Cardiorespiratory Performance in Kidney and Liver Transplant Recipients: The Dilemma to Combine Lifestyle and Fitness.

It is widely demonstrated that moderate-intensity exercise is associated with improved fitness in non-communicable chronic diseases. However, there are no specific guidelines available for transplant recipients. Body composition is closely linked to exercise capacity, typically estimated by cardiopulmonary testing, but its potential correlation with cardiovascular health outcomes has not been investigated yet. This study aims to evaluate and compare cardiorespiratory performance and body composition in two groups of liver and kidney transplant recipients. A mixed group of transplant recipients (10 kidney and 15 liver) participating in a lifestyle reconditioning program through unsupervised physical exercise prescription was examined. Both groups were assessed using bioimpedance analysis (BIA), lifestyle, and physical activity levels by IPAQ questionnaire and cardiopulmonary testing (CPET). The two groups differed by IPAQ examination: liver transplant patients practiced more physical activity. Statistically significant differences were found in peak VO2/HR (oxygen pulse), which was higher in the kidney group compared to the liver group (15.63 vs. 12.49 with p < 0.05). Body composition did not show significant differences in BMI and the percentage of FM/FFM (FFM: 78.04 ± 7.7 in Kidney T vs. 77.78 ± 7.2 in Liver T). Systolic pressure measured at the peak was significantly higher in the liver group (162.6 vs. 134 with p < 0.01). The correlation between the CPET and BIA parameters showed a positive VO2 max and FFM mass trend. The results suggest differences in cardiorespiratory fitness between the two populations of solid organ transplant recipients despite not being related to the physical activity level. The data support the importance of body composition analysis in sports medicine and the prescription of physical exercise, especially considering the potential correlation with VO2 max, even though home-based exercise does not seem to alter it substantially. BMI does not appear to be a determinant of cardiovascular performance. Other determinants should be investigated to understand the differences observed.

Unsupervised Exercise Intervention vs. Adherence to a Mediterranean Diet Alone: The Role of Bioelectrical Impedance Vector Analysis and Cardiovascular Performance in Liver-Transplanted Recipients.

(1) Background: Cardiovascular disease is one of the leading causes of mortality after liver transplantation. Body composition and cardiovascular performance assessment represent a potential approach for modulating lifestyle correction and proper follow-up in chronic disease patients. This study aimed to verify the additional role of an unsupervised physical activity program in a sample of male liver transplant recipients who follow the Mediterranean diet. (2) Methods: Thirty-three male liver transplant recipients were enrolled. Sixteen subjects followed a moderate-intensity home exercise program in addition to nutritional support, and seventeen received advice on the Mediterranean diet. After six months, bioelectrical vector impedance analysis (BIVA) and cardiopulmonary exercise testing (CPET) were performed. (3) Results: No differences in CPET (VO2 peak: exercise 21.4 ± 4.1 vs. diet 23.5 ± 6.5 mL/kg/min; p = 0.283) and BIVA (Z/H: exercise 288.3 ± 33.9 vs. diet 310.5 ± 34.2 Ω/m; p = 0.071) were found. Furthermore, the BIVA values of resistance correlate with the submaximal performance of the Ve/VCO2 slope (R = 0.509; p < 0.05) and phase angle with the maximal effort of the VO2 peak (R = 0.557; p < 0.05). (4) Conclusions: Unsupervised physical exercise alone for six months does not substantially modify liver transplant recipients' cardiovascular performance and hydration status, despite their adherence to a Mediterranean diet. The body composition analysis is useful to stratify the risk profile, and it is potentially associated with better outcomes in transplanted subjects.

Physical activity in liver transplant recipients: a large multicenter study.

