Sarcopenia and osteoporosis are common age-related conditions that lead to frailty, functional decline, and increased fracture risk. Resistance training (RT) improves muscle strength and bone mineral density (BMD), but the optimal training intensity remains unclear. This systematic review and meta-analysis synthesized evidence from randomized controlled trials evaluating high-intensity (≥ 70% one-repetition maximum) versus low-to-moderate-intensity (< 70% one-repetition maximum) RT in older adults (age ≥ 50 years). The review included 18 studies (1283 participants). The primary outcomes were lower limb muscle strength (leg press and leg extension), lumbar spine BMD, and femoral neck BMD. The secondary outcomes were fall incidence and adverse events. Standardized mean differences (SMDs) and risk ratios (RRs) were pooled using a random-effects model. High-intensity RT significantly outperformed low-to-moderate-intensity RT in improving leg press (SMD: 0.95; 95% confidence interval [CI]: 0.48-1.43) and leg extension (SMD: 0.63; 95% CI: 0.09-1.17). No significant between-regimen difference was observed in lumbar spine BMD (SMD: 0.28; 95% CI: -0.02 to 0.58), femoral neck BMD (SMD: 0.13; 95% CI: -0.08 to 0.33), fall incidence (RR: 2.68; 95% CI: 0.65-11.11), or adverse events (RR: 2.42; 95% CI: 0.66-8.88). High-intensity RT outperforms low-to-moderate-intensity RT in improving lower limb muscle strength in older adults. The modalities appear similarly effective in maintaining BMD. No significant between-regimen differences were observed in fall incidence or adverse events, suggesting similar safety profiles. Further randomized controlled trials with well-defined populations and standardized RT protocols are required to validate these findings. International Prospective Register of Systematic Reviews Database: CRD420251076841.

People with type 1 diabetes are recommended to modify insulin dosing and/or carbohydrate intake before, during and after exercise to manage blood glucose levels and prevent hypoglycaemia. An exercise strategy that produces a more consistent glycaemic response may facilitate glycaemic management around exercise, thereby reducing barriers to exercise related to blood glucose concentration, such as fear of hypoglycaemia, for people with type 1 diabetes. The aim of this study was to compare the consistency of the glycaemic response to resistance exercise performed in the morning while fasted vs in the afternoon after eating. Twelve adults with type 1 diabetes, HbA1c <85 mmol/mol (10.0%), aged 18-55 years and without contraindications to resistance exercise completed six identical resistance exercise sessions, three in the morning while fasted (AM-FAST) and three in the afternoon in a fed state (PM-FED). The six sessions were completed in a random order in an unblinded, crossover trial, supervised at the Physical Activity and Diabetes Laboratory at the University of Alberta. We compared the within-participant standard deviation (wpSD) of the capillary blood glucose response to AM-FAST vs PM-FED sessions. Capillary glucose was measured pre-exercise, immediately post exercise and 30 min after exercise. Continuous glucose monitoring data were analysed from immediately post exercise up to 24 h after exercise. The wpSD of the change in capillary glucose during exercise was lower for AM-FAST (1.0±1.1 mmol/l) than PM-FED (1.5±1.0 mmol/l; p=0.029). There was no difference in the wpSD between conditions during the subsequent 30 min seated recovery (p=0.76). During exercise capillary glucose increased by 1.4±1.9 mmol/l for AM-FAST and decreased by 0.9±2.3 mmol/l for PM-FED (p=0.017). There was a greater percentage of time in hyperglycaemia in the 6 h post-exercise period following AM-FAST vs PM-FED (56.7% [27.2, 67.9] vs 33.0% [22.6, 41.5]; p=0.003, respectively). The glycaemic response to AM-FAST was more consistent and characterised by increases in glucose concentration, whereas the glycaemic response to PM-FED was less consistent and produced decreases in glucose concentration. Performing resistance exercise while fasted may reduce barriers to exercise for people with type 1 diabetes due to a more consistent glycaemic response that is less likely to cause hypoglycaemia during exercise. ClinicalTrials.gov NCT05168488. Dexcom Canada provided in-kind funding in the form of Dexcom G6 transmitters, sensors and receivers. LifeScan Canada provided in-kind funding in capillary glucose testing strips. JEY was supported by a Heart and Stroke Foundation of Canada Alberta New Investigator Award.

