Health and fitness trends in Southern Europe for 2023: A cross-sectional survey

The physical activity, exercise and wellness sector is rapidly growing and seems to be an exciting field for business and professional development with great potential globally. The purpose of this observational and cross-sectional study was to determine the most popular health and fitness trends in Southern Europe for the first time, including data from Italy, Spain, Portugal, Greece and Cyprus, and to investigate any potential differences in this area compared to the Pan-European and global fitness trends for 2023. A national online survey was conducted in five Southern European countries, using the methodology of similar regional and worldwide surveys conducted by the American College of Sports Medicine since 2007. In total, a web-based questionnaire was sent to 19,887 professionals who worked in the Southern European physical activity, exercise and wellness sector. A total of 2645 responses were collected from five national surveys with an overall mean response rate of 13.3%. The ten most important fitness trends in Southern Europe for 2023 were personal training, licensure for fitness professionals, exercise is medicine, employing certified fitness professionals, functional fitness training, small group training, high-intensity interval training, fitness programs for older adults, post-rehabilitation classes and body weight training. The present findings are aligned with those reported for the European and worldwide fitness trends.


Introduction
The European health and fitness industry has experienced huge growth in the past 10 years, showing a significantly increased number of all industry stakeholders, such as entrepreneurs, employees, customers and businesses [1]. Although this particular service industry has currently passed through an economic crisis in the past decade [2] as well as an unbelievably diff icult two-year period due to the coronavirus pandemic (COVID- 19), recent evidence and popular trends have been documented, highlighting the merit of fitness services either digitally or on -site worldwide [3]. Small and medium-sized enterprises represent the vast majority of all businesses in the European Union (EU) [4], playing a key role in the economy while demonstrating a business field characterized by innovation, continuous development and great potential for the future [5]. However, the inactivity and obesity epidemics seem to be the most challenging global public health issues nowadays, affecting more than 50% of the adult population in the Western world [6,7]. On the other side, regular exercise appears as a vital strategy for preventing, managing an d treating several chronic diseases [8,9].
The four largest (Italy, Spain, Portugal and Greece) and one of the smallest (Cyprus) Southern European countries selected for this study represent almost 30% of the EU population, showing a similar socioeconomic status compared to other EU members located in the North, West and East [10]. In these countries, the prevalence of the most common cardiometabolic health-related diseases is on the rise, creating significant concerns for the public health status and adversely affecting important physiological and psychological health markers compared to the mean of the EU countries [11]. Remarkably, several lifestyle-related health issues such as sedentarism, unhealthy weight, glucose intolerance, raised blood pressure an d impaired blood lipid profile significantly impact the masses in Southern Europe [11,12]. However, the latest available data just before the COVID-19 pandemic show promising insights into the annual revenue, market size, penetration and growth reported for all selected countries [13]. More specifically, Italy ranked fifth among all European fitness markets, demonstrating total revenue of EUR 2.3 billion, 5.5 million customers, 0.9% growth rate and 9.5% penetration rate [13]. Spain is the fourth largest national fitness market in Europe, with total revenue of EUR 2.4 billion, 5.5 million members in fitness clubs and growth and penetration rates of 3.3% and 13%, respectively [13]. Notably, Italy and Spain represent 16% of the total European market. On the other hand, Portugal and Greece are smaller fitness markets compared to Italy and Spain, and they are not included in the top 10 European national markets [1,13]. Portugal and Greece

Study design
An observational and cross-sectional study of health and fitness trends was conducted, using an online survey and a descriptive approach. The present cross-sectional study applied the same methodology with relevant surveys conducted by the ACSM, using similar criteria to those that have been commonly used in relevant national [34][35][36][37][38][39][40][41][42][43][44][50][51][52][53], regional [45][46][47][48][49][50] and worldwide [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] surveys of fitness trends in the past 15 years. In this paper, data collected from five different national surveys are presented in order to compare the main findings not only among the five selected Southern European countries but also with those observed at European [49] and global levels [33]. In brief, the survey was developed to detect the trends (not fads) that are considered popular because of their positive influence on the physical activity, exercise and wellness sector while showing high attractiveness among key industry stakeholders based in all five selected Southern European countries, involving fitness services with a wide spectrum of clients. As such, a distinction between a "fad" and a "trend" according to the dictionary was included in the introduction of the survey to help participants recognize the difference between these two key terms [33].