AIM: Healthy lifestyle and appropriate diet are of critical importance after liver transplant (LT). We provided an analysis of the main patterns of physical activity and found factors associated with physical activity itself. METHODS: Clinically stable LT recipients were enrolled between June and September 2021. Patients completed a composite questionnaire about physical activity, adherence to Mediterranean Diet (MD), quality of life (QoL), and employment. Correlations were analysed using the Pearson coefficients while different subgroups were compared by t-test for independent samples or ANOVAs. Multivariable logistic regression analysis was conducted to find predictors of inactivity. RESULTS: We enrolled 511 subjects (71% males, mean age 63 ± 10.8 years). One hundred and ninety-three patients reported high level of physical activity, 197 a minimal activity and 121 declared insufficient activity. Among these latter, 29 subjects were totally inactive. Considering the 482 LT recipients performing some kind of physical activity, almost all reported a low-quality, non-structured activity. At multivariate analysis, time from LT (odds ratio 0.94, 95% CI 0.89-0.99, p = 0.017), sedentary lifestyle (odds ratio 0.99, 95% CI 0.19-0.81, p = 0.012), low adherence to MD (odds ratio 1.22, 95% CI 1.01-1.48, p = 0.049), and low level of QoL (physical dimension) (odds ratio 1.13, 95% CI 1.08-1.17, p < 0.001), were independently associated with total inactivity. CONCLUSION: A large portion of LT recipients report an insufficient level of physical activity or are wholly inactive. Inactivity increases with time from LT and was strongly associated with suboptimal diet and low QoL.

Flow Dynamic Pattern in Liver and Renal Transplantation under Exercise Prescription Program.

BACKGROUND: Cardiovascular diseases in the context of renal and liver transplants remain the leading cause of morbidity and mortality. Physical exercise at a moderate intensity is allowed to contrast the risk profile. Echocardiographic evaluation is essential to stratifying potential cardiotoxicity by the standard and, more recently, the deformation and dynamic study of the intracardiac vortex. This study aims to investigate the vortex echo parameters of solid-organ-transplanted subjects who are physically active compared to a control group of healthy subjects. METHODS: A group of 33 transplanted subjects (16 kidneys and 17 livers) was studied via a transthoracic echocardiography exam, comprehending the myocardial deformation parameters of global longitudinal strain (GLS), twisting of the left ventricle (LV) chamber, and HyperDoppler image acquisition. RESULTS: The subjects enrolled in this study were 50 in total: there were 33 transplanted and 17 healthy subjects. The transplanted subjects presented higher values of interventricular septum in diastole (IVSd p = 0.001), posterior wall diastolic (PWd p = 0.05), and left ventricle mass index (LVMI p = 0.029); ejection fraction (EF) was found to be higher in athletes (p < 0.001). Transplanted subjects presented mild diastolic dysfunction, emerging only from septal E values (p = 0.001). The 4DStrain (p = 0.018) and GLS2c (p = 0.017) were significantly better in the athletes. All of the geometrical and energetical vortex data were in the normal range and no significant differences were found. An interesting positive correlation was evident for the diastolic parameter, particularly the E/A ratio (p = 0.023) and E' septal value (p = 0.049), along with the vorticity fluctuation. This behavior was present for all subjects, particularly those that were transplanted (p = 0.005). CONCLUSIONS: In the vortex investigation, especially in cases of normal EF, the positive correlation of some diastolic parameters with the flow dynamic patterns corroborates this hypothesis. The HyperDoppler analysis could be helpful to detecting potential damage earlier in the diastolic time before a systolic deficiency.

Acute Coronary Syndrome Treated with Percutaneous Coronary Intervention in Hutchinson-Gilford Progeria.

Hutchinson-Gilford progeria syndrome is an extremely rare genetic disease caused by a de novo mutation in the LMNA gene, leading to an accumulation of a form of Lamin A, called Progerin, which results in a typical phenotype and a marked decrease in life expectancy, due to early atherosclerosis and cardiovascular disease. We report the case of a fourteen-year-old Chinese boy with Hutchinson-Gilford progeria syndrome admitted to the emergency room because of precordial pain. Physical examination showed tachycardia 130 beats/min and arterial hypertension: 170/120 mmHg, normal respiratory rate, no neurological impairment; ECG evidenced sinus tachycardia, left ventricular hypertrophy, horizontal ST-segment depression in I, aVL, II, III, aVF leads, and V4-V6 and ST-segment elevation in aVR and V1 leads. Echocardiography highlighted preserved global left ventricular function with concentric hypertrophy, altered diastolic flow pattern, mitral valve insufficiency, and minimal aortic regurgitation. Blood tests evidenced an increase in high-sensitivity troponin T level (335 pg/mL). NSTEMI diagnosis was performed, and the patient was admitted to the intensive care unit. A coronary CT angiography showed a severe obstruction of the common trunk of the left coronary artery, for which an urgent percutaneous coronary intervention (PCI) was proposed. A selective coronary angiography imaged complete chronic occlusion of the left main coronary artery as well as severe stenosis at the origin of a very enlarged right coronary artery that vascularized the left coronary artery through collaterals. Afterwards, the right coronary artery was probed using an Amplatz right (AR1) guiding catheter, through which a large 3.5 mm drug-eluting coronary stent (Xience Sierra, Abbott, Abbott Park, IL, USA) was implanted. At the end of the procedure, no residual stenosis was imaged and improved vascularization of the left coronary artery distribution segments was observed. Dual antiplatelet therapy (DAPT) consisting of aspirin (75 mg daily) and clopidogrel (37.5 mg daily) and anti-hypertensive therapy were started. At the one-year follow-up, the patient had not reported any occurrence of anginal chest pain.

