Impact of multicomponent physical exercise and high-intensity interval training on osteoporosis in postmenopausal women: protocol for a systematic review and network meta-analysis of randomized controlled trials António Miguel Monteiro, André Schneider, Samuel Encarnação, Pedro Forte, Tiago Barbosa, Daniel Pecos Martín Systematic Reviews, 2026 BACKGROUND: Osteoporosis is a progressive degenerative bone condition leading to increased fracture risk. Therefore, osteoporosis acknowledges around 200 million cases, with about 70% of the cases occurring in postmenopausal women. Medicaments are often suggested to treat osteoporotic conditions, but physical exercise also plays an essential role. The current literature highlights multicomponent training (MCT) and high-intensity and high-impact exercises as physical exercise interventions that positively affect postmenopausal women's bone health. Furthermore, there is prior evidence of systematic reviews about the positive effects of both methods on the bone health of this population. Despite this prior evidence, no systematic reviews with metanalytic methods compare the effectiveness of the two interventions. METHODS: and analysis. The study will follow the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number (CRD42024604930). This systematic review and meta-analysis will include only randomized controlled clinical trials (RCTs), which have verified the effects of one or both physical exercise methods on postmenopausal women's bone mineral density (BMD). The systematic search will be implemented at eight electronic databases, namely PubMed/MEDLINE, Web of Science (WoS), EBSCO, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, CINAHL, and SPORTDiscus, which will be used to retrieve the data of interest. The RCTs' risk of bias (RoB) will be assessed with the RoB 2 Cochrane tool, and between-study heterogeneity will be checked through the analysis of Half-Cauchy distribution. Additionally, a network meta-analysis will be applied to compare the between-studies dose-response on the patients' bone health. The final database search was completed on January 18, 2025. DISCUSSION: In this study, we hope to find consistent results about the effects of MCT and HIIT in postmenopausal women with osteoporosis. Therefore, we also expect to observe between-intervention effects after the network meta-analysis approaches. A Bayesian network meta-analysis will be conducted using Markov Chain Monte Carlo simulations. Exercise dose will be modeled in METs-min/week to explore dose-response relationships. The deviance information criterion (DIC) will be used to compare model fit. Confidence in the results will be evaluated using the CINeMA framework. This way, this study will significantly impact this field of knowledge. ETHICS AND DISSEMINATION: The design of this review protocol did not involve patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024604930.
Adherence to the Mediterranean Diet and Metabolic Health in Older Adults: Insights from a Feasibility Study Sara Brás Alves, Leandro Moreira de Sá, Carla Agradém, Eugénia Mendes, António Miguel Monteiro, Adília Fernandes, Hélder Fernandes, Josiana Vaz, Ana Pereira Journal of Ageing and Longevity, 2026 Introduction: The Mediterranean Diet is known for its protective effects against cardiovascular and metabolic diseases. Metabolic syndrome, characterized by multiple health risk factors, is increasingly concerning in older populations. Understanding dietary impacts on metabolic health is key for promoting healthy ageing. Objectives: This feasibility study aimed to explore the relationship between adherence to the Mediterranean Diet and metabolic risk factors in older adults participating in a community exercise program and to evaluate the feasibility of applying validated tools in this setting. Methods: A cross-sectional design was used. Adherence to the Mediterranean Diet was evaluated using the PREDIMED questionnaire, while Metabolic Syndrome was evaluated according to National Cholesterol Education Program criteria. Blood samples were taken following WHO guidelines. Results: Ten participants (mean age 73.1 years; 90% women) were included. 50% showed high adherence to the Mediterranean Diet, while 40% had moderate or low adherence. No participants met the full criteria for Metabolic Syndrome. Significant associations were found between Mediterranean Diet adherence and chronic disease (r = 0.869, p < 0.01), and an inverse correlation with the number of Metabolic Syndrome criteria (r = –0.707, p < 0.05). The Mediterranean Diet score was also inversely related to cholesterol (r = –0.740, p < 0.05). Conclusions: Higher adherence to the Mediterranean Diet was associated with better metabolic profiles, highlighting its potential protective role. The study demonstrates the feasibility of incorporating nutritional screening in community exercise programs for older adults. Future research should include larger and longitudinal samples and integrate inflammatory biomarkers.