Skeletal muscle is a highly adaptable tissue that plays a central role in overall health. The dynamic balance between muscle protein synthesis and breakdown governs skeletal muscle mass maintenance. Increased loading and hyperaminoacidemia (via protein ingestion) are positive drivers of skeletal muscle protein accretion, which, when combined, drive a hypertrophic phenotypic adaptation. In contrast, unloading (disuse) results in skeletal muscle atrophy and metabolic dysregulation. Hypertrophy enhances metabolic health and functional capacity, underscoring the importance of understanding the mechanisms that regulate this process. External variables, such as resistance exercise and dietary protein, influence hypertrophy; however, resistance exercise is the primary driver, with protein playing a minor supporting role. Signals from external input loading (resistance exercise) and nutritional manipulation (protein ingestion) are sensed and transduced into intracellular pathways that promote muscle protein synthesis, yet the precise mechanisms underlying their integration remain incompletely understood. This review summarizes current knowledge on how resistance exercise and dietary protein converge on the intracellular level to regulate skeletal muscle hypertrophy in humans.

Parkinson's disease is a neurological condition with motor and non-motor symptoms that negatively affect well-being and quality of life. This review aimed to analyze the effects of resistance training on quality of life in individuals with Parkinson's disease and to summarize recommendations for clinical application. Following PRISMA recommendations, searches were conducted in Web of Science, PubMed, EMBASE (with ClinicalTrials.gov), PEDro, CINAHL, and Scopus. RCTs were included that compared the effects of resistance training with other therapeutic modalities or a control group on the quality of life in people with Parkinson's. Data were extracted using Microsoft Excel and analyzed in RevMan. The risk of bias was assessed using the RoB 2 tool, the protocol reporting completeness was evaluated using CERT and certainty of the evidence was rated using GRADE. Fourteen studies were included, featuring highly heterogeneous protocols. Resistance training was superior to control (SMD -0.81; CI -1.45 to -0.18; I2 88%; moderate certainty of the evidence), although no significant difference was found compared to other therapeutic modalities (SMD -0.02; CI -0.44 to 0.41; low certainty of the evidence). Exploratory subgroup analyses suggested a trend toward more favorable results in trials lasting longer than 12weeks, involving patients with mild-to-moderate disease severity (H&Y≤3), and reporting high protocol completeness (CERT>11). Most of the studies were classified as having a low risk of bias and presented a moderate description of the protocols in the CERT. The included studies exhibited high heterogeneity and required data imputation for missing standard deviations. Additionally, exploratory subgroup analyses were underpowered due to the limited number of trials. Current evidence suggests that resistance training may improve quality of life in individuals with Parkinson's disease. Exploratory subgroup analyses tentatively suggest potential trends favoring mild-to-moderate stages and intervention exceeding 12weeks, while being a safe practice. However, high heterogeneity limits the certainty of the evidence. Future studies should prioritize standardized reporting (CERT) to ensure intervention reproducibility. PROSPERO record (CRD42024588780).

Exercise training is an effective non-pharmacological strategy for reducing blood pressure; however, current guideline recommendations are largely derived from studies reporting resting clinic blood pressure rather than ambulatory blood pressure (ABP), which provides greater prognostic value. Comparative evidence on the effects of different exercise modalities on ABP remains limited. To compare the effects of major exercise modalities on 24-h systolic ABP using a Bayesian network meta-analysis, and to outline practical implications for antihypertensive exercise prescription. PubMed (MEDLINE) and the Cochrane Library were searched for randomized controlled trials published before January 2025 reporting changes in 24-h systolic ABP following an exercise intervention of at least 2 weeks' duration. Eligible studies included adults and compared aerobic exercise training (AET), resistance training (RT), high-intensity interval training (HIIT), combined training (CT), or isometric exercise training (IET), with a non-exercise control or another exercise modality. Bayesian network meta-analyses were conducted, with interventions ranked using surface under the cumulative ranking curve (SUCRA) values. Twenty-five studies (1096 participants) met inclusion criteria; 16 were included in the network meta-analysis. AET and HIIT reduced 24-h systolic ABP (-4.77 mmHg and -6.86 mmHg), with a smaller reduction following RT (-2.25 mmHg). Data were insufficient to analyse comparative effects for CT or IET. In the Bayesian network, rank order of effectiveness based on SUCRA values was HIIT (91.4%), AET (68.2%), and RT (35.4%). No statistically significant comparative differences were observed between exercise modalities. This Bayesian NMA demonstrates HIIT and AET as effective for reducing 24-h systolic ABP, supporting their role in hypertension management. However, the limited scale and connectivity of available trials restrict definitive comparisons between wider exercise modes. Larger, well-designed head-to-head trials incorporating ABP outcomes are needed to clarify the relative effectiveness of different exercise strategies and to better inform evidence-based exercise prescription for blood pressure management. Registration:PROSPERO: CRD420251177743.

