Massimo Sacchetti

Physical activity supports prevention and chronic disease management, but the effective delivery of exercise programmes requires clearly defined responsibilities, access arrangements, including professional referral, delivery standards, and financing mechanisms. In Italy, Legislative Decree No. 36/2021 defines attività fisica adattata (AFA; adapted physical activity) and structured physical exercise (EFS) and specifies the functions of the Chinesiologo delle Attività Motorie Preventive e Adattate (Chinesiologo AMPA). Yet no coherent national pathway governs access to and coordinated delivery of these programmes. The reformulated amendment 4.47 to A.C. 2700 does not expressly include the Chinesiologo AMPA in its interdisciplinary framework, exposing an implementation gap in coordination among professional groups. This concept paper proposes an intersectoral, competence- and phase-based model linking clinical care with community-based prevention and exercise through AFA, EFS, and the long-term maintenance of physical activity. Six priorities follow: (i) alignment of emerging legislation with existing law; (ii) implementation of Article 41, especially through verifiable competence criteria under paragraph 8-bis; (iii) national standards for programme access, documented handover, reassessment, and accountability; (iv) explicit specification and financing of AFA and EFS pathways within the Livelli Essenziali di Assistenza (LEA; essential levels of care); (v) distinct rules for provider qualification, healthcare accreditation, and public contracting; and (vi) public, interdisciplinary, and intersectoral governance. The model preserves the responsibilities of healthcare professionals for diagnosis, treatment, and rehabilitation while operationalising, in qualified non-healthcare settings, the functions assigned to the Chinesiologo AMPA in prevention through exercise, adapted exercise programme design and delivery, and functional recovery after completion of rehabilitation. The inclusion of AFA and EFS in the LEA and their functional integration into Servizio Sanitario Nazionale pathways should be prioritised; formal recognition of the Chinesiologo AMPA within Italy’s healthcare-professions framework could be considered only if the necessary political and institutional conditions are in place. Implementation of this model should ensure safe and documented transitions between clinical care and community-based prevention and exercise, equitable access to programmes, and outcomes assessed using shared indicators.

Respiratory frequency (f_R) and tidal volume (V_T) show distinct responses during high-intensity interval training (HIIT) bouts, yet the underlying mechanisms remain unclear. We investigated the effects of hypoxia and hyperthermia on ventilatory responses to HIIT bouts. Ten recreationally trained males (mean ± SD: peak oxygen uptake: 3.98 ± 0.62 L/min, age: 28 ± 6 years) performed the same HIIT protocol to exhaustion in three randomized conditions: normobaric hypoxia (HYP, 15% O₂), hyperthermia (HOT, 35 °C, 40% humidity), and control (CON, 18 °C and 40% humidity). Work-recovery phases (30-30 s) were performed at 109% of peak power output from a prior incremental test and 50 W, respectively. Time-to-exhaustion (TTE) differed (P < 0.05) across CON (18.0 ± 4.4 min), HYP (9.4 ± 2.8 min), and HOT (12.6 ± 3.1 min) conditions. Iso-time f_R was associated with changes in TTE and positively correlated with perceived exertion (P < 0.001; r = 0.85) and aural temperature (P < 0.001; r = 0.58). On average, f_R increased during the work phase and decreased during recovery, primarily driving pulmonary ventilation ([Formula: see text]) during work-recovery alternations. Conversely, V_T showed a smaller and opposite response, with higher values during recovery. V_T plateaued in all conditions, but higher values were observed in HYP versus CON and HOT, accompanied by higher capillary blood lactate levels and lower blood oxygen saturation. f_R is associated with changes in exercise tolerance irrespective of the environmental conditions tested and is more closely related to perceived exertion than to aural temperature. f_R primarily drives the [Formula: see text] response to high-intensity work-recovery alternations, while V_T appears fine-tuned on f_R levels and the magnitude of metabolic inputs.

