The course of physical fitness and nutritional status in patients following prehabilitation before esophageal cancer surgery: Results from the PRIOR study.

To optimize prehabilitation for patients with oesophageal cancer, insight is required into the response to prehabilitation, and factors affecting this response. This study investigated (1) the response to prehabilitation in patients with oesophageal cancer following neoadjuvant treatment, (2) the association between baseline physical fitness and preoperative changes in fitness, (3) differences in physical fitness, nutritional status, and fatigue between responders and non-responders to prehabilitation. This multicenter cohort study included patients with oesophageal cancer, following a 6-10 week personalized prehabilitation program as part of standard care. Prehabilitation, consisting of supervised exercise and nutritional counseling, started after neoadjuvant treatment. Preoperative physical fitness and nutritional status were monitored before and after neoadjuvant treatment, and after prehabilitation. Changes over time were analyzed using linear mixed models. Impact of baseline fitness on preoperative changes in exercise capacity was investigated using a linear mixed regression model. Differences between responders to prehabilitation (> 0 Watt improvement during exercise training) and non-responders were analyzed using Independent T-Tests and multivariable logistic regression. Two hundred forty patients were included (mean age 66.0 (9.3) years; 77.1% male). On average, physical fitness and nutritional status declined during neoadjuvant treatment, and significantly improved during prehabilitation. Exercise capacity increased by + 32.7 Watts (95% CI: 25.2-40.2) during prehabilitation, with similar improvements across patients with low, moderate, and high baseline capacity. Substantial heterogeneity in preoperative changes was observed, with only 49.6% of patients following a pattern of decline-improvement (corresponding to average values for exercise capacity). Sixty-five percent of patients were classified as responders. Greater decline in fitness during neoadjuvant treatment (p < .001), lower fitness after neoadjuvant treatment (p = .001), and higher fatigue (p = .01) were associated with a positive response to prehabilitation. On average, patients with oesophageal cancer improved in physical fitness and nutritional status during prehabilitation, recovering from the impact of neoadjuvant treatment. Response to prehabilitation was independent of baseline fitness. A greater decline in fitness during neoadjuvant treatment, lower fitness before prehabilitation and higher fatigue were associated with a positive response. The heterogeneity in preoperative trajectories among patients underscores the importance of regular monitoring to tailor interventions to individual needs.

Surgical treatment for gynaecological malignancies is still associated with high postoperative morbidity. Multimodal prehabilitation may improve functional capacity and thereby reduce surgical-related morbidity. Therefore, this study aims to assess the effect of multimodal prehabilitation on physical fitness and nutritional status of gynaecological oncology patients. Within the F4S-PREHAB trial, a stepped-wedge trial assessing the effect of multimodal prehabilitation comprising exercise, nutrition, psychological support and intoxication cessation, a subgroup analysis was performed in women with gynaecological cancer undergoing surgery between May 2022 and April 2024 at the Radboudumc, Nijmegen. Physical fitness was compared before and after participation using estimated peak oxygen uptake, muscle strength (indirect 1-Repetition Maximum (1-RM) leg press), handgrip strength and Five-times Chair-Stand-Test. In addition, nutritional status was assessed through risk of malnutrition assessments. Further outcomes include the effect on body composition and biomarkers (Haemoglobin, Leukocytes, C-Reactive Protein, Albumin). In total, 140 women underwent the prehabilitation programme. Significant improvements were observed in VO2peak with 8% (P=0.001), 1-RM leg press with 20% (p<0.001) and Five-times Chair-Stand-Test with 0.5s (p=0.001). The number of patients at moderate to high risk of malnutrition significantly decreased after the programme, from 29% to 19% (p=0.001). No changes in body composition and biomarkers were found. This study demonstrates that multimodal prehabilitation has the ability to improve physical fitness and nutritional status preoperatively in gynaecological oncology patients. Further studies are needed to define the role of prehabilitation in improving physical fitness and nutritional status, and its association with postoperative outcomes, allowing for more personalized and effective treatment.