Resistance exercise enhances executive function (EF) more effectively at moderate or higher intensities than at low intensity resistance exercise (LRE), probably with increased neural activity and lactate production to meet brain energy demands. Given that LRE remains widely applicable with less perceived exertion, and electrical muscle stimulation (EMS) increases lactate production and neural activation, we investigated whether combining LRE with EMS (LRE-EMS) effectively enhances EF, without increasing perceived exertion. A crossover randomized study. Seventeen young men participated in a crossover randomized study to assess the cognitive effects of LRE alone, EMS alone, and LRE-EMS. The LRE protocol involved knee extensions at 40% one-repetition maximum for 4 sets of 10 repetitions. During the EMS condition, the participants remained seated for 260 s to match the duration of the other conditions, with EMS applied to the lower limb muscles. Subjective perceptions of exertion and fatigue during exercise were recorded. IC and lactate were measured at baseline, immediately postexercise, and 15 min postexercise. The LRE condition did not significantly increase IC (p = 0.100), whereas LRE-EMS resulted in significant IC improvements immediately and 15 min postexercise (both p < 0.001), with greater lactate increases compared to LRE and EMS. EMS demonstrated significant IC improvement at 15 min postexercise (p = 0.022). Perceived exertion and fatigue were greater with LRE-EMS compared with LRE and EMS. These findings suggest that LRE combined with EMS and EMS alone are effective strategies for cognitive improvement, but increased perceived exertion still exists.

To compare the effects of various physical therapy interventions on proprioception in individuals with chronic ankle instability (CAI) and to provide an evidence-based medical basis for choosing the best physical therapy. Six electronic databases were systematically searched from the time the database was created until March 1, 2025. Randomized controlled trials evaluating the efficacy of physical therapy for joint position sense were included. A total of 24 randomized controlled trials, including 949 individuals with CAI, were included. Seven physical therapy methods were used. Network meta-analysis revealed that balance training [standardized mean difference (SMD)=0.66, 95% CI: 0.26-1.05], strength training (SMD=0.97, 95% CI: 0.53-1.41), balance combined with strength training (SMD=0.94, 95% CI: 0.50-1.37), cognitive motor training (SMD=0.77, 95% CI: 0.08-1.45), electroacupuncture (SMD=0.84, 95% CI: 0.03-1.65), and whole-body vibration training (SMD=1.00, 95% CI: 0.45-1.55) significantly reduced ankle joint position error. Although whole-body vibration training had the highest ranking (75.4%), it was not significantly better than other therapies. With the exception of electrophysical agents, all 6 physical therapy treatments significantly improved ankle proprioception and yielded similar results. However, interventions should be chosen carefully, as the certainty of evidence is very low.