Sample recruitment and inclusion criteria
Eligible participants included all adults aged 18 and older with any occupational role, experience and education level, work status and annual salary within the health and fitness industry. Databases of contacts of local universities (departments and schools of physical education, exercise or sports sciences) across all selected countries were primarily used to recruit participants for this survey. In addition, national associations of gym owners and national registries of exercise professionals in all involved countries were also used to collect data. The online survey was sent electronically to 19,887 individual contacts in total. All contacts were stakeholders in the physical activity, exercise and wellness industry based in Italy, Spain, Portugal, Greece and Cyprus under various occupational roles (e.g., employees, freelancers, students, educators, fitness club operators and managers). Likewise, the survey was posted on relevant web sites and social media (e.g., Facebook, Instagram, Twitter and LinkedIn) accounts of all involved parties.

Data collection tool
According to the ACSM's methodology, a technical experts group consisting of experienced practitioners and educators in the physical activity, exercise and wellness sector as well as academia was recruited to review a list of previously recognized trends as well as some new emerging trends [33]. Thus, a web-based questionnaire using an online survey platform (Google Forms, Survio or SurveyMonkey) was developed, including 40-50 related trends that were retrieved from several sources and from the personal experiences of some experts. A short explanation for each trend was provided to help participants become familiar with a basic description as previously reported [33]. The submitted responses on the potential trends were evaluated using a 10-point Likert scale ranging from 1 (least likely to be a trend) to 10 (most likely to be a trend) as previously described [33]. Demographi c questions (e.g., gender, age, education, occupation, experience, work status, career choice and annual salary) were also included in the questionnaire that was developed to be completed in less than 15 minutes. The questionnaire was provided in local languages without any change from the original edition designed by the ACSM in English. The authors from each country were in charge of translation into local languages. Afterwards, native/bilingual English speakers with an academic background in the field of exercise science reviewed the draft, aiming to revise it where needed in order to be 100% correct compared to the original English version.

Recruitment and study period
The research was conducted electronically from May 2022 to July 2022 in Spain, Portugal and Greece and from September 2022 to November 2022 in Italy and Cyprus. No incentives (financial or material) were offered to attract participants to the survey in all countries. Several reminders were sent to all contacts via email during the study period. The online survey was filled out anonymously, and an informed consent letter was signed by all participants at the commencement of the electronic questionnaire. The first page of the online questionnaire included all required details regarding the research aims, confidentiality of information and the right to withdraw the participation in the study.

Data analysis
Given that the present survey was an explanatory study methodologically based on several similar studies widely conducted by the ACSM and associates , the information collected was analyzed using quantitative methods presented in the form of percentages of the respondents and the mean scores of the candidate trends, aiming to summarize the main findings of a large data sample and its measurements in a given moment. All descriptive analyses were performed using the IBM SPSS Statistics 25.0 software (IBM Corp., Armonk, NY, USA).