Interaction between Geographical Areas and Family Environment of Dietary Habits, Physical Activity, Nutritional Knowledge and Obesity of Adolescents.

There are marked differences in the regional distribution of childhood obesity in Italy. This study sought to investigate the interaction between geographical areas and family environment of dietary habits, physical activity, nutritional knowledge and obesity of adolescents. A cross-sectional study was conducted on 426 school-aged children and 298 parents residing in Central Italy (Florence, Tuscany) and Southern Italy (Corigliano, Calabria), in 2021. Survey questionnaire investigated anthropometry, eating behavior, nutritional knowledge and physical activity. BMI was determined and compared with reference percentile charts for adolescents. Multivariate regression analyses showed that: (1) an adolescent's BMI was directly influenced by their parents' BMI independently of parental nutritional knowledge and dietary or physical activity habits; (2) parents transmitted eating or physical activity habits to their children; (3) the geographic region of residence is not in itself an independent determinant of children's BMI. The clear message is that prevention of childhood obesity should consider family-based approaches. Parental obesity can be the point of convergence of the complex interactions between a parent's and child's habits and should be one of the most important factors to look for.

Normative values for heart rate response to exercise in young athletes at 10-18 years old.

The assessment of the chronotropic response during acute physical exertion can allow the discovery of many cardiovascular diseases even at a young age. However, the increase in heart rate (HR) depends on the age and sex of the subject and the modality of the graded exercise test. This study aims to provide sex- and age-related normative values for heart rate performance in young athletes aged 10-18. A retrospective study was carried out on 7896 young athletes (5356 males and 2540 females) aged between 10 and 18 who underwent pre-participation screening to obtain eligibility for competitive sport. First, anthropometric parameters, performance data, and HR are reported. Thus, each age calculated third, tenth, twenty-fifth, fiftieth, seventy-fifth, ninetieth, and ninety-seventh percentiles for the stage-by-stage HR response, according to sex and graded exercise test modality category. Young female athletes of all ages showed lower performance with fewer stages performed on the cycle ergometer and the treadmill. Young male athletes on treadmill and cycle ergometers show lower HR values at submaximal intensities. The treadmill allows a longer duration than the cycle ergometer for males and females. Sex, age, and the specificity of the movement performed must be considered in assessing the chronotropic response in the young population, particularly for those who carry out a training program. In addition, providing reference values of HR response to acute physical exertion may allow for a better functional assessment of the young athletes.HighlightsGrowth and physical training induce continuous changes in the cardiovascular system. However, each young athlete shows individual features. The chronotropic response to incremental load is a common method for assessing health and fitness.Comparing the heart rate data obtained from the incremental effort with the reference percentiles can provide information in a short time in the evaluation of young athletes and the general youth population. Therefore, this methodology is regularly performed in the evaluation of anthropometric growth.In evaluating the chronotropic response to physical exertion, in addition to age and sex, should take the specificity of the movement performed during the test into account.

Normative values and a new predicted model of exercise blood pressure in young athletes.

OBJECTIVES: Assessing the systolic and diastolic blood pressure during acute physical exertion can allow the discovery of many cardiovascular diseases even at a young age. However, this response depends on the age, sex of the subject, and the modality of the graded exercise test. This study aims to provide sex-and age-related normative values of peak and recovery blood pressure performance and to develop a predicted model of systolic and diastolic blood pressure peak in young athletes. DESIGN: Retrospective-study. METHODS: We analyzed 8224 young athletes (5516 males and 2708 females) aged between 8 and 18. Anthropometric and blood pressure parameters related to the effort are reported. Then, according to sex, graded exercise test modality, and age were calculated 1) the fifth, tenth, fiftieth, ninetieth, and ninety-fifth percentiles for the systolic and diastolic blood pressure at peak and after 1 min of recovery and 2) predictive equations of systolic and diastolic blood pressure at the peak. RESULTS: Younger athletes show lower peak blood pressure values, gradually increasing as they age. Males showed higher peak systolic blood pressure values starting at 12-13 years on the cycle ergometer and 10-11 years on the treadmill, while there was no difference in peak diastolic blood pressure values. CONCLUSIONS: Sex, age, and the specificity of the movement performed must be considered in assessing the blood pressure response in the young population. In addition, providing reference values and predictive equations of blood pressure response to acute physical exertion may allow for a better functional assessment of young athletes.

