Introduction: 1st THiNK Active Exercise for Health Summit 2023: Bridging Exercise & Health

The contents of this Exercise, Sport, and Movement (ESM) supplementary issue include the proceedings from the first annual Exercise for Health Summit (EfHS). EfHS was hosted in Madrid, Spain, in November 2023 by THiNK Active in partnership with the Research Centre in Sports Science of King Juan Carlos University and SpainActive Foundation. Founded in September 2020 by EuropeActive’s Board of Directors and backed by the President’s Council for Operators, THiNK Active is EuropeActive’s exclusive scientific research operation. THiNK Active is a pioneering initiative aimed at offering evidence and advocating for best practices in the fitness and physical activity sector throughout Europe and beyond, and creating meaningful and long-lasting public health impacts. The Madrid EfHS was established as a key part of EuropeActive’s new strategy, “Moving Forward Together 2022–2025,” and was attended by 256 individuals from 23 different countries. EfHS consisted of 12 invited lectures, along with six concurrent sessions of thematically clustered topics hosted by local, regional, and international health, fitness, and club industry experts. The primary aim of the Madrid EfHS was to bring together representatives from a broad constituency of the health and healthcare sector. Presenters and attendees included academics/scientists, health and life insurance companies, public health policymakers, international institutions, public-health-related nongovernmental organizations, relevant healthcare providers, club operators, equipment suppliers, digital/technology providers, health professionals, training providers, and exercise professionals. As part of its aim, EfHS intended to identify and disseminate existing promising research and/or best practices across Europe and globally, build-up innovative and transformative partnerships, provide evidence about the potential impact of co-location initiatives, and discuss new policies promoting active living. The first article of the ESM supplement, “The co-location of healthcare and leisure as part of a whole-system approach to physical activity promotion,” by Grinvalds et al. discusses the benefits of an integrative, holistic approach to providing key healthcare and wellness services in underserved communities through the development of regional health hubs. The authors apply systems thinking and co-design to a healthcare context by co-locating healthcare clinics within leisure facilities to make it easier for people to engage in physical activity. “The case of Wellness Valley: promoting physical activity and exercise medicine for a sustainable healthcare system” by Bigica and colleagues shares attributes with the UK effort to co-locate health and fitness services. The Wellness Valley initiative, located in Emilia-Romagna, Italy, exemplifies a model for fostering an active, healthy lifestyle as a means of mitigating noncommunicable disease (NCD). This effort is promoted by various public and private stakeholders, with the local medical community supporting the concept of exercise as medicine through continuous education and dedicated infrastructure. The primary premise of this effort is that shifting health models toward preventive strategies can reduce the burden on local healthcare systems. By fostering a community of healthy and active living centered on exercise, there will be an increased likelihood of NCD prevention and less need for healthcare system intervention, which is a costly and time-consuming burden for individuals and communities. The paper by Mora-Rodriguez and colleagues, “Can exercise potentiate the effects of habitual medicines to lower blood pressure, blood lipids, and blood glucose?” was presented at the conference as a review of the potentiating effect of exercise on usual pharmacological treatments for high blood pressure, dyslipidemia, and elevated blood glucose. In particular, the authors discuss specific medicines (angiotensin inhibitors, statins, and metformin) and the interactions between exercise and each of them. They provide a detailed explanation of potential interactions and epidemiological associations between medication and exercise and conclude with an overview of randomized intervention studies that address cause–effect. This paper is particularly helpful to practitioners wanting to learn more about different exercise–pharmacology interactions, and how to best help their clients achieve optimal health and fitness outcomes. The next paper, “Role of high intensity exercise interventions in the management of frailty: a short systematic review,” by Guadalupe-Grau et al. summarizes the current evidence on the impact of high-intensity exercise training interventions on frailty and physical function in older adults. Using a systematic review of controlled trials, the authors examined resistance, power, and aerobic training, as well as combinations of these methods, yielding eight studies with 437 participants with an average age of 78 yr. The results showed that high-intensity exercise training significantly improved frailty phenotype scores and enhanced physical function metrics, including the Short Physical Performance Battery, usual gait speed, and the five-repetition sit-to-stand test, with concurrent training programs yielding the most substantial benefits. Of course, the authors argue that these results warrant incorporating high-intensity exercise training into routine care to reduce frailty and improve the quality of life in older adults. In their paper, “Understanding the social return on investment of physical activity and sport: an international consensus,” Davies et al. describe the growing demand from policymakers and practitioners to understand and measure the social impact of physical activity and sport (PAS). Of course, the impetus for this is to justify private or public investment in sport and to improve the establishment of PAS managers to produce robust and defensible evidence to underpin international and national policy. The authors establish the social return on investment as a credible framework for measuring the nonfinancial impact of PAS, which they argue is significant and important. However, they also acknowledge the lack of agreement on what and how social outcomes should be valued. Ultimately, they aim to address this gap by identifying five domains of social impact: health, education, crime, social capital, and well-being. A Delphi study achieved consensus across 29 statements relating to these domains. The final paper, “Exploring the effects of exercise on overall adiposity, targeted fat depots, and cardiometabolic risk in children with obesity,” by Cadenas-Sanchez et al. highlights the role of exercise interventions in improving the health of children with overweight/obesity. The authors provide an overview of the current understanding regarding exercise interventions and their impact on overall adiposity, specific fat depots, and cardiometabolic health in children with overweight/obesity. Aerobic exercise and combined aerobic and resistance training interventions have demonstrated a significant capacity to enhance or provide cardiovascular benefits, and to improve various cardiometabolic health outcomes in this population, all of which can reduce the risk of cardiovascular diseases later in life. We hope you enjoy reading these papers as much as we enjoyed being part of the first annual EfHS in Madrid. We would like to thank the American College of Sports Medicine and Dr. Jennifer Heisz, ESM Editor-in-Chief, for supporting this initiative, along with ESM Managing Editor Stephanie Custer in assisting us through the publication process.