Angina pectoris, a primary manifestation of ischemic heart disease, imposes a significant clinical and economic burden globally. This review highlights recent advancements in the management of angina, emphasizing a patient-centred approach that integrates pharmacological, interventional, and lifestyle strategies to reduce cardiovascular risk and improve patient outcomes. For obstructive coronary artery disease, optimal medical therapy represents the cornerstone of treatment. Individualized regimens should be tailored to clinical factors such as blood pressure, heart rate, left ventricular function, comorbidities like heart failure and diabetes, concomitant medications, patient preferences, and drug availability. Myocardial revascularization is reserved for select cases to alleviate symptoms or improve prognosis. For angina or ischemia with non-obstructive coronary arteries (ANOCA/INOCA), precise endotype classification, differentiating microvascular angina, vasospastic angina, mixed type and non-coronary chest pain, enables personalized treatment strategies. Lifestyle interventions, including smoking cessation, weight management, adherence to Mediterranean diet, and exercise therapy, are essential components of care, promoting improved cardiovascular outcomes and quality of life. Structured exercise programs, particularly within cardiac rehabilitation settings, have demonstrated efficacy in enhancing functional capacity and reducing adverse events. Emerging therapies, including pharmacological agents and novel interventional approaches such as the coronary sinus reducer, hold promise for addressing unmet needs in refractory angina and challenging ANOCA/INOCA cases. Future directions should prioritize the integration of precision medicine, digital health technologies, and multidisciplinary care to optimize outcomes and advance personalized angina management.

Despite the importance of objective measures for prescribing aerobic exercise for mitigating cardiovascular risk in people with coronary artery disease (CAD), no study has examined sex differences in the utility of the cardiopulmonary exercise test (CPET) for developing the exercise prescription.

CPET results from 1352 females and 5875 males with CAD were analysed to determine if there was a sex difference in achieving maximal oxygen uptake (V˙O2max) or an identifiable first ventilatory threshold (VT1). Secondary outcomes were to determine correlates of not achieving V˙O2max or VT1 in all patients and in males and females separately.

A greater proportion of males than females achieved V˙O2max or VT1 (89.7% vs 71.3%; P < 0.001) as well as specifically achieving V˙O2max (40.2% vs 26.7%; P < 0.001) and VT1 (88.0% vs 69.2%; P < 0.001). The most influential correlates of not achieving V˙O2max or VT1 were female sex (odds ratio 3.1, 95% confidence interval 2.6-3.7), age > 60 years, tested on treadmill vs cycle, depressive symptoms, and a secondary heart failure diagnosis. At entry to cardiac rehabilitation, these correlates were more prevalent in females than in males. Correlates differed by sex. The threshold for when age affected achieving V˙O2max or VT1 on the cycle CPET was earlier for females (> 50 years of age) than for males (> 70 years of age) with no difference on treadmill (> 80 years of age for both).

Although most patients achieved V˙O2max or VT1 on the CPET, females were 3 times less likely than males to achieve V˙O2max or VT1. Strategies to improve utility of CPETs for females, such as alternative exercise test protocols and investigation into underlying mechanisms for effects of depressive symptoms, should be conducted.

This study aimed to systematically search for relevant evidence on the management of kinesiophobia in patients after cardiac surgery both home and abroad. The evidence was evaluated and integrated to provide reference for clinical practice.

According to the '6S' evidence pyramid model, evidence related to managing kinesiophobia in patients after cardiac surgery were systematically searched from relevant domestic and foreign guideline websites and professional association websites and databases from the date of their establishment to December 31, 2024. The quality of the literature was evaluated by two master's students who had completed their professional training and assessment at the Evidence-based Nursing Center of Fudan University. These students also extracted and summarised the pertinent evidence that met the literature quality evaluation standards.

Sixteen studies were included, including two guidelines, three expert consensus, six systematic reviews, two meta-analyses, and threerandomizedcontrolled trials. A total of 20 pieces of evidence were formed in seven aspects: management principles, exercise guidance, pain management, psychological intervention, health education, social support, and follow-up management.

The comprehensive evidence summarised in this study for managing kinesiophobia in patients after cardiac surgery can provide resources for clinical translation. These insights can inform the development of kinesiophobia management plans to support the rapid recovery of patients after major surgery.

This study was registered at the Center for Evidence-Based Nursing of Fudan University (registration number ES20245486).

This study was registered at the Center for Evidence-Based Nursing of Fudan University (registration number ES20245486).This study is a summary of the best evidence and does not involve clinical trials and, therefore, no Clinical trial number.