Side Bioimpedance Analysis in Menopausal Post-Oncological Breast Cancer.

BACKGROUND: Post-oncological BC (breast cancer) has an increased cardiovascular risk due to the variation of some anthropometric parameters. This study investigates the differences between a quadrantectomy and a mastectomy on the body composition over time in presence of a breast prothesis. METHODS: A group of BC patients (n = 41 aged 56.6 ± 9.5 years; 15 mastectomy patients; and 26 quadrantectomy patients) were compared to controls (C) (n = 22 aged 46.5 ± 13.44 years). Through bioimpedance analysis (Akern-BIA 101), the body mass index (BMI), total body water (TBW), extracellular water (ECW), body cell mass (BCM), fat mass (FM), free fat mass (FFM), and angle phase (PA) were compared within each group and between different groups using the Student's Test T. RESULTS: The BC group showed lower values of FFM and TBW compared to C. The FFM was significantly (p = 0.04) lower in those with quadrantectomy. The right hemisome of the quadrantectomy has increased values of FFM, BCM (p = 0.04) and TBW compared to the counter-lateral hemisome, and FM values (p = 0.0008) lower than the counter-lateral. The hemisome with intervention has increased values of FM and ECW compared to the counter lateral, as well the FFM, BCM, TBW, and PA. CONCLUSIONS: The results support the hypothesis that non-conservative surgical treatment (mastectomy) is associated with a better BIA profile without any substantial impact of breast implants in the body composition analysis. The awareness of a severe diseases could play a role to ameliorate lifestyle; however, further studies will be necessary to support this theory.

From Strain toward Hyperdoppler Echocardiographic Evaluation in Sports Medicine.

Sports medicine is often involved in the evaluation of a wide population composed by active or less active individuals [...].

Integrated Sports Medicine: A First Investigation of Heart Performance in Opera Singers.

INTRODUCTION: Opera singers are continuously subjected to cardiopulmonary exercise. The impact on cardiac performance has not been studied. Our aim was to verify the impact of singing on heart performance, particularly by the evaluation of ECG and deformation parameters as strain, rotation and twist. METHODS: A population of 17 OS (opera singers) underwent a 12-lead ECG and 2D echocardiographic evaluation. A post-processing analysis of the images to obtain the deformation parameters was included. The data expressed as mean as SD were compared to a group of 15 high-level athletes (A). RESULTS: In both groups, the ECG parameters, 2D standard systodiastolic parameters and pulmonary pressure were normal, and in the OS group-LVDd: 47 ± 2.75 mm, LVSd: 31 ± 3.38 mm, E/A: 1.08 ± 0.23, RV: 27.63 ± 3.38 mm; in the A group-LVDd: 51 ± 1.50 mm, LVSd: 32 ± 2.50 mm, E/A: 2.37 ± 0.73, RV: 25.00 ± 3.00 mm. Indexed LV mass was significantly greater in athletes, while ejection fraction (EF) results were higher in OS. Deformation parameters did not differ among the two groups, with the exclusion of GLS expressing a major value in athletes. Rotational parameters resulted in the OS group similar to the athletes. CONCLUSIONS: OS show myocardial performance as high as the athletes. The data obtained suggest a positive impact of regular training as an opera singer. Deformation parameters highlight the fitness status in this group with a specific remodeling in RV in the presence of normal PP. Classic music singing appears to have a training effect on the heart. Further studies are necessary to confirm this hypothesis.

Myocardial Fitness of Bicuspid Aortic Valve Athletes during COVID 19 Pandemic.

