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Abstract Over the last few years, radiation therapy (RT) techniques have evolved very rapidly, with the aim of conforming high-dose volume tightly to a target. Although to date CT is still considered the imaging modality for target delineation, it has some known limited capabilities in properly identifying pathologic processes occurring, for instance, in soft tissues. This limitation, along with other advantages such as dose reduction, can be overcome using magnetic resonance imaging (MRI), which is increasingly being recognized as a useful tool in RT clinical practice. This review has a two-fold aim of providing a basic introduction to the physics of MRI in a narrative way and illustrating the current knowledge on its application “from head to toe” (i.e., different body sites), in order to highlight the numerous advantages in using MRI to ensure the best therapeutic response. We provided a basic introduction for residents and non-radiologist on the physics of MR and reported evidence of the advantages and future improvements of MRI in planning a tailored radiotherapy treatment “from head to toe”. Critical relevance statement This review aims to help understand how MRI has become indispensable, not only to better characterize and evaluate lesions, but also to predict the evolution of the disease and, consequently, to ensure the best therapeutic response. Key Points MRI is increasingly gaining interest and applications in RT planning. MRI provides high soft tissue contrast resolution and accurate delineation of the target volume. MRI will increasingly become indispensable for characterizing and evaluating lesions, and to predict the evolution of disease. Graphical Abstract

Three years after the SARS-CoV-19 pandemic, a chronic post-COVID syndrome “LONG COVID” persists, causing fatigue and shortness of breath, along with distress, anxiety, and depression. Aim: To assess the impact of physical activity on the management and rehabilitation of LONG COVID, as well as to investigate the persistence of LONG COVID symptomatology in individuals over 40 years, beyond the pandemic. Methods: A total of 1004 participants (aged 53.45 ± 11.35) were recruited through an online snowball sampling strategy to complete a web-based survey. The following questionnaires were administered: Physical Activity Scale for Elderly (PASE), Shortness of Breath Questionnaire (SOBQ), Patient Health Questionnaire-9 item (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7), and Fatigue Scale for Motor and Cognitive Functions (FSMC). Results: Significant gender differences were discovered, with women reporting higher symptoms than men (p < 0.001). Significant age differences were also found, with participants under 55 showing higher values than those over 55 (p < 0.001). No significant differences were found between aerobic and mixed physical activity (p > 0.05) while significant results emerged between physical activity groups and the no activity group (p < 0.001). The low-frequency group reported higher symptoms than the high-frequency group (all ps < 0.001). Conclusion: Regardless of the type of physical activity performed, our survey identified the frequency of training as a crucial factor to overcome LONG COVID symptoms; the challenge lies in overcoming the difficulties due to the persistent feelings of inefficiency and fatigue typical of those who have contracted the infection.

The aim of the study was to evaluate whether the static stabilometric parameters among elite fencers, were affected by prolonged, asymmetric training regimen. A sample of 26 elite fencers of both genders, aged 19.15 ± 2.24 years, practising one of the three disciplines foil, épée, or sabre, was recruited for the study. Anthropometric measurements including thigh and calf circumferences and postural assessment based on the weight distribution on a stabilimeter platform were performed. Postural tone, as indicated by measures such as sway length and sway area ratio was calculated.. No notable anthropometric asymmetries were detected within the examined group The weight distribution patterns on the support quadrants in static stabilometric measurements did not suggest clinically significant issues. There were no significant differences among subgroups based on gender and lower limb dominance for both anthropometric and stabilimeter variables. However, 30.8% of participants showed anomalies in postural tone (hypertonic and hypotonic condition). Five out of eight athletes found with abnormal postural tone were foil fencers, suggesting a potential discipline-specific effect. Individual adjustments were found in foil fencers. These findings provide insights into the potential effects of fencing training on postural parameters among elite athletes.

The aim of the study was to assess the effects of 8 weeks of resistance training using a flywheel device applied to upper limbs, compared to traditional isotonic training, on strength and shot precision in tennis. Twenty-seven elite senior tennis players (age: 55.78 ± 2.69) were randomly divided into an experimental group (EG) using flywheel devices (n = 13) and a control group (CG) performing isotonic training (n = 14). The EG program included forehand, backhand, and one-handed shoulder press movements, while the CG performed seven resistance exercises on isotonic machines. A similar workout intensity was ensured using the Borg’s CR-10 scale. The assessment included a 30s arm curl test, a medicine ball throw test, and forehand/backhand/overhead shot precision tests. A significant time effect was found in the 30s arm curl test for the EG (F(1,25) = 13.09; p = 0.001), along with a time * group interaction (F(1,25) = 5.21; p = 0.031). A significant group difference was observed in the forehand shot precision test, where the EG achieved better scores than the CG and significant interaction time * group (F(1,25) = 8.35; p = 0.008). In the shot backhand precision test, a significant effect of time (F(1,25) = 5.01; p = 0.034) and significant time * group interaction were found (F(1,25) = 4.50; p = 0.044), but there was no significant difference between groups. Resistance training with flywheel devices has shown potential in improving tennis performance. Applying overload to specific athletic movements during both concentric and eccentric phases in the EG has shown enhanced strength and neuromuscular coordination in relation to shot precision, thereby enabling simultaneous improvements in both conditioning and the technical aspects of fundamental tennis shots.

