The biological index of frailty: A new index for the assessment of frailty in human skeletal remains.

OBJECTIVE: Frailty is the physiological stress that individuals suffer during their life. In past populations, frailty is conventionally assessed through the occurrence of different biomarkers of biological stress. Some efforts have been made to propose indexes that combine all biomarkers. However, these indices have some critical limitations: they cannot be used on incomplete skeletons, do not consider the severity and/or healing of lesions, and assign equal importance to different biomarkers. To address these limitations, we propose a new index to assess frailty in skeletal individuals. MATERIAL AND METHODS: By statistically analyzing a large amount of osteological data available from the Museum of London, and using a Logit model, we were able to define a different weight for each reported biomarker of frailty, based on their importance in increasing the risk of premature death for the individuals. RESULTS: The biological index of frailty (BIF) is the weighted mean of all biomarkers scored on the individuals, according to a different degree of importance assigned to each one. It also considers the severity and healing of the biomarkers when this is relevant to diagnose frailty. We applied BIF on a sample of Monastics and Non-Monastics from medieval England and compared it with the skeletal index of frailty (SFI). DISCUSSION: BIF is the first frailty index that gives a different weight to each skeletal biomarker of stress, considers both severity and healing of the lesions, and can be applied on partial skeletal remains. The comparison with SFI showed that BIF is applicable to a larger number of skeletal individuals, revealing new differences between the Monastic and the Non-Monastic groups.

Body image perception and body composition in early adolescents: a longitudinal study of an Italian cohort.

BACKGROUND: Adolescence is a sensitive period of life in which everyone faces physical and psychological changes. No longitudinal studies considering changes in body image perception and body composition in Italian adolescents have been carried out. The aims of this study were to evaluate the longitudinal change in body composition and weight status in a sample of Italian students of both sexes over the 3 years of middle school and to analyse the influence of these parameters on the perception and satisfaction of one's own body image. METHODS: Sixty-four males and seventy females were followed longitudinally from 11 to 14. Age at first measurement was 11.8 ± 0.3 yrs. in males and 11.9 ± 0.3 yrs. in females, then the students were measured again after 1 year and 2 years. Anthropometric measurements were collected and body composition was assessed by skinfolds. Maturity status was detected by age at menarche in females and by estimated age at peak height velocity in males; sports practice was assessed by a questionnaire. Body Silhouette Charts were used to assess body image perception. The degree of body image dissatisfaction and improper perception of weight status were evaluated. Univariate and multivariate analyses were applied. RESULTS: Height, sitting height, leg length, and weight increments were higher in males than in females, and in both sexes the sitting height increment was higher than that of leg length. Skinfold thicknesses and percentage of body fat, showed a decrease in males and an increase in females over the 3 years. About 90% of the sample practiced sport during the 3 years. No significant variations in body image perception were observed among repeated measures but significantly differences were observed between sexes. Although the girls showed a lower incidence of overweight and obesity than boys, girls had a higher dissatisfaction than males. Males were less accurate in one's perception of one's own weight status. CONCLUSIONS: The changes in body composition observed in the sample of the present study were in accordance with their maturity stage. An increase in parameters connected with adiposity is observed in females and a decrease in males. Body image perception did not seem to change with growth, but associations were found between body image perception and BMI and sex. Monitoring body image perception in young adolescents, especially in females and in overweight/obese subjects, is a priority to prevent nutritional disorders.

Body image perception and body composition: assessment of perception inconsistency by a new index.