Results
In total, the five national online surveys collected 2645 responses, which represents a return rate of 13.3%. According to the demographic characteristics (Table 1), respondents (43% females and 57% males) with diverse backgrounds and experience levels participated in the study. Specifically, 44% of respondents had over 10 years of experience in the industry, and 15% had over 20 years of experience. Furthermore, 61% of respondents currently work as practitioners under various occupational roles, mostly as personal trainers (26%), while 74% of participants held a bachelor's degree in exercise science or a related field. Full-time work and number one career choice were stated by 38% and 73%, respectively. Lastly, 71% of participants reported an annual salary lower than EUR 20,000. All candidate trends were ranked from highest (most popular trend) to lowest (least popular trend) mean score and are illustrated in Table 2. A comparison of the top 20 fitness trends among Italy, Spain, Portugal, Greece, Cyprus, Europe and the world is shown in Table 3. Trends were also categorized in the following six groups, as articulated elsewhere [54]: trends related to i) fitness professionals, ii) fitness activities, iii) training modalities, iv) programs oriented to specific populations, v) technology and iv) health. Table 4 presents a grouped approach of the comparative analysis of the top 20 fitness trends in Italy, Spain, Portugal, Greece, Cyprus, Europe and the world.
In brief, personal training was the only common trend included in the top three selections in all Southern European countries for 2023. On average, personal training, employing certified fitness professionals, licensure for fitness professionals, exercise is medicine, functional fitness training, small group training and exercise for weight loss were widely selected as some of the seven most popular trends in the Southern European region. More specifically, the two trends related to fitness professionals (employing certified fitness professionals and licensure for fitness professionals) included in the survey were present on the list of top 20 fitness trends in all selected Southern European countries. Similarly, five trends related to fitness activities (outdoor activities, high-intensity interval training, functional fitness training, strength training with free weights and body weight training), four trends related to fitness modalities (personal training, small group training, health/wellness coaching and group training), three trends related to programs oriented to specific populations (exercise for weight loss, fitness programs for older adults and children and exercise) and three trends related to health (post-rehabilitation classes, exercise is medicine and lifestyle medicine) were ranked among the top 20 most attractive options regionally. Interestingly, some trends related to fitness activities were popular in specific countries, such as circuit training (Greece and Cyprus), core training (Spain and Greece) and Pilates (Portugal, Greece and Cyprus). In addition, a large majority of trends related to technology were not included in top 20, and only outcome measurements and wearable technology were present on the top 20 list, but not in all countries. Comparing the top 20 Southern European fitness trends with the Pan-European and worldwide ones published by the ACSM for 2023, there is one trend (boutique fitness studios) that is included only in the European list, and there are two trends (home exercise gyms and yoga) included only in the global list. Figure 1 illustrates the top five health and fitness trends in each Southern European country included in the present study in comparison to the European [49] and worldwide [33] ACSM surveys for 2023.

Main results in brief
An online survey of health and fitness trends in Southern Europe, including Italy, Spain, Portugal, Greece and Cyprus, was carried out for the first time, aiming to help all industry stakeholders detect the current state of the health and fitness trends linked to specific services and programs. Moreover, it may help employers, health club managers, fitness professionals and educators to enhance customer engagement and experience through evidence-based practices and attractive strategies in this vibrant sector. In Southern Europe, personal training, licensure for fitness professionals, exercise is medicine, employing certified fitness professionals, functional fitness training, small group training, high-intensity interval training, fitness programs for older adults, post-rehabilitation classes and body weight training were identified as the top 10 trends for 2023. Interestingly, almost 50% of top 20 selections are trends related to fitness activities associated with various exercise types and settings. Trends related to fitness modalities and health were the second and third most attractive categories of trends, respectively. In contrast, technology-oriented trends showed low popularity, while specific population-oriented trends demonstrated significant potential among selected countries in the Southern European region. Importantly, the majority of mind-body fitness modalities such as yoga, tai chi and mind-body movement were not ranked in top 20, indicating low attractiveness in Southern Europe. However, Pilates showed a greater popularity than other mind-body fitness activities, since it was included in the top 20 list in three out of five selected countries in the region.

What is most popular?
The results of the first-ever Southern European survey of fitness trends using the ACSM's methodology [33] show several common findings with other recently published observational studies investigating fitness trends in several countries [34][35][36][37][38][39][40][41][42][43][44][50][51][52][53] and regions [45][46][47][48][49][50]. On average, personal training was ranked #1 in the present study, which is an outcome that agrees with the findings reported in Europe [49] but not the world for 2023 [33]. Moreover, this particular trend appears to be popular globally as the tenth most attractive fitness trend [33] while it was ranked #8 in the USA, #1 in Brazil, #3 in Mexico, #3 in Europe, #7 in Australia and #17 in China [49]. Personal training sessions seem to be remarkably popular among Europeans, and therefore the big majority (75%) of fitness ser-vices offered in health clubs and boutique fitness studios are primarily focused on the one-on-one exercise setting [55]. Furthermore, the occupation of personal trainer has been reported as the second most promising profession among European exercise professionals [56,57]. The present results may underline the current state of the health and fitness sector, which seems to be linked to client-centered services, aiming to improve customer engagement, satisfaction and loyalty through individualized exercise experiences [58].

Fitness professionals: The frontline players
Trends related to fitness professionals such as licensure for fitness professionals and employing certified fitness professionals seem substantially popular in the Southern European region, since both were reported as some of the top 20 trends in all five countries included in the present survey for 2023. It is of note that these particular trends have recently increased their popularity not only in Southern Europe but also in numerous other countries and regions globally [32,33,[47][48][49]. The high demand for qualified practitioners is systematically growing because of the rapidly increasing prevalence of populations affected by several lifestyle-related cardiometabolic health diseases that negatively impact physical and mental health as well as life expectancy at the global level [7,11]. The present results highlight that licensed, certified and well-equipped exercise professionals should be able to work on the front line against the inactivity epidemic by offering client-centered services based on good practices. This is an important finding considering that a significantly high percentage of the adult population in all five countries involved in this study are not apparently healthy individuals (Figure 2). More importantly, such populations belong to underserved markets [59], showing that personalized services through adapted fitness programs delivered by qualified training staff aiming to provide an inclusive environment appear to be a high priority among customers, employees and entrepreneurs in the health and fitness industry [60]. Interestingly, the occupational role of personal trainer has been selected as one of the most promising professions among practitioners in the European health and fitness industry [56,57]. Such observations underline the key role of fitness professionals in public health [61], working as members of a multidisciplinary healthcare team in collaboration with physicians and allied healthcare practitioners in both gym and clinical settings [62,63]. Examining the main results of the present cross-sectional study, it is important to indicate that there may be an interaction among trends related to exercise professionals and those related to health as well as some particular training modalities (e.g., personal training, small group training, health/wellness coaching and group training), since all of them are included in top 20 fitness trends among all five Southern European countries. However, this is an outcome that cannot be explained thoroughly here, and therefore further research is needed in the future in this area. Moreover, the first-ever Southern European survey of health and fitness trends may underline the rationale for regulation and licensing requirements for practitioners in the physical activity, exercise and wellness sector as applied by other allied healthcare professions (e.g., physical therapy, dietetics, chiropractic, osteopathic and nursing) globally, aiming to ensure higher standards for practitioners and protect consumers in the health and fitness sector. Lastly, given that fitness professionals based in Spain and Portugal demonstrated moderate to high levels of job satisfaction [64,65] and quality of life [66], it seems that the physical activity, exercise and wellness industry is a vibrant sector full of professional opportunities and a pleasant work environment.

