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Fitness in Portugal results from a set of historical intersections marked by various influences and personalities. To a large extent, knowledge of this path is essential to understanding the current reality and some of the problems the area faces. The present opinion intends to situate and summarise the leading influences of national and international events and some time frames that led to the development of the intervention area commonly called fitness. For this purpose, the work is structured in three parts: i) the beginnings of fitness, where some of the international influences that were at the origin of this area will be presented; ii) some of the main influences and factors that allowed the growth of fitness in Portugal; and iii) the effect of the historical trajectory of fitness in the current context and future considerations about the area. Given the scarcity of records on the subject, the present work, as an opinion article, will also be a self-report of the authors, who, having experienced different moments of this history, intend to leave a contribution to this record and for future reflections of its impact on the development of the area, professionals, and respective practices. O fitness em Portugal resulta de um conjunto de intersecções históricas marcadas por várias influências e personalidades. Em grande parte, o conhecimento desse percurso é essencial à compreensão da realidade atual e de alguns dos problemas que a área enfrenta. O presente estudo pretende, de forma breve, situar e sintetizar os principais acontecimentos e influências nacionais e internacionais, assim como alguns marcos temporais, que levaram ao desenvolvimento da área de intervenção comummente denominada de fitness. Para esse propósito, o trabalho encontra-se estruturado em três partes: i) os primórdios do fitness, onde se irá apresentar algumas das influências internacionais que estiveram na origem desta área; ii) as principais influências e fatores que permitiram o crescimento do fitness em Portugal; e iii) o efeito do percurso histórico do fitness no contextual atual e considerações futuras sobre a área. Dada a escassez de registos sobre o tema, o presente trabalho, na qualidade de artigo de opinião, será também um autorrelato dos autores, que, tendo vivenciado diferentes momentos desta história, pretendem deixar um contributo para esse registo e futuras reflexões sobre o seu impacto no desenvolvimento da área, profissionais e respetivas práticas.

Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude that the evidence provided does not justify the causal claims. We discuss how causes are conceptualised in modern epidemiology and highlight shortcomings in the current definitions and measurement of exposures (RHI) and outcomes (CTE). We address the Bradford Hill arguments that are used as evidence in the original review and conclude that assertions of causality having been established are premature. Members of the scientific community must be cautious of making causal claims until the proposed exposures and outcomes are well defined and consistently measured, and findings from appropriately designed studies have been published. Evaluating and reflecting on the quality of research is a crucial step in providing accurate evidence-based information to the public. Graphical abstract

A clearer understanding of, and tighter boundaries between, terms are important for researchers designing studies as well as for other sport stakeholders creating evidence-informed policies. This article considers the terms ‘athlete’, ‘talent’, and ‘player’ from psychological and sociocultural perspectives and in different sporting communities to highlight the importance of terminological clarity in sport research. We present considerations to clarify the use of these terms within different contexts and how the use of specific terms may affect knowledge mobilization in diverse sporting populations. A conceptual discussion is provided to help operationalize development-related terminology and its associated stages, to better reflect contemporary academic thought, and enhance practical interpretations. Importantly, we also call for greater transparency from researchers when presenting findings and encourage practitioners to clearly define key terms when working in sport. Our intention in this paper is to energize readers to consider how we use language in athlete identification and development contexts, to stimulate deeper thought and discourse around the possible implications these terms may have at any point of an individual’s development in sport. Greater deliberation, identification, and acknowledgment of the drawbacks accompanying these terms will be needed before more confident assertions can be made on how researchers and practitioners could (or even should) implement certain terminology across youth sport contexts moving forward. This paper adds to a growing literature on the importance of clarity in terminology and acts as an impetus for those working in specific sports to co-design key terms used by researchers, practitioners, and policy makers.