BACKGROUND: A correct perception of the body image, as defined by comparison with actual anthropometric analyses, is crucial to ensure the best possible nutritional status of each individual. Bioimpedance analysis (BIA) represents a leading technique to assess body composition parameters and, in particular, the fat mass. This study examined the self-perception of body image at various levels of adiposity proposing a new index. METHODS: We investigated 487 young Italian adults (mean age of males: 21.9 ± 2.4 years; mean age of females: 21.0 ± 2.2 years). Each subject could choose, on the Contour Drawing Rating Scale, the silhouette that he/she considered most resembling his/her perceived body image as well as his/her ideal body image. On each subject, we performed anthropometric measurements and determined the values of Fat mass and  %Fat with BIA. A new index, FAIFAT (Feel fat status minus Actual fat status Inconsistency), was developed to evaluate possible fat status perception inconsistencies by BIA. RESULTS: Based on ideal and feel body image comparison, women showed higher dissatisfaction than men and preferred slimmer silhouettes. FAIFAT values indicated that the fat status perception was correct in the majority of the examined individuals and only three subjects showed a serious misperception. CONCLUSIONS: Our findings suggest that FAIFAT is an appropriate index for assessing the perceived fat status from the body image when compared with data obtained by BIA. In a population, the use of this index will allow the correct identification of groups at risk for eating disorders.

Performance prediction models based on anthropometric, genetic and psychological traits of Croatian sprinters.

Elite athletes differ from each other in their characteristics according to their discipline. This study aimed to identify performance predictors in elite Croatian sprinters taking into consideration their anthropometric, psychological and genetic characteristics. One hundred and four elite Croatian sprinters (68 males and 36 females) participated in this study. Of them, 38 are currently competing in the 100-metre dash. The others are former sprinters. The participants underwent direct anthropometric assessment. Participants were also tested by means of the Competitive State Anxiety Inventory-2 and for ACE and ACTN3 polymorphisms. Multiple linear regression analysis was applied to identify the best model for performance prediction. Different models were developed for males and females. Anthropometric traits accounted for 44% of the variance in performance for males, 62% for females. Once other traits (psychological for females) were entered into the model, no additional contribution to the variance was observed. The most significant predictors of higher running velocity were bicristal diameter and foot dimensions in males, and leg length and clean one-repetition maximum in females. The findings suggest that performance in sprinters is associated with anthropometric characteristics, with biomechanical implications that may be used to provide a more complete evaluation of sprinters' performance.

Stature estimation from tibia percutaneous length: New equations derived from a Mediterranean population.

Stature is a fundamental anthropometric character to trace the biological profile of a person. In some cases, when dismembered or mutilated bodies are discovered in a forensic context, it is essential to estimate stature from single districts of the body. Nevertheless, to date and worldwide, there are only few population-specific studies on stature estimation from leg length and none of them concerns modern populations in southern Europe. We attempted to fill this gap, focusing on the estimation of stature from the length of the tibia in a Mediterranean population (Italians). We carried out the current study on a sample of 374 Italian university students of both sexes (age range: 19.9-34.4). Both, actual stature and percutaneous length of tibia were measured and new equations were developed for stature estimation. We tested separate regression equations for each sex, as well as an equation for remains, whose sex is unknown. To assess their reliability, the equations were tested on a holdout sample of 30 individuals from the same population. Moreover, results of new specific linear regression equations were compared to others from the literature. We demonstrated that the newly proposed formulae (for males and combined sexes) and the ones by Olivier (for females) provided the most reliable estimations of stature for southern Europeans.

Body image perception of African immigrants in Europe.

Nutritional disorders are now spreading worldwide both in developed and developing countries. Body image ideals and dissatisfaction have been linked to a number of poor health outcomes, including nutritional disorders. While previous studies have offered insight into weight status and body image perception of immigrants in North America, very few studies have analysed these aspects in migrants from Africa to Europe. Our review examines the effects of the migration process on beauty ideals and body dissatisfaction in African immigrants in Europe compared to residents in their own countries. The PubMed, PsycINFO and Google Scholar databases were searched for studies published from January 2000 till November 2015. Of the 730 titles identified, 26 met the inclusion criteria and were included in the present review. Among African residents, the body preferences depend on the country of residence and their socio-cultural status. Ethnic groups living in great isolation or with low incomes still have an ancestral idea of beauty, preferring a shapely body. However ethnic groups living in urban areas are moving toward Westernization of beauty ideals, preferring underweight or normal weight bodies. This review highlights that both residents and migrants are at high risk of nutritional disorders due to the adoption of Western beauty ideals. The results suggest that body dissatisfaction and BMI are increasing from Southern Africa to Europe according to a geographical gradient (described for females by Spearman's coefficient and linear regression, respectively). We emphasize the need for monitoring of the weight and psychological status of immigrants and the development of specific preventive strategies in European countries.