Rest-pause (RP) and drop sets (DS) are widely used as intensification strategies during resistance training. However, their incorporation within a repetition-based progressive-overload (PO) model and their effects under supervised conditions are not well established. We compared progressive-overload rest-pause (PO-RP) with progressive-overload drop-set (PO-DS) training, assessing changes in body composition and maximal strength in resistance-trained adults. Twenty-three participants (20 men and 3 women; 29.1 [5.9] years; 25.0 [3.1] kg/m2) were randomized to either PO-RP (n = 12) or PO-DS (n = 11). After a 1-week familiarization phase, both groups trained twice weekly for 8 weeks under supervision while following a prescribed nutritional protocol. Pre/post measures of body composition were assessed by DXA, and maximal strength was evaluated by the one-repetition maximum (1-RM) bench press. Adiposity-related outcomes (total and upper-body fat mass, and total and upper-body fat-free adipose tissue) remained essentially unchanged in both protocols (all group × time p > 0.05). Lean soft tissue mass increased in PO-DS (Δ = 1.4 kg; 95% CI, 0.8-2.2; p < 0.001; g = 0.1) and PO-RP (Δ = 1.2 kg; 95% CI, 0.8-2.0; p < 0.001; g = 0.1), with no between-protocol difference in change (group × time p = 0.688). Bench press 1-RM increased in both protocols (PO-DS: Δ = 12.3 kg; 95% CI, 9.6-14.0; p < 0.001; g = 0.7; PO-RP: Δ = 9.5 kg; 95% CI, 7.3-11.2; p < 0.001; g = 0.4), without a statistically significant group × time effect (p = 0.086). Under supervised training and a standardized nutritional protocol, PO-RP and PO-DS produced comparable adaptations. Adiposity-related outcomes remained stable, fat-free compartment measures increased, and maximal strength improved, with no statistically significant between-protocol differences in change. Future research should determine whether these adaptations are maintained over longer interventions and whether responses differ across populations with different characteristics, including women, older adults, clinical populations, or individuals with different training experience. Further studies incorporating larger samples, direct assessments of muscle hypertrophy, additional strength outcomes, and mechanistic measures of fatigue and recovery may help refine the application of advanced resistance-training strategies in evidence-based exercise programs.

Current exercise guidelines for cancer survivors continue to rely on a binary separation of resistance and aerobic training. This review proposes a stimulus-based continuum in which mechanical load, cardiorespiratory strain, metabolic stress, recovery density, and contraction velocity collectively determine physiological adaptations. This framework provides a conceptual basis for designing time-efficient, individualized exercise strategies beyond traditional modality labels in cancer care.

We investigated the influence of progressive overload (PO) on resistance exercise-induced muscle growth. Fifty-five untrained young women participated in the study. Each participant's arm was randomly assigned to one of the following conditions: 1) PO ( n = 37), 2) nonprogressive overload (N-PO, n = 32), and 3) time-matched nonexercise control (Control, n = 41). The training conditions performed unilateral elbow extension exercise in three sets of 8-12 repetitions, 3 d·wk -1 , for 8 wk. The PO condition increased the load whenever it reached the upper limit of the repetition range, whereas N-PO remained training with the same load and number of repetitions throughout the 8 wk. Triceps brachii (TB) muscle thickness was assessed using ultrasonography at 60% (TB60) and 70% (TB70) of the upper arm length, and the sum of both sites was calculated (∑TB). TB60 muscle thickness increased in both training conditions compared with Control, with greater increases in PO relative to N-PO (PO = 0.40 cm, +21.4% > N-PO = 0.22 cm, +11.3% > Control = 0.02 cm, +1.3%; P < 0.001). TB70 muscle thickness increased in both training conditions compared with Control, with greater increases in PO relative to N-PO (PO = 0.38 cm, +25.0% > N-PO = 0.19 cm, +12.0% > Control = 0.03 cm, +2.5%; P < 0.001). ∑TB increased in both training conditions compared with Control, with greater increases in PO relative to N-PO (PO = 0.79 cm, +22.9% > N-PO = 0.41 cm, +11.6% > Control = 0.05 cm, +1.8%; P < 0.001). Muscle growth appears to be more pronounced when resistance exercise is progressively overloaded. Notably, training without overload progression is sufficient to induce muscle hypertrophy in young, untrained women. Whether resistance training without increasing overload remains effective in promoting muscle growth when performed for longer periods remains an open question and warrants further investigation.