Our aim was to report the functional outcome of Stanford type A aortic dissection (TAAD) after 1 year as well as morbidity and mortality.

This is a retrospective analysis including 642 patients with TAAD from January 2005 to December 2021. Mean age at TAAD was 62 years (95% CI, 61-63), and 30% of the population were women. One year after surgery for TAAD, 75% of patients were living at home with New York Heart Association functional class I. No patients were observed with New York Heart Association functional class IV. Less than 2% resided in an assisted-living facility. Eighty-five percent of nonretired patients had returned to work. Two hundred twelve (33%) patients were retired after 1 year at a mean age of 73 years (95% CI, 72-74). Stroke (defined as any kind of neurological symptoms) occurred in 148 (23%) patients and was the cause of death in 33 patients. Of the remaining patients with stroke, 115 (30%) had no residual limitations 1 year after TAAD. The cross-clamp time was significantly higher in patients with stroke (98 minutes [95% CI, 94.0-101.1] in patients without stroke versus 106 minutes [95% CI, 98.5-114.1] in patients with stroke; P=0.026). Sixty-nine percent of patients with stroke lived at home, 28% lived at home with support, and 3% lived in an assisted-living facility. One year after stroke, 77% of the patients achieved a modified Rankin Scale score ≤2, whereas no patient had a modified Rankin Scale score of 5. There was no significant correlation between sex and recovery rate (P=0.48). However, experiencing a stroke significantly increased the likelihood of residing in an assisted-living facility or receiving support at home 1 year after TAAD (odds ratio, 9.46 [95% CI, 5.06-17.70]; P<0.001). Thirty-day mortality was 11.8%, and 92 patients (14%) died within the first year after TAAD. There was no significant sex difference in mortality (P=0.101).

One year after surgery for Stanford acute type A aortic dissection, almost 3 out of 4 patients lived unassisted at home. Stroke survivors have a favorable outcome, with the majority having mild or no residual neurological deficits at 1 year.

Cardiopulmonary Exercise Testing (CPET) provides detailed insights into athletes' cardiovascular and pulmonary function, making it a valuable tool in assessing recovery and injury risks. However, traditional statistical models often fail to leverage the full potential of CPET data in predicting reinjury. Machine learning (ML) algorithms offer promising capabilities in uncovering complex patterns within this data, allowing for more accurate injury risk assessment.

This study aimed to develop machine learning models to predict reinjury risk among elite soccer players using CPET data. Specifically, we sought to identify key physiological and performance variables that correlate with reinjury and to evaluate the performance of various ML algorithms in generating accurate predictions.

A dataset of 256 elite soccer players from 16 national and top-tier teams in Iran was analyzed, incorporating physiological variables and categorical data. Several machine learning models, including CatBoost, SVM, Random Forest, and XGBoost, were employed to predict reinjury risk. Model performance was assessed using metrics such as accuracy, precision, recall, F1-score, AUC, and SHAP values to ensure robust evaluation and interpretability.

CatBoost and SVM exhibited the best performance, with CatBoost achieving the highest accuracy (0.9138) and F1-score (0.9148), and SVM achieving the highest AUC (0.9725). A significant association was found between a history of concussion and reinjury risk (χ² = 13.0360, p = 0.0015), highlighting the importance of neurological recovery in preventing future injuries. Heart rate metrics, particularly HRmax and HR2, were also significantly lower in players who experienced reinjury, indicating reduced cardiovascular capacity in this group.

Machine learning models, particularly CatBoost and SVM, provide promising tools for predicting reinjury risk using CPET data. These models offer clinicians more precise, data-driven insights into athlete recovery and risk management. Future research should explore the integration of external factors such as training load and psychological readiness to further refine these predictions and enhance injury prevention protocols.

