Linda S. Pescatello

Background: Post-COVID-19 syndrome (PCS) is associated with persistent pulmonary, autonomic, and hemodynamic impairments. However, the acute effects of spinal manipulation on these systems in adults with PCS remain unclear. Purpose: To investigate the acute effects of combined cervical and thoracic spinal manipulation on pulmonary function, heart rate variability, and blood pressure in adults with PCS. Methods: This exploratory, hypothesis-generating study included 10 adults with PCS randomized to three sequences of spinal manipulation, sham manipulation, and control using a Latin-square crossover design with one-week washouts. Spirometry (FVC, FEV1, and FEV1/FVC) was assessed immediately after each intervention. Blood pressure and heart rate variability indices (RMSSD, SDNN, pNN50, LF, HF, and LF/HF ratio) were recorded at rest and 15, 30, 45, and 60 minutes post-intervention. Friedman/Wilcoxon tests and baseline-corrected sensitivity analyses were performed. Results: No significant differences were observed among conditions for FVC, FEV1, FEV1/FVC (all p>0.70), or the area under the curve of blood pressure, RMSSD, pNN50, HF, and LF/HF ratio (all p>0.27). Differences in SDNN and LF did not survive Bonferroni-corrected comparisons and disappeared after baseline correction, indicating between-session baseline variability rather than intervention effects. Conclusion: A single session of combined cervical and thoracic spinal manipulation did not produce consistent acute improvements in pulmonary function, blood pressure, or heart rate variability in adults with PCS. These physiological variables should not be considered primary indicators of response to an isolated manipulation session.

Using qualitative methods, we investigated barriers and facilitators to promoting physical activity in an HIV clinic in New Haven, CT. We conducted focus groups with HIV clinicians/staff ( n = 12) and interviews among people with HIV with unhealthy substance use ( n = 10). Data collection and deductive analysis were guided by the Health Equity Implementation Framework domains. Innovation barriers included lack of evidence-based interventions; facilitators included behavioral strategies and app-based programs. Clinical encounter barriers included lack of protocols and competing priorities; facilitators included discussing the benefits of physical activity. Recipient-level barriers included cost, physical capacity restrictions, and unhealthy substance use; facilitators included social support and tailoring interventions to individual interests/fitness levels. Contextual barriers included budget restrictions and lack of billing options; facilitators included having a physical activity specialist and infrastructure to link patients to physical activity services. Future research should investigate the feasibility of implementing a physical activity intervention into HIV clinical care.

To evaluate the effects of aerobic exercise (AE) versus resistance training (RT) on cardiometabolic health-related outcomes in patients with type 2 diabetes mellitus and concurrent obesity (diabesity). Systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, Web of Science, Scopus, ScienceDirect, Cochrane Library, and Google Scholar databases were searched from inception up to April 2026. RCTs comparing AE and RT for a minimum duration of two weeks. Participants were adults with diabesity. A total of 23 RCTs qualified, involving 1, 184 patients (58/42 women/men ratio; age range: 30-70 years; body mass index: 32.1 ± 6.6 kg/m2). AE appears to be more efficacious than RT in reducing fasting blood glucose (mean differences (MD) = -0.89 mmol/L, 95% CI: -1.62 to -0.16; I2 = 0%) and increasing cardiorespiratory fitness (MD = 1.78 mL/kg/min, 95% CI: 0.38 to 3.18; I2 = 66%). However, AE led to a greater increase in body fat (MD = 0.34%, 95% CI: 0.10 to 0.57; I2 = 1%) and less fat-free mass retention (MD = -0.86 kg, 95% CI: -1.46 to -0.26; I2 = 37%) compared with RT. For selected cardiometabolic health-related outcomes, including anthropometrics, blood lipids, and hemodynamics, no statistically significant between-group difference was detected. The overall certainty of the evidence across outcomes ranged from high to very low, with most being moderate. In adults with diabesity, AE appears to provide greater benefits for FBG and CRF, whereas RT appears more favorable for preserving FFM and improving BF. For the majority of cardiometabolic outcomes, the two modalities exhibit analogous effects. The present findings support a goal-directed and complementary approach to exercise prescription, as opposed to a one-modality-fits-all model, for the improvement of cardiometabolic health in patients with diabesity.

Cardiovascular disease involves complex molecular, cellular, and physiological derangements that present challenges for traditional diagnostic and therapeutic approaches. Precision medicine is an evolving field that seeks to tailor interventions according to an individual's genetic, molecular, and physiological characteristics. By leveraging advanced omics approaches, including genomics, proteomics, metabolomics, and microbiomics, precision medicine may enable more comprehensive patient phenotyping and support the development of more individualized strategies. The emerging concept of precision cardiac rehabilitation (CR) could provide a more tailored approach to cardiac care by integrating artificial intelligence (AI) with multimodal data, including clinical, imaging, physiological, and omics information. In this context, AI has been explored as a tool to support risk assessment, exercise prescription, and monitoring during CR. However, current evidence remains limited and heterogeneous. Omics-based approaches are primarily confined to research and translational settings, and their role in guiding individualized exercise prescription or clinical decision making in CR remains unestablished. Similarly, while AI shows promise for improving adherence, remote monitoring, and data integration, its effectiveness for optimizing clinical outcomes in CR requires further validation. Overall, precision CR represents a promising but still evolving paradigm. Future progress will depend on well-designed clinical trials, real-world data integration, standardized methodologies, and interdisciplinary collaboration to determine whether these technologies can be safely and effectively integrated into routine clinical practice.

