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Maximal oxygen uptake (V̇O2max) gradually declines across the lifespan. However, little is known about the octogenarians. This is a knowledge gap given that individuals living >80 years old is the fastest expanding age-group world-wide. The increase in the elderly population has generated greater awareness in healthy ageing including psychosocial, physical, and cognitive domains, all of which benefit from engagement in physical activity or sport. In the present article are reported characteristics of an octogenarian man (GM), starting training for triathlon when he was 75 years old. GM performed an incremental Cardiopulmonary Treadmill-Running Exercise Test (CPX). A competitive 5-day consecutive triathlon event (sprint distance on days 1, 3, 4, 5 and Olympic distance on day 2) was monitored using an advanced smartwatch. Between 2021 and 2022, he trained for 10-to-12 hours/week, and participated in 59 and 39 competitions, respectively. The CPX showed a V̇O2max of 39.8 mL·min -1 ·kg -1 , the 3 rd highest value ever described in the literature among octogenarians and corresponding to the ≈60 th percentile of 40-to-49-year-old men. During the 5-day triathlon (overall 12:15 h:min), 88% of time was spent at 77-95% of maximum heart rate (i.e., vigorous exercise intensity). In addition, GM was the 2022 Triathlon Olympic distance World Champion. The remarkably high V̇O2max and performance described herein were associated with exceptionally high exercise volume and intensity during training and competition, up to more than four times the recommended physical activity by current guidelines. These results further support the benefits of endurance exercise among octogenarians.

Introduction: Major colorectal surgery is associated with 20 to 40% reduction in physiological and functional capacity and higher level of fatigue 6 to 8 weeks after surgery. The primary aim of this study was to analyse the effects of a multimodal prehabilitation program in colorectal cancer patients to improve functional capacity. The secondary outcome was to evaluate postoperative complications and length of postoperative hospital stay as well as to determine the costs of implementation and indirect costs., Methods: A single centre, single-blind, randomized controlled trial was conducted. Patients of age > 18 years undergoing elective colorectal resection for colonic cancer were eligible. Exclusion criteria were metastatic disease, severe walking impairments, renal failure stage > 2, ASA score > 3, preoperative chemo-radiation therapy. Patients have been randomized either to prehabilitation intervention groups, receiving 4-week trimodal prehabilitation (physical exercise and nutritional and psychological support) or to control receiving no prehabilitation. Both groups followed enhanced recovery programs and received rehabilitation accordingly. The primary outcome for functional capacity was measured by the 6-Minute Walking Test (6MWT) 4 and 8 weeks after surgery; to evaluate post-operative complications the Clavien-Dindo classification was used., Results: An interim analysis of 71 patients undergoing colorectal surgery was performed, with 35 assigned to interventional arm and 36 to control arm. Baseline characteristics were comparable in both groups. The prehabilitation group showed a significant increase in mean 6MWT distance pre-operatively compared to the control group, with an increase of 96 m (523 ± 24.6 vs. 427 ± 25.3, p = 0.01). At 4 and 8 weeks, the prehabilitation group maintained significant improvements, with an increase of 103 m (514 ± 89 vs. 411 ± 115, p = 0.003) and 90 m (531 ± 82 vs. 441 ± 107, p = 0.008), respectively. There were no statistical significant differences in post-operative complications and hospital length of stay between the two groups., Conclusions: The preliminary results of this study indicate that it is feasible to implement a prehabilitation protocol lasting approximately 4 weeks. This protocol appears to yield a significant improvement in the physical performance of patients with colon cancer undergoing elective colorectal resection at 4 and 8 weeks after surgery., Competing Interests: Declarations. Disclosure: Drs Antonio Pesce, Nicolò Fabbri, Simona Colombari, Giovanni Grazzi, Rosario Lordi, Gabriele Anania and Carlo Vittorio Feo and Ms Lisa Uccellatori have no conflicts of interest or financial ties to disclose. Research group: Francesco Bagolini, Luca Bonazza, and Sabrina Pedon (surgeons); Anna Chiara Piva and Cristina Sgarbi (dietitians); Maria Giulia Nanni, Rosangela Caruso, and Luigi Grassi (psycho-oncologists); Gianni Mazzoni (sport doctor); Stefano Volpato (geriatrician, statistical analysis); Emidia Vagnoni (Health economist); Desi Angeli (colorectal cancer case manager)., (© 2024. The Author(s).)