Aims/Background A novel exercise protocol for cardiac rehabilitation aerobic (CRA) has been developed by Hebei Sport University, demonstrating efficacy in patients with coronary heart disease (CHD). The objective of this study was to evaluate the impact of CRA on precise cardiac rehabilitation (CR) for CHD patients presenting with stable angina pectoris. Methods The study cohort comprised patients with stable angina who were categorized into three groups: the CRA group (n = 35), the power bicycles (PB) group (n = 34), and the control group (n = 43). In addition to standard treatment, the CRA group underwent a 12-week CRA-based CR intervention, while the PB group participated in a similar program centered on PB exercise, and the control group received only standard treatment. Results At the end of the 12-week intervention, significant differences were observed among the groups in several physiological parameters, including systolic blood pressure (SBP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), Glycated Haemoglobin (Hb-A1c), peak oxygen uptake (Peak VO2), anaerobic threshold (AT), and Peak VO2/heart rate (HR) (p < 0.05). Both the CRA and PB groups showed significant reductions in SBP, FBG, TG, TC, LDL, and Hb-A1c compared to the control group (p < 0.05). Additionally, both groups exhibited significant improvements in Peak VO2, AT, and Peak VO2/HR (p < 0.05). Intra-group analysis revealed that the CRA group showed significant improvements from baseline to post-intervention in SBP, diastolic blood pressure (DBP), FBG, TG, TC, high-density lipoprotein (HDL), LDL, Hb-A1c, Peak VO2, AT, and Peak VO2/HR (p < 0.05). Similarly, the PB group demonstrated significant improvements across these parameters (p < 0.05). Conclusion Both CRA and PB exercises are safe and effective for achieving precise CR in patients with CHD. A 12-week CRA intervention, conducted three times per week for 30 minutes per session, significantly improves cardiopulmonary function and biochemical makers in patients with stable angina. These improvements are comparable to those achieved through PB exercise in precise CR.

Background/Objectives: Solid organ transplant recipients (OTR) have been recently involved in exercise prescription programs in order to reduce the high prevalence of cardiovascular diseases. The normal systolic and diastolic cardiac function is fundamental to personalizing the prescription. Diastolic dysfunction can be associated to a higher risk of cardiovascular events and left atrial (LA) strain is an emerging parameter in the evaluation of diastolic compromising, especially in subjects with preserved ejection fraction. Left atrial (LA) strain has never been explored in this category. The study aimed to evaluate the contribution of the LA strain in the assessment of diastolic function of OTR and its potential contribution in the exercise program. Methods: 54 solid OTR (liver and kidney transplants) regularly trained for at least 12 months in a home-based, partially supervised model at moderate intensity estimated by cardiopulmonary exercise test, underwent a complete echocardiographic analysis. The measured variables included left ventricle systolic function (ejection fraction, EF), diastolic function (E/A and E/E'), LA indexed volumes, LA peak atrial longitudinal strain (PALS) and LA peak atrial contraction strain (PACS). The data were compared to those of 44 healthy subjects (HS). Results: The OTR showed an overweight condition (BMI: 25.79 ± 2.92 vs. 22.25 ± 2.95; p < 0.01). Both groups showed a preserved systolic function (EF: OTR 63.1 ± 3.5% vs. HS 66.9 ± 6.1; p < 0.001), while diastolic standard parameters were significantly different (E/A, 1.01 ± 0.4 vs. 1.96 ± 0.74; p < 0.001; E/E', 9.2 ± 2.7 vs. 6.9 ± 1.3; p < 0.001, in OTR and HS respectively) despite being normal. LA strain was significantly lower in OTR vs. HS (4C PALS, 33.7 ± 9.7 vs. 45.4 ± 14.19; p < 0.001; 4C PACS, 15.9 ± 6.7 vs. 11.6 ± 7.5; p = 0.006; 2C PALS, 35.3 ± 11.1 vs. 47.6 ± 14.9; p < 0.001; 2C PALS, 17.4 ± 4.9 vs. 13.2 ± 14.97; p = 0.001; in OTR and HS respectively). A specific correlation of two- and four-chamber PACs and PALs with BMI has been observed (R for 4C PALS -0.406 ** and 2C PALS -0.276 *). Conclusions: These findings suggest that the coexistence of increased bodyweight in asymptomatic OTR patients can exacerbate the impairment of LA strains. LA strain detection could be useful in the development of a personalized exercise program for OTRs, especially for asymptomatic subjects and those with elevated cardiovascular risk profile, to potentially manage the exercise program in the long term. Larger studies will confirm the role via an eventual structured clinical score index.

Despite the well-known positive effects of exercise in patients with coronary artery disease, the best exercise training protocol is still under discussion.

We performed a systematic review and a meta-analysis to investigate the effects of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on exercise capacity and health-related quality of life (HRQoL) in patients with coronary artery disease.

We searched MEDLINE/PubMed, the Cochrane Library EMBASE, and the PEDro database for randomized controlled trials that evaluated the effects of HIIT versus MICT. Mean difference and 95 % confidence intervals (CI) were calculated.

27 studies, with 1454 patients, met the eligibility criteria. Twenty-four studies with 1259 patients assessed peak oxygen consumption (VO2peak) as an outcome. The HIIT group showed an increase of VO2peak (MD = 2.11 mL/kg/min; 95 % CI: 1.14, 3.07; I2 = 78 %; N = 1259) compared with the MICT group. Six studies with 316 patients assessed HRQoL as outcome. No differences in physical, emotional, and social domains of HRQoL were found between the HIIT and MICT groups. In the subgroup analysis of 10 studies with isocaloric exercise training, the HIIT and MICT groups showed similar VO2peak (MD = 0.72 mL/kg/min; 95 % CI: -0.03, 1.48; I2 = 44 %; N = 453).