What is trending in fitness activities?
Functional fitness training, body weight training, high-intensity interval training (HIIT), strength training with free weights and outdoor activities are popular trends in all selected Southern European countries. Circuit training, Pilates and core training were popular mostly in Greece and Cyprus and somewhat popular in Spain and Portugal but not in Italy. These observations are aligned with those reported in Europe [49] and worldwide [33] for 2023. Their attractiveness may be gradually growing in the worldwide health and fitness industry since these particular trends are mainly linked to first-line services in boutique fitness studios, which appear to be an emerging type of fitness facility in Europe and globally [3,67]. It is noteworthy that this particular workplace has been reported as one of the most promising gym settings among fitness professionals based in Europe [57]. However, boutique fitness studios are not currently popular in Southern Europe, since only in Greece was this option included in the top 20 fitness trends for 2023.
Considering that the physical activity, exercise and leisure sector has been significantly impacted by the COVID-19 pandemic in the past two years [1,3] and a long-lasting socioeconomic crisis in the past decade [68], especially in Southern European countries that demonstrate lower socioeconomic status than those in Northern and Central Europe [69], the personal training space seems to be recovering according to the present results. In addition, boutique fitness studios appear as the next generation of gym facilities, aiming to enhance customer engagement by off ering targeted training programs and services [58,67]. On the other hand, conventional health clubs with large facilities may be still attractive in Southern Europe, since traditional fitness activities such as strength training with free weights and group training are reported as popular in all five countries in this region for 2023. It is noteworthy that group training classes delivering HIIT, functional fitness and bodyweight training classes have been reported as some of the principal fitness services in the European health and fitness sector [70]. Likewise, resistance training has been widely established as an essential component of every physical exercise program for health, performance and well-being [71]. However, outdoor activities gained a lot of popularity during the COVID-19 pandemic due to fitness club restrictions worldwide [32,48]. This seems to be a trend that has retained its popularity even after that period, since it has been reported as one of the top 20 trends in Italy, Spain, Portugal and Greece, but not in Cyprus, for 2023. The currently increasing attractiveness of outdoor activities may be also supported by the fact that the running movement is systematically growing not only in Southern Europe but also globally [72].
In general, gym services related to group fitness and muscle-strengthening programs appear to be significantly popular to customers in some Southern European markets [2,14,15]. In the attempt to explain the attractiveness of the top trends related to fitness activities from a scientific perspective, the existing body of evidence shows that HIIT-based programs may be a user-friendly, effective, time-efficient and pleasant exercise option for the masses seeking to improve several physical and mental health markers in both group and small group training settings [73,74]. Furthermore, recent evidence indicates that training programs integrating some of the most popular fitness activities (e.g., HIIT, functional fitness and body weight training) as a hybrid-type session into real-world gym conditions provide beneficial changes in several psychophysiological indicators [75] among people representing the big majority of the adult population in the Western world [11]. Interestingly, people with an unhealthy weight are also underlined in this study, since exercise for weight loss was included in the top 20 trends in all five Southern European countries for 2023.
Another important outcome from the Southern European survey that should be taken into consideration is the low ranking of trends related to mind-body fitness such as yoga and tai chi. These particular trends were absent from the top 20 among all five countries included in this study. This is a result ultimately in line with findings recently reported in other national and regional surveys [47][48][49][50]. Such alternative fitness activities may need a more user-friendly approach to regularly engage the masses in these meditative exercise types that require greater functional capacity and less movement dysfunction than other training modes [76]. Instead, Pilates may be more inclusive compared to other mind-body fitness modalities, showing higher popularity in the Southern European region for 2023 [77,78]. However, Pilates demonstrates low attractiveness in other countries and regions [32][33][34][35][36][37][38][47][48][49][50]52,53,79], and this is an observation that may need additional investigation in the next years.