Weight status, fatness and body image perception of North African immigrant women in Italy.

OBJECTIVE: To investigate the nutritional status of North African (NA) immigrant women in Italy, analysing their body size, adiposity and body image perception in comparison to Italian natives and NA residents. DESIGN: The study utilized a cross-sectional design. Anthropometric traits were directly measured and a few indices were computed as proxy measures of nutritional status and adiposity. Body image perception was assessed using silhouette drawings. ANCOVA, adjusted for age, was used to compare anthropometric traits among different groups of women and the χ 2 test to analyse differences in the prevalence of nutritional status. SETTING: Italy and North Africa (Tunisia, Morocco). SUBJECTS: A sample of 433 women aged 18-60 years old: NA immigrants (n 105); Italians (n 100); Tunisians (n 104); Moroccans (n 124). RESULTS: Overweight/obesity prevalence was very high in immigrants (79·8 %). Immigrants had the highest BMI value, the greatest hip circumference and mid upper-arm circumference. Their triceps skinfold thickness was significantly higher than that of Italians, but lower than that of NA residents. CONCLUSIONS: NA immigrant women in Italy showed a higher incidence of overweight compared with Italians and NA residents. All groups showed a preference for a thinner body in comparison to their actual bodies and the immigrants are the most dissatisfied. Immigrants remain a high-risk group for obesity. Assessment of their body composition and health risk profile should be improved by using specific anthropometric measures that are easy to collect even in the case of large migration flows.

Obesity and physical activity in children of immigrants.

Childhood overweight and obesity have increased in recent decades, reaching alarming proportions. Children with a migrant background seem to be particularly at risk of developing overweight and obesity. This article provides an overview of the prevalence of overweight or obesity among North African (NA) children living in their own countries or as immigrants in Europe. The aim is to show the effect of the migration process on this trend and to discuss its possible contributing factors. Publications were identified by a systematic search of PubMed and the existing literature. Original longitudinal or cross-sectional studies on the prevalence of childhood and adolescent overweight and obesity and of physical activity among ethnic groups from North Africa compared with the native population were reviewed. The results confirmed that children of NA origin in Europe have higher levels of overweight and obesity than the native ones, especially girls. However, this trend can also be detected in urban areas of NA countries. Important factors contributing to the increase of overweight and obesity among children and adolescents are discussed, in particular the westernization of eating habits, the level of physical activity and body image perception. The review shows that factors linked to acculturation in the host society and others maintained from the country of origin come into play in determining childhood overweight and obesity among NA immigrants in Europe. The importance of health promotion targeting the groups most at risk of childhood overweight and obesity, i.e. aspects of a healthy diet and the benefits of physical activity, is underlined.

The COVID-19 Experience in Adolescents: Emotional and Behavioral Recall at the End of the Pandemic.

The COVID-19 pandemic and the resulting lockdown countermeasure may have significantly affected adolescents' physical and mental health. This study aims to assess adolescents' recollections of this period, also analyzing their current weight status along with factors they traced back to the epidemic phase and their current sports practice. A survey among 233 Italian adolescents aged 12.4 ± 0.9 years was conducted in October 2023. To achieve the research objectives, a new questionnaire was developed: the COVID-19 AdolesceNt/chilDren Lockdown Experience questionnaire (CANDLE). The new questionnaire was employed to gather data on the adolescents' recollections of the lockdown situation they experienced. The stature and weight of participants were measured directly. The results indicated that middle schoolers remember both positive and negative experiences of the lockdown: the change perceived as the most positive was spending more time with family, while social detachment from peers represents the most negative aspect. According to multivariate regression analysis, certain behaviors they assumed during the lockdown, such as comfort food consumption in boys and sleeping disturbances in girls, in addition to their current sports practice, affected their actual Body Mass Index. This study supports the evidence that changes caused by the COVID-19 lockdown affected adolescents' physical and mental health, albeit with sex differences.