Our meta-analysis showed low-quality evidence that HIIT training was more effective than MICT for improving VO2peak but not HRQoL in patients with coronary artery disease. However, when the analysis was limited to isocaloric protocols no difference between HIIT and MICT was found for VO2peak.

Hypertension is responsible for more than two million deaths due to cardiovascular disease annually in Latin America (LATAM), of which one million occurs before 70 years of age. Hypertension is the main risk factor for cardiovascular morbidity and mortality, affecting between 20 and 40% of LATAM adults. Since the publication of the 2017 LASH hypertension guidelines, reports from different LATAM countries have confirmed the burden of hypertension on cardiovascular disease events and mortality in the region. Many studies in the region have reported and emphasized the dramatically insufficient blood pressure control. The extremely low rates of awareness, treatment, and control of hypertension, particularly in patients with metabolic disorders, is a recognized severe problem in LATAM. Earlier implementation of antihypertensive interventions and management of all cardiovascular risk factors is the recognized best strategy to improve the natural history of cardiovascular disease in LATAM. The 2024 LASH guidelines have been developed by a large group of experts from internal medicine, cardiology, nephrology, endocrinology, general medicine, geriatrics, pharmacology, and epidemiology of different countries of LATAM and Europe. A careful search for novel studies on hypertension and related diseases in LATAM, together with the new evidence that emerged since the 2017 LASH guidelines, support all statements and recommendations. This update aims to provide clear, concise, accessible, and useful recommendations for health professionals to improve awareness, treatment, and control of hypertension and associated cardiovascular risk factors in the region.

The aims of this study were to assess the efficacy of the rate of perceived exertion (RPE) scale based on the number of repetitions in reserve (RIR) before exhaustion for the prescription of resistance training in cardiac rehabilitation and to compare it to the percentage of estimated one-repetition maximum (1RM) prescription method. Sixteen male patients (age 60 ± 8) with history of coronary artery disease were randomly assigned to two resistance training rehabilitation protocols lasting nine weeks and consisting of three sessions per week, with the same exercise selection, number of sets and repetitions, and rest periods, but different load prescription method (RPE vs. %1RM). Patients' strength was evaluated pre- and post-intervention. Patients in the RPE group showed significant increases in strength across all the exercises of the protocol (leg press 24.25 ± 17.07 kg; chest press 7.25 ± 3.41 kg; seated row 13.88 ± 7.57 kg; leg extension 14.24 ± 4.53 kg; shoulder press 5.75 ± 4.06 kg; lat pulldown 7.50 ± 4.66 kg). Post-intervention between-group analysis showed no differences in strength gains (leg press p = 0.955; chest press p = 0.965; seated row p = 0.763; leg extension p = 0.565; shoulder press p = 0.868; lat pulldown p = 0.780) and trivial effect sizes (ES) for one prescription method over the other (leg press ES = -0.03; chest press ES = 0.00; seated row ES = 0.10; leg extension ES = -0.29; shoulder press ES = 0.18; lat pulldown ES = 0.05). RPE based on RIR seems to be an effective prescription method for resistance training in cardiac rehabilitation, showing similar efficacy to the standardized practice of percentage of 1RM.

Breast cancer treatments often cause serious side effects, but physical exercise has shown the potential to improve both the physical and psychological health outcomes of survivors. This review and meta-analysis aimed to synthesize and analyze the scientific evidence on the effectiveness of concurrent training on physical, psychological, and biomarkers variables on breast cancer survivors.; Methods: A systematic review and meta-analysis was registered in PROSPERO (CRD42024571851). The ISI Web of Science, PubMed, and Scopus databases were searched. The methodological quality of all the included studies was assessed using the Cochrane risk of bias tool. This review included 14 articles that met the inclusion criteria on the effect of concurrent training on breast cancer survivors.

The results of the meta-analysis on body composition revealed a significant overall effect on body mass (effect size [ES] = -2.23; 95% CI: -4.16, -0.29) and body mass index (ES = -0.66; 95% CI: -1.32, 0.01). In contrast, no significant differences were shown in the % fat mass (ES = -2.63; 95% CI: -5.58, 0.33). Strength significantly improved after simultaneous training (ES = 4.93; 95% CI: 1.94, 7.92). In addition, cardiorespiratory fitness (maximum oxygen consumