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Background Despite growing scientific evidence and health guidelines, the global health paradox persists, with rising lifestyle-related diseases and escalating healthcare costs exposing the inadequacy of current efforts. Objective Three multidisciplinary congresses were held to generate evidence-based conclusions aimed at addressing the global health paradox. Methods A total of 58 experts from 62 entities participated in the international research and knowledge-exchange panels. Experts reviewed the latest findings to develop practical strategies and identify key research and policy priorities, focusing on the Healthy Eating & Active Living (HEAL) approach. Results, conclusion, and relevance The expert consortium endorsed a 33 evidence-based consensual-statement policy roadmap for addressing global health challenges, emphasizing that the HEAL approach can significantly contribute to the “Prevention First” appeal and broad ethical, social, ecological, and economic advantages, and ultimately supporting policy change.

Background: We aimed to (i) identify the factors associated with performance in non-elite runners, (ii) present the terms and definitions/attributes used to characterize runners, and (iii) identify how performance has been operationalized. Methods: Our search was conducted using the databases PubMed, Web of Science, Medline Ovid, Cochrane, PsycInfo, Scielo, Scopus, and SportDiscus in October 2023 and updated in February 2026. Original articles that assessed factors associated with performance in non-elite runners competing in distances ranging from 5 km to ultramarathons were included. The findings were summarized by race distance. The Joanna Briggs Institute Analytical Cross-Sectional Studies critical appraisal tool was used for quality assessment. Results: A total of 4151 studies were identified, and 66 studies were included in the final selection. “Recreational” and “athletes” were the most used terms, and finish time was the most common indicator of performance. Performance decline was influenced by arm circumference and mid-axillary skinfold thickness, smoking, body mass index, alcohol consumption, and weather characteristics. Training variables, physiological determinants, and social variables were positively related to performance. Conclusions: The field struggles with a lack of clarity regarding the nomenclature and criteria used to categorize runners. The relevance of a predictor differs according to race distance, with physiological aspects becoming less important at higher distances (i.e., marathon and ultramarathon).

Pacing in multi-day long-distance triathlons has been investigated mainly in male athletes. We analyze physiological aspects such as energy expenditure and heart rate changes as well as biomechanical aspects in swimming (e.g. strokes per lane) and running (e.g. stride frequency, stride length, vertical ratio, vertical movement, ground contact time) in the first and only female triathlete to finish 30 IRONMAN®-distance triathlons in 30 days. The split times, lap times for swimming, cycling and running and variables were recorded with Fenix 7 Sapphire Solar with Normalized Power® (NP®), Intensity Factor® (IF®) and Training Stress Score® (TSS®), and were analyzed. The models' estimations for pacing were assessed with R2. Variance (ANOVA) and associative (Pearson and Spearmen) analysis were conducted at a level of significance of 5 %. Swimming pace remained stable throughout the race (linear p = 0.473), cycling pace demonstrated a significant slowdown (third-order polynomial p < 0.001), and running pace significantly improved (third-order polynomial p < 0.001). Energy expenditure slightly decreased in swimming (p = 0.099) and progressively increased for both cycling (p = 0.034) and running (p = 0.044). Moderate-intensity swimming time initially increased and later decreased, with an opposite trend for high-intensity swimming time. Cycling times at both moderate and high intensities slightly decreased. Running showed decreasing moderate-intensity time and increasing high-intensity time, consistent with improved pace. Transition times increased over the race period, with T1 increasing more prominently. Biomechanical parameters in swimming, including total stroke count and SWOLF index, showed increasing trends. Overall, significant differences were observed in running time at moderate intensity (p < 0.001, η2 = 0.513), high intensity (p < 0.001, η2 = 0.518) and average pace (p < 0.001, η2 = 0.603). The athlete spent significantly more time at moderate intensity (p = 0.019 and p = 0.002) and significantly less time at high intensity (p = 0.011 and p = 0.005) running in the initial phase, compared to the middle and final stages of the race. All biomechanical variables decreased slightly in the opening phase of the race but then increased in the middle and final stages of the race. Overall, the results highlight that running was the discipline most affected by physiological and pacing adaptations throughout the race; while cycling and swimming parameters demonstrated weaker or no consistent associations.