"Heal the sick": Health status and caregiving during the 17th-18th century in Northern Italy (St. Biagio cemetery, Ravenna).

OBJECTIVE: The study of health-related care provision in archeology gives important indications on the culture and community organization of past populations. This study aims to assess the health status of the skeletal assemblage recovered from the burial site of St. Biagio (Ravenna, 17th-18th Centuries); next, we identified likely instances of need for and receipt of caregiving in response to the condition, to examine evidence of community attitudes toward disease and disability. MATERIALS AND METHODS: The skeletal assemblage is composed of 133 individuals in a generally good state of preservation. Sex and age-at-death were estimated through classical anthropological methods. Health status was inferred through the biological index of frailty (BIF) and paleopathological analysis was performed through macroscopic and radiographic investigations. The "bioarcheology of care" approach was applied to individuals who showed evidence of impairment and disability. RESULTS: The skeletal assemblage of St. Biagio was equally represented by males and females (50% males), with a higher percentage of adults (83.4%) than subadults (10.5%), and this is reflected in the high life expectancy at birth (40.3 years). No significant differences in health status emerged between age groups and sexes, with a generally high percentage of joint diseases, antemortem trauma, and infectious diseases. Evidence of care and compassion was found in some individuals with a high degree of impairment or disability, as in the case of probable Angelman syndrome. DISCUSSION: This study provided important insights into the biological and social aspects of an Early Modern population in Northern Italy, showing that people with functional and/or visible abnormalities were probably cared for in life and were presumably considered full members of the society.

Technical note: Application and potentiality of quantitative ultrasonometry for the evaluation of bone mineral density status.

The evaluation of bone mineral density (BMD) is an important task in paleopathology. Techniques commonly applied in bone quantity assessment, such as DXA or radiogrammetry (XR), suffer from several limitations when applied to skeletal remains. In recently published research, we developed a new methodology and new reference curves for the evaluation of BMD on human skeletal remains, applying for the first time Quantitative Ultrasonometry (QUS), a user-friendly, portable, and reliable clinical technique. This study aims to apply this new methodology to an archeological sample and to compare the results with those obtained through XR. We apply QUS and XR to a sample of 104 adults from Medieval Italian cemeteries. Fragility fractures were recorded. Descriptive statistics and comparisons between sexes, age-at-death cohorts, and individuals with and without fragility fractures were performed. Moreover, univariate and multivariate logistic regression models were used to define the parameters most predictive of fracture risk in past populations. The comparison between sexes showed no significant results concerning BMD parameters, whereas a decrease in BMD with increasing age is confirmed. The comparison between fracture and non-fracture individuals and the logit model demonstrated that QUS parameters, especially UBPI, are more reliable predictors of fracture risk in comparison to XR. Our results confirmed that QUS is a valuable technique that can be efficiently applied to archeological remains, also considering its portability. We also propose a modification of the previously published QUS standard curves, to easily assess osteopenia and osteoporosis in archeological material.

A Pilot Study on the Association of Internet Use with Sports Practice and Sex in Italian Adolescents.

The use of the Internet has several positive functions, but at the same time it also represents a health risk, especially for adolescents. The increased use of the Internet in recent decades has also been linked to an increase in problematic Internet use, which has now become a global social issue. During the COVID-19 pandemic, Internet use increased even more and influenced adolescents' habits, leading to an increase in sedentary behaviors. The aim of this study was to understand whether Internet addiction differed between sportive and nonsportive adolescents and between males and females. We analyzed two samples of adolescents, with different behaviors regarding sports practice. Internet addiction was assessed by the administration of a validated questionnaire (UADI) via an online survey. Although all the mean values of both the subgroups fell into the "non-pathological" category, differences between sports groups and sexes were found, with different trends for each one of the five dimensions of Internet use. In conclusion, sportive adolescents generally showed less severe Internet addiction; therefore, encouraging sports practice can help to fight wrong habits related to a sedentary lifestyle. The promotion of sports practice in these ages is therefore a priority aspect, especially in females, who showed a general predisposition to escape from reality in comparison to males.

