Federico Schena

Background/Objectives: Circulating nucleosomes containing H3.1 represent a distinct fraction of extracellular chromatin. Although strenuous exercise is known to increase circulating extracellular chromatin components, it remains unclear whether H3.1-containing nucleosomes also respond to moderate physiological stress and whether this response varies with the underlying biological condition. Methods: Sixteen healthy subjects and 13 subjects with cancer completed a standardized 5 km walking exercise. Venous blood samples were collected immediately before and after exercise, and circulating H3.1-containing nucleosomes were quantified in K2-EDTA plasma with an automated immunoassay. Within-group and between-group comparisons were performed using non-parametric tests. Relative exercise-induced changes and age-adjusted analyses were evaluated as sensitivity analyses. Results: Circulating H3.1-containing nucleosome concentrations increased significantly after exercise in both healthy subjects (p < 0.0001) and those with cancer (p = 0.001). Cancer patients displayed higher baseline concentrations (p = 0.0056), whereas post-exercise concentrations were comparable between groups (p = 0.840). The absolute exercise-induced increase was significantly higher in healthy subjects (p = 0.028). This difference was confirmed when the response was expressed relative to individual baseline concentrations (median increase: 124.7% [IQR 63.9–191.5%] vs. 36.5% [20.6–42.0%]; p = 0.0009) and persisted after age adjustment (p = 0.0046). Conclusions: Circulating H3.1-containing nucleosomes respond to moderate aerobic exercise, with distinct patterns in healthy subjects and those with cancer. These preliminary findings support further investigation of H3.1-containing nucleosomal chromatin as a dynamic marker of the biological response to exercise.

Background/Objectives: Exercise is a supportive strategy for patients with cancer; however, evidence in individuals with established cancer cachexia remains limited. This study aimed to provide a preliminary description of feasibility and exploratory changes during a supervised exercise program in patients with cancer cachexia. Methods: Five women diagnosed with gastrointestinal or breast cancer and meeting the diagnostic criteria for cancer cachexia participated in a 12-week supervised exercise program, combining aerobic with resistance training, conducted twice weekly. Feasibility outcomes included completion, attendance, adherence, and adverse events. Muscle strength, flexibility, body composition, functional capacity, and patient-reported outcomes were assessed at baseline and post-intervention. Results: All participants completed the intervention and post-intervention assessments. Attendance ranged from 54% to 96%, with interruptions primarily related to treatment schedules and treatment-related side effects. No serious exercise-related adverse events occurred. Functional capacity improved in all participants (+ 33 to +73 m). Grip strength increased in all patients for the right hand (+0.5 to +5.5 kg) and in three patients for the left hand (+2.0 to +3.5 kg). Body composition responses were heterogeneous: fat-free mass increased in three patients (+1.3 to +2.8 kg), whereas two patients showed reductions. Fat mass decreased in three patients (−2.6 to −5.0 kg) and increased in two. Several domains of quality of life and symptom burden improved in most participants. Conclusions: In these five women with cancer cachexia, a supervised exercise program showed variable attendance and no serious exercise-related adverse events, whereas favorable changes for functional outcomes and heterogeneous response in body composition were observed.

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.

Background: High-intensity interval training (HIIT) is increasingly used in exercise-based cardiac rehabilitation (ebCR) after myocardial infarction (MI), yet the temporal sequence of physiological, cardiac, biochemical, and functional adaptations remains incompletely characterized. Methods: Stable post-STEMI (ST-segment elevation myocardial infarction, MI-group) and previously inactive participants without known cardiovascular, metabolic or systemic disease (CTRL group) completed 12-week supervised outpatient HIIT (4 × 4 min intervals at 85–90% HRpeak (peak heart rate), ~80–90% of VO₂peak, 3 sessions/week). Assessments were performed at baseline (T1), 4 (T2), 8 (T3), and 12 weeks (T4), including cardiopulmonary exercise testing (CPET), echocardiography, blood biomarkers, body composition, six-minute walk test (6MWT), and RAND-36. Longitudinal changes were analyzed using Friedman tests with Dunn post hoc comparisons; between-group differences used Mann–Whitney U tests with Holm correction. Results: VO₂peak increased significantly in both groups (p < 0.001), increasing by ~22% from T1 to T4 in MI (median 20.1 to 24.5 mL·kg⁻¹·min⁻¹) and ~23% from T1 to T4 in CTRL (median 22.3 to 27.6 mL·kg⁻¹·min⁻¹). LVEF (left ventricular ejection fraction) improved early in MI, increasing from 52.5% (50.0–55.0) at T1 to 57.5% (55.2–58.7) at T2 and up to 60% (55.8–60.0) at T4 (all p < 0.001), while LV dimensions remained stable. NT-proBNP (N-terminal pro-B-type natriuretic peptide) showed no significant longitudinal change (p = 0.510), and CRP (C-reactive protein) decreased from 2.1 to 0.7 mg·L⁻¹ (p = 0.008) in MI. Both groups improved body fat % and 6MWT distance (p < 0.001). Conclusions: In low-risk stable post-STEMI patients, longitudinal changes during supervised HIIT-based ebCR were consistent with improved VO₂peak and LVEF, without clinically relevant increases in cardiac stress biomarkers. However, due to the observational design and absence of clinical comparator groups, these findings should be interpreted as descriptive and support further evaluation in larger randomized studies.