BackgroundUltra-marathon running popularity is increasing, with the 6-h run being the shortest time-limited ultra-marathon. Since very little is known regarding the country from which the fastest 6-h runners originate, the fastest age group, and where the fastest 6-h race courses are located, this study aims to close this gap.MethodsA machine learning model based on the XG Boost algorithm was built to predict running speed based on the athletés age, gender, country of origin, and the country where the race takes place. Model explainability tools were used to investigate how each independent variable would influence the predicted running speed. To assess the impact of individual performance against the other variables under study, a Mixed Effects Linear Model was also built.ResultsA total of 117,882 race records from 51,018 unique runners from 65 countries participating in races held in 56 different countries were analyzed. Participation is spread across a wide range of countries, with a high correlation between the country of origin and the country of the event. Most runners originated from Germany, Italy, France, the USA, and Sweden, with Europe (Belgium, Russia, Spain, Poland, Romania, and Lithuania), being the fastest. Most athletes competed in Italy, Germany, France, the USA, and The Netherlands. The fastest average running speeds were also achieved in European countries (Russia, Belgium, Poland, Netherlands, Romania, Croatia, and Lithuania).ConclusionsFor athletes competing in a 6-h ultramarathon, gender was the most important predictor, followed by the origin of the athlete, the age, and the race location. The 6-h running event seems to be dominated by European athletes regarding both participation and performance.

Pacing in ultra-triathlon has been investigated by analyzing lap times from Double to Deca Iron ultra-triathlon for World Cup races but not for a World Championship. The present study aimed to investigate pacing in ultra-triathletes competing in the fastest and largest World Championship in Quintuple Iron ultra-triathlon ever held in history. A total of 11 female and 24 male finishers who completed the 2024 Quintuple Ultra Triathlon World Championship in Colmar, France, were analyzed. Independent t-tests assessed sex-based performance variations with effect sizes (Cohen's d). A two-way ANOVA evaluated the effects of sex and performance quartiles on cycling and running, with eta squared (η²) used to measure effect sizes. Overall, men were slower in swimming and cycling and faster in running and overall race time. The variability in lap times was similar in cycling for both women and men but higher in running for women. There was a significant interaction between sex and performance quartiles in cycling but not running. For cycling, the variability in performance was higher in men compared to women; for running, it was similar for both women and men. The finding that women outperformed men in swimming and cycling, likely due to the elite nature of the World Championship, which featured a highly selected and committed female cohort with a high completion rate. While both sexes showed consistent pacing in cycling, women exhibited greater variability in running, possibly due to more frequent breaks.

Ciprofloxacin is among the most commonly prescribed Fluoroquinolones. Side effects of Fluoroquinolones include tendinopathies, ar-rhythmias, gastrointestinal discomfort, and neurological symptoms. The definition of a "Fluoroquinolone-associated disability" includes dis-ability, symptoms in several body systems and duration of symptoms after discontinuation of the antibiotic. The pathophysiology of this disease is probably due to a damage to the redox system. We report on a 41-year-old patient who felt pain in his Achilles tendons three days after starting to take ciprofloxacin (of a total of 3 g) and presented as an emergency. In the course of the disease, the pain became chronically disabling and the patient developed paresthesia of both extremities and intermittent heart palpitations. The only tolerated pain medication was Pregabalin. Several MRI examinations showed minimal peritendinitis and irritation of the Achilles tendons. Blood samples indicated probable intracellular damage at low intracellular ATP and coenzyme Q10 values.

This study aimed to assess the impact of physical education teachers' verbal encouragements on the psychophysiological aspects, physical enjoyment, and mood states of obese children (OC) in a physical education context. Sixteen OC students (mean age = 13.81 ± 0.73 years) from a preparatory school participated in two test sessions, conducted in a randomized order. Each session involved a series of passing games (games of 10 successive passes) with and without verbal encouragement, with a one-week interval between sessions. The games, formatted as 3 vs. 3 with two additional obese joker' players, lasted 18 minutes. Each game comprised four 3-minute active periods interspersed with 2-minute passive recovery bouts, played on a 10 × 20-m pitch. Heart rate was continuously measured throughout each session. Additionally, the Brunel Mood Scale (BMS) was assessed before and after the PG. Furthermore, rating of perceived exertion (OMNI-RPE) and physical activity enjoyment (PACES) were assessed after the testing sessions. Video analysis was used to quantify technical actions during PG. PGs with VE induced higher HR (% maximum HR and mean HR), OMNI-RPE, and PACES scores than PGs without VE (ES=-1.51, ES=-0.78, ES=-0.73, ES=2.07, respectively). Compared with PGs without VE, SSGs with VE resulted in an increased percentage of successful passes, number of Goal (10 passes) and fewer lost balls (ES=O.70, ES=-0.54, ES=-0.86, respectively). The PGVE trial also showed higher vigor and lower total mood disturbance (TMD) compared to the PGNVE trial (ES = -1.11, d = 0.78, respectively). Physical education teachers are encouraged to incorporate joker exercises with verbal encouragement to enhance game intensity, mood state, physical enjoyment and technical performance during games among OCs.

BackgroundUnderstanding university students’ health-related quality of life (HRQoL) can help propose strategies that support targeted care for this population and identify issues affecting these individuals. Therefore, it is necessary to identify the commonly used instruments and possible study designs for the university population, enabling the standardization of interventions and instruments to evaluate the HRQoL of university students. We aim to conduct a scoping review to identify the main measurement instruments and key characteristics in studies using HRQoL measures among university students. It is also aimed at identifying the foundations for guiding future research priorities.MethodsThis review will consider original peer-reviewed articles that used any generic HRQoL measurement instruments exclusively used with university students aged 18–59. Validation, qualitative, language translation, or adaptation studies will be excluded. This review will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The research will be conducted in five electronic databases (PubMed, Embase, Web of Science, Scopus, and SPORTDiscus). Two reviewers will independently screen records using predefined eligibility criteria and extract data using tables. The extracted data will include specific details about the title, authors, year of publication, HRQoL instrument utilized, participants, intervention design, and critical findings. The results will be presented in a narrative summary with data displayed in tabular and diagrammatic formats.DiscussionThis proposed scoping review aims to provide a comprehensive overview of the existing methods for assessing health-related quality of life in university students. The results will help identify gaps in the literature and establish a foundation for guiding future research priorities.Scoping review registrationRegistration with Open Science Framework can be found under registration number https://doi.org/10.17605/OSF.IO/FY9GU.

The sex difference in athletic performance has been thoroughly investigated in single sport disciplines such as swimming, cycling, and running. In contrast, only small samples of long-distance triathlons, such as the IRONMAN® triathlon, have been investigated so far. The aim of the study was to examine potential sex differences in the three split disciplines by age groups in 5-year intervals in a very large data set of IRONMAN® age group triathletes. Data from 687,696 (553,608 men and 134,088 women) IRONMAN® age group triathletes (in 5-year intervals from 18-24 to 75+ years) finishing successfully between 2002 and 2022 an official IRONMAN® race worldwide were analyzed. The differences in performance between women and men were determined for each split discipline and for the overall race distance. Most finishers were in the age group 40-44 years. The fastest women were in the age group 25-29 years, and the fastest men were in the age group 30-34 years. For all split disciplines and overall race time, men were always faster than women in all groups. The performance difference between the sexes was more pronounced in cycling compared to swimming and running. From the age group 35-39 years until 60-64 years, the sex differences were nearly identical in swimming and running. For both women and men, the smallest sex difference was least significant in age group 18-24 years for all split disciplines and increased in a U-shaped manner until age group 70-74 years. For age groups 75 years and older, the sex difference decreased in swimming and cycling but increased in running. Considering the different characteristics of the race courses, the smallest performance gaps between men and women were found in river swimming, flat surface cycling and rolling running courses. The sex difference in the IRONMAN® triathlon was least significant in age group 18-24 years for all split disciplines and increased in a U-shaped manner until age group 70-74 years. For 75 years and older, the sex difference decreased in swimming and cycling but increased in running.