Layout 1 Maccarone et al.’s comments on “home Gym-Bed” exercises and sarcopenia Eur J Transl Myol 34 (3) 13132, 2024 doi: 10.4081/ejtm.2024.13132 We appreciate the insightful comments provided by Josef Finsterer regarding our article on the first evidence on the effects of the Home Full-Body in-Bed Gym protocol as a potential intervention to mitigate age- related muscle loss based on the preliminary positive results of a Padua prospective observational study.1 We acknowledge the importance of the points raised and would like to address them in this response. At the University of Padua, we conducted a study aimed at evaluating the impact of a home-based Full-Body in- Bed Gym protocol on various outcomes in elderly indi- viduals, which was published in 2023.1 The rational of our proposal is based on the fact that functional muscle decay of aging is inevitable, but that the general population is highly hypoactive, let's say "lazy". The increase in daily muscular activity even through “Home In-Bed Gym” re- covers at least in part the potential abilities progressively lost. Therefore, it is easy to rejuvenate the “lazy” pop- ulation, that is, the vast majority of elderlies. We included 22 participants with a median age of 71.90 years, who engaged in the exercise program three times a week for two months. Although the improvement in sarcopenia risk was not statistically significant, there was a positive trend. This can be explained by the small number of patients we evaluated in this initial study on an elderly population. While our results regarding sarcopenia risk were not statistically significant, we believe that the observed trends warrant further investi- gation with larger sample sizes and longer follow-up periods to better understand the potential benefits of this protocol. Nevertheless, our study did not focus solely on sarcopenia prevention but also evaluated quality of life, including both mental and physical components, as well as pain re- duction, all of which showed statistically significant im- provements. These outcomes are of fundamental importance since, in elderly individuals, both physical and mental health play a crucial role in maintaining overall well-being. Various studies suggest that exercise can con- tribute to enhanced self-confidence and emotional well- being, as well as prevent cognitive decline.2,3 Participation in easily accessible home-based exercise programs should be encouraged to achieve these numerous benefits and im- prove overall quality of life. An important finding from our study was related to compliance: the high compliance rate over six months supports the feasibility and sustainability of the program, suggesting that it could be extended over a longer period. We agree that comorbidities and medications can in- fluence muscle mass and should be considered in future studies. While our study aimed to reflect real-world con- ditions by including subjects with common age-related co- morbidities, we excluded those with orthopedic issues, severe cardiovascular or oncological diseases, and signif- icant neurological disorders. Finally, we recognize that factors such as diet, hormonal levels, and genetics also affect muscle mass. While our study mainly examined the functional effects of the Home Full-Body in-Bed Gym program, incorporating assess- ments of these factors could offer a more complete under- standing of the intervention's impact. Additionally, future research should use consistent imaging methods to reli- Key Words: sarcopenia; home Gym-Bed; Padua prospective observational study; quality of life; compliance. Eur J Transl Myol 34 (3) 13132, 2024 doi: 10.4081/ejtm.2024.13132 Maccarone et al.’s comments on Cohort studies using 3D-CT are needed to assess whether “home Gym-Bed” exercises are beneficial against sarcopenia Maria Chiara Maccarone,1 Allegra Caregnato,2 Gianluca Regazzo,2 Alessandra Carriero,2 Giacomo Casellato,2 Claudia Finamoni,2 Rossella Jirillo,2 Olena Laskova,2 Elena Marigo,2 Daniela Yolanda Sánchez,2 Irene Seno,2 Chiara Venturin,2 Hillary Veronese,2 Barbara Ravara,3,4,5 Walter Giurati,3 Ugo Carraro,2,3,4,5 Stefano Masiero1,2,4 1Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua, Italy; 2Physical Medicine and Rehabilitation School, University of Padova, Padua, Italy; 3Department of Biomedical Sciences, University of Padova, Padua, Italy; 4CIR-Myo-Interdepartmental Research Center of Myology, University of Padova, Padua, Italy; 5A&CM-C Foundation for Translational Myology, Padua, Italy This article is distributed under the terms of the Creative Commons Attribution Noncommercial License (CC BY-NC 4.0) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. - 124 - Non -co mmerc ial us e o nly Maccarone et al.’s comments on “home Gym-Bed” exercises and sarcopenia Eur J Transl Myol 34 (3) 13132, 2024 doi: 10.4081/ejtm.2024.13132 ably assess changes in muscle volume. The study by Quadrelli et al., which employed advanced imaging tech- niques