Body Image Perception in High School Students: The Relationship with Gender, Weight Status, and Physical Activity.

Body image perception includes body size assessment, body desirability estimation, and perceptions concerning one's own body shape and size. Adolescence is a period of intense and prompt physical transformation, which changes the perception of one's body. This represents a critical period for the development of body image. Therefore, the present cross-sectional study aimed to evaluate body image perception and investigate the relationships between it, weight status, sex, and physical activity in a sample of high school students living in Italy. General demographic information and details about physical activity were collected. Body image perception was measured with a body silhouette and two indexes were calculated: the FID (Feel minus Ideal Discrepancy) to evaluate the discrepancy between the perceived current figure and the ideal figure; and the FAI (Feel weight status minus Actual weight status Inconsistency) to observe improper perception of weight status. In addition, body shape concerns were evaluated with the Body Shape Questionnaire (BSQ), in which participants reported the frequency of experiencing negative thoughts about their body shape in the last four weeks. Two hundred and four students were included in the study (155 = female, mean age = 17.13 ± 1.70; 49 = male, mean age = 17.25 ± 1.69). Females felt more concerned about body shape than males (χ2 = 11.347, p = 0.001). Distinctions emerged in terms of body mass index, the scores of Feel minus Ideal Discrepancy (FID), Feel weight status minus Actual weight status Inconsistency (FAI), the Body Shape Questionnaire (BSQ), and of the silhouette mean comparisons due to sex, weight status, and PA interaction effects (p < 0.001). Additionally, 94% of the BSQ variability could be explained by sex, weight status, and PA. Although no direct effects were observed on body image perception, healthy habit promotion, such as physical activity, could positively affect adolescent lives.

The Issue of Gender Bias Represented in Authorship in the Fields of Exercise and Rehabilitation: A 5-Year Research in Indexed Journals.

Despite progress made in recent decades, gender bias is still present in scientific publication authorship. The underrepresentation of women and overrepresentation of men has already been reported in the medical fields but little is known in the fields of exercise sciences and rehabilitation. This study examines trends in authorship by gender in this field in the last 5 years. All randomized controlled trials published in indexed journals from April 2017 to March 2022 through the widely inclusive Medline dataset using the MeSH term "exercise therapy" were collected, and the gender of the first and last authors was identified through names, pronouns and photographs. Year of publication, country of affiliation of the first author, and ranking of the journal were also collected. A chi-squared test for trends and logistic regression models were performed to analyze the odds of a woman being a first or last author. The analysis was performed on a total of 5259 articles. Overall, 47% had a woman as the first author and 33% had a woman as the last author, with a similar trend over five years. The trend in women's authorship varied by geographical area, with the higher representation of women authors in Oceania (first: 53.1%; last: 38.8%), North-Central America (first: 45.3%; last: 37.2%), and Europe (first: 47.2%; last: 33.3%). The logistic regression models (p < 0.001) indicated that women have lower odds of being authors in prominent authorship positions in higher-ranked journals. In conclusion, over the last five years, in the field of exercise and rehabilitation research, women and men are almost equally represented as first authors, in contrast with other medical areas. However, gender bias, unfavoring women, still exists, especially in the last authorship position, regardless of geographical area and journal ranking.

Assessing the Impact of COVID-19 Prevention Measures on Adolescent Growth in Italy.

