervention (12 weeks), post-intervention (24 weeks), and after a 12-week detraining period. Results: Primary outcomes include cognition, brain activity, physical fitness, and fall risk; secondary outcomes are quality of life and exercise satisfaction. Discussion: If successful, this study could provide evidence supporting the inclusion of boxing in community health programs aimed at preventing falls, improving cognitive health, and enhancing physical fitness in older adults. It could offer a low-cost, accessible intervention with significant potential benefits for older adults. Trial Registration: ClinicalTrials.gov - Identifier NCT05826314, registered April 24, 2023

Background/Objectives: Aging usually leads to physical disability and a detrimental performance in activities of daily living. Among the functional capacity components, cardiorespiratory fitness is one of the most important. The 6-min walk test (6MWT) is the most widely performed test, using the test configuration to determine patients' results and allow interpretation of the results by healthcare professionals. Therefore, this study aimed to compare distances and body accelerations obtained from two 6MWT protocols (25-m walkway vs. 20-by 5-m rectangle). Methods: A cross-over study design was used where 43 older adults (>65 years old) performed the 6MWT using two different setups (25-m walkway vs. 20-by 5-m rectangle), gathering distances covered and body acceleration data. Results: Covered distance was significant superior in the 20-by 5-m rectangle in comparison with the 25-m walkway (p < .05). Axis Z counts per minute were superior in the 25-m walkway than in the 20-by 5-m rectangle (p < .05). Despite that the distances covered in both setups were significantly correlated (r = .891; p < .001), the lack of agreement (p < .001) suggests they should not be considered interchangeably. Additionally, more than 30% of the participants changed their percentile for cardiorespiratory fitness classification according to the two test configurations. Conclusion: 6MWT setup determines patient's performances and fitness classification. Then, it is crucial to clearly describe test configuration to properly contextualize older adults' cardiorespiratory fitness by health care professionals. Significance/Implications: Our findings highlight the need to normalize the 6MWT configuration to improve accuracy in the assessment of cardiorespiratory fitness in older adults.

BACKGROUND:Physical exercise is known to modulate arterial stiffness. However, this modulation can vary according to the type of exercise or training. This study aims to compare levels of arterial stiffness among healthy young men practicing different exercise modalities, including resistance training (RT), high-intensity cross-training (HICT), and running (RUN), and comparing these results with a control group. METHODS:Eighty healthy young men were divided into three exercise groups according to the type of exercise they practiced (RT, N.=20; HICT, N.=20; RUN, N.=20), plus a sedentary control group (CON, N.=20). In this observational study, participants were evaluated for arterial stiffness with carotid-femoral Pulse Wave Velocity (c-f PWV, m/s) and pulse wave analyses (Augmentation Index [Aix] and Augmentation Index normalized to a heart rate of 75 bpm [AIx@75bpm]). Participants were also assessed for cardiorespiratory fitness (VO2max, mL/kg/min) by means of maximal graded exercise testing. RESULTS:Despite the absence of statistical significance (P>0.05), the CON group showed less favorable arterial stiffness indices (AIx: 1.85±2.99; AIx@75bpm: -7.41±3.00) compared to all exercise groups ([RT AIx: -5.68±2.29; AIx@75bpm: -13.98±2.41]; [HICT AIx: -1.36±2.20; AIx@75bpm: -10.26±2.16]; [RUN AIx: -2.29±3.09; AIx@75bpm: -7.14±3.09]). The RUN group showed significantly higher VO2max than the other groups (RUN vs. CON, P<0.001; RUN vs. RT, P<0.001; and RUN vs. HICT, P<0.001). CONCLUSIONS:The findings suggest that arterial stiffness does not differ according to different exercise modalities practiced by healthy young men.