Objectives. This review aimed to explore the extent to which physical fitness and nutritional status serve as significant predictors of learning outcomes in physical education (PE) among secondary school students. Given the growing concern about sedentary lifestyles and poor eating habits among teens, understanding these relationships is critical to improving physical and academic performance. Materials and methods. This study used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to screen and analyse the literature related to assessing various relevant studies in the scope of physical education, physical fitness, and nutritional status through a systematic analysis of appropriate literature. Articles published between 2020 and 2025 were examined to determine how to prepare learners to have better physical fitness. A comprehensive search was conducted using the databases Scopus, Web of Science, Google Scholar, and PubMed, with keywords including “physical fitness”, “nutritional status”, “academic achievement”, and “physical education” through a literature review. Results. This review revealed a strong correlation between physical fitness components (cardiovascular endurance, muscle strength, body composition) and PE learning outcomes. Nutritional adequacy, especially sufficient micronutrient intake and a balanced diet, has also been shown to influence cognitive function, motor skill acquisition, and classroom engagement. However, the interaction between fitness and nutrition appeared to be synergistic and context-dependent. Conclusions. The findings emphasize that physical fitness and nutritional status are not only important for health but also for successful learning in PE. Schools and policymakers should promote integrated programs that support both areassimultaneously. Further longitudinal and experimental research is needed to confirm the causal pathway. Therefore, strategies are required to improve students’ physical fitness and nutritional status to optimize learning and the development of learning outcomes holistically.

Few comprehensive studies have assessed the long-term trends in physical fitness and nutritional status among Chinese adults, along with the socioeconomic inequalities. This study aimed to bridge this gap by examining the temporal changes and the evolution of socioeconomic disparities in physical fitness and nutritional status among Chinese adults aged 20-59, based on five successive national surveillance surveys. We integrated data from five consecutive rounds of National Physical Fitness Surveillance (2000, 2005, 2010, 2014, and 2020) among Chinese adults aged 20-59 years. BMI was categorized into underweight (<18.5kg/m2), overweight (24.0-27.9kg/m2), and obesity (≥28.0kg/m2). Central obesity was defined as a waist circumference ≥90cm for males and ≥85cm for females. A composite physical fitness indicator (PFI) was calculated by aggregating the Z-scores of all six components. Provinces were ranked by GDP per capita ($) and stratified into three socioeconomic strata from least (T1) to most developed (T3). Generalized additive models (GAMs), adjusted for age and sex, were employed to assess the associations between nutritional status, PFI, and both per capita GDP and urbanization levels. A total of 716,790 Chinese adults aged 20-59 were included in the analysis. The PFI score declined from 0.71 in 2000 to-0.84 in 2020, with a particularly sharp annual decline between 2014 and 2020. The underweight prevalence declined from 5.54% in 2000 to 3.51% in 2020, while the prevalence of overweight, obesity, and central obesity increased to 35.84%, 15.05%, and 32.10% in 2020, respectively. After 2005, the urban-rural disparities in physical fitness narrowed, whereas the gap between most and least developed regions widened, with urban and high-SES regions consistently showing better fitness. The prevalence of overweight, obesity, and central obesity in urban and economically developed regions was higher than in less economically developed and rural regions in earlier years, but this pattern reversed over time. The underweight prevalence showed the opposite trend. With increasing GDP per capita, PFI initially rose before declining at higher levels, and it showed a positive correlation with urbanization. Overweight prevalence increased with GDP per capita but slowed at higher levels, while obesity and central obesity exhibited an N-shaped relationship with GDP per capita. Moreover, prevalence of overweight, obesity, and central obesity were positively correlated with urbanization. During the first two decades of the 21st century, China experienced rapid economic growth accompanied by declining physical fitness and rising prevalence of overweight, obesity, and central obesity among adults aged 20-59 years. Inequalities in nutritional status between urban and rural areas and across socioeconomic strata reversed. Less developed and rural regions may face dual challenges of deteriorating physical fitness and the growing burden of overnutrition, which requires urgent attention. The complex interplay between socioeconomic development, urbanization, and physical health further emphasizes the need for health policies tailored to diverse socioeconomic contexts and subpopulations. National Natural Science Foundation of China (72474005, 72122001) and the Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health (PKUWF-Y12).