COVID-19 infection has caused increased morbidity and mortality worldwide. Several strategies have been adopted around the world to prevent its spread. Italy underwent a long lockdown for face-to-face educational activities, which were replaced with online classes. This longitudinal study aimed to analyze the effects of COVID-19 prevention measures on physical growth and body image perception in a sample of Italian adolescents who experienced the pandemic-induced lockdown in 2020. In particular, we wished to ascertain how lifestyle changes had affected their growth rates and health. Special attention was paid to increases in adiposity indicators (BMI, waist circumference, waist-to-height ratio) and weight caused by reduced physical activity, and consequent possible dissatisfaction with body image. We assessed the impact of school closures by comparing the annual growth rate and body image perception changes of adolescents (n = 60; age = 11.3 ± 0.4 years) who experienced this isolation with those in the following years who did not experience these restrictions (n = 68; age = 11.4 ± 0.3 years). As a consequence of the lockdown, our results indicate a greater annual growth rate in weight and other indices of adiposity (p < 0.05). As the virus is continuing to evolve and propagate, larger population studies can verify and confirm our findings. In promoting health policy to prevent the ongoing prevalence of obesity in adolescents, an accurate assessment of whether the increase in obesity rates during the pandemic is to be considered a temporary trend is highly recommended.

Lower All-Cause Mortality Risk in Females and Males with Peripheral Artery Disease following Pain-Free Home-Based Exercise: A 7-Year Observational Study.

We evaluated the sex-specific difference in response upon participation in an exercise program with respect to the risk of adverse clinical outcomes among patients with peripheral artery disease (PAD) and claudication. The records of 400 PAD patients were assessed between 2012 and 2015. Two hundred of them were addressed to a walking program prescribed at the hospital and executed at home at symptom-free walking speed (Ex), while the remaining 200 acted as a control group (Co). The number and date of deaths, all-cause hospitalizations, and amputations for a 7-year period were collected from the regional registry. At baseline, no differences were observed (MEXn = 138; FEXn = 62; MCOn = 149; FCOn = 51). The 7-year survival rate was significantly higher in FEX (90%) than in MEX (82% hazard ratio, HR: 0.542 95% CI 0.331-0.885), FCO (45%, HR: 0.164 95% CI 0.088-0.305), and MCO (44%; HR: 0.157 95% CI 0.096-0.256). A significantly lower rate of hospitalization (p < 0.001) and amputations (p = 0.016) was observed for the Ex group compared to the Co group, without differences by sex. In conclusion, in PAD patients, active participation in a home-based pain-free exercise program was associated with a lower rate of death and better long-term clinical outcomes, particularly among women.

Foot Temperature by Infrared Thermography in Patients with Peripheral Artery Disease before and after Structured Home-Based Exercise: A Gender-Based Observational Study.

Decreased arterial perfusion is a typical condition of patients with peripheral artery disease (PAD), with the microvascular picture particularly present among women. This observational study aimed to detect foot perfusion changes by infrared thermography (IRT) after a home-based exercise program in both sexes. A total of 76 PAD patients with claudication (72 ± 4 years; 52 males) were enrolled in a structured in-home exercise program composed of two daily 8 min interval walking sessions (1:1 walk:rest ratio) with progressively increasing speed. Outcome measures collected at baseline (T0) and at each hospital visit after 5 weeks, 12 weeks and 20 weeks included foot temperature measured by IRT (anterior tibial, posterior tibial, dorsalis pedis and arcuate artery regions), ankle brachial index and the 6 min walking test. After 20 weeks, foot temperature in both limbs showed a significant increasing trend, with a mean variation of 1.3 °C for the more impaired limb and 0.9 °C for the contralateral limb (t = 8.88, p < 0.001 and t = 5.36; p < 0.001, respectively), with significant changes occurring after 5 weeks of training. The sex-oriented analysis did not highlight any significant difference, with an improvement of mean foot temperature of 1.5 ± 0.6 °C in females versus 1.2 ± 0.5 °C in males (p = 0.42). Ankle brachial index and performance also significantly improved over time (p < 0.001) without gender differences. In patients with PAD, a structured low-intensity exercise program significantly improved foot temperature and exercise capacity without any sex-related difference.

Effects of Exercise, Rehabilitation, and Nutritional Approaches on Body Composition and Bone Density in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis.