like 256-slice CT scanners and 3D muscle segmen- tation with DAFNE software, complements our research by tracking muscle mass changes over a decade.4 Future studies should include standardized imaging protocols to accurately measure muscle mass changes and consider these additional variables to fully evaluate their inter- actions with exercise programs. In conclusion, we appreciate the constructive feedback and acknowledge the limitations of our study. We hope that our response clarifies the scope of our research and contributes to the ongoing discussion on effective strategies for addressing age-related muscle loss. Case re- ports and preliminary clinical studies are useful, if not es- sential, steps toward organizing randomized, double-blind, placebo-controlled, cross-over trials. Our preliminary positive results suggest that the Home Full-Body in-Bed Gym program holds potential benefits, particularly in improving quality of life and pain manage- ment. To build upon these findings, future research should incorporate advanced imaging techniques and comprehen- sive assessments of dietary and hormonal influences. Such an approach will be essential to validate and expand upon our findings. In light of the valuable feedback and the identified areas for further investigation, we invite Josef Finsterer, readers of his Letter and other experts in the field to collaborate with us on future comprehensive studies. Please message us if anyone is interested in participating in such a study! Conflict of Interest The authors declare no financial, personal, or other con- flicts of interest. Contributions MCM and UC – development of the study design; MCM, AC, GR, AC, GC, CF, RJ, OL, EM, DYS, IS, CV and HV - data collection; MCM, UC and SM data interpretation; MCM, UC and SM – writing; BR, WG, UC and SM - su- pervision. All authors read and approved the final edited manuscript. Funding The authors received no specific funding for this work. Ethical Publication Statement Not applicable. Acknowledgments A&C M-C Foundation for Translational Myology, Pa- dova, Italy and PAGEpress, Scientific Publications, Pavia, Italy sponsored publication of this reply. Corresponding Author Maria Chiara Maccarone, Rehabilitation Unit, Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128 Padua, Italy ORCID ID: 0000-0003-2793-1334 Email: mariachiara.maccarone@phd.unipd.it Allegra Caregnato: allegra.caregnato@studenti.unipd.it ORCID ID: 0000-0001-8926-5301 Gianluca Regazzo: gianluca.regazzo@studenti.unipd.it ORCID ID: 0009-0004-6277-4199 Alessandra Carriero E-mail: alessandra.carriero@studenti.unipd.it ORCID ID 0009-0008-2356-5457 Giacomo Casellato E-mail: giacomo.casellato@studenti.unipd.it ORCID ID: 0009-0000-6788-6238 Claudia Finamoni E-mail: claudia.finamoni@studenti.unipd.it ORCID ID: 0009-0005-3603-4725 Rossella Jirillo E-mail: rossella.jirillo@studenti.unipd.it ORCID ID: 0009-0009-2495-1074 Olena Laskova E-mail: olena.laskova@studenti.unipd.it ORCID ID: 0009-0006-2387-0190 Elena Marigo E-mail: elena.marigo.1@studenti.unipd.it ORCID ID: 0000-0002-0263-0351 Daniela Yolanda Sánchez E-mail: danielayolanda.sanchez@studenti.unipd.it ORCID ID: 0009-0008-9532-6746 Irene Seno E-mail: irene.seno@studenti.unipd.it ORCID ID: 0009-0001-9142-6482 Chiara Venturin E-mail: chiara.venturin@studenti.unipd.it ORCID ID: 0009-0003-7682-9421 Hillary Veronese E-mail: hillary.veronese@studenti.unipd.it ORCID ID: 0009-0000-4818-0264 Barbara Ravara E-mail: barbara.ravara@unipd.it ORCID ID: 0000-0002-0159-3245 Walter Giurati E-mail: walter.giurati@unipd.it ORCID ID: 0000-0000-9991-3488 - 125 - Non -co mmerc ial us e o nly Maccarone et al.’s comments on “home Gym-Bed” exercises and sarcopenia Eur J Transl Myol 34 (3) 13132, 2024 doi: 10.4081/ejtm.2024.13132 Ugo Carraro E-mail: ugo.carraro@unipd.it ORCID ID: 0000-0002-0159-3245 Stefano Masiero E-mail: stef.masiero@unipd.it ORCID ID: 0000-0002-0361-4898 References 1. Maccarone MC, Caregnato A, Regazzo G, et al. Ef- fects of the Full-Body in-Bed Gym pro-gram on qual- ity of life, pain and risk of sarcopenia in elderly sedentary individuals: preliminary positive results of a Padua prospective observational study. Eur J Transl Myol 2023; 33:11780. 2. Mahindru A, Patil P, Agrawal V. Role of Physical Ac- tivity on Mental Health and Well-Being: A Review. Cureus 2023;15:e33475. 3. Yamasaki T. Preventive strategies for cognitive decline and dementia: benefits of aerobic physical activity, especially open-skill exercise. Brain Sci 2023;13:521. 4. Quadrelli M, Baccaglini T, Morra A. Quantitative 3D- CT imaging of sarcopeniamitigation in the elderly: ev- idence from a case report. Eur J Transl Myol 2024; 34:12715. Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their af- filiated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Submitted: 20 September 2024. Accepted: 20 September 2024. Early access: 20 September 2024. - 126 - Non -co mmerc ial us e o nly mailto:ugo.carraro@unipd.it mailto:stef.masiero@unipd.it