The selection for surgery is multifaceted for patients diagnosed with esophageal cancer. Since it is uncertain how comorbidity should influence the selection, this study addressed comorbidities in relation to risk of severe complications following esophageal cancer surgery. This population-based cohort study was based on prospectively included patients who underwent surgical resection for an esophageal or gastro-esophageal junctional cancer in Sweden during 2001-2005. The participation rate was 90%. Associations between pre-defined comorbidities and pre-defined post-operative complications occurring within 30 days of surgery were analyzed using multivariable logistic regression. The resulting odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, sex, tumor stage, tumor histology, neoadjuvant therapy, type of surgery, annual hospital volume, other comorbidities, and other complications. Among 609 included patients, those with cardiac disease (n = 92) experienced an increased risk of pre-defined complications in general (adjusted OR 1.81, 95% CI 1.13-2.90), while patients with hypertension (n = 137), pulmonary disorders (n = 79), diabetes (n = 67), and obesity (n = 66) did not. Patients with a Charlson comorbidity index score ≥2 had substantially increased risks of pre-defined complications (adjusted OR 2.44, 95% CI 1.60-3.72). Cardiac disease and a Charlson comorbidity index score ≥2 seem to increase the risk of severe and early post-operative complications in patients with esophageal cancer, while hypertension, pulmonary disorders, diabetes, and obesity do not. These findings should be considered in the clinical decision-making for improved selection of patients for surgery.

This cross-sectional study compared the physical fitness and mental health status of 140 school-age children who participated in sport-specific training with 180 age-matched peers. All the participants were grouped by sport-specific training frequencies in extracurricular time into the following: (i) high sports training frequency group (HFG): training three to five times per week (n = 77, mean [SD] age: 9.60 [0.12] years); (ii) low sports training frequency group (LFG): training once per week (n = 63, mean [SD] age: 9.88 [0.14] years); and (iii) control group (CG): maintaining routine life (n = 180, mean (SD) age: 9.77(0.09) years). Physical fitness status, including body composition (body mass index), endurance (vital capacity; 50 × 8 round trip), speed and agility (50 m sprint), flexibility (sit-and-reach), coordination (1-min rope skipping), and core strength (1-min sit-ups) as well as mental health status was measured. Overall, the results showed that Grade 3 to 4 HFG students showed better total physical fitness scores than the LFG and CG students. Grade 2 and 5 participants in the three groups showed no significant difference in the total physical fitness score. Children in HFG performed better in several PF indicators (i.e., cardiopulmonary function, flexibility, core strength, and coordination) than those in LFG and CG, and children in LFG got a higher score than those in CG on a testing item of 1-min rope skipping. The mental health test results showed that HFG performed better than LFG and CG. The results indicated that participating in sport-specific training 3–5 times per week was beneficial for children’s physical and mental health. Additionally, there was a weak and negative correlation between physical fitness and mental health in LFG and CG, while no correlation was found between physical fitness and mental health in HFG.

Objective To understand the changes of nutritional status of patients with esophageal cancer who underwent neoadjuvant therapy before and after surgery, and analyze the relevant factors to provide evidence for improving postoperative nutritional status of patients. Methods 142 patients with esophageal cancer accepted by the Fourth Affiliated Hospital Hebei Medical University from May 1st 2017 to May 31th 2019 were randomly selected for this study. The clinical records of these patients were collected by electronic medical record system. The physiological-biochemical index of those patients before and after the neoadjuvant esophageal cancer surgery were compared, including the levels of prealbumin(PA), albumin (Alb), total protein(TP), globulin(Glob), hemoglobin(Hgb), total lymphocyte count(TLC), glutamic-pyruvic transaminase(GPT), glutamic-oxaloacetic transaminase(GOT) , creatinine(Cr), and urea nitrogen(UN). Results Compared with before the surgery, the patients’ nutritional indicators after surgery including albumin (Alb), prealbumin(PA), total protein(TP), hemoglobin(Hgb), globulin(Glob), total lymphocyte count(TLC) levels were significantly reduced(P 0.05). Conclusions Surgical treatment significantly reduces the nutritional status of neoadjuvant esophageal cancer patients, and has a great impact on the liver function of the patients. Therefore, clinicians should pay attention to it and timely implement nutritional intervention measures to improve the postoperative nutritional status of the patients. Key words: Esophageal cancer; Neoadjuvant therapy; Nutritional assessment; Surgical treatment