Key Features: * The Physical Activity Cohort Repository (PACe) project created a searchable online database of cohort studies that have prospectively collected data on physical activity and/or sedentary behaviour (self-report and/or device-based measurement) at three or more timepoints. Only cohorts with ≥ 1,000 participants at baseline were included. * The PACe is a freely available resource created to encourage researchers to return to existing cohorts to apply contemporary causal inference methods that appropriately deal with time varying exposures and confounders, to improve the quality of evidence pertaining to physical activity, sedentary behaviour and health. * Two hundred and nineteen unique cohorts were included in the initial iteration of the PACe, representing all World Health Organization regions. The earliest included cohort started in 1922 (the Terman Life-Cycle Study) and extends to ongoing cohorts. * The development of the PACe was an international effort; this resource was designed to facilitate global collaboration and building research capacity in low- and middle-income countries. * We will update the repository every two years, to ensure that new cohorts and cohorts adding additional waves of follow-up are captured. ### Competing Interest Statement Dr Lynch has received travel and accommodation funding from the International Epidemiological Association (IEA) to attend IEA Council meetings. Dr Lynch receives payments from Elsevier for editorial work. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced are available online at https://www.cancervic.org.au/research/epidemiology/pace

This study analyzed data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) to examine the prevalence of frailty and its association with physical activity (PA) and mobility impairments in a nationally representative sample of older adults aged 80 and older in Brazil. ELSI-Brazil is a national resource that investigates aging-related health, psychosocial, and economic factors to inform public policies promoting healthy aging. Data from 1,171 participants were analyzed using chi-square tests, ANOVA, and logistic regression adjusted for confounders. About 14% were classified as frail, 73% as pre-frail, and 13% as robust. Frail individuals were less likely to meet PA guidelines (OR = 12.95; 95% CI [6.44-26.08]) and had higher odds of short-distance walking impairment (OR = 1.88; 95% CI [1.02-3.48]) compared to their robust counterparts. Our findings suggest a relatively low prevalence of frailty among Brazil's oldest old but indicated a significant association with physical inactivity and mobility impairment.

OBJECTIVE:To map the evidence on the effects of physical activity on sleep quality in people living with human immunodeficiency virus (PLHIV). METHODS:A scoping review was conducted using PubMed, EMBASE, LILACS, Scopus, Web of Science, EBSCO Sport Discus/CINAHL, and Biblioteca Virtual em Saúde. Additionally, Google Scholar and OpenGrey servers were checked. There were no language or publication year restrictions for the search. Primary studies that evaluated the relationship between physical activity and sleep quality in PLHIV were included. Two researchers performed the analysis and selection of studies independently, following established criteria. RESULTS:Nine studies were included, covering experimental, cross-sectional, and cohort studies. The results suggest that physical activity is associated with reduced sleep latency, longer sleep duration, and overall improvements in sleep efficiency and subjective perception of sleep quality. These results indicate that exercise-based interventions can be incorporated as complementary strategies to improve sleep in this population. However, methodological variability limits the generalization of the results. Future studies should focus on longitudinal designs and standardized assessment methods. CONCLUSION:Adequate physical activity levels appear to positively influence sleep quality in PLHIV.

BACKGROUND/OBJECTIVES:Aging decreases cognitive and physical fitness (PF). Though evidence links PF to cognitive function, few studies focus on this association in older adults with dementia. The aim of this study is to investigate the association between cognitive function and PF in institutionalized older adults with cognitive impairment. METHODS:This is a cross-sectional study encompassing 75 older adults with suggestive major neurocognitive disorder (76% women, 78.00 ± 8.13 years) residing in nursing homes. Cognition was assessed with Montreal Cognitive Assessment (MoCA), and the eligible participants (MoCA < 17 points) were categorized as having high or low cognition function according to the 50th percentile of the MoCA score. PF was measured with the Senior Fitness Test, and a global physical fitness score (GPF), computed as the average obtained from the six tests of the Senior Fitness Test, was thereafter classified based on the 25th percentile. Linear regression and binary logistic regression were applied. RESULTS:GPF was significantly associated with MoCA (B = 0.078; 95% confidence interval [0.016, 0.139]; R2 = .300). GPF > 25th percentile (odds ratio = 7.8; 95% confidence interval [2.1, 30.4]; p = .003) and years of education (odds ratio = 1.5; 95% confidence interval [1.0, 2.1]; p = .016) were associated with a higher likelihood of having high MoCA, independently of age, medication use, and clinical conditions. CONCLUSION:A higher GPF was associated with better cognitive function in institutionalized older adults with dementia. Significance/Implications: It is crucial to understand the relationships between cognitive decline and PF in older adults with dementia. Once both are correlated, we might suggest that improving fitness may help slow cognitive decline and vice versa, which must be ascertained through longitudinal and experimental studies.