Eleni Karagianni

Background: Inter-arm blood pressure difference (IAD) ≥ 10 mmHg is an established marker of cardiovascular risk in adults; however, evidence in paediatric populations remains limited. Handgrip strength (HGS) is increasingly recognized as a simple and reliable indicator of neuromuscular fitness and cardiometabolic health during growth and development. Objectives: We aimed to investigate the association between IAD and HGS in children and adolescent athletes and to explore the influence of anthropometric characteristics. Methods: Forty-one non-professional athletes aged 6–16 years participated in this cross-sectional study. Anthropometric characteristics, bilateral resting BP, and bilateral HGS were assessed using standardized protocols. Inter-arm differences in systolic and diastolic BP were calculated. Results: An inter-arm systolic BP difference ≥ 10 mmHg was observed in 12.2% of participants. Dominant-arm systolic BP and HGS were significantly higher compared with the non-dominant side (p < 0.05). HGS showed a positive association with systolic BP, particularly in boys, whereas weaker associations were observed with diastolic BP. In regression analysis, BMI emerged as a significant predictor of systolic blood pressure. Conclusions: In young athletes, dominant-arm superiority in both muscular strength and systolic BP was evident. Bilateral BP assessment combined with HGS measurement may provide information during cardiovascular evaluation paediatric athletic populations.

Objective: The objective of this study is to conduct a systematic review of the evidence on the use of remotely administered walking tests (RaWTs) in patients with chronic pulmonary diseases (CPDs) and heart failure (HF), focusing on agreement, reliability, feasibility, and clinical utility as outcomes. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and was registered on the International Prospective Register of Systematic Reviews platform (ID: CRD420251180996). The PubMed, Web of Science, CENTRAL, Scopus, and ACM databases were comprehensively searched from inception up to October 2025. Observational, randomized and non-randomized control studies assessing the agreement, reliability, feasibility, and clinical utility of RaWTs in people with CPDs and HF and reporting quantitative outcomes were eligible. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the COSMIN Risk of Bias tool for the reliability studies, the Risk of Bias in Non-Randomized Studies—of Interventions (ROBINS-I) tool for non-randomized studies, and the Quality in Prognosis Studies (QUIPS) tool for the prognostic studies. Results: Eleven studies met the inclusion criteria. Five studies included patients with HF, five with pulmonary hypertension (PH), and one study included candidates for lung transplantation due to advanced CPD. All studies used the 6 min walk test (6MWT); one also included the incremental shuttle walk test. Agreement with face-to-face in-clinic testing (in five studies) is setting-dependent and influenced by the testing setup. Reliability (in eight studies), derived from variable statistical indices in both patient populations, showed that RaWTs are reliable. Adherence and safety were used as the main feasibility indicators. Eight studies concluded that remote assessment is feasible, acceptable, and safe. Clinical utility was examined in only one HF study, showing that remotely administered 6MWT can predict all-cause mortality and HF hospitalization. According to COSMIN, the overall methodological quality of nine studies ranged from very good to inadequate. One study was rated as having a serious risk of bias according to ROBINS-I, and one study as having a high risk of bias according to QUIPS. Conclusions: Although the evidence is limited and heterogeneous, RaWTs demonstrate robust reliability across repeated measurements while agreement with in-clinic testing is context-dependent and strongly influenced by test setup and environmental conditions. RaWTs appear to be acceptable to patients; however, further high-quality studies are needed to confirm these findings and determine the clinical utility of RaWTs on specific clinical outcomes in these populations.

Background/Objectives: Muscle strength is a vital indicator of the development and health-related fitness in children and adolescents, and it also plays a crucial role in clinical assessments across pediatric rehabilitation. The aim of this review was to evaluate the available literature on handheld dynamometry (HHD) assessments of the overall muscle strength in the pediatric population, focusing on measurement protocols, validity and reliability, and the availability of reference and normative data. Methods: Following PRISMA 2020 guidelines, a systematic review was conducted across PubMed, Scopus, Cochrane CENTRAL, CINAHL, and Web of Science. The protocol was registered in PROSPERO (CRD42024537557). Eligible studies (2005–2023) included healthy participants under the age of 18 reporting on isometric muscle strength using HHDs. Studies reporting handgrip strength or alternative methods (e.g., isokinetic and 1RM) of assessment were excluded. Due to the heterogeneity of the studies, the JBI and COSMIN risk of bias checklists were used to assess risk of bias. A narrative synthesis approach was used to summarize the findings. Results: Twelve studies were included, with a total of 1683 participants aged 4–17 years (764 girls and 919 boys). Test re-test reliability and low measurement error were established in measuring the toe strength, while the concurrent validity of lower limb torque was determined as poor. Conclusions: When standardized protocols and fixed stabilization are implemented, studies confirm good intra- and inter-rater reliability. Substantial heterogeneity in measurement protocols highlights the need for standardized procedures. It is essential to establish normative or reference values by age and sex to enhance clinical decision making and the utility of HHDs in pediatric overall strength assessments.

