Oxidative stress (OS) is an important factor in the pathophysiology of numerous neurodegenerative disorders, such as Parkinson’s disease, multiple sclerosis, cerebrovascular pathology or Alzheimer’s disease. OS also significantly influences progression among the various neurodegenerative disorders. The imbalance between the formation of reactive oxygen species (ROS) and the body’s capacity to neutralize these toxic byproducts renders the brain susceptible to oxidative injury. Increased amounts of ROS can result in cellular malfunction, apoptosis and neurodegeneration. They also represent a substantial factor in mitochondrial dysfunction, a defining characteristic of neurodegenerative disorders. Comprehending the fundamental mechanisms of OS and its interactions with mitochondrial function, neuroinflammation and cellular protective pathways becomes essential for formulating targeted therapeutics to maintain brain health and reduce the impacts of neurodegeneration. We address recent highlights on the role of OS in brain function in terms of significance for neuronal health and the progression of neurodegenerative disorders.

Metabolic syndrome (MetS) is characterized by central obesity, insulin resistance, hypertension, dyslipidemia, and chronic inflammation, significantly increasing the risk of cardiovascular disease and type 2 diabetes. Effective management of MetS is critical, with exercise being a key intervention. This review analyzed the effects of different exercise intensities—low, moderate, and high-intensity interval training (HIIT)—on metabolic health, oxidative stress (OS), inflammation, and cardiovascular function. A search of Medline, PEDro, and EBSCO identified 2251 articles, with 159 studies published between 1999 and 2025 included after screening. Low-intensity exercise improved insulin sensitivity, reduced OS markers (e.g., MDA, 8-OHdG), and enhanced antioxidant enzyme activity. Moderate-intensity exercise showed similar benefits with notable reductions in inflammatory markers (e.g., IL-1β, TNF-α). HIIT promoted fat loss and improved metabolic markers but temporarily increased OS and inflammation. Dietary strategies also play a critical role. The Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) diets are well established, emphasizing nutrient-dense foods like unsaturated fats and fiber to reduce inflammation and manage weight. The ketogenic diet (KD), a high-fat, low-carbohydrate approach, has recently gained attention for its metabolic benefits. KD induces ketosis, improving insulin sensitivity, reducing triglycerides, and enhancing fat oxidation. Studies show KD effectively reduces body weight and glucose levels, though long-term adherence and nutrient deficiencies remain challenges. Intermittent fasting also showed potential benefits, though effects on glucose metabolism were inconsistent. This review underscores the need for tailored approaches combining exercise, diet, and fasting to optimize MetS outcomes, offering integrative strategies for prevention and management.

Background: Metabolic syndrome (MetS) is a multifactorial condition characterized by insulin resistance, dyslipidemia, hypertension, and central obesity, and is strongly influenced by lifestyle factors. Growing evidence highlights the gut microbiota as a key mediator linking diet and physical exercise to cardiometabolic health. Objective: This narrative review aims to qualitatively synthesize current evidence on the effects of physical exercise and major dietary patterns including the Mediterranean diet (MedDiet), Dietary Approaches to Stop Hypertension (DASH), and ketogenic/very-low-calorie ketogenic diets (KD/VLCKD) on gut microbiota composition and function, and their implications for metabolic health in MetS. Methods: A qualitative narrative synthesis of experimental, observational, and interventional human and animal studies was performed. The reviewed literature examined associations between structured physical exercise or dietary interventions and changes in gut microbiota diversity, key bacterial taxa, microbial metabolites, and cardiometabolic outcomes. Considerable heterogeneity across studies was noted, including differences in populations, intervention duration and intensity, dietary composition, and microbiota assessment methodologies. Results: Across human interventional studies, moderate-intensity physical exercise was most consistently associated with increased gut microbial diversity and enrichment of short-chain fatty acid (SCFA)-producing taxa, contributing to improved insulin sensitivity and reduced inflammation. MedDiet and DASH were generally linked to favorable microbiota profiles, including increased abundance of Faecalibacterium prausnitzii, Akkermansia muciniphila, and Bifidobacterium, alongside reductions in pro-inflammatory metabolites such as lipopolysaccharides and trimethylamine N-oxide. In contrast, KD and VLCKD were associated with rapid weight loss and glycemic improvements but frequently accompanied by reductions in SCFA-producing bacteria, depletion of Bifidobacterium, and markers of impaired gut barrier integrity, raising concerns regarding long-term microbiota resilience. Conclusions: Lifestyle-based interventions exert diet- and exercise-specific effects on the gut microbiota–metabolism axis. While MedDiet, DASH, and regular moderate physical activity appear to promote sustainable microbiota-mediated cardiometabolic benefits, ketogenic approaches require careful personalization, limited duration, and medical supervision. These findings support the integration of dietary quality, exercise prescription, and individual microbiota responsiveness into translational lifestyle strategies for MetS prevention and management.