The purpose of this perspective is to provide recommendations on the use of Artificial Intelligence (AI) in health promotion. To arrive at these recommendations, we followed a 6-step process. The first step was to recruit an international authorship team from the Healthy Living for Pandemic Event Protection (HL- PIVOT) network. This enabled us to achieve an international perspective with insights from Canada, Great Britain, Kenya, Italy, and the US. A philosophical inquiry was conducted addressing 5 questions. What should the relationship be between humans and AI in health promotion? How can the public and professionals trust AI? How can we ensure AI is aligned with our values? How can we ensure the ethical use of data by AI? How can we control AI? 4 hypothetical scenarios were also developed to provide perspectives on: i) Artificial 'Versus' Human Intelligence; ii) AI Empowerment in Self-Care; iii) Could AI Improve Patient Provider Relationship; and iii) The Kenyan Cancer Patient at the Height of a Pandemic. Based on the philosophical inquiry and the scenarios 11 recommendations are made by the HL-PIVOT on the use of AI in health promotion. The golden thread running through these recommendations is a human centric approach. The recommendations begin by suggesting that workforce planning should take account of AI. They conclude with the statement that any serious incidents involving an AI in Health Promotion should be reported to the relevant regulatory authority., Competing Interests: Declaration of competing interest No conflicts of interest declared., (Copyright © 2024. Published by Elsevier Inc.)

The relationship between vigorous physical activity (PA) and the development of coronary atherosclerosis has remained less explored for many years. Recently, literature data have focused on coronary atherosclerosis in athletes showing that prevalence is not trivial, that there are differences among various types of sport, and that there are some peculiar features. As a matter of fact, plaque composition in athletes seems to be characterized by calcium rather than soft components. Specific mechanisms through which vigorous PA influences coronary artery disease are not yet fully understood. However, the prevalent calcific nature of coronary plaques in athletes could be related with a trend in a lower cardiovascular event rate.

Background: The response of oxygen uptake (VO2) and heart rate (HR) to continuous progressive large muscle mass exercise is not always linear. This study aimed to compare the patterns of the Speed/VO2 (S/VO2) and speed/HR (S/HR) relationships during an incremental treadmill-running test in professional rugby players., Methods: Fourteen professional rugby athletes performed a maximal incremental treadmill-running test, following the Conconi test protocol. Speed, heart rate, and gas exchange parameters were recorded. The slope of the S/VO2 and S/HR relationships were mathematically determined., Results: The S/VO2 and S/HR relationships were linear up to a submaximal speed and curvilinear thereafter. The speed of locomotion at which the slope of the S/VO2 and S/HR relationships start to attenuate (VO2att and HRatt) were coincident (12.3±1.0 and 12.4±0.9 km/h), strongly correlated and in good agreement. VO2 values at VO2att (44.9±8.7 mL/kg/min) were significantly correlated with VO2 values at the ventilatory threshold (43.3±6.0 mL/kg/min) (R 2 =0.83, P=0.001) and in good agreement. The running speed/VO2 ratio (ΔS/ΔVO2) up to VO2att was significantly lower than that beyond VO2att (2.98±1.1 vs. 5.16±2.31); P<0,001)., Conclusions: The speed/oxygen uptake and S/HR relationships during progressive exercise start to attenuate at a coincident exercise intensity, and at oxygen uptake values strongly correlated with the ventilatory threshold. These findings further support the usefulness of the attenuation of the S/HR relationship as a practical tool for exercise testing and training purposes in professional rugby players.