Lubiak, SM, Howard, MA, Schmidt, JT, Shah, NM, Patel, NN, Prajapati, AJ, Herring, EK, and Hill, EC. Ischemic preconditioning does not attenuate reductions in rate of torque development after fatiguing resistance exercise. J Strength Cond Res 40(7): e676-e683, 2026-The purpose of this investigation was to examine the acute effects of ischemic preconditioning (IPC) on indices of rate of torque development (RTD) and peak torque (PT) after fatiguing resistance exercise. Twelve college-aged females randomly completed 3 cycles of IPC at low (20 mmHg [IPCSHAM]), moderate (80% of total arterial occlusion pressure [IPC80]), and high (220 mmHg [IPC220]) pressures. Each cycle consisted of 5 minutes at the assigned pressure followed by 5 minutes of zero pressure. After IPC, subjects performed one-set to volitional failure of unilateral, isotonic, concentric-only leg extension muscle actions at 30% of 1-repetition maximum. Two maximal voluntary isometric contractions (MVICs) were performed before and immediately after the fatiguing exercise protocol to derive RTD at early (0-100 ms; RTD100), late (0-200 ms; RTD200), and peak (0-peak; RTDPK), as well as PT from the highest pretest and post-test MVIC. Separate 2-way, 3 (Pressure [IPCSHAM, IPC80, and IPC220]) × 2 (Time [Pretest, Post-test]), repeated-measures analysis of variance were performed to examine mean differences. Collapsed across Pressure, RTD100 (-113.9 Nm·s-1; p = 0.045), RTD200 (-94.5 Nm·s-1; p = 0.008), RTDPK (-157.0 Nm·s-1; p = 0.028), and PT (-15.2 Nm; p = 0.002) decreased from pretest to post-test. There were no significant interactions (p = 0.463-0.934) or main effects of Pressure (p = 0.235-0.581). Applying IPC at various pressures did not attenuate reductions in RTD or PT after fatiguing resistance exercise. Thus, coaches and practitioners may consider alternative exercise adjuncts or strategies to attenuate resistance exercise fatigue-induced performance reductions.

Validity of the individualized load-velocity profile to predict one-repetition maximum on a pneumatic leg press device in adults aged 55-81years.

In the past, large observational cohort studies suggested that ahigher protein intake might slow the age-associated loss of muscle mass and muscle strength. This observation led to the conclusion that ahigher protein intake may contribute to apreservation of function and to the prevention of sarcopenia. Therefore, the German Nutrition Society increased their recommendation for daily protein intake in adults aged ≥ 65years from 0.8to 1.0 g/kg body weight (estimated value); however, current data indicate that ahigher protein intake has no beneficial effect on muscle mass or muscle strength in healthy older adults. Yet, in patients with sarcopenia abeneficial effect on muscle health can be assumed for an increase in protein intake when combined with resistance exercise, while the evidence for an increase in protein intake alone is less convincing. Current research gaps pertain to the effect of different types of protein on muscle mass and muscle strength as well as to the relevance of avegan diet for healthy aging.

Some individuals consume food before or after exercise to compensate for energy expended. If this behaviour is prevalent, it could have implications for population-level health. We estimated the prevalence of eating in response to exercise (before and after exercise) and explored associated factors using an online questionnaire. A nationally representative sample of UK adults engaging in weekly exercise (N=1054) reported how their eating behaviours (portion size, frequency, perceived healthiness) change on exercise days compared to non-exercise days. Other measures included demographics (e.g., sex, dieting status), exercise characteristics (frequency, intensity, duration, mode), exercise motivation and enjoyment, the Three-Factor Eating Questionnaire (dietary restraint and disinhibition), and the Diet-Related Beliefs of Exercisers Scale (DBES) (sub-scales: food as reward, nutritional replenishment, healthy eating and refrain from eating). Associations with eating in response to exercise were examined using multiple logistic regression. Eating in response to exercise was reported by 24% (n=251) of the sample, and occurred most often after exercise (17%, n=178). The DBES food as reward sub-scale (OR=2.26, 95% CI 1.91, 2.67) and the DBES nutritional replenishment sub-scale (OR=1.42, 95% 1.13, 1.79) were strongly and positively associated with eating in response to exercise. Internal motivation for exercise (OR=1.53, 95% CI 1.21, 1.93), strength training (OR=1.74, 95% CI 1.28, 2.36), and disinhibition (OR=1.12, 95% CI 1.07, 1.17) were also positively associated with eating in response to exercise. We conclude that nearly a quarter of regular exercisers report consuming more food on exercise days and that reducing this behaviour has the potential to improve population-level health.