The relationship between diabetes mellitus (DM) and microvascular brain pathology is complex and not very well debated, especially when referred to lacunar strokes, a major subset of cerebral small vessel disease (CSVD). Chronic hyperglycaemia, insulin resistance, and endothelial dysfunction drive microvascular injury, often compounded by coexisting hypertension and dyslipidaemia. Imaging and cohort studies confirm that DM accelerates CSVD progression and increases the risk of lacunar strokes, while antihypertensive and lipid-lowering therapies can modulate this risk. Nonetheless, a differential diagnosis of demyelinating lesions of the brain remains complicated, especially in young patients, as DM increases the likelihood of vascular or infectious mimics, but does not fundamentally influence diagnostic or pharmacological algorithms for acquired demyelinating syndromes. The differential diagnosis for Multiple Sclerosis is also essential in young patients with an autoimmune background. There is also growing evidence that artificial intelligence (AI) and computational modelling are increasingly useful when applied to cerebrovascular disease with DM as a key risk factor, by providing: risk stratification, automated neuroimaging analysis and decision-support systems, that integrate multimodal data to predict risks, classify aetiologies and forecast outcomes (along with retinal imaging and neuroimaging AI). AI-driven cerebrovascular morphology analysis, CSVD markers and perfusion imaging analyses are advancing the ability to predict short-term and longer-term outcomes, including cognitive impairment. For all that, challenges still arise throughout data standardisation, generalisability across diabetic subgroups, integration with electronic health records or regulatory considerations that need further prospective multicenter validation. Although pharmacological management in diabetic patients with lacunar stroke may not benefit from a diabetes-specific protocol beyond standard guidelines, physiotherapy stands as both a rehabilitative and preventive tool, contributing to microvascular risk reduction through exercise, improved metabolic control, and overall lifestyle modification. While calling for larger, diabetes-stratified studies to guide future interventions and refine personalised treatment strategies, the following narrative review, with emphasis on an AI and computational modelling in diabetes-related cerebrovascular disease, offers a brief insight into the current level of knowledge and recent updates in the correlations between DM and lacunar strokes.

Post-stroke rehabilitation integrates technological feedback systems to enhance motor relearning and autonomic regulation. Among these, physiological biofeedback—based on electromyography (EMG), heart rate variability (HRV) and electrocardiography (ECG)—represents a multimodal approach for restoring neuromotor control and autonomic balance. EMG biofeedback enables patients to visualize and voluntarily modulate muscle activation, supporting cortical reorganization and improving movement precision through real-time feedback. Recent meta-analyses confirm that EMG biofeedback significantly improves upper- and lower-limb function in stroke survivors, particularly when combined with task-oriented physiotherapy. EMG biofeedback demonstrates improvements in swallowing function, motor control, and patient motivation. Beyond the motor domain, HRV biofeedback has shown substantial benefits lately, especially in regulating the autonomic nervous system (ANS) activity, improving vagal tone, and reducing sympathetic overdrive: a major contributor to fatigue and cardiovascular instability post-stroke. By targeting the sympathetic–parasympathetic balance, HRV biofeedback not only enhances autonomic flexibility but also supports emotional and cognitive recovery. Together, these modalities integrate neuromuscular and autonomic rehabilitation, offering a path toward individualized, feedback-driven recovery protocols. This narrative review synthesizes recent evidence on the mechanisms, the clinical outcomes, and translational potential of EMG- and HRV-based biofeedback in stroke rehabilitation, highlighting their role in advancing physiotherapy toward an adaptive, data-driven, and neuroplastic paradigm, as from now on, the emerging directions will include integrating physiological biofeedback with immersive or AI-driven platforms for enhanced personalization and motivation.