Herpes zoster (HZ) is caused by the reactivation of latent varicella zoster virus and is a disease with a high incidence and great morbidity. Risk factors for HZ and its most common complication, postherpetic neuralgia (PHN), include age ≥ 50 years, immunosuppression, and chronic disorders. Vaccination is an effective strategy to prevent HZ and PHN. In Europe, two HZ vaccines are available: the live attenuated vaccine and the recombinant vaccine. The latter of these has greater efficacy against HZ and its complications, particularly in populations at higher risk, such as older adults. The recombinant vaccine is the only one indicated for immunocompromised patients. In some European countries, HZ vaccination is not included in national immunization programs, and recommendations for immunization are lacking. This was the case in Portugal until 2023, when the guidelines for HZ vaccination issued by the Portuguese Society of Internal Medicine and the Portuguese Association of General and Family Medicine filled this gap. Such recommendations reflect a paradigm shift toward a broader definition of HZ high-risk groups, including individuals with chronic diseases, along with immunocompromised patients and older adults. This article summarizes the availability and reimbursement of HZ vaccines across European countries with recommendations for HZ immunization and aims to provide evidence for HZ vaccination of special populations and expand the coverage of immunization programs to prevent HZ and complications in people at higher risk. We also aim to inspire other countries to follow the example of Portugal regarding vaccination against HZ and other diseases for which vaccines have been developed but recommendations do not yet exist.

Until recently, there has been less demand for and interest in female-specific sport and exercise science data. As a result, the vast majority of high-quality sport and exercise science data have been derived from studies with men as participants, which reduces the application of these data due to the known physiological differences between the sexes, specifically with regard to reproductive endocrinology. Furthermore, a shortage of specialist knowledge on female physiology in the sport science community, coupled with a reluctance to effectively adapt experimental designs to incorporate female-specific considerations, such as the menstrual cycle, hormonal contraceptive use, pregnancy and the menopause, has slowed the pursuit of knowledge in this field of research. In addition, a lack of agreement on the terminology and methodological approaches (i.e., gold-standard techniques) used within this research area has further hindered the ability of researchers to adequately develop evidenced-based guidelines for female exercisers. The purpose of this paper was to highlight the specific considerations needed when employing women (i.e., from athletes to non-athletes) as participants in sport and exercise science-based research. These considerations relate to participant selection criteria and adaptations for experimental design and address the diversity and complexities associated with female reproductive endocrinology across the lifespan. This statement intends to promote an increase in the inclusion of women as participants in studies related to sport and exercise science and an enhanced execution of these studies resulting in more high-quality female-specific data.

Scaling up industrial microbial processes for commercial production is a high-stakes endeavor, requiring time and investment often exceeding that for laboratory microbe and process development. Omissions, oversights and errors can be costly, even fatal to the program. Approached properly, scale-up can be executed successfully. Three guiding principles are provided as a basis: begin with the end in mind; be diligent in the details; prepare for the unexpected. A detailed roadmap builds on these principles. There is a special emphasis on the fermentation step, which is usually the costliest and also impacts downstream processing. Examples of common scale-up mistakes and the recommended approaches are given. It is advised that engineering resources skilled in integrated process development and scale-up be engaged from the very beginning of microbe and process development to guide ongoing R&D, thus ensuring a smooth and profitable path to the large-scale commercial end.

Monkeypox virus infections (mpox) in humans have become increasingly common since the virus was first identified in 1970. Coverage of the ongoing mpox outbreak has emphasized the role of skin-to-skin contact in monkeypox virus transmission and has focused on the community of men who have sex with men. While close contact from sexual activity is currently the main mechanism of monkeypox virus transmission, the potential for contact sports to exacerbate the 2022 outbreak has largely been overlooked. Infectious diseases rapidly spread in sports with significant skin-to-skin contact (i.e., wrestling and other combat sports, American football, and rugby). Mpox has not yet reached the athletic community, but once it does, it may follow a similar pattern of other infectious skin diseases in sports. Thus, it is critical to initiate a discussion of the risk of mpox and potential preventive measures within a sports context. This Current Opinion aims to provide stakeholders within the sports community with a brief review of infectious skin diseases in athletes, an overview of mpox and why it is relevant to athletes, and recommendations to reduce the risk of monkeypox virus transmission within sports settings. Guidelines for sports participation in athletes exposed to mpox and those with suspected, probable, and confirmed cases of monkeypox are provided.