Parkinson's disease (PD) leads to motor and neuromuscular impairments, with the rigid-akinetic (RA) subtype progressing more rapidly and affecting daily activities and balance. Beyond medication, strength training can improve disease severity and muscle function. However, research on land-based and aquatic physiotherapy for the RA subtype is limited. The objective of the study was to describe and compare the effects of 12weeks of land-based physiotherapy (LP) and aquatic physiotherapy (AP) on the motor function of individuals with rigid-akinetic PD. Thirty individuals with rigid-akinetic PD were allocated to two groups (LP and AP) and participated in a 12-week intervention. Motor function was assessed using the Unified Parkinson's Disease Rating Scale-Part III (UPDRS III) (primary outcome). Secondary outcomes included trunk strength (explosive and maximal), functional capacity, mobility, flexibility, and balance, assessed through the rate of torque development (RTD) and peak torque (PT) using an isokinetic dynamometer, the Sit-to-Stand test (STS), Timed Up and Go (TUG), the Sit-and-Reach test (SR), and the Berg Balance Scale (BBS), respectively. Both LP and AP groups showed no significant changes in UPDRS III, RTD, PT, or TUG, while STS, SR, and BBS showed significant interactions over time (p<0.05). RTD intervals between 100 and 300ms, as well as STS and TUG, were significantly linearly associated with UPDRS scores (p<0.05). The results indicate that while motor function and explosive and maximal muscle strength were not significantly affected by the interventions, functional capacity and balance improved, highlighting the importance of continuing physical training as an integral component of rehabilitation. Clinical trial registration data are publicly accessible at ClinicalTrials.gov under the identifier NCT05866120.

Reliability of flywheel hip extension and leg curl tests and their associations with isokinetic hamstring strength.

Chiang, YC, Lin, WC, Weakley, J, and Chiang, CY. Variable resistance training improves velocity and power output by reducing concentric deceleration in the back squat. J Strength Cond Res 40(7): e663-e669, 2026-Free-weight resistance training (FWT) presents constant resistance, potentially causing a sticking region that negatively affects velocity and power outputs. We aimed to compare FWT with 15, 25, and 35% variable resistance training (VRT) using elastic bands on back squat kinetics and kinematics in the concentric phase. Twenty resistance-trained men performed back squats at 90% of their one-repetition maximum across the 4 conditions in a counterbalanced order in a single session. Resistance in VRT conditions was normalized to ensure the average resistance was equivalent to the FWT condition. Kinetic and kinematic data in the concentric phase were recorded using force plates and linear position transducers. One-way repeated-measures analysis of variance with Bonferroni post hoc comparisons compared dependent variables between conditions. Significance was set at p ≤ 0.05. No significant differences were found between conditions for peak velocity, peak power, peak force, or mean force in the concentric phase. However, a dose-response relationship was observed for other variables. Increasing the VRT percentage led to a significant reduction in sticking region duration, particularly at 25% and 35%VRT, and a significant decrease in force at zero velocity. Conversely, mean concentric velocity, velocity at sticking region onset, and mean concentric power all increased with higher VRT percentages. In conclusion, VRT enhances back squat concentric mean velocity and power output by reducing force at zero velocity and increasing velocity at sticking region onset, representing an effective alternative to FWT for improving these specific performance characteristics.

Lis, R, Long, A, Goode, N, McDowell, K, Nelson, D, Mizuguchi, S, Duca, M, Baur, M, Wagle, JP, Fry, AC, and Stone, MH. Chronic comparison of upper- and lower-body muscle soreness in trained individuals completing traditional or accentuated eccentric loading. J Strength Cond Res 40(7): 739-746, 2026-The purpose of this study was to compare the effects of accentuated eccentric loading (AEL) and traditional resistance training (TRAD) in terms of muscular soreness in the barbell bench press (BP; anterior deltoid, triceps brachii, and pectoralis major) and back squat (BS; vastus lateralis and gluteus maximus). Eighteen recreationally active subjects (males: n = 12, age: 22.75 ± 4 years, BW: 89.42 ± 21.09 kg, BP one rep max [1RM]: 104.67 ± 23.58 kg, relative BP 1RM: 1.19 ± 0.22, BS 1RM: 140.75 ± 39.17 kg, relative BS 1RM: 1.59 ± 0.34, females: n = 6, age: 23.6 ± 4.5 years, BW: 64.3 ± 10.8 kg, BP 1RM: 51.7 ± 13.4 kg, relative BP 1RM: 0.80 ± 0.13, BS 1RM: 93.7 ± 18 kg, relative BS 1RM: 1.47 ± 0.30) completed 4 weeks of strength endurance training. Resistance training occurred 3 times a week (M, W, F), whereas speed and agility happened twice weekly (T and R). Subjects completed the 10-cm palpation and movement visual analog scale (PVAS and MVAS, respectively) immediately before (PRE) and after (POST) every training session. The lower-body (LB) musculature soreness statistically decreased over time for the AEL group only for the MVAS ( p < 0.05). The PVAS and MVAS showed statistically significant lower LB scores in AEL compared with TRAD. We conclude that AEL training appears to create less soreness, specifically within the LB when compared with TRAD. Practitioners should not be concerned about excessive soreness when completing AEL training.