Ergogenic aids have long attracted scientific interest for their potential to enhance neuromuscular performance, with caffeine being among the most extensively studied. While traditionally attributed to peripheral actions on skeletal muscle, accumulating evidence indicates that, at physiological doses, caffeine’s ergogenic effects are predominantly mediated by antagonism of central adenosine receptors. This antagonism leads to increased arousal, reduced inhibitory neuromodulation, enhanced corticospinal excitability, and altered motor unit recruitment and firing behavior. Importantly, the concentrations required to elicit direct effects on excitation–contraction coupling via ryanodine receptors exceed those compatible with human safety, rendering such mechanisms unlikely in vivo. This narrative review synthesizes contemporary neurophysiological evidence to propose that caffeine acts primarily by “tuning” motor system gain through central neurotransmitter modulation, rather than by directly augmenting muscle contractile properties. Additionally, we highlight unresolved questions regarding persistent inward currents, sex-dependent neuromodulatory influences—including the potential role of estrogen in regulating adenosine receptor expression—and the implications of repeated caffeine use during training for neural adaptation and motor control. Finally, we outline key methodological and conceptual directions for future research aimed at refining our understanding of caffeine’s neuromuscular effects in both acute and chronic contexts.

Purpose : Traditional training metrics do not distinguish between the different components of internal training load contributing to training-induced fatigue, whereas the National Aeronautics and Space Administration Task Load Index (NASA-TLX) may offer a compelling multidimensional alternative. However, the NASA-TLX subscales have been overlooked in the context of endurance training. Therefore, this study investigated whether the NASA-TLX subscales are associated with acute performance decrement (APD) and physiological responses across different endurance training sessions. Methods : Twelve well-trained runners (10 males, 2 females; age 26.8 [6.9] y; maximal oxygen uptake [VO ₂ max] 65.6 [6.4] mL·kg ⁻¹ ·min ⁻¹ ) completed 6 visits in the laboratory, an incremental test, a time to exhaustion (TTE) test, and 4 experimental training sessions in randomized order. A TTE test was performed at baseline and after each of 4 exercise sessions: low-intensity training, medium-intensity training, long-interval high-intensity (HIT _long ), and short-interval high-intensity (HIT _short ). APD was calculated as the percentage drop in TTE compared to baseline. The NASA-TLX questionnaire was administered between each training session and the TTE test to assess mental demand, physical demand, temporal demand, effort, frustration, and perceived performance. Results : All sessions led to significant APD ( P = .041), with HIT _long producing greater APD than low-intensity training ( P = .035). Subscale analysis showed lower mental, physical, temporal, and effort scores after low-intensity training compared to HIT sessions ( P < .001). All subscales were significantly correlated with APD and key physiological ventilatory and metabolic parameters ( P < .001). Conclusion : NASA-TLX subscales appear valid and may help athletes to discriminate distinct components of perceived workload.

Purpose: We investigated the association between training metrics commonly used in soccer and the acute performance decrement (APD) observed after 3 training sessions differing in exercise intensity and duration. Methods: In separate randomized visits, 16 male soccer players performed a Yo-Yo Intermittent Recovery level 2 test (Yo-Yo IR2) at baseline or 5 minutes after 3 different training sessions consisting of a 10-minute small-sided game (SSG), a 26-minute passing and shooting drill (PSD), or 60 minutes of technical drills (Tech-D). The APD was computed as the percentage reduction in the Yo-Yo IR2 distance from baseline. Training was quantified using metrics of training impulse, a metric based on perceived exertion, movement load, energy expenditure, total distance, and the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Results: A lower (P < .017) Yo-Yo IR2 distance was covered after SSG and PSD than at baseline and after Tech-D. The APD was higher (P < .022) for SSG (45.6% [19.3%]) than for PSD (31.9% [21.3%]) and Tech-D (9.1% [24.6%]). However, the APD response dissociated from the response of several training metrics recorded. Indeed, higher values (P < .05) were found in Tech-D and/or PSD than in SSG for training impulse, perceived exertion, movement load, energy expenditure, and total distance. Conversely, the response of the NASA-TLX broadly resembled that of APD. Conclusions: Several training metrics used in soccer dissociate from the APD observed after training sessions differing in intensity and duration, unlike the often-overlooked NASA-TLX. These findings suggest revising the combination of training intensity and duration to improve soccer metrics.