Premature deaths in bodybuilders regularly make headlines and are cited as evidence that bodybuilding is a dangerous activity. A wealth of research has revealed elite athletes typically enjoy lower mortality rates than non-athletes, but research on bodybuilder lifespan is surprisingly limited. Anabolic androgenic steroid (AAS) use is commonly cited as a key contributor to morbidity and premature mortality in bodybuilders, but this area of research is highly nuanced and influenced by numerous confounders unique to bodybuilding. It is quite possible that bodybuilders are at elevated risk and that AAS use is the primary reason for this, but there remains much unknown in this realm. As global participation in bodybuilding increases, and healthcare providers play a more active role in monitoring bodybuilder health, there is a need to identify how numerous factors associated with bodybuilding ultimately influence short- and long-term health and mortality rate. In this Current Opinion, we discuss what is currently known about the bodybuilder lifespan, identify the nuances of the literature regarding bodybuilder health and AAS use, and provide recommendations for future research on this topic.

Interval training is a simple concept that refers to repeated bouts of relatively hard work interspersed with recovery periods of easier work or rest. The method has been used by high-level athletes for over a century to improve performance in endurance-type sports and events such as middle- and long-distance running. The concept of interval training to improve health, including in a rehabilitative context or when practiced by individuals who are relatively inactive or deconditioned, has also been advanced for decades. An important issue that affects the interpretation and application of interval training is the lack of standardized terminology. This particularly relates to the classification of intensity. There is no common definition of the term “high-intensity interval training” (HIIT) despite its widespread use. We contend that in a performance context, HIIT can be characterized as intermittent exercise bouts performed above the heavy-intensity domain. This categorization of HIIT is primarily encompassed by the severe-intensity domain. It is demarcated by indicators that principally include the critical power or critical speed, or other indices, including the second lactate threshold, maximal lactate steady state, or lactate turnpoint. In a health context, we contend that HIIT can be characterized as intermittent exercise bouts performed above moderate intensity. This categorization of HIIT is primarily encompassed by the classification of vigorous intensity. It is demarcated by various indicators related to perceived exertion, oxygen uptake, or heart rate as defined in authoritative public health and exercise prescription guidelines. A particularly intense variant of HIIT commonly termed “sprint interval training” can be distinguished as repeated bouts performed with near-maximal to “all out” effort. This characterization coincides with the highest intensity classification identified in training zone models or exercise prescription guidelines, including the extreme-intensity domain, anaerobic speed reserve, or near-maximal to maximal intensity classification. HIIT is considered an essential training component for the enhancement of athletic performance, but the optimal intensity distribution and specific HIIT prescription for endurance athletes is unclear. HIIT is also a viable method to improve cardiorespiratory fitness and other health-related indices in people who are insufficiently active, including those with cardiometabolic diseases. Research is needed to clarify responses to different HIIT strategies using robust study designs that employ best practices. We offer a perspective on the topic of HIIT for performance and health, including a conceptual framework that builds on the work of others and outlines how the method can be defined and operationalized within each context.

Human monkeypox is a zoonotic orthopoxvirus with presentation similar to smallpox. Monkeypox is transmitted incidentally to humans when they encounter infected animals. Reports have shown that the virus can also be transmitted through direct contact (sexual or skin-to-skin), respiratory droplets, and via fomites such as towels and bedding. Multiple medical countermeasures are stockpiled for orthopoxviruses such as monkeypox. Two vaccines are currently available, JYNNEOS TM (live, replication incompetent vaccinia virus) and ACAM2000 ® (live, replication competent vaccinia virus). While most cases of monkeypox will have mild and self-limited disease, with supportive care being typically sufficient, antivirals (e.g. tecovirimat, brincidofovir, cidofovir) and vaccinia immune globulin intravenous (VIGIV) are available as treatments. Antivirals can be considered in severe disease, immunocompromised patients, pediatrics, pregnant and breastfeeding women, complicated lesions, and when lesions appear near the mouth, eyes, and genitals. The purpose of this short review is to describe each of these countermeasures.