Strength training elicits benefits both in performance and on a psychological level in women, such as increased muscle strength and improved self-esteem. Whole-body electromyostimulation (WB-EMS) could be a training strategy for enhancing muscular strength. The aim of this study was to assess the acute effects of a single session of WB-EMS superimposed over classic resistance training on isometric strength, endurance strength and flexibility. Furthermore, the safety of the protocol was assessed by monitoring the levels of creatine kinase (CK) 48 h after the training protocol was completed. Sixteen active women (aged 22.06 ± 1.88) were randomly assigned to an experimental group (EG) (n = 8) and a control group (CG) (n = 8). The EG performed four sets of 12 repetitions of three strength exercises with superimposed WB-EMS, while the CG performed the same protocol without WB-EMS. RM-ANOVA showed a significant time*group interaction on posterior kinetic chain extensors’ mean and peak strength in the EG (F(1,14) = 10.036; p = 0.007; and F(1,14) = 20.719; p < 0.001; respectively). A significant time*group interaction was found in the sit and reach test for the EG (F(1,14) = 10.362; p = 0.006). Finally, ANOVA performed on the CK levels showed no significant difference between the groups (F(1,14) = 0.715; p = 0.412). WB-EMS training led to an immediate improvement in strength performance and flexibility, and this protocol was shown to be safe in terms of CK levels, 48 h after completing the training protocol.

Background: Although physical activity (PA) has been shown to enhance hypertension control, the impact of exercise on the potential decrease of the use of antihypertensive medications remains inadequately researched. Aim: The aim was to assess the impact of a two-year PA on the medication requirements of individuals with hypertension. Methods: A clinical trial was conducted, involving 130 participants with essential hypertension who took at least one antihypertensive medication. Participants were randomly assigned to either a control group (CG n = 65) or an experimental group (EG n = 65) that underwent a 24-month supervised PA program based on a combination of aerobic and resistance training. The antihypertensive drug load for each participant was determined by adding the ratios of the prescribed daily dose (PDD) to the defined daily dose (DDD) for all antihypertensive medications taken by the participants. The outcome measures were evaluated at 0, 6, 12, 18, and 24 months. Results: A total of 76 participants completed the 24-month assessment, and RM-ANOVA revealed a significantly lower antihypertensive drug load in the EG compared to the CG at 18 (p < 0.017) and 24 months (p < 0.003). Conclusion: A long-term PA program can decrease the antihypertensive drug load in older adults with essential hypertension. The trend of improvement regarding the EG drug load intake and the trend of CG drug load increase, although not significant over time, results in a significant difference between the groups at 18 months and an even greater difference at 24 months. This trend certifies the protective value of PA against the aging process and its related health risk factors.

The objective of this systematic review was to examine the effectiveness of flywheel training, which allows for the replication of specific sports movements, overloading both the concentric and eccentric phases. Inclusion criteria were injury prevention outcomes; ability in terms of strength, power, sprinting, jumping and change of direction; competitive athletes; and RCTs. Exclusion criteria were a lack of a control group and lack of baseline and/or follow-up data. The databases used were Web of Science, Scopus, PubMed, Cochrane Library, and Sage. The revised Cochrane risk-of-bias tool was used to assess the quality of the selected RCTs. The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence was used. A PICOS (participants, intervention, comparators, study outcomes, and study design) approach was used to evaluate eligibility. A total of 21 RCTs with 8 to 54 participants in each study analyzed flywheel technology and its application in nine sports. The results showed that flywheel training is a good strategy to improve sports performance, providing variation in training methodologies and athletes’ adherence. Further studies are needed to define guidelines on training modality, weekly frequency, volume, and inertia load. Only a few studies have applied the flywheel device directly to overload specific multidirectional movements at different joint angles. This method is not exempt from criticalities, such as the cost and the ability to carry out only individual training.