Purpose: This study investigated the relationship between training-load (TL) metrics and the acute performance decrement (APD) measured immediately after 4 training sessions performed by well-trained runners. Methods: On a treadmill, 12 well-trained runners (10 men and 2 women) performed an incremental test, a baseline time-to-exhaustion (TTE) test at maximal aerobic speed, and 4 randomized training sessions followed by a TTE test to measure APD. The training sessions were matched for external load (60 arbitrary units) but differed in the time spent in the 3 intensity domains. The TL metrics used were based on training impulse, heart-rate variability, ratings of perceived exertion, and the NASA Task Load Index (NASA-TLX) rating scale. Results: TTE was significantly shorter after all the training sessions compared with baseline (P < .001). While APD was higher (+16%, P = .035) for long-duration high-intensity training (HIT_long) compared with low-intensity training (LIT), most TL metrics showed higher values (P < .001) in LIT than in HIT_long. Conversely, NASA-TLX values were higher (P < .001) in HIT_long than in LIT and were significantly associated with APD values (P < .001, β = 0.54). Physiological parameters showed that less time was spent above 90% of O₂max during LIT compared with the other training sessions (P < .01), while average respiratory frequency and mean respiratory exchange ratio were higher during HIT_long compared to LIT (P < .01). Conclusion: APD was observed after the 4 running training sessions, and it was not associated with most of the TL metrics. Only NASA-TLX was associated with APD, suggesting that this TL metric could be leveraged for training monitoring.

Diabetes mellitus is a chronic disorder that progressively induces complications, compromising daily independence. Among these, diabetic neuropathy is particularly prevalent and contributes to substantial neuromuscular impairments in both types 1 and 2 diabetes. This condition leads to structural damage affecting both the central and peripheral nervous systems, resulting in a significant decline in sensorimotor functions. Alongside neuropathy, diabetic myopathy also contributes to muscle impairment and reduced motor performance, intensifying the neuromuscular decline. Diabetic neuropathy typically implicates neurogenic muscle atrophy, motoneuron loss and clustering of muscle fibres as a result of aberrant denervation‐reinervation processes. These complications are associated with compromised neuromuscular junctions, where alterations occur in pre‐synaptic vesicles, mitochondrial content and post‐synaptic signalling. Neural damage is intensified by chronic hyperglycaemia and oxidative stress, exacerbating vascular dysfunction and reducing oxygen delivery. These complications imply a severe decline in neuromuscular performance, evidenced by reductions in maximal force and power output, rate of force development and muscle endurance. Furthermore, diabetes‐related complications are compounded by age‐related degenerative changes in long‐term patients. Aerobic and resistance training offer promising approaches for managing blood glucose levels and neuromuscular function. Aerobic exercise promotes mitochondrial biogenesis and angiogenesis, supporting metabolic and cardiovascular health. Resistance training primarily enhances neural plasticity, muscle strength and hypertrophy, which are crucial factors for mitigating sarcopenia and preserving functional independence. This topical review examines current evidence on the physiological mechanisms underlying diabetic neuropathy and the potential impact of physical activity in counteracting this decline. image

Introduction: Early increases in muscle strength following unilateral resistance training are typically accompanied by strength gains in the contralateral untrained muscles, a phenomenon known as cross-education. However, the specific motor unit adaptations responsible for this gain transfer remain poorly understood. To address this gap, we recorded myoelectrical activity from the biceps brachii using high-density electromyography.Methods: Nine participants performed 8-week unilateral resistance training and were compared to nine control individuals who did no intervention. Discharge characteristics of longitudinally tracked motor units were assessed during maximal voluntary contractions and isometric ramp contractions at 35% and 70% of the maximal voluntary force (MVF) at baseline (T0), 4 weeks (T1), and 8 weeks (T2) post-intervention.Results: MVF increased by 7% in untrained muscles at T1 and 10% at T2 (p < 0.05). These gains were accompanied by significant decreases in motor unit recruitment thresholds (p < 0.01) and higher net discharge rate (i.e., gain in discharge rate from recruitment to peak) following intervention (p < 0.05). Trained muscles presented greater MVF (+11%, T1; +19%, T2) with similar motor unit adaptations, including a lower recruitment threshold (p < 0.01) and a higher net discharge rate (p < 0.01).Discussion: Our findings indicate that higher strength in untrained muscles is associated with a higher net discharge rate, implying a greater spinal motoneuron output to muscles. The present results underscore the role of motor unit adaptations in the transfer of strength gains to non-trained muscles, offering novel insights into the neural mechanisms underlying cross-education.