Which setting is most popular? Private, semi-private or group training?
Private and semi-private training settings are shown as more popular than group training settings among fitness industry stakeholders in Southern Europe for 2023. This fact underlines the importance of delivering personal and small group training sessions in a gym environment, aiming to offer more customized services and promoting engaging exercise experiences. According to the present study, on average, personal training has been selected as the most attractive trend. Small group training, as well as group training, also appear as popular trends in all Southern European countries involved in this survey. However, client-centered services through personal training sessions may experience higher demand than other training modalities among customers in the Southern European health and fitness industry, and this finding corroborates recently published data regarding the popularity of personal training in Europe [47][48][49][50]. Private training sessions may ensure a supervised environment that makes a substantial difference compared to other popular training modalities, since such a setting promotes an engaging exercise experience. This fact may be one of the greatest advantages of personal training compared to other trends related to fitness activities and modalities. An inclusive environment is likely to be provided by personalized training sessions, which seems to be critical for increasing customer engagement in the physical activity, exercise and wellness industry [58].
On the other side, group training involves exercise professionals instructing people through in-person group classes involving more than five participants. Group training classes are primarily designed for clients of all ages and all fitness levels, applying a variety of equipment to deliver several types of classes, from aerobic-based and indoor cycling classes to dance-based and step classes. Group training had been significantly impacted by the coronavirus pandemic in 2020-2022, and thus it was not listed high on the top 20 fitness trends worldwide [32,47,48]. Moreover, danceand aquatic-based training programs demonstrate limited applicability in all five Southern European countries since both were ranked very low among all candidate fitness trends in this region. Lastly, the presence of health/wellness coaching, as a trend related to training modalities, among the top 20 trends in the Southern European region shows a potential interaction between this particular trend and various health-related trends. Such a finding highlights the important role of regular exercise in physical and mental health, indicating a new landscape in the fitness industry regionally.

What is going on with underserved markets?
In this Southern European survey, four out of the top 20 selections are related to health: post-rehabilitation classes, exercise is medicine, lifestyle medicine and clinical integration / medical fitness. Likewise, another four trends related to programs focused on specific populations, children and exercise, fitness programs for older adults, exercise for weight loss and pre-and post-natal fitness, were ranked in the top 20. These results indicate the potential of these trends for all fitness industry stakeholders, since various lifestyle-related cardiometabolic health issues currently demonstrate an increasing prevalence in Southern Europe. According to the World Health Organization, Italy, Spain, Portugal, Greece and Cyprus demonstrate similar country health profiles ( Figure 2) [11], which may support the present findings showing that public health needs an enhancement by the physical activity, exercise and well-being sector at the national level. Interestingly, similar results can be found in other countries and regions, showing that various underserved markets may be under the microscope of the health and fitness sector. Such an observation shows that both businesses and practitioners are seeking to serve populations struggling with inactivity, overweight/obesity, aging and several controlled chronic conditions. Importantly, such groups of people represent a large part of the adult population not only in Southern Europe but also worldwide. However, despite the fact that gyms seem to be feasible settings for exercise in populations with cardiovascular risk factors in Italy [80], the current state of the physical activity, exercise and wellness sector does not appear well-equipped to offer an inclusive environment in order to support public health and meet its mission optimally [59].

The impact of technology
Certain changes in the fitness industry have been reported in the past decade due to the impactful role of social media and networks in the development of trends related to technology within the health and fitness sector [81]. Importantly, technology-oriented trends such as online personal training, mobile exercise apps, virtual training, online live and on-demand exercise classes and electrical muscle stimulation training were not included in the top 20 in all Southern European countries involved in the present survey. Only outcome measurements and wearable technology demonstrate some potential in Italy, Spain, Portugal and Greece, but not in Cyprus. This finding agrees with data recently published by similar studies carried out in several regions [32,[47][48][49]. The rapid digitalization and aggressive transformation of the traditional services mainly based on in-person fitness programs in a gym environment due to the COVID-19 pandemic may not have happened in an absolute way in all five countries involved in the Southern European survey. On the one hand, exercise professionals may understand the importance of applying technology for delivering their services under the urgent and challenging circumstances; however, the majority of them did not seriously follow the technology-oriented path in order to promote engaging fitness services and interactive user experience [82]. In summary, digital services do not seem to be high-priority fitness trends in the Southern European health and fitness sector. This outcome is aligned with the results presented by a Pan-European survey for 2020, 2021, 2022 and 2023 [47][48][49][50], indicating that trends related to technology are not widely established regionally among gym operators and practitioners. This observation cannot be explained here. However, further research is needed in this area to identify the potential factors that play a major role in the interaction among technology-oriented trends, job satisfaction and quality of life of fitness professionals and customer engagement in the Southern European physical activity, exercise and wellness industry.

