Yuri Russo

Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson’s. However, we understand little about lived experiences of FOG. The current study aimed to develop a new conceptual model designed to reflect the broad lived experience of FOG. In Phase 1 we carried out semi-structured interviews with 35 people with Parkinson’s and FOG. Participants described memorable freezes along with factors that they considered to influence, or be influenced by, FOG. We used inductive thematic analysis to identify themes that served as foundation for an initial conceptual model. Phase 2 was a 5-year long iterative process of Patient and Public Involvement and Engagement. Through discussion with over 250 people living with Parkinson’s, the conceptual model generated from Phase 1 was scrutinised and adapted to: i) provide additional context that supports the interpretation of findings from Phase 1 results; and ii) maximise the resonance of interpretations. Collectively, these processes highlighted the critical importance of one’s perceived sense of rhythm. Several themes describe ways in which perceived rhythm can be compromised either through requirements for adapting movement (Changers), distracting attention away from the intended movement (Distractors) or causing problems with gait initiation (Blockers). Other themes describe factors that promote the maintenance (Maintainers) or regeneration (Initiators) of rhythm to avoid FOG or break a freeze and start walking. Results also highlight the importance of Accumulated Experiences of FOG (e.g. altered perceptions of one’s sense of self and identity), and how these can amplify Rhythm Changers, Distractors and Blockers. Though Phase 2, a clear focus emerged on one’s perceived uncertainty about how planned movements will feel and associated shifts in attention towards vigilant monitoring and control of movements. We provide a detailed interpretation of study findings (relating to cognitive, emotional, sensory and motor processes) using a Predictive Processing Framework, followed by descriptions of practical implications for managing FOG and associated Accumulated Experiences.

Background/Objectives: Physical activity is a cornerstone of preventive health, yet its practice often coexists with the consumption of alcoholic beverages like beer and wine. While these beverages contain bioactive compounds with potential health properties, alcohol itself carries significant risks. This systematic review aimed to synthesize and critically assess the evidence on physical activity and beer and wine consumption. Specifically, we examined their combined effects on metabolic syndrome components (body composition, blood pressure, lipids, glucose metabolism); inflammation and oxidative stress markers; mental health outcomes (cognitive function, mood, sleep); and physical performance, neuromuscular recovery, and fluid balance. Methods: Following a pre-registered protocol (PROSPERO: CRD420261281945), a systematic search of PubMed/MEDLINE, Scopus, and SPORTDiscus was conducted for studies published between 2000 and 2025. Included studies were randomized controlled trials or observational studies involving physically active adults (aged ≥ 18 years) who consumed beer or wine. Studies focusing solely on sedentary populations were excluded. Outcomes assessed included metabolic syndrome components, inflammation, oxidative stress, mental health, cognitive function, and physical performance. Risk of bias was evaluated using Cochrane RoB 2 for RCTs and ROBINS-I for non-randomized studies. Results: Eight studies were included. Moderate beer or wine consumption did not substantially negate the beneficial effects of exercise on cardiometabolic health, body composition, or cognitive function. Higher alcohol intake was associated with elevated blood pressure. Acute post-exercise consumption of alcoholic beer impaired rehydration and neuromuscular recovery, whereas non-alcoholic beer did not. Conclusions: Given the small number of studies and risk of bias, these findings should be interpreted with caution. In physically active populations, moderate beer or wine consumption does not clearly undermine the benefits of regular exercise on metabolic syndrome components (body composition, blood pressure, lipids, glucose metabolism). No additional benefits on inflammation or oxidative stress were observed, nor on mental health outcomes (cognitive function, mood, or sleep). However, acute post-exercise alcohol intake impairs rehydration and neuromuscular recovery, whereas non-alcoholic beer represents a safer alternative.