Background: Reduced cardiorespiratory fitness along with poor exercise tolerance are regarded as potential morbidity and mortality predictors within the heart failure (HF) population. Despite the reliability and accuracy of the gold-standard cardiopulmonary exercise test (CPET) for assessing cardiorespiratory fitness, its complexity and tolerability issues among HF patients mean that the 6 min walk test (6MWT) is a cost-saving and well-tolerated complementary assessment. We aimed to systematically review the validity, reliability, and safety of the 6MWT compared to CPET for patients with HF. Methods: This study is a systematic review and meta-analysis. Embase, Medline, and Scopus were searched from inception to November 2023. We applied Fisher’s z-transformation to correlation coefficients and pooled effects under a random-effects model; heterogeneity (I²), leave-one-out sensitivity, and Egger’s test were reported. Results: Twenty studies were finally included, involving 5379 HF participants. A significant moderately strong positive correlation was shown between the 6MWT distance and CPET peak oxygen consumption: (r) = 0.62, 95% CI 0.58–0.66; I² = 56.95%; p < 0.001. The results showed an excellent test–retest reliability, with a pooled intraclass correlation coefficient of 0.93 (95% CI 0.89–0.95; I² = 92.06%; p < 0.001). A pooled weighted mean difference of 15.5 m (95% CI 10.2–20.8) was found for the learning effect between the first and second 6MWT. Although some patients required rest stops or reported symptoms such as fatigue or dyspnea, no 6MWTs were terminated due to serious adverse events. Conclusions: Compared with CPET, the 6MWT distance demonstrated a moderately strong correlation with peak VO₂, excellent test–retest reliability, and a small learning effect. The 6MWT can therefore complement CPET or serve as a pragmatic alternative when CPET is not feasible; it does not replace comprehensive CPET assessment.

Article: Modeling the associations of cardiorespiratory fitness with the cardiometabolic profile and sedentary behavior in school-aged nonprofessional athletes - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2025 March;184(3):183-91 - Minerva Medica - Journals

(1) Background: Dynamic knee valgus (DKV) is a common biomechanical risk factor for knee injuries, particularly in sports involving high-intensity movements, such as basketball. While neuromuscular control and structural alignment contribute to DKV, recent evidence indicates that lower limb muscle power (LLMP) and cardiorespiratory fitness (CRF) may significantly influence DKV. This study aims to examine the relationship among LLMP, CRF, and DKV in adolescent basketball athletes. (2) Methods: A total of 104 adolescent basketball athletes (63.5% boys), 12 to 17 years old (13.87 ± 1.46 years) participated in this study. Anthropometric and demographic characteristics such as sex, age, height, weight, and body mass index (BMI) were recorded. The Counter Movement Jump (CMJ) was used for the evaluation and prediction of the LLMP, the 20 m shuttle run test (20mSRT) was used for the evaluation and prediction of CRF, and the single-leg drop jump (SLDJ) was used for the evaluation of DKV via a two-dimensional (2D) kinematic analysis. Statistical analysis included Pearson and Spearman correlations, as well as multiple linear regression, to determine the relationship among LLMP, CRF, and DKV. (3) Results: A statistical analysis revealed strong correlations among LLMP, CRF, and DKV. Pearson’s correlation coefficients demonstrated significant associations between the VO₂max and frontal plane projection angle (FPPA) (r = 0.78, p < 0.001), as well as between LLMP and FPPA (r = 0.82, p < 0.001). Multiple linear regression analysis showed that VO₂max and LLMP together accounted for 85% of the variance in FPPA (R² = 0.85, p < 0.001). (4) Conclusions: The findings highlight that both aerobic capacity and lower limb muscle power significantly contribute to knee valgus control among adolescent basketball players. Implementing training programs focused on improving lower limb muscle power and cardiorespiratory fitness may enhance knee stability and reduce the risk of lower limb injuries. Given the strong predictive value of VO₂max and LLMP for knee control, targeted training programs focusing on neuromuscular conditioning and aerobic capacity may be effective for injury prevention.

Obesity in adolescents combined with the increased exposure time to electronic devices, enhances a sedentary lifestyle and is linked to the risk of developing musculoskeletal injuries. The aim of this study was to identify possible correlations between anthropometric characteristics, body composition, exposure time to electronic devices or screen time (ST) and physical activity (PA) level along with muscle power and dynamic knee valgus (DKV) in young athletes to avoid future injuries. A total of 125 adolescent basketball athletes (66.4% boys), 12 to 17 years old (13.94±1.58 years) participated. Anthropometric and demographic characteristics were recorded. PA level was assessed through IPAQ and ST through a single question from the HELENA study. The Counter Movement Jump test was used for the evaluation of the lower limb muscle power, while the Single Leg Drop Jump test was used for the evaluation of the dynamic knee valgus via two-dimensional (2D) kinematic analysis. The Pearson index showed a statistically significant positive correlation between muscle power and height (r=0.788, p<0.001), while the Spearman index showed a smaller but equally statistically significant positive correlation with BMI (rs =0.651, p<0.001) and age (rs=0.579, p<0.001). The ST (rs= -0.194, p=0.03) showed a weak negative correlation with DKV, while PA (r=0.85, p<0.001) showed a high, statistically significant, positive correlation. The anthropometric characteristics of adolescent athletes can determine their ability to produce muscle power. A high level of physical activity could play a key role in compensating and thus reducing the negative effects of high exposure to screen time on the dynamic knee valgus