The COVID-19 pandemic deeply affected sports and athletes, influencing performance and psychological wellbeing. In order to provide useful guidelines for coaches, a web-based survey was conducted. Three web-based questionnaires were administered during the last phase of the Omicron wave to a total of 204 Italian athletes (age 24.96 ± 9.82): an informative questionnaire to collect sociodemographic data and infection symptoms information, the Fatigue Severity Scale (FSS) and the General Health Questionnaire-12 (GHQ-12). No differences between infection sequels of different variant typologies were found over the long term after the infection. The most frequently declared symptoms included cough (50%), muscular skeletal impairments (48%) fatigue (43%) and fever (43%). Results showed that female athletes have a higher risk of developing post-COVID-19 symptoms, GHQ-12 worse results (p = 0.005) and greater fatigue (p = 0.0002) than males. No significant difference in infection incidence between high- and low-level athletes was found. Endurance athletes showed greater perceived fatigue than anaerobic sports athletes (p = 0.045). Conclusions: These results suggested the need for specific approaches and continuous updating to differentiate training programs for different athletes during the return to play. Medical controls and daily monitoring of athletes of all levels after the infection could be advisable.

The outbreak of the 2019 coronavirus disease (COVID-19) created an international public health emergency, challenging the psychological resilience of the general population. Regarding this matter, a web-based survey was performed. Data were collected from the following 1,668 self-selected volunteers: 800 athletes (28.30 ± 10.93 years old); 558 coaches (36.91 ± 11.93 years old); and 310 sports managers (42.07 ± 13.38 years old). To assess the level of psychological stress, an Impact of the Event Scale-Revised (IES-R) questionnaire was used. The results indicated that 34.4% of the participants who were interviewed were affected by subjective distress while 26.4% rated their psychological impact from the sports activity interruption as severe. Separated one-way analysis of variance (ANOVA) tests showed significant differences in the IES-R total score (TS), indicating that the level of stress in terms of gender revealed that women were more stressed than men (p = 0.000), for "sports roles" in which the manager and coaches were more stressed than the athletes (p < 0.05), and "type of sport" in which fitness and individual athletes were more stressed than team athletes (p < 0.01). The middle-level athletes showed significantly more hyperarousal levels than high-level athletes (p = 0.012). The results of this survey may raise awareness of this problem and help athletic associations to have appropriate guidelines in order to better sustain their memberships and organize an optimal resumption of their sports activities. Along these lines, social interactions, which are typical of team sports, are crucial to warrant resilience and psychological health. The athletes by managing independently the new rules and measures, thanks to a clear communication, could improve their adaptive stress reaction.

Intergenerational physical activity could be a pleasant method to prevent elderly sedentary behaviors. The aim of this study is to provide a basis to develop an intergenerational physical activity between preschool children and elderly people. An assessing enjoyment three questionnaire survey was administered to 140 participants (aged 67.8 ± 9.1): the global physical activity questionnaire (GPAQ) assessing the sedentariness degree; the physical activity enjoyment scale (PACES-Q) assessing enjoyment for the physical activity usually practiced; the physical activity enjoyment scale (PACES-INT) assessing the enjoyment for a hypothetical intergenerational program. Successively, the sample was divided into subgroups based on age, gender, marital status, education, employment, sports background, sedentariness level and residential location. Four multichoice questions, aiming to have guidelines in organizing an intergenerational program, were used. A total of 44.3% of the sample found the physical activity practiced pleasant, whereas 81.5% enjoyed the intergenerational program (only 7.1% expressed a negative judgment). A separated one-way ANOVA showed significant differences in PACES-INT for gender, (p = 0.009), residential location, (p < 0.001) and employment (p = 0.004). About 80% of the sample would adhere to the intergenerational programs, despite the fatigue fear and logistic or family relationship problems.

Functional inertial training, a popular high-intensity training mode, provides high neuromuscular activation, developing proprioception, postural control, power, and sprint time. Aim of the study was to assess the acute effects of two types of warm-up (WU), inertial warm-up (IWU) vs. traditional warm-up (TWU), on explosive and reactive strength, sprint, and Change of Directions (COD) in young soccer players. In a randomized cross-over design study, twelve soccer players (aged 13.3 ± 0.7) performed 16 min of IWU and 16 min of TWU. IWU and TWU were spaced two weeks apart. Pre and post intervention tests, aimed at assessing explosive and reactive strength, sprint, and COD ability included: Squat Jump test (SJ), Countermovement Jump test (CMJ), Drop Jump test (DJ), Seven Repetition Hopping test (7R-HOP), 40 m-sprint test (40 m), and Illinois Agility Test (IAT). RM-ANOVA, used to compare differences between IWU and TWU effects (the level of significance set at ρ ≤ 0.05), showed enhanced performance after the IWU compared to the TWU. In addition, the effects of the IWU on performance lasted longer after the IWU than after the TWU. For IAT, the enhanced effects of IWU on performance lasted up to ten minutes after the administration of the IWU. Our results suggest that IWU affects functional changes displaying earlier adaptation in explosive and reactive strength with longer lasting effects compared to TWU and it could be recommended in young soccer athletes as a WU procedure.