Purpose: The purpose of this study was to determine the ability of the moderate 1-km treadmill walking test (1km-TWT) to predict changes in peak oxygen uptake (V˙O 2peak ) in patients with stable cardiovascular disease (CVD) during an exercise-based secondary prevention program., Methods: Sixty-four male outpatients with stable CVD (age 64 [41-85] yr) performed the 1km-TWT before and after an 8-wk walking training program. Patient V˙O 2peak was estimated using a sex-specific equation including age, body mass index, 1km-TWT performance time, and heart rate (V˙O 2peakEST ). Forty-one patients completed a maximal cardiopulmonary treadmill test (CPX) for direct V˙O 2peak determination (V˙O 2peakMEAS ). The training prescription consisted of moderate-to-high intensity supervised walking for 30-40 min/session, and an additional 2-4 times/wk of unsupervised home moderate walking sessions between 20-60 min at the end of the program. The walking intensity was based on the results of the 1km-TWT., Results: Patients participated in an average of 14 of the 16 supervised sessions. An overall significant improvement in V˙O 2peakMEAS and weekly recreational physical activity levels were observed. No differences were observed between V˙O 2peakMEAS and V˙O 2peakEST . Compared with CPX results, the 1km-TWT underestimated the V˙O 2peak increase after the exercise intervention (mean difference -0.3 mL/kg/min, P > .05)., Conclusions: The 1km-TWT provides a reasonably accurate and simple tool to predict changes in V˙O 2peak due to moderate walking training in male outpatients with CVD. These findings contribute to the growing body of evidence supporting the use of the 1km-TWT for exercise testing and training purposes in the context of cardiac rehabilitation/secondary prevention programs., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Coronary artery disease is the major pathophysiological driver of ventricular remodeling. A multimodal intervention is the key strategy to promote a positive left ventricular remodeling with improvement in volumes and ejection fraction, known as "reverse remodeling." The aim of this review was to highlight the effect of physical activity (PA) on echocardiographic and cardiac magnetic resonance parameters of left ventricle in patients with myocardial infarction., Evidence Acquisition: We performed a systematic review of the literature to summarize current evidence about the efficacy (in terms of improvement in chamber dimensions, ejection fraction, speckle tracking and diastolic function) of physical activity in patients with myocardial infarction, supported by echocardiographic or magnetic resonance data. Articles were searched in Pubmed, Cochrane Library and Biomed Central., Evidence Synthesis: Only papers published in English and in peer-reviewed journals up to November 2022 were selected. After an initial evaluation, 1029 records were screened; the literature search identified 20 relevant articles. From this data, some PA protocols appeared to favor left ventricular reverse remodeling., Conclusions: PA provides beneficial effects on left ventricular parameters analyzed by echocardiography and cardiac magnetic resonance.