Short-Term 8-Foot up and Go Responsiveness in Institutionalized vs. Community-Dwelling Older Adults Filipe Rodrigues, Diogo Monteiro, Pedro Forte, António Miguel Monteiro Sports, 2026 This study aimed to examine the combined effects of Body Mass Index (BMI) and living setting on fall risk trajectories in older adults over a 16-week period. A total of 124 older adults were recruited from nursing homes (n = 65; Mage: 84.4 ± 7.7 years) and community settings (n = 59; Mage: 70.3 ± 3.6 years). Participants were stratified by BMI (normal weight, overweight, and obesity) and assessed for functional mobility using the 8-foot Timed Up and Go test at baseline and after 16 weeks. A 3 × 2 × 2 repeated-measures GLM using the multivariate approach (Pillai’s Trace) revealed significant main effects for time (p < 0.001) and Living Setting (p < 0.001), but not for BMI (p = 0.408). A significant time × living setting interaction (p < 0.001) indicated that institutionalized older adults demonstrated a significant reduction in 8-foot Up-and-Go completion time (~16%), whereas community-dwelling peers maintained their baseline levels. These findings suggest that the observed reduction in time reflects a test familiarization effect rather than physiological improvement. Analysis revealed that the living setting profile was strongly associated with performance, showing a more significant link to functional decline than BMI-defined weight status, as no significant differences were found across BMI categories.
Interactions Between BMI and Age on Fall Risk in Older Adults Filipe Rodrigues, Diogo Monteiro, António Miguel Monteiro, Pedro Forte Epidemiologia, 2026 Background/Objectives: The aging process is typically marked by a reduction in functional fitness, which heightens the likelihood of falling. Although obesity is established as a determinant of poor mobility, the interplay between excess weight and advanced age is still a topic of research interest. Therefore, this research investigated how age, sex, and Body Mass Index (BMI) interact to influence fall risk among older adults living in the community. Methods: This cross-sectional investigation involved 815 participants (Mage = 70.45 ± 6.10 years), stratified by age (sexagenarians, septuagenarians, octogenarians) and BMI (normal weight, overweight, obesity). Fall risk was assessed using the Timed Up and Go test. A Three-Way ANOVA examined the main and interaction effects. Results: No significant three-way interaction (p = 0.334) or main effect of sex (p = 0.079) was found. However, a significant age x BMI interaction was observed (p = 0.007). In sexagenarians and septuagenarians, obesity was associated with significantly slower fall risk performance compared to normal weight (p < 0.001). Conversely, in octogenarians, this difference was not significant (p = 1.000) with normal-weight individuals. Conclusions: Obesity may be a significant risk factor for falls, especially in adults aged 60 to 79 years. In octogenarians, the protective benefit of normal weight disappears, revealing a “weight paradox” likely driven by sarcopenia. Fall risk assessments and weight management strategies should be tailored to age, focusing on preserving muscle mass in octogenarians.
The Impact of Knee Braces on Plantar Pressure Distribution in Elderly Individuals: Implications for Fall Risk Prevention José Lumini, Andrea Ribeiro, André Schneider, António M. Monteiro, João Sousa Sports, 2026 (1) Background: Falls are a major public health concern in older adults, largely due to age-related declines in proprioception and postural control. Although knee braces are commonly prescribed to enhance joint stability and sensory feedback, their effects on plantar pressure distribution remain unclear; (2) Methods: Thirteen community-dwelling older adults (mean age: 79.6 ± 3.2 years) participated in a repeated-measures study under three conditions: no brace, knee brace A, and knee brace B. Plantar pressure variables were assessed barefoot during quiet standing using a baropodometric platform. Conditions were compared using non-parametric Friedman tests; (3) Results: Significant differences were observed for left foot total surface area (p = 0.041) and left rearfoot surface area (p = 0.020). Compared with no brace, brace A increased plantar contact area, whereas brace B reduced it. No significant differences were found for pressure magnitude, load distribution, or right foot variables; (4) Conclusions: Knee braces induce subtle, brace-specific and lateralized changes in plantar pressure distribution, potentially reflecting altered postural control strategies. Although limited to specific variables, these effects may be clinically relevant for fall risk assessment and individualized knee brace prescription in older adults.