Older patients undergoing gastrectomy frequently exhibit sarcopenia and reduced physiologic reserve, increasing vulnerability to perioperative muscle loss. However, randomized evidence supporting multimodal exercise-nutrition prehabilitation in gastric cancer surgery remains limited. This trial evaluated whether prehabilitation attenuates preoperative lean body mass (LBM) loss and explored subgroups with greater benefit. In this single-center, open-label randomized controlled trial, patients aged ≥ 65 years with resectable gastric adenocarcinoma scheduled for curative gastrectomy were randomized 1:1 to standard care or multimodal prehabilitation. The intervention included daily walking, resistance training, and β-hydroxy-β-methylbutyrate supplementation. The primary endpoint was change in LBM from baseline to preoperative assessment. Secondary endpoints included physical function and postoperative outcomes. Prespecified subgroup and exploratory adherence analyses were conducted. Of 110 randomized patients, 101 were analyzed (control, n = 52; prehabilitation, n = 49). Mean (SD) change in LBM was - 0.3 (1.2) kg in controls and 0.1 (1.0) kg with prehabilitation, yielding a mean difference of 0.4kg (95% CI, 0.02-0.86; P = 0.043). Physical function and postoperative outcomes did not differ between groups. Greater LBM preservation was observed in women and in patients with lower baseline C-reactive protein or skeletal muscle index. Higher resistance training adherence was associated with greater LBM gain. Multimodal exercise-nutrition prehabilitation modestly preserved preoperative LBM in elderly gastrectomy patients but did not improve functional or postoperative outcomes. Risk-enriched trials are needed to determine whether targeted prehabilitation improves clinically meaningful endpoints.

Osteoporosis is a major health concern in postmenopausal women, characterized by reduced bone mineral density (BMD) and deteriorated bone microarchitecture due to estrogen deficiency. While pharmacological therapies are widely used, exercise represents a promising non-pharmacological approach to enhancing bone health. This systematic review and meta-analysis evaluated the effects of exerciseinterventions on BMD and bone-related biomarkers in ovariectomized (OVX) rats as a model of postmenopausal osteoporosis. A comprehensive search was conducted across Scopus, PubMed, and ScienceDirect databases for studies investigating exercise interventions in OVX rats. Random-effects meta-analyses were performed using Review Manager 5.4 to pool mean differences in BMD and bone-relatedbiomarkers. Subgroup analyses were conducted according to skeletal site and exercise modality. Risk of bias was evaluated using the SYRCLE tool. Twenty-nine studies were included, involving treadmill running (55%), swimming (14%), resistance training (7%), jumping exercises (17%), and downhill running (7%). Across 14 studies, OVX rats demonstrated significant reductions in BMD at the vertebrae, femur, and tibia (MD: 0.03 g cm-2, P < 0.0001). Exercise partially reversed these deficits, yielding small but significant BMD at skeletal sites (MD: -0.01 g cm-2, P < 0.0001). Moderate-intensity treadmill and jumping/plyometric exercise showed significant effects on BMD. Exercise decreases bone resorption biomarkers (TRACP/TRACP5b/TRAP, CTX-1/β-CTX/NTX) and balances bone formation biomarkers (OCN, ALP, P1NP), while regulating PPARγ, Wnt/β-catenin, sirtuins, RANKL, and oxidative stress. Exercise interventions significantly mitigate OVX-induced bone loss, improve BMD, and positively influence biomarkers of bone remodeling, supporting its role as a potential non-pharmacological strategy for managing postmenopausal osteoporosis.