Adaptive walking relies on proactive gaze behaviour to plan foot placement and maintain stability. This study examined how mental workload and task complexity affect gaze behaviour and gait biomechanics during a precision target-stepping task in healthy young adults. We also quantified the frequency of cross-stepping during the experimental task. Twenty-three participants (18–23 years) walked along an L-shaped pathway containing raised stepping targets under single-task (ST) and dual-task (DT) conditions. Targets had four different layouts to create high and low difficulty conditions. Eye movements were recorded using mobile eye-tracking, and gait kinematics were recorded via motion capture. Compared with ST, DT walking produced slower walking speeds, longer stance times, and reduced velocity between stepping targets, indicating a more inefficient gait strategy. In addition, eye-tracking analyses revealed fewer and shorter fixations on task-relevant targets and a greater number of fixations directed toward task-irrelevant areas and, saccadic amplitudes were reduced despite increased outside fixations, suggesting a breakdown in visual exploration between proximal and distal regions of the walkway. In ST conditions, cross-stepping was more frequent than in DT. These findings indicate that increased mental workload compromises proactive gaze behaviour, likely through working-memory and attentional limitations that disrupt feedforward gait planning. Contrary to expectation, cross-stepping occurred more often during ST than DT walking, suggesting that in this population cross-stepping may not be a maladaptive strategy. Overall, these results highlight the cognitive demands of adaptive walking even in young, low-risk individuals and underscore the importance of preserving visual–motor coordination under cognitive stress.

Background: Analgesics are widely used in competitive sports, but their patterns of use and detection in anti-doping controls vary significantly across drug classes. This study examined a decade of Italian anti-doping reports with three aims: to describe trends involving non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and narcotics; to characterize the distribution of specific active ingredients; and to analyze the relative contribution of these classes to anti-doping violations, placing the findings within the regulatory framework. Methods: Data from national anti-doping reporting systems were analyzed from 2013 to the first half of 2023. Yearly data included tested athletes, athlete declarations of NSAID use, and laboratory analytical findings for prohibited substances (glucocorticoids and narcotics). NSAID prevalence was calculated relative to tested athletes, while glucocorticoid and narcotic findings were assessed as absolute counts and proportions of total violations. Temporal trends were assessed using the Cochran–Armitage test. Results: NSAIDs consistently ranked as the most frequently reported medication, with nearly half of the tested athletes reporting their use and no significant linear trend in overall prevalence. However, a significant shift was observed within the NSAID class, with a marked decrease in declarations of COX-2 selective agents over time. Glucocorticoids accounted for a significant portion of prohibited substances, with fluctuating proportions (showing no significant linear trend), betamethasone being the most common active ingredient. Narcotics appeared only sporadically, although the use of non-prohibited opioids such as tramadol and codeine—absent from official reports—remains relevant for understanding analgesic practices. Conclusions: Analgesic use in Italian elite sports shows distinct patterns driven by therapeutic needs and anti-doping regulations. NSAIDs remain the primary choice for routine pain management, though the type of NSAID reported has shifted significantly. Glucocorticoids represent a notable share of prohibited findings with a fluctuating, rather than steadily increasing, pattern. Narcotics appear only sporadically in violation data. Ongoing monitoring will be crucial to understanding how evolving clinical practices and recent regulatory changes influence future detection trends and athlete health.

Anticipatory postural adjustments (APAs) are crucial for maintaining postural stability during voluntary movements such as gait initiation. While APAs have been extensively studied in forward stepping, little is known about their characteristics during turning initiation. This study aimed to identify the characteristics of (i) APAs and subsequent first steps during turning in older adults (OA) and (ii) compare them to people with Parkinson’s disease (pwP). Twenty-two pwP (tested on medication) and 17 OA performed self-paced 360˚ turns which were embedded in a complex walking task. APAs and first step characteristics were recorded using motion capture and force plate data. For pwP, APAs in turning (unloading phase) were found to be primarily mediolateral, and of significantly reduced amplitude (median = 2.5, 95% CI[0.0053; 0.0089]) in comparison to OA (median = 5.0, 95% CI[0.0073; 0.0181]). Unlike OA there was no significant association between APAs and step characteristics. These findings suggest that APAs during turning are significantly impaired in pwP, even when tested ON medication, and that this impairment may contribute to the turning difficulties often experienced by this population. Overall, these results have potential implications for clinical assessments and rehabilitation interventions, emphasising the need to tailor strategies to address turning challenges pwP face in their daily life.