SLOfit Lifelong is a public health initiative which was created to upgrade a well-established, national physical fitness surveillance system for Slovenian schoolchildren that has been collecting annual fitness and health data for over three decades. The ultimate objective of creating SLOfit Lifelong was to build a modern societal infrastructure with the capacity and ability to detect future causal associations between childhood physical fitness trends and future health outcomes based on the lifelong surveillance of one's own fitness status. By instilling citizens with an ambition to test, understand, and follow-up their own physical fitness and health status (including related health risk factors), this initiative provides the technical support and expert feedback needed to engender greater individual control over understanding (and thus modulating), one's own physical fitness status as they progress into older adulthood. This perspective paper details the extensive approach taken to devise appropriate fitness test batteries for adults and older adults which can also relate to the student version of the original SLOfit test database, including establishing criterion health risk zones and a public approach to establish this national, citizen-driven health feedback framework. Through its sophisticated online web applications, social media, print media, and outreach workshops, SLOfit Lifelong provides the expert support for public health engagement by fostering positive lifelong physical literacy experiences an individual can enjoy across their aging journey.

PurposeSLOfit Lifelong is a public health initiative which was created to upgrade a well-established, national physical fitness surveillance system for Slovenian schoolchildren that has been collecting annual fitness data for over three decades.Project or policy descriptionThe ultimate objective of creating SLOfit Lifelong was to build a modern societal infrastructure with the capacity and ability to detect future causal associations between childhood physical fitness trends and future health outcomes based on the lifelong surveillance of one's own fitness status. By instilling citizens with an ambition to test, understand, and follow-up their own physical fitness and health status (including related health risk factors), this initiative provides the technical support and expert feedback needed to engender greater individual control over understanding (and thus modulating), one's own physical fitness status as they progress into older adulthood.ConclusionsThrough its sophisticated online web application My SLOfit, social media, print media, and outreach workshops, SLOfit Lifelong provides the expert support for public health engagement by fostering positive lifelong physical literacy experiences an individual can enjoy across their aging journey.

Objective This study aimed to determine whether physical fitness is related to nutritional status in a sample of female adolescents with anorexia nervosa, to contrast the nourished and undernourished patients, and to compare the physical fitness in these patients with normative data of healthy subjects stratified by age and gender. Methods Nutritional status was determined using the body mass index Z-score, fat mass, fat-free mass (bioelectrical impedance analysis), and the Controlling Nutritional Status score in 15 anorexic adolescents with 14.3±1.6 years. Physical fitness was assessed using the ALPHA-Fitness Battery (handgrip strength, standing broad jump, 4x10m shuttle run, and 20m shuttle run tests). Results Handgrip strength was significantly associated with all variables of nutritional status, except with the three blood components of the Controlling Nutritional Status score. The undernourished anorexic patients showed significantly worse physical fitness than the nourished anorexic patients in all tests, except in the standing broad jump and the 4x10m shuttle run tests. The physical fitness tests of the female anorexic adolescents showed scores significantly worse than those of the normative European female adolescent population. Conclusion The observation of female adolescents with anorexia nervosa showed associations between higher physical fitness levels and better nutritional statuses. Handgrip strength and 20m shuttle run tests may be options of additional indicators of undernutrition in anorexic female adolescents. The undernourished anorexic patients showed worse physical fitness than the nourished ones. According to normative data for healthy sex- and agematched adolescents, physical fitness is severely impaired in anorexic female adolescents.