COVID 19 pandemic has induced a large sedentarism in several kinds of sports. Some peculiar categories of athletes could particularly suffer from a prolonged inactivity as those affected by minimal cardiopathies as bicuspid aortic valve (BAV) athletes. This study aims to verify the myocardial performance in a restricted group of BAV athletes compared to a control group of agonistic athletes evaluated by traditional echocardiography and deformation parameters. 2D standard and deformations parameters were measured at rest conditions in BAV athletes and controls. Particularly EF, LVDD/LVS diameters, GLS rotation and twisting were considered as myocardial performance data; E/A, E1 and A1 as diastolic ones. All the 2D standard parameters measured were within the normal range in both groups, especially the EF value. Significant differences were found in the diastolic function with reduced values of E and E1 waves in BAV vs. controls. The strain analysis showed a significant reduction in GLS measured in 2C, 3C, 4C in BAV if compared to controls, while no significant differences were found in torsional and rotational parameters. These results are suggestive for a potential long term negative impact of inactivity on cardiac performance more evident in BAV athletes, if compared to athletes with normal aortic valve. GLS of LV and RV can be considered as a predictive parameter of this mild dysfunction and assumed as follow-up parameter to restore a progressive training.

Frequency of fragmented QRS in sports activity: a pilot study.

BACKGROUND: Fragmented QRS (fQRS), is a marker of intraventricular conduction delay. No sufficient data are available regarding the presence in different sports disciplines. The present study aims to evaluate the frequency of fQRS in athletes and the morphological myocardial associated pattern. METHODS: This retrospective study of 5 years, involved 605 subjects and evaluated for the eligibility in competitive sport activity. A sample of 100 subjects for 6 kinds of sport was considered. Fragmented QRS was defined as the presence, during a resting ECG, of various RSR' patterns in at least two contiguous leads. All subjects had an echocardiographic examination. RESULTS: fQRS was found in 47 athletes of the 605 subjects. fQRS+ subjects were older than fQRS- (33.17 vs. 24.12 P<0.001) and were predominantly male (89.4% vs. 10,6% P=0.007). The presence of fQRS had a different prevalence among sports. Fragmented QRS was independently associated with age (OR=1.026, 95% CI 1.006-1.047; P=0.010), sex (OR=0.354, 95% CI 0.133-0.943; P=0.038), left ventricle cardiac mass index values (OR=1.017, 95% CI 1.001-1.033; P=0.033) and E peak (OR=0.979, 0.959-0.999; P=0.043) in multivariate analysis. CONCLUSIONS: The prevalence of fQRS in sport disciplines appears to be around 13% to 2% with major evidence among older male subjects. Despite the presence of physiological hypertrophy in athletes, no significant influence was found regarding the type of sport practiced on the prevalence of fQRS. A larger investigation will be necessary to validate this first hypothesis.

Body composition and eating behavior in non-professional adolescent female dancers.

BACKGROUND: Dance is one of the most practiced sports in women's childhood and adolescence. It is often difficult for dancers to maintain a normal body composition without changing their eating habits, despite the presence of high intensity training. The study aims to investigate, through nutritional habits and body composition, the impact of this sports regime in the prepubertal period. METHODS: Two groups of 10 adolescent dancers of classic and modern style were evaluated in terms of anthropometric parameters and hydration. Lifestyle, eating habits, adherence to Mediterranean diet, characteristics of menstrual cycle and risk stratification of Athletes' Triad Syndrome were evaluated through questionnaires. The data were reinterpreted based on the presence or absence of menarche. RESULTS: The average BMI value was within the normal range (17.9±2.2 kg/m2) in both groups. No significant differences emerged for anthropometric parameters and body composition between the two groups with the exclusion of the suprailiac fold which was significantly lower in G2 (classical: 0.1±0.1 mm) compared to G1 (modern: 11.0±6.6 mm) P<0.001. Instead, differences observed (P<0.05) was related to the presence or absence of the menstrual cycle. Despite the poor adherence to the Mediterranean diet, there was no evidence of risk of developing eating disorders or Athletes' Triad Syndrome. CONCLUSIONS: The training of classical and modern dance does not seem to have any negative impact on the body composition especially in pre-pubertal age. The onset of the menarche determines the major modification of the body composition.

Home-based exercise program improves normal right ventricle function in renal transplant recipients.