Introduction: Cardiovascular disease (CVD) is the principal cause of death in U.S. women. Peak oxygen uptake is strongly related to mortality and CVD. This study aimed to investigate the association between estimated peak oxygen uptake, determined using a moderate 1-km walking test, and all-cause mortality in female patients with stable CVD., Methods: Of the 482 women in our registry between 1997 and 2020, we included 430 participants in the analysis (aged 67 [34-88] years). A Cox proportional hazard model was used to determine the variables significantly associated with mortality. On the basis of the peak oxygen uptake estimated using the 1-km walking test, the sample was subdivided into tertiles, and mortality risk was calculated. The discriminatory accuracy of peak oxygen uptake in estimating survival was assessed by receiver operating characteristic curves. All results were adjusted for demographic and clinical covariates., Results: A total of 135 deaths from any cause occurred over a median of 10.4 years (IQR=4.4-16.4), with an average annual mortality of 4.2%. Estimated peak oxygen uptake was a stronger predictor of all-cause mortality than demographic and clinical variables (c-statistic-0.767; 95% CI=0.72, 0.81; p<0.0001). The survival rate decreased from the highest tertile of fitness to the lowest. Compared with the lowest group, hazard ratios (95% CIs) for the second and third tertiles were 0.55 (0.37, 0.83) and 0.29 (0.16, 0.51), respectively (p for trend <0.0001)., Conclusions: Higher peak oxygen uptake levels were associated with a lower risk of all-cause mortality. The indirect estimation of peak oxygen uptake using the 1-km walking test is feasible and can be applied for risk stratification among female patients undergoing secondary prevention programs., (Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The clinical value of cardiopulmonary exercise testing (CPET) in cardiac amyloidosis (CA) is uncertain. Due to the growing prevalence of the disease and the current availability of disease-modifying drugs, prognostic stratification is becoming fundamental to optimizing the cost-effectiveness of treatment, patient phenotyping, follow-up, and management. Peak VO 2 and VE/VCO 2 slope are currently the most studied CPET variables in clinical settings, and both demonstrate substantial, independent prognostic value in several cardiovascular diseases. We aim to study the association of peak VO 2 and VE/VCO 2 slope with prognosis in patients with CA., Methods and Results: We performed a systematic review and searched for clinical studies performing CPET for prognostication in patients with transthyretin-CA and light-chain-CA. Studies reporting hazard ratio (HR) for mortality and peak VO 2 or VE/VCO 2 slope were further selected for quantitative analysis. HRs were pooled using a random-effect model. Five studies were selected for qualitative and three for quantitative analysis. A total of 233 patients were included in the meta-analysis. Mean peak VO 2 resulted consistently depressed, and VE/VCO 2 slope was increased. Our pooled analysis showed peak VO 2 (pooled HR 0.89, 95% CI 0.84-0.94) and VE/VCO 2 slope (pooled HR 1.04, 95% CI 1.01-1.07) were significantly associated with the risk of death in CA patients, with no significant statistical heterogeneity for both analyses., Conclusions: CPET is a valuable tool for prognostic stratification in CA, identifying patients at increased risk of death. Large prospective clinical trials are needed to confirm this exploratory finding., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Objective: This review aimed to collect evidence about the effectiveness of exercise programs for managing binge eating disorder (BED) (recurrent binge eating episodes)., Methods: Meta-analysis was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Articles were searched in PubMed, Scopus, Web of Science, and Cochrane Library. Randomized controlled trials were eligible for inclusion if they reported the effect of an exercise-based program on BED symptoms in adults. Outcomes were changes in binge eating symptom severity, measured through validated assessment instruments, after an exercise-based intervention. Study results were pooled using the Bayesian model averaging for random and fixed effects meta-analysis., Results: Of 2,757 studies, 5 trials were included, with 264 participants. The mean age was 44.7 ± 8.1 years for the intervention group and 46.6 ± 8.5 years for the control group. All participants were female. A significant improvement was observed between groups (standardized mean difference, 0.94; 95% credibility interval, -1.46 to -0.31). Patients obtained significant improvements either following supervised exercise programs or home-based exercise prescriptions., Implications for Research and Practice: These findings suggest that physical exercise, within a multidisciplinary clinical and psychotherapeutic approach, may be an effective intervention for managing BED symptoms. Further comparative studies are needed to clarify which exercise modality is associated with greater clinical benefits., (Copyright © 2023 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Competing Interests: The authors declare no conflicts of interest.

Background: Traditional cardiac rehabilitation (CR) is effective in improving physical performance and prognosis after myocardial infarction (MI). Anyway, it is not consistently recommended to older adults, and its attendance rate is low. Previous studies suggested that alternative, early and tailored exercise interventions are feasible and effective in improving physical performance in older MI patients. Anyway, the demonstration that they are associated also with a significant reduction of hard endpoints is lacking., Aim: To describe rationale and design of the "Physical activity Intervention in Elderly patients with myocardial Infarction" (PIpELINe) trial., Methods: The PIpELINe trial is a prospective, randomized, multicentre study with a blinded adjudicated evaluation of the outcomes. Patients aged ≥ 65 years, admitted to hospital for MI and with a low physical performance one month after discharge, as defined as short physical performance battery (SPPB) value between 4 and 9, will be randomized to a multi-domain lifestyle intervention (including dietary counselling, strict management of cardiovascular and metabolic risk factors, and exercise training) or health education. The primary endpoint is the one-year occurrence of the composite of cardiovascular death or re-hospitalization for cardiovascular causes., Results: The recruitment started in March 2020. The estimated sample size is 456 patients. The conclusion of the enrolment is planned for mid-2023. The primary endpoint analysis will be available for the end of 2024., Conclusions: The PIpELINe trial will show if a multi-domain lifestyle intervention is able to reduce adverse events in older patients with reduced physical performance after hospitalization for MI., Trial Registration: ClinicalTrials.gov NCT04183465., (© 2023. The Author(s).)