People with multiple sclerosis (pwMS) are affected by a wide range of disabilities, including a decrease in bone mineral density (BMD) and a worsening of body composition (BC), which negatively impact their quality of life quality. This study aims to analyze the effects of nonpharmacological interventions-in particular, physical activity, nutritional approaches, and rehabilitation-on BC and BMD in pwMS. This systematic review and meta-analysis was performed following the updated version of the PRISMA guidelines. In July 2022, five databases (MEDLINE, Embase, The Cochrane Library, Google Scholar, Web of Science) and gray literature were screened. Relevant articles published between 1 January 1990 and 1 September 2022 in any language were included. Outcomes of interest were anthropometric, BC measures, and BMD. The RoB 2.0 tool was used to assess the risk of bias. After duplicates elimination, 1120 records were screened, and 36 studies were included. A total of 25 articles were focused on physical activity and rehabilitation, 10 on nutrition, and 1 on multimodal intervention. One-third of the studies were judged to be at high risk of bias. The meta-analysis showed a high degree of heterogeneity due to the high variability in disease severity and intervention duration, intensity, frequency, and type. In general, no intervention showed consistent positive effects on BC. However, the most promising interventions seemed to be high-intensity training and ketogenic diets. Only a few studies considered BMD, and the results are inconsistent. Nevertheless, more studies are needed in order to confirm these results.

Inspiratory-Expiratory Muscle Training Improved Respiratory Muscle Strength in Dialysis Patients: A Pilot Randomised Trial.

End-stage kidney disease (ESKD) exposes patients to progressive physical deconditioning involving the respiratory muscles. The aim of this pilot randomized controlled trial was to determine the feasibility and effectiveness of low-intensity respiratory muscle training (RMT) learned at the hospital and performed at home. A group of ESKD patients (n = 22) were randomized into RMT or usual care (control group, CON) in a 1:1 ratio. The respiratory training was performed at home with an inspiratory-expiratory system for a total of 5 min of breathing exercises in a precise rhythm (8 breaths per minute) interspersed with 1 min of rest, two times per day on nondialysis days for a total of 4 weeks, with the air resistance progressively increasing. Outcome measures were carried out every 4 weeks for 3 consecutive months, with the training executed from the 5th to the 8th week. Primary outcomes were maximal inspiratory and expiratory pressure (MIP, MEP), while secondary outcomes were lung capacity (FEV1, FVC, MVV). Nineteen patients without baseline between-group differences completed the trial (T: n = 10; Age: 63 ± 10; Males: n = 12). Both MIP and MEP significantly improved at the end of training in the T group only, with a significant difference of MEP of 23 cmH2O in favor of the RMT group (p = 0.008). No significant variations were obtained for FVC, FEV1 or MVV in either group, but there was a greater decreasing trend over time for the CON group, particularly for FVC (t = -2.00; p = 0.046). Low-fatiguing home-based RMT, with a simple device involving both inspiratory and expiratory muscles, may significantly increase respiratory muscle strength.

Physical Activity and Body Image Perception in Adolescents: A Systematic Review.

Adolescence represents a vulnerable phase of life for psychological health. The practice of physical activity (PA) appears to have a positive influence on adolescents, increasing self-esteem and producing a more positive body image. A systematic review of published articles over the past 10 years until June 2022 was conducted according to the PRISMA statement employing the electronic databases MEDLINE and Web of Science (639 records) to summarize the literature on the relationship between body image dissatisfaction (BID) and assessed by figural scales and practice of structured and unstructured PA in adolescents (10-18 years), taking into account BMI and/or weight status. All articles were independently reviewed using inclusion/exclusion criteria, retrieved data, and assessed quality with the adapted Newcastle-Ottawa Scale for observational studies. The main finding of interest that emerged from most of the 28 included studies is the negative association between BID and PA during adolescence: as PA increases, BID decreases. However, this updated systematic review also identified some flaws in the existing literature, highlighting the need for high-quality adolescent research using validated figural scales and objective PA assessments. In conclusion, the reviewed studies showed that PA involvement can be efficacious in protecting from body image perception concerns and enhancing body satisfaction. Future interventions should promote structured and unstructured PA during adolescence to improve self-esteem and body image.