Adaptive walking relies on proactive visual search to plan foot placement and maintain stability. This study examined how cognitive load and task complexity affect gaze behaviour and gait biomechanics during a precision target-stepping task in healthy young adults. We also quantified the frequency of cross-stepping during the experimental task. Twenty-three participants (18–23 years) walked along an L-shaped pathway containing raised stepping targets under single-task (ST) and dual-task (DT) conditions. Targets had four different layouts to create high and low difficulty conditions. Eye movements were recorded using mobile eye-tracking, and gait kinematics were captured via motion capture. Compared with ST, DT walking produced slower walking speeds, longer stance times, and reduced velocity between stepping targets, indicating a more inefficient gait strategy. Eye-tracking analyses revealed fewer and shorter fixations on task-relevant targets and a greater number of fixations directed toward task-irrelevant areas under DT conditions. In DT, saccadic amplitudes were reduced despite increased outside fixations, suggesting a breakdown in visual exploration between proximal and distal regions of the walkway. Cross-stepping was more frequent in ST conditions than in DT. These findings indicate that increased cognitive load compromises proactive visual search, likely through working-memory and attentional limitations that disrupt feedforward gait planning. Contrary to expectation, cross-stepping occurred more often during ST than DT walking, suggesting that in this population cross-stepping may not be a maladaptive strategy. Overall, these results highlight the cognitive demands of adaptive walking even in young, low-risk individuals and underscore the importance of preserving visual–motor coordination under cognitive stress. Highlights: Cognitive load during walking restricts proactive visual search and alters gait dynamics in healthy young adults. Dual-tasking led to slower walking speeds, longer stance times, and reduced step-to-step velocity. Eye-tracking showed fewer and shorter fixations on stepping targets, and more gaze directed toward task-irrelevant areas under dual tasking. Reduced proactive gaze under dual-task conditions likely reflects limitations of available cognitive resources rather than task-specific prioritisation. Findings highlight how cognitive demands compromise visual–motor coordination, supporting interventions that promote gait automaticity and reduce cognitive load. Cross-stepping was more frequent in ST than in DT conditions, suggesting that cross-stepping may not be maladaptive in healthy young people.

Objective: To assess the efficacy of anticipatory postural adjustments training on the ability to successfully step from freezing of gait, and to evaluate the contribution of attentional processes to potential benefits using an additional attentional-control training intervention. Design: Crossover-design. Subjects/Patients: Nineteen people with Parkinson’s and freezing (females: 10; age:75.5 ± 7.5 years) tested while ON medication. Methods: Participants navigated a cluttered virtual domestic environment with freeze-provoking tasks. Assessments occurred in the laboratory at baseline, post-anticipatory postural adjustments training, and post-attentional-control training, with randomized training order. All training was video-based. Video annotation was used to identify freezing events. Participants’ immediately recollected thoughts they had during the tasks were analysed with content analysis. Perceived safety and effectiveness of the strategies were reported in follow-up calls held 4 weeks post-assessment. Results: Successful step initiations increased from 57% at baseline to 77% post-anticipatory postural adjustments training (p = 0.034). Participants rated the interventions as safe and effective, reporting increased balance confidence (70% to 90%), and reduced fear (p = 0.01), after the anticipatory postural training. Attentional-control training alone was perceived as less effective compared with more goal-directed anticipatory postural adjustments training. Conclusion: Video-based anticipatory postural adjustments training significantly improved step initiation from freezing when used during challenging tasks and in complex environments. Anticipatory postural adjustments training shows promise as an effective “rescue strategy” that could be learned remotely/at home.

Lateral stepping is a motor task that is widely used in everyday life to modify the base of support, change direction, and avoid obstacles. Anticipatory Postural Adjustments (APAs) are often analyzed to describe postural preparation prior to forward stepping, however, little is known about lateral stepping. The aim of the study is to characterize APAs preceding lateral steps and to investigate how these are affected by footwear and lower limb preference. Twenty-two healthy young participants performed a lateral step using both their preferred and non-preferred leg in both barefoot and shod conditions. APA spatiotemporal parameters (size, duration, and speed) along both the anteroposterior and mediolateral axes were obtained through force plate data. APAs preceding lateral stepping showed typical patterns both along the anteroposterior and mediolateral axis. RM-ANOVA highlighted a significant effect of footwear only on medio-lateral APAs amplitude (p = 0.008) and velocity (p = 0.037). No differences were found for the limb preference. APAs in lateral stepping presented consistent features in the sagittal component, regardless of limb/shoe factors. Interestingly, the study observed that footwear induced an increase in the medio-lateral APAs size and velocity, highlighting the importance of including this factor when studying lateral stepping.