The Coronavirus Disease 2019 (Covid-19) pandemic had dramatic effect on mental health, causing long-term psychiatricmorbidity. At present, there are no randomized trials reporting the effect of physical exercise on individuals with post- Covid-19 condition are available. The aim of this review was to summarize the evidence regarding the evidence on exercise as a treatment for anxiety and depression symptoms secondary to chronic diseases, which may be generalized to individuals suffering from the post- Covid-19 condition. Trials were included if they reported the effects of physical exercise programs on anxiety or depression symptoms in adults, either healthy or affected by chronic diseases. Outcomes were changes of anxiety or depression severity after an exercise-based intervention. Of the 2161 RCTs identified, eight out of 15 studies were included. Exercise was associated with greater improvements of depressive (SMD = -0.169; 95 % CI -0.302 at -0.003; p = 0.013) and anxiety symptoms (SMD = -0.263, 95 % CI -0.418 at -0.109; p = 0.001), compared with control interventions. Supervised exercise programs were effective against symptoms of anxiety or depression among individuals with chronich illnesses. Pending specific clinical trials, exercise may be considered for adoption among patients with the post Covid-19 condition., Competing Interests: Conflict of interest The authors declare that they have no competing interests., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Traditional cardiac rehabilitation (CR) programs effectively improve physical performance and outcomes after myocardial infarction (MI). However, older patients are less likely to participate in such programs. The aim of this qualitative analysis was to investigate experiences and perceptions of cardiac outpatients enrolled in an innovative and exercise-based CR program and to identify possible barriers to improving adherence and quality of life. Semi-structured interviews were conducted on a sample of 31 patients (84% male; age 76 ± 6 years) from the Physical Activity Intervention in Elderly after Myocardial Infarction (PIpELINe) trial, after about six months of the event. Three main themes were identified: Personal feelings after the event; lifestyle change and perception of barriers; and relationships with familiars. Participants perceived sensations of fear at the time of their diagnosis and showed awareness of the importance of following specific health suggestions. They reported a significative change in previous habits and highlighted the need for periodic controls. Few of them felt insecure in carrying out daily activities or practicing exercise and reported an unnecessary protection from the family members. These findings will provide valuable insights for the development of a more feasible patient-centered CR model of intervention.

Aims: To estimate the association between average walking speed (WS), determined using a moderate 1-km treadmill-walking test (1 k-TWT), and all-cause mortality in female patients with stable cardiovascular disease (CVD)., Methods: A sample of 431 patients (age 67 [34-88] years), performed a 1 k-TWT and were followed for all-cause mortality for up to 23 years. Variables significantly associated with mortality were determined by Cox proportional hazard models. Based on average WS during the 1k&#95;TWT the sample was subdivided into tertiles, and mortality risk was calculated. Receiver-operating-characteristic curves were constructed to assess the discriminatory accuracy of WS for estimating survival., Results: During a median follow-up of 10.4 years, a total of 135 deaths from any cause occurred, with an average mortality rate of 4.2%. The strongest predictor of mortality was WS (c-statistic for all-cause mortality 0.801, 95% confidence intervals: 0.51-1.11, p < 0.0001). Survival rate decreased from the fastest to the lowest tertile. Compared to the group with the lowest WS, the hazard ratios (95% confidence intervals) for the second and third tertiles were 0.73 (0.48-1.12) and 0.47 (0.25-0.91), respectively (p for trend <0.0001)., Conclusion: Average WS maintained during a moderate treadmill-walk is inversely related to survival in female patients with CVD. The 1 k-TWT is a simple and useful tool for assessing progress and stratifying risk in women undergoing secondary prevention programs., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The jugular venous pulse (JVP) is a one of the crucial parameters of efficient cardiovascular function. Nowadays, limited data are available regarding the response of JVP to exercise because of its complex and/or invasive assessment procedure. The aim of the present work is to test the feasibility of a non-invasive JVP plethysmography system to monitor different submaximal exercise condition. Twenty (20) healthy subjects (13M/7F mean age 25 ± 3, BMI 21 ± 2) underwent cervical strain-gauge plethysmography, acquired synchronously with the electrocardiogram, while they were carrying out different activities: stand supine, upright, and during the execution of aerobic exercise (2 km walking test) and leg-press machine exercise (submaximal 6 RM test). Peaks a and x of the JVP waveform were investigated since they reflect the volume of cardiac filling. To this aim, the Δax parameter was introduced, representing the amplitude differences between a and x peaks. Significant differences in the values of a, x, and Δax were found between static and exercise conditions (p < 0.0001, p < 0.0001, p < 0.0001), respectively. Particularly, the Δax value for the leg press was approximately three times higher than the supine, and during walking was even nine times higher. The exercise monitoring by means of the novel JVP plethysmography system is feasible during submaximal exercise, and it provides additional parameters on cardiac filling and cerebral venous drainage to the widely used heartbeat rate value.