This review critically evaluates exercise-induced myokines as neuroprotective agents against Alzheimer’s disease (AD) and is structured around three thematic sections: (1) mechanistic foundations of myokine neuroprotection, (2) translational barriers to therapeutic development, and (3) a strategic framework for future research. Epidemiological studies associate physical exercise with reduced AD risk (30–45%), yet mechanisms remain incompletely resolved. Preclinical studies demonstrate that exercise-induced myokines (Irisin, BDNF, Cathepsin B) modulate AD pathology by: (1) attenuating amyloid-beta (Aβ)/tau accumulation, (2) suppressing neuroinflammation, and (3) enhancing synaptic plasticity. However, human exercise interventions show conflicting results influenced by APOE genotype, age, and exercise modality. Associative human data suggest that Interleukin-6 (IL-6) exemplifies pleiotropy—affording neuroprotective effects in acute contexts but potentially detrimental effects in states of chronic inflammation. Therapeutic hurdles include blood-brain barrier (BBB) penetration, pleiotropic risks, and patient heterogeneity. Emerging concepts such as combinatorial approaches (nanocarriers, exercise mimetics) and biomarker-driven trials are proposed as hypothetical future strategies; however, these remain unvalidated and require substantial preclinical development before implemented in clinical care. This narrative review is structured around three thematic sections: mechanistic foundations of myokine neuroprotection, translational barriers to therapeutic development, and a strategic framework for future research. The muscle-brain axis represents a compelling but complex therapeutic target. Based on current preclinical and correlational human evidence, future research should prioritize mechanistic rigor, standardized biomarker validation, and clinically viable delivery strategies. Notably, several approaches discussed herein—including nanocarrier delivery systems, exercise mimetics, and combinatorial myokine cocktails—remain speculative and are presented as future research directions rather than established therapeutic interventions.

Background: Lifestyle interventions incorporating medically-tailored meal delivery may support rapid behavior change among pregnant individuals with gestational diabetes (GDM). Purpose: To examine the feasibility and acceptability of a multicomponent lifestyle intervention for pregnant individuals with GDM. Primary outcomes included recruitment, retention, intervention receipt, and acceptability. Methods: We conducted a pilot randomized feasibility trial among pregnant individuals with GDM recruited from maternal fetal medicine clinics in the Hartford, Connecticut area. Participants were randomized to usual GDM care or the Meals4Moms intervention plus usual care. The intervention included medically-tailored meal delivery, personalized physical activity support, and multimodal education with digital tools. Participants completed a survey and three 24-hour dietary recalls at baseline and post-intervention. Meals4Moms participants also completed a semi-structured interview at follow-up. Intervention receipt was tracked by study staff. Results: Of 30 individuals approached, we screened 80% (n=24), of whom 75% (n=18/24) were eligible; we randomized 8 participants. Seventy-five percent (n=6/8) completed at least one component of the follow-up assessment (100%, n=4/4 Meals4Moms, 50%, n=2/4 Usual Care). One participant spent ≥80% of her total food budget (n=1/4, 25%), and no participants completed ≥80% of prescribed exercise sessions (range: 0-50%). All (n=4) Meals4Moms participants reported they would be very likely to participate in the program if they had GDM again, and 100% (n=4) would be very likely to recommend the program to a friend with GDM. Conclusions: While the Meals4Moms intervention was highly acceptable to participants, procedural refinements are needed prior to conducting a full-scale efficacy trial.

This study aimed to perform a bibliometric review to map scientific advances and research trends related to post-exercise hypotension (PEH), a transient blood pressure reduction following physical exercise, increasingly recognized as a non-pharmacological strategy for hypertension management. A comprehensive search was conducted on Scopusdatabase to identify publications on PEH from 1985 to 2024. Metadata from 440 selected articles were analyzed using VOSviewer™ and Gephi™ software to construct keyword co-occurrence networks and identify emerging research topics, influential authors, and leading institutions. Bibliometric analysis revealed an increasing trend in PEH publications over the past decade, with Brazil and the United States leading in research output. High-intensity interval training, isometric resistance exercise and nutritional interventions emerged as key topics. Findings emphasized exercise intensity, recovery posture, and dietary strategies modulate PEH magnitude and duration. Complex autonomic and vascular factors were consistently implicated as physiological mechanisms of PEH, supporting the importance of individualized exercise prescriptions. This review highlights the growing clinical and scientific importance of PEH research. Notable gaps include the need for standardized assessment methodologies, greater biomarker utilization, and further evaluation of multimodal exercise–nutrition strategies to improve clinical translation. Future studies should expand PEH research in clinically high-risk and underrepresented groups (e.g., older adults and individuals with cardiometabolic or renal comorbidities), using harmonized protocols to enhance comparability and applicability.