Background: This study aimed to explore the characteristics of trends in physical fitness and nutritional status among school-aged students during the COVID-19 pandemic, which could help to develop targeted guidelines and policies for students (adolescents) to promote health during lockdowns resulting from public health emergencies. Methods: The physical fitness and nutritional status were measured from 2019 to 2021; the correlation between years and grade were analyzed. Results: a declining trend was found in aerobic fitness, strength fitness, speed fitness, and BMI during this lockdown. Conclusion: The changes in dietary behavior and the decrease in outdoor physical activities may be the reason for the decline. Furthermore, differences in subjects’ growth and limited space at home must be considered in the formulation of exercise and nutritional plans. According to the results of our study, exercise for aerobic fitness should receive more attention when students are enduring a pandemic lockdown. In addition, saying “no” to high-calorie foods in the form of snacking and ultra-processed food was the key to improving subjects’ nutritional status.

Objective: Using the Chinese National Survey on Students' Constitution and Health data from 1985 to 2014 to analyze the trend of excellent and good physical fitness and health status among Chinese Han students aged 13 to 18 years and the related influencing factors. Methods: 738 523 students aged 13 to 18 years with completed data of gender, age, urban and rural, physical form, vital capacity and physical fitness were selected from the six Chinese National Surveys on Students' Constitution and Health. According to National Standards for Students' Physical Health (2014 revision), the comprehensive scores and the prevalence of excellent and good physical fitness and health status were calculated (90.0-120.0 was classified as excellent, and 80.0-89.9 was classified as good). The trend of prevalence of excellent and good physical fitness and health status in different years and the corresponding differences among students with different characteristics were analyzed and compared. The log-binomial regression model was used to analyze related factors of physical fitness and health status. Results: From 1985 to 2014, the overall prevalence of excellent and good physical fitness and health status increased from 27.6% in 1985 to 35.6% in 1995, and then declined to 13.9% in 2005. In the 2010 and 2014 cycles, the prevalence increased steadily, at 16.5% and 19.1% respectively. Except for 1995 and 2014, the prevalence of boys was higher than that of girls (P<0.001). The prevalence of students aged 13 to 15 was higher than that of students aged 16 to 18 (P<0.001). Log-binomial regression model analysis showed that girls ［PR（95%CI）=1.03（1.00-1.05）, P=0.021］, rural area ［PR（95%CI）=1.09（1.07-1.12）, P<0.001］, 13-15 years old［PR（95%CI）=1.89（1.84-1.94）, P<0.001］, eastern region［PR（95%CI）=1.94（1.88-2.00）, P<0.001］, middle region［PR（95%CI）=1.15（1.11-1.20）, P<0.001］, Exercise time ≥1 h/d［PR（95%CI）=1.41（1.37-1.45）, P<0.001］, parents support participation in sports activities after school［PR（95%CI）=1.10（1.06-1.15）, P<0.001］, TV time ≤1 h/d［PR（95%CI）=1.26（1.21-1.30）, P<0.001］, playing video games, watching videos or e-books ≤1 h/d［PR（95%CI）=1.05（1.02-1.09）, P<0.001］ were all related to the high prevalence of excellent and good physical fitness and health status. Conclusion: The prevalence of excellent and good physical fitness and health status among students aged 13 to 18 was changing between 1985 and 2014. Gender, age, area, physical exercise time, screen time for non-learning purposes, and parents' attitudes toward students' participation in physical activities were all related to the excellent and good physical fitness and health status of students.