BACKGROUND: Right ventricular function is strongly associated with clinical outcomes in populations at high cardiovascular risk. Renal Transplant Recipients have multiple coexisting comorbidities potentially involved in the biventricular dysfunction including the right ventricular chamber. Speckle tracking echocardiography is recently used to investigate the normal function of this chamber. The study aims to verify whether global longitudinal strain carries clinical and prognosis implications in the renal transplant recipients during 1 year of regular unsupervised physical activity and compared to a control group. METHODS: A group of 50 transplant recipients, aged 49.6±11.5 was submitted for 1 year to a moderate intensity of mixed exercise. All the subjects were followed by echocardiographic exam every 6 months, only 25 subjects with a high quality of image were investigated by 2D Speckle tracking strain analysis with the measurement calculated at T0, T6, and T12 months. RESULTS: Renal transplant recipients started with low values of right ventricle global longitudinal strain compared to health controls; it increased significantly (P<0.01) after 12 months of exercise, restoring the normal range. CONCLUSIONS: Moderate intensity of physical exercise, despite unsupervised, support a normal RV ventricular performance in renal transplant recipients' strain analysis contribute to plan a correct follow-up, with prognostic impact in these patients practicing physical exercise.

Gender differences in acculturation and cardiovascular disease risk-factor changes among Chinese immigrants in Italy: Evidence from a large population-based cohort.

BACKGROUND: In recent decades, the Chinese presence in Southern Europe has grown rapidly but no data is available on the influence that residing in Mediterranean countries has on Chinese immigrants. In this study, we aim to examine the association between acculturation and cardiovascular risk factors among first-generation Chinese immigrants in Italy. DESIGN: Population-based, cross-sectional study. METHODS: A sample of 2589 Chinese first-generation immigrants (1599 women and 990 men) living in Prato, Italy, underwent blood pressure measurement, blood tests (with measurement of glucose, cholesterol, and triglycerides), and anthropometric measurements. The influence of length of residence (dependent variable) on hypertension, type 2 diabetes, overweight/obesity, and hyperlipidemia (high cholesterol) (independent variables) was investigated with multivariable logistic regression adjusted for age, sex, education and urban/rural home area in China before migration. RESULTS: Mean age of Chinese participants was 47.2 ± 10.7 years and 61.7% were women. Immigrants residing in Italy for ≥20 years were more likely to be hypertensive [odd ratio (OR) 1.84; 95% confidence interval (CI) 1.33 to 2.59], or diabetic (1.91; 1.26 to 2.86) than those residing in Italy for <10 years. Differently, prevalence of hypercholesterolemia (total cholesterol≥240 mg/dl) was lower in immigrants residing in Italy for ≥20 years than in those with <10 years of residence (0.52; 0.32 to 0.83). The association between indicators of acculturation and cardiovascular risk factors appeared to differ by sex. CONCLUSION: Acculturation of Chinese immigrants in Italy was associated with hypertension and type 2 diabetes whereas a favorable effect on hypercholesterolemia was observed.

Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the COVID-19 pandemic.

BACKGROUND AND AIMS: Italy responded to the Covid-19 pandemic early by forcing the entire population into a 2-month domestic confinement. The aim of this study was to assess gender differences in the impact of lockdown on physical activity and lifestyle habits. METHODS AND RESULTS: A cross-sectional web-based survey was conducted in April 2020 on a general population sample residing in Italy. Participants completed validated questionnaires. Gender differences were assessed using a multivariable adjusted logistic regression model using gender as independent and exposures as dependent variables. Metabolic equivalents-hour/week was used to evaluate physical activity. A total of 2218 participants (761 men and 1457 women) agreed to participate in the study and completed the questionnaire. The survey found that women compared to men showed 1) a lower level of physical activity before the institution of lockdown, 2) a lower tendency to reduce physical activity levels during the lockdown, when gender differences in compliance with guideline recommendations for physical activity disappeared, 3) and a worsening of sleep and stool passage; men experienced an increase in alcohol consumption. CONCLUSIONS: Women, who previously had a lower level of physical activity than men, showed a lower tendency to reduce it during lockdown, revealing greater resilience than men. However, the worsening in sleep, in stool passage, and a trend to weight increase revealed signs of psychological suffering after a protracted lockdown period.

The ST segment depression pattern in asymptomatic peri-menopausal female athletes.