Purpose: The purpose of this study was to investigate the benefits of long-distance running through two prominent frameworks: the self-determination theory (SDT) and the dualistic model of passion (DMP). Specifically, we investigated the associations between the satisfaction of psychological needs (i.e., autonomy, competence, and relatedness), harmonious and obsessive passion, functional and dysfunctional psychobiosocial (PBS) states, and life satisfaction in a sample of amateur long-distance runners. Methods: Using a cross-sectional survey design, data on psychological needs satisfaction, passion, PBS states, and life satisfaction were collected from 209 amateur long-distance runners participating in the Italian Run for Science (R4S) event series (2017–2019). Results: Correlations and structural equation modeling results showed autonomy to be positively associated with functional PBS states and life satisfaction, and obsessive passion to be negatively associated with dysfunctional PBS states. Functional PBS states were found to mediate the relationship between autonomy and life satisfaction. Conclusion: We found partial support for our predictions based on the SDT and DMP. Findings suggest that autonomy, social connections, adaptive forms of passion, and functional PBS states are important correlates of life satisfaction of amateur long-distance runners.

Purpose: Caregivers of patients with metastatic cancer may be exposed to an overwhelming sense of burden. Physical exercise may help patients improve their physical condition, manage symptoms, and enhance their quality of life. Nevertheless, it is unclear if these interventions may also likely affect caregivers. Methods: Five focus group ( n = 20 participants) were conducted to explore the caregivers’ experiences/perspectives of patients affected by metastatic cancer and performing a supervised physical exercise intervention. Thematic analysis using an inductive approach was performed. Theme, sub-themes, and illustrative quotes are displayed. Results: Four themes were identified. Theme 1 captured, with two sub-themes, the impact of the diagnosis on caregivers’ emotional status and daily routines. Theme 2 was related to the perceived benefits of patients’ engagement in the physical exercise program, enclosing three sub-themes (physical advantages, management of side effects, psychological well-being) and how this has helped caregivers enhance their emotional well-being. Theme 3 reported how caregivers have felt supported by the physical exercise program for the care of their loved ones (three-sub-themes: supervised by specialists, tailored and flexible program). Finally, theme 4 explained that caregivers, thanks to the patient’s participation in the exercise, were able to take back control of their own lives, having more time available and enhancing their relationship with the patient. Conclusion: Participation of patients with metastatic cancer in a structured physical exercise program may be effective in reducing caregiver’s burden. This study may serve as a trailblazer to guide future investigations and consolidate the present findings.

Purpose: Physical activity is associated with a lower mortality and recurrence risk in cancer, yet the underlying mechanisms remain unclear. This study aimed to evaluate the effects of running sessions on the tumorigenic potential of prostate cancer cells using a 3D in vitro model. Methods: Fifteen healthy males completed two outdoor running sessions (5 km and 10 km), interspersed by 1 month of wash-out time. Blood samples were collected before (PRE), immediately after (POST), and 3 h after (POST-3 h) sessions. Human serum (HS) samples were used to stimulate LNCaP and PC3 cell lines in 3D in vitro culture technique. The spheroid formation ability was quantified after 21 days of incubation, using GelCount. Results: In both prostate cancer cell lines, a reduction in spheroid number was shown, by both running sessions and in all timepoints considered (LNCaP cells: 5 km: − 23.8%; 10 km: − 5.6% POST HS; 5 km: − 37.8%; 10 km: − 34.8% POST-3 h HS; PC3 cells: 5 km: − 14%; 10 km: − 15.9% POST HS; 5 km: − 14.2%; 10 km: − 13% POST-3 h HS). The spheroid volume was reduced by 42.6% (5 km) and 51.1% (10 km) with POST-3 h HS, in LNCaP cells; no significant reduction was observed in PC3 cells. No differences were found between the running sessions, while higher muscle mass, cardiorespiratory fitness and age were associated with greater reductions in spheroid number and volume, especially in LNCaP cells. Conclusion: Running sessions reduce prostate cancer cell spheroid formation, especially in participants with higher physical fitness. Shorter running distances showed comparable effects to longer ones, highlighting practical implications for real-world exercise prescriptions in oncology.

Purpose: Reduction in exercise capacity and peak oxygen uptake (V̇O ₂ ) are common in acromegaly, but ventilatory alterations during exercise remain unstudied. We evaluated the exercise ventilatory response in terms of efficiency in patients with acromegaly. Methods: We prospectively evaluated 10 patients with acromegaly in a phase of disease control. To minimise confounders related to ventilatory response and anthropometric differences, acromegalic patients were matched with 10 control subjects according to age, body mass index, and body surface area. Chronic diseases, any cardio-respiratory condition likely to alter ventilatory response, and evidence of cardiac dysfunction were excluded. Pulmonary function tests and maximal cardiopulmonary exercise testing were performed. Ventilatory response was assessed via minute ventilation (V̇ _E )/carbon dioxide(CO ₂ ) output slope (V̇ _E /V̇CO _2slope ) and end-tidal carbon dioxide pressure (PETCO ₂ ). Exercise ventilatory inefficiency (EV in ) was defined according to reference values for healthy individuals. Results: No alterations in lung function were observed in either group. Compared with controls, patients with acromegaly showed lower power output and V̇O ₂ at peak (1.38 ± 0.20 vs. 1.90 ± 0.64 L·min ⁻¹ ; p = 0.033). Breathing patterns were similar to those of controls, but acromegalic patients exhibited higher values of V̇ _E /V̇CO _2slope (31.8 ± 3.7 vs. 28.0 ± 2.7; p = 0.018), lower PETCO ₂ at peak (31.1 ± 5.3 vs. 36.9 ± 3.0 mmHg; p = 0.008), and a greater prevalence of EV in (60% vs. 10%; p = 0.019). No correlations emerged between ventilatory inefficiency and biochemical or clinical variables. Conclusion: Patients with acromegaly display ventilatory inefficiency during exercise. These findings suggest subclinical alveolar-capillary impairment or altered CO ₂ chemosensitivity. Exercise testing may help unmask these abnormalities, supporting its role in risk stratification and rehabilitation planning.