COVID-19: A "game changer"
Considering that 2023 appears to be a critical transition and recovery period from the global epidemiological crisis due to COVID-19 [1,3], it is important to detect the role of COVID-19 in the top trends of the physical activity, exercise and wellness industry. Notably, the industry's aggressive and rapid adaptation to an unprecedented business environment played a crucial role in the provision of fitness services among the masses globally. In all Southern European countries, fitness clubs closed for almost 6 months in both 2021 and 2022. When indoor fitness facilities reopened, they experienced numerous challenges and barriers due to rigorous hygiene protocols and restrictions with regard to the global pandemic. Such regulations discouraged customers from using the gym facilities, and more importantly, exercise behavior was modified for reasons related to safety and social distancing. This may explain the rising attractiveness of home exercise gyms and outdoor activities in all relevant studies conducted during the COVID-19 pandemic at global level [32,47,48]. However, outdoor activities are still popular in the Southern European region for 2023, dem onstrating that walking, running and riding may be accessible and pleasant physical activity solutions. It would be interesting to investigate the evolution of all fitness trends highly impacted by COVID-19 in the future in order to identify the critical role of the pandemic crisis on the state of the physical activity, exercise and wellness sector in Southern Europe and other regions around the globe.

Strengths and limitations
The present survey, as an observational study, has several drawbacks, such as difficulties in determining causal effects, cohort differences and potential report biases. In particular, the absence of randomness in the samples and potential coverage errors appear to be the main limitations of this study. No incentive (financial or material) was offered to participants across all Southern European studies, which may be an additional tool for collecting more responses in this type of survey. On the other side, the replication of the methodology widely used by the ACSM and associates in relevant studies at national, regional and global levels seems to be the major strength of this study, highlighting a high degree of standardization that may lower potential bias frequently reported for research attempts of this kind. The large sample size (n = 2645) and the response rate (13.3%) in all involved national fitness surveys provide important summarized data for Southern Europe, which is an additional strength of the present survey. With the dissemination of the present results, Southern Europe is now included in a list of regions that regularly conduct this type of survey, allowing observations to be collected and compared over time. This type of observational study supports the evolution of services and products in the physical activity, exercise and wellness sector. Thus, it may be useful to continue with this research approach in Italy, Spain, Portugal, Greece and Cyprus in the coming years.

Conclusions
The results from this survey, focused on fitness trends in Southern Europe, may guide the physical activity, exercise and wellness sector in making critical business and professional development decisions. On average, personal training was the most attractive fitness trend in Southern Europe for 2023. This outcome is aligned with current results from a Pan-European survey [49] but not a global survey of fitness trends for 2023 [33]. This regional study delivers the opportunity to investigate useful comparisons among Italy, Spain, Portugal, Greece, Cyprus and other countries or regions in order to provide observations regarding the top health and fitness trends associated with various fitness services, products and programs worldwide [54]. Considering that the inactivity epidemic is on the rise not only in Southern Europe [83] but also worldwide [6], the aim of this regional cross-sectional study is to help all involved parties in the health and fitness industry on how to develop and apply safe, efficient and pleasant exercise solutions relevant to the most popular health and fitness trends. Given that the emerging development of the physical activity, exercise and wellness sector needs employers and fitness professionals to be continually modernized and to apply evidence-based practices within a multi-layered and challenging space [84], the translation of the present outcomes into high-quality services may enhance engaging exercise experiences for clients in the fitness market both locally and regionally. Lastly, further research should definitely help the investigation in this particular area, aiming to identify whether clients' opinions differ from the current findings in Southern Europe and other regions. Such an attempt may enhance the vital role of the physical activity, exercise and wellness sector, aiming to promote regular exercise as a top priority for the vast majority of the world's population through innovative and evidence-based services, programs and products.