Major hepatectomy with bile duct resection (BDR) is associated with severe postoperative complications; therefore, evaluation of preoperative liver function is important. However, little is known about mechanisms of increased severe complications in patients with poor liver function. The aim of this study was to evaluate whether indocyanine green retention rate after 15 minutes of injection (ICG-R15) is useful for predicting the risk of severe postoperative complications in this operation, and to reveal the mechanisms of increasing severe complications by focusing on immune function and liver regeneration after hepatectomy. Patients receiving major hepatectomy with BDR between 2000 and 2017 were retrospectively reviewed. Severe postoperative complications were defined as Clavien-Dindo grade ≥IV. In 284 patients undergoing major hepatectomy with BDR, ICG-R15 was correlated with severe postoperative complications, with cut-off value of 11.8%. In brief, the incidences of hyperbilirubinemia, coagulopathy, liver failure, respiratory failure, severe complications, and mortality were higher in the high ICG-R15 group. Moreover, high ICG-R15 (≥11.8%) was an independent factor for predicting severe complications after major hepatectomy with BDR. Immune dysfunction in the early phase after operation, prolonged postoperative immunosuppression, and delayed liver regeneration were reasons for increasing severe postoperative complications in patients with high ICG-R15. High ICG-R15 is an independent risk factor for severe complications after major hepatectomy with BDR, and its cut-off value is 11.8%. Compromised condition and delayed liver regeneration induced by immune dysfunction are reasons of increased severe postoperative complications in patients with high ICG-R15.

Aims The aim of our study is to examine the physical fitness and nutritional status of geriatric individuals with and without Type 2 diabetes mellitus (DM). Methods A total of 80 geriatric individuals, 40 with and 40 without Type 2 DM, aged 65-75, participated in the study. Geriatric individuals in both groups were evaluated with physical fitness tests and Mini Nutrition Assesment-Short Form (MNA-SF) was evaluated. Body mass index values (BMI) of the participants were calculated and their nutrition consumption was analyzed by taking 3-day nutrition consumption records. Results The average age of the geriatric individuals participating in the study was 68.78 ± 6.25. A statistically significant difference was found between the groups in terms of physical fitness, MNA-SF, BMI and energy-nutrient intake (p < 0.05). Conclusions Geriatric individuals with Type 2 DM had worse physical fitness and nutritional status than those without Type 2 DM, but their protein intakes (gram/kilogram/day) were better than those without Type 2 DM.

BackgroundPrevious studies have examined the “fat but fit” paradox, revealing that greater levels of physical fitness may diminish the harmful consequences of excess weight on cardiometabolic risk. Despite the above, specific information about the “fat but fit” paradox in prepuberal population is scarce. The aim of this study was to determine the relationship between cardiometabolic risk across (individual and combined) physical fitness and excess weight status and whether the “fat but fit” paradox is met in the sample of schoolchildren analyzed.MethodsA cross-sectional study was conducted including 452 children (59.1% girls), aged 7–9 years from Santiago (Chile). Physical fitness was assessed as cardiorespiratory fitness and muscular fitness. Cardiorespiratory fitness was determined by the 6-minute-walk-test and muscle strength was assessed by the handgrip and standing long jump tests. Excess weight (overweight and obesity) was computed through body mass index (z-score). Cardiometabolic risk was established by summing the z-score of the serum glucose, triglycerides, high-density lipoprotein, insulin and waist-to-height ratio.ResultsSchoolchildren with high physical fitness (individual or combined) showed the lowest cardiometabolic risk mean scores (P for trend <0.001 for all physical fitness groups). Conversely, schoolchildren with low physical fitness (individual or combined) showed the highest cardiometabolic risk mean scores (P for trend <0.001 for all categories). Additionally, schoolchildren without excess weight and with high individual or combined physical fitness status exhibits lower cardiometabolic risk mean scores compared to schoolchildren with excess weight and low physical fitness status (individual or combined) (P for trend <0.001 for all physical fitness groups). A lower odd of having high cardiometabolic risk was found in schoolchildren without excess weight and with both high physical fitness (both cardiorespiratory fitness and muscular fitness) [odds ratio (OR) =0.08; 95% confidence interval (CI): 0.04 to 0.16] in comparison to those with excess weight and low physical fitness.ConclusionsOur results suggest that improvements in both fatness and aerobic fitness could be associated with lower cardiometabolic risk.