Associations Between Quality of Life, Functional Fitness, Body Composition, and Accelerometer-Measured Physical Activity in Postmenopausal Women: A Cross-Sectional Study André Schneider, Flavio Teresinho Mendonça, Letícia Amaral, Tiago M. Barbosa, Pedro Forte, José E. Teixeira, António M. Monteiro Sports, 2026 Introduction: Postmenopausal aging is accompanied by declines in functional fitness, changes in body composition, and increased osteoporosis risk, which may affect quality of life. Understanding how these factors interrelate is important for supporting healthy aging. Objective: To examine the associations between accelerometer-measured physical activity, functional fitness, DEXA-derived body composition and bone parameters, and quality of life in postmenopausal women. Methods: Forty community-dwelling postmenopausal women (68.7 ± 5.7 years) participated in this cross-sectional study. Physical activity was assessed using a wrist-worn accelerometer for seven days. Body composition and bone health were measured by DEXA, functional fitness by the Senior Fitness Test, and quality of life by the WHOQOL-BREF. Spearman correlations were applied. Results: Associations were predominantly weak to moderate. Higher-intensity physical activity showed the strongest association with the Physical Health domain of quality of life (ρ ≈ 0.29). Total bone mineral density was also positively associated with perceived physical health (ρ ≈ 0.36). Adiposity was inversely related to light and lifestyle activity. Conclusion: Physical activity, functional fitness, body composition, and perceived physical health co-occur in postmenopausal women, supporting the relevance of promoting active lifestyles in this population.
MCT-HIIT improves physical fitness, body composition, and quality of life in postmenopausal women with osteoporosis António M. Monteiro, André Schneider, Samuel G. Encarnação, José E. Teixeira, Pedro Forte, Tiago M. Barbosa, Daniel Pecos-Martín Journal of Orthopaedic Reports, 2026 Introduction Osteoporosis is common among postmenopausal women and is associated with reduced physical function, lower quality of life (QoL), and increased fracture risk. Multicomponent training (MCT) and high-intensity interval training (HIIT) are potential strategies to counter these effects. Objective To examine the effects of an 8-month MCT combined with HIIT on physical fitness, body composition, bone health, and QoL in postmenopausal women with osteoporosis. Methods Forty women aged ≥65 years participated. Functional fitness was assessed using the Senior Fitness Test battery. Body composition and bone parameters were measured using dual-energy X-ray absorptiometry (DEXA), and QoL was evaluated with the WHOQOL-BREF. Pre–post differences were analyzed using Brunner–Langer nonparametric models, and individual responsiveness was evaluated using cut-off criteria based on control group variability. Results Significant improvements were found in flexibility (p = 0.032) and aerobic endurance (p = 0.014), along with a small reduction in BMI (p = 0.048). No significant changes were observed in fat mass, lean mass, or bone mineral density. QoL outcomes showed heterogeneous responses, with improvements in social and environmental domains among some participants. Responder analysis indicated that 25–45% of participants responded positively in functional fitness and selected QoL outcomes, while responsiveness for bone and body composition variables was minimal. Conclusion An 8-month MCT + HIIT programme improved functional fitness and certain QoL dimensions in postmenopausal women with osteoporosis but did not alter bone density or body composition. Programmes including higher mechanical loads, impact-based exercises, or individualized progression may be required to elicit osteogenic and compositional adaptations in this population. Trial registration ClinicalTrials.gov Identifier: NCT06843486, registered on February 5, 2025. URL: https://clinicaltrials.gov/study/NCT06843486
Machine learning prediction of adolescent obesity using physical fitness data Tatiana Sampaio, Samuel Encarnação, Bruna Amaro, Joana Ribeiro, Luís Branquinho, António M. Monteiro, José E. Teixeira, Soukaina Hattabi, Andrew Sortwell, Luciano Bernardes Leite, Alexandra Malheiro, Pedro Rodrigues, Beat Knechtle, Pedro Flores, Pedro Forte Obesity Medicine, 2026
Impact of physical exercise interventions on functional fitness in older adults Cheng Chen, Cristiana Freire, Zhiyang Fu, Inês Teixeira, Matilde Adegas, Rafael Gomes, Ricardo Rabaçal, Sara Silva, Alexandra Malheiro, Luciano B. Leite, António Reis, António M. Monteiro, Jing Yang, Yao Xiaolin, Pedro Forte Frontiers in Medicine, 2026 Introduction Aging is associated with a progressive decline in functional fitness—the physiological capacity for performing everyday activities safely and independently—which compromises autonomy in older adults. Maintaining functional fitness is crucial for preserving independence and promoting healthy aging. This systematic review synthesized evidence from recent randomized and controlled clinical trials to evaluate the effects of physical exercise on functional fitness in people aged ≥65 years. Methods A systematic search was conducted in three major databases (MEDLINE, PMC, and PubMed Central Canada) using comprehensive sets of keywords and MeSH terms related to “older adults” and specific exercise modalities (e.g., endurance, strength, resistance training). The search included studies published between 2015 and 2024. After duplicate removal and application of eligibility criteria, 95 studies were included. A meta-analysis was not performed due to substantial methodological heterogeneity among the included studies. Results The synthesized evidence indicates that most exercise interventions improved functional fitness outcomes in older adults. Multicomponent programs, resistance training, and supervised protocols were particularly effective. Significant benefits were observed in muscular strength (e.g., ~20–40% improvement in 30-second chair stand test), mobility (e.g., ~1.0–2.5-second reduction in Timed Up and Go test time), balance, and gait speed (e.g., ~0.08–0.15 m/s increase). Positive effects on body composition, such as increased lean mass, were also reported. However, effects on cognitive function were inconsistent. Interventions lasting more than 12 weeks and demonstrating high adherence were associated with more favorable outcomes. Discussion Structured, well-designed exercise programs tailored to the needs and capacities of older adults represent effective, non-pharmacological strategies to enhance functional independence and promote healthy aging. The observed improvements in muscular strength, mobility, balance, and gait speed underscore the value of regular physical activity in mitigating age-related functional decline. However, the heterogeneity of interventions and limitations in the quality appraisal of included studies should be considered when interpreting these findings. Future research should focus on standardizing intervention protocols and exploring long-term adherence and sustainability of exercise programs in older populations.