BACKGROUND: ST segment has not been well investigated in asymptomatic peri-menopausal female athletes, when the CV risk is higher. AIMS: The aims of the study is to investigate the prevalence of ST segment depression in peri-menopausal female athletes, divided in four age groups. METHODS: in a cohort of 6010 female athletes aged 45-65 years old, 161 subjects were selected for the presence of ST segment depression, revealed by maximal ergometric test. All athletes were also evaluated by physical examination and echocardiography. Inclusion criteria for ST segment depression were ST depression >0.5 mm respect to baseline and its depth was divided in 0.5 mm, 0.5-1 mm, 1-2 mm categories. Its behavior was classified in ascending, horizontal and descending and it was studied in relation to the age range (<51; 51-55; 56-60; >60). RESULTS: ST segment depression was mainly evident in inferolateral leads in all groups (63%, 70,3%, 71%, 63,6%, for <51; 51-55, 56-60 and 61-65 respectively) with horizontal pattern (52,2%, 59,5%, 57,8%, 63,6%) and 1-2 mm depth (43,5%, 46,7%, 60,6%), with the exception of the range 51-55, mainly showing a depth of 0,5-1 mm (45,9%). The older group showed increased SBP (137.5 mmHg, p = 0.007) and BMI (24.3, p = 0.093) values. Mitral prolapse was shown in 11,8% while 36,6% showed systolic flattening of mitral leaflets. CONCLUSIONS: ST depression in asymptomatic menopausal female athletes is frequent and it is characterized by a specific presentation pattern. This is particularly important in the menopausal age when CV risk factors are more prevalent.

Gender differences in barriers to physical activity among adolescents.

BACKGROUND AND AIMS: Great attention is now being paid to effective policies and programs to promote physical activity among adolescents, girls consistently found to be less active than boys. The aim of this study was to assess gender differences in perceived barriers for physical activity practice and their relationship with physical activity levels and physical condition among adolescents. METHODS AND RESULTS: A cross-sectional study was conducted in February-April 2017 among students (n = 368) in the last year of two state high schools in Florence (Italy). Participants underwent the measurements of anthropometric parameters (height, weight, waist, and hip circumferences), blood pressure and administration of 3 standardized questionnaires (International Physical Activity Questionnaire, Mediterranean Diet Score Quiz, and Barriers to Being Active Quiz). Gender differences were assessed using a multivariate logistic regression model (adjusted for age and body mass index). The prevalence of participants who reached recommended levels was lower among girls compared to boys (OR 0.27; 95% CI 0.17-0.43). The number of perceived barriers to physical activity was higher among girls than among boys (OR 1.52; 95% CI 1.29-1.79), lack of energy for exercise and lack of willpower being the two barriers most frequently reported by girls. At multivariable adjusted logistic regression analysis, gender (female), and positivity of at least one perceived barrier (score ≥ 5) were independently selected as the main determinants of non-compliance with WHO criteria for physical activity. CONCLUSIONS: Exercise professionals should be aware of the barriers that young girls can face during exercise prescription and be able to contrast them with useful individual strategies.

Bioelectrical impedance vector analysis (BIVA) in renal transplant recipients during an unsupervised physical exercise program.

BACKGROUND: Muscle weakness, incorrect body water distribution and reduced exercise tolerance are the main characteristics found in renal transplant recipients after surgical treatment. Regular physical supervised exercise programs, at moderate intensity, have been promoted to contrast these aspects, while few data are available for long-term unsupervised mixed exercise plans. Bioelectrical impedance vector analysis (BIVA) provides a semi-quantitative evaluation of body cell mass and body water. This study aims to approach the role of the BIVA analysis in the follow-up of Renal Transplant Group (RTG) and analyze the impact of unsupervised exercise program. METHODS: Thirteen male RTG and ten healthy subjects, adherent to a tailored exercise program, at moderate intensity and prescribed in an unsupervised way, have been followed up for one year. Every six months all the subjects have been submitted to the ergometric test, echocardiographic exam and an analysis of body composition by bioimpedance. They were compared to a healthy control group (HG). RESULTS: A significant reduction of the BMI was observed at the end of the study in the RTG group (T0 24.8±3.2, T12 24.2±3.2 kg/m2; P<0.05). BIVA has shown a lower right quadrant for RTG. All echocardiographic parameters were in a normal range, and no differences were found over time. CONCLUSIONS: Unsupervised tailored and mixed exercise intervention reduces some cardiovascular risks factors. However, it does not modify the frailty of RTG. BIVA analysis seems to have appropriate sensitivity to highlight this aspect.