Background: Progressive ageing of the population has highlighted the importance of the relationship between physical function and frailty in patients with chronic disease. The aim of this study was to assess the association between exercise capacity and grip strength (GS) in a cohort of older patients involved in an exercise-based secondary prevention program., Methods: Sixty-five outpatients (aged 75±6 years) were included. Exercise capacity was assessed through the estimation of maximal oxygen consumption (V̇O2peak) and the measurement of walking speed (WS). GS was evaluated in the dominant arm using a hand-held dynamometer., Results: Patients with higher V̇O2peak and WS values exhibited significantly higher GS (P<0.01). GS was significantly related to WS (P<0.01) and V̇O2peak (P<0.01), and inversely associated with age (P<0.01). Results from linear multiple regression analysis (P<0.01) demonstrate that GS was strongly associated with WS (P<0.01) and age (P=0.01), while BMI, weekly LTPA, cardiovascular diagnosis, V̇O2peak and education were not., Conclusions: The evaluation of WS, V̇O2peak and GS was feasible and well tolerated. These preliminary results suggest that prescribing regular walking activity, educating subjects to perform it at higher average WS, can help to maintain physical function in older patients with cardiovascular disease.

Aims: To examine long-term changes in lifestyle and exercise capacity of older patients hospitalized for acute coronary syndrome (ACS) involved in an innovative centre- and home-based exercise-based secondary prevention program., Methods: A sample of 118 patients with ACS (age 76 [72-80] years) was analysed. Long-term changes in self-reported weekly leisure-time physical activity (wLTPA), walking speed (WS), and estimated cardiorespiratory fitness (eCRF, VO 2 peak, mL/kg/min) were the outcome variables. The program consisted of seven individual on-site sessions including motivational interviewing to reach exercise goals. Exercise prescription was based on the results of a standardized moderate and perceptually regulated treadmill walk to estimate VO 2 peak. wLTPA, WS, and eCRF were assessed at 1 (baseline), 2, 3, 4, 6, 12, and 24 months after discharge., Results: 87, 76, and 70 patients completed follow-up at 6, 12, and 24 months, respectively. wLTPA significantly increased during the follow-up period (median METs/H/week 2.5, 11.2, 12.0, and 13.4 at baseline, 6, 12, and 24 months, respectively; P < 0.0001). At baseline, 18% of the sample met the current international guidelines for physical activity, while 75%, 70%, and 76% of them met the recommended values at 6-, 12-, and 24-month follow-up sessions, respectively. These results were associated with increasing median WS (2.9 ± 1.0, 4.3 ± 1.2, 4.5 ± 1.1, 4.5 ± 1.2 km/h, respectively, P < 0.0001), and VO 2 peak (16.5, 21.4, 21.1, 21.3 mL/kg/min, respectively, P < 0.0001)., Conclusions: This early, individualized exercise intervention improved long-term adherence to a physically active lifestyle, walking capacity, and eCRF in older patients after ACS. Larger studies are needed to confirm short- and long-term clinical benefits of this intervention., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)