3D Analysis of the Initial and End Positions of an Active and Passive Prone Hip Extension Test and Its Correlation with Lower Limb Isokinetic Neuromuscular Function of College Students: A Pilot Study José Lumini, Benjamin Hedirian, Pedro Fonseca, Andrea Ribeiro, André Chenu Schneider, António M. Monteiro, João Paulo Vilas-Boas Applied Sciences Switzerland, 2025 Introduction: Manual therapists routinely evaluate changes in pain, movement, and function through clinical tests that support clinical reasoning. The Prone Hip Extension Test (PHET) is commonly used as a self-perturbation task to assess lumbopelvic control and hip motion patterns related to gait. Performing the PHET actively and passively may reveal how voluntary activation and passive structures influence joint kinematics and contribute to force production. This study aimed to compare active and passive PHET execution and investigate how initial (IP) and final hip positions (FP) correlate with lower-limb neuromuscular function. Methods: Seven healthy volunteers (24.3 ± 3.4 years; 173.1 ± 7.5 cm; 72.1 ± 9.5 kg) without musculoskeletal conditions participated. Hip kinematics were recorded using a 12-camera Qualisys Oqus system (200 Hz) with 22 reflective markers, processed in Qualisys Track Manager 2.13 and exported to Visual3D. Participants performed three PHET trials in both IP and FP, with mean an-gles considered for analysis. Knee isokinetic performance was assessed on a Biodex System 4 at 180°/s and 300°/s for flexion and extension. Results: Significant differences between active and passive PHET emerged in the FP for rotational movements bilaterally (p = 0.02) and in IP adduction/abduction for both hips (right p = 0.03; left p = 0.02). No side-to-side differences were observed. Passive FP of the right hip showed multiple significant correlations with isokinetic flexion and extension parameters at 180°/s and 300°/s, particularly with torque/body weight, acceleration and deceleration times, and agonist/antagonist ratios (ρ ranging from −0.86 to 0.90). Conclusions: Meaningful differences exist between active and passive PHET performance, especially in frontal-plane IP and rotational FP measures. Additionally, passive FP strongly correlates with several neuromuscular variables, suggesting that PHET kinematics may reflect lower-limb isokinetic function.
The Aging Curve: How Age Affects Physical Performance in Elite Football Luís Branquinho, Elias de França, Adriano Titton, Luís Fernando Leite de Barros, Pedro Campos, Felipe O. Marques, Igor Phillip dos Santos Glória, Erico Chagas Caperuto, Vinicius Barroso Hirota, José E. Teixeira, Pedro Forte, António M. Monteiro, Ricardo Ferraz, Ronaldo Vagner Thomatieli-Santos Journal of Functional Morphology and Kinesiology, 2025
The Influence of Abdominal Adiposity and Physical Fitness on Obesity Status of Portuguese Adolescents Samuel Gonçalves Almeida da Encarnação, Pedro Flores, David Magalhães, Gil Afonso, Albino Pereira, Rui Brito Fonseca, Joana Ribeiro, Sandra Silva-Santos, José Eduardo Teixeira, António Miguel Monteiro, Ricardo Ferraz, Luís Branquinho, Pedro Forte International Journal of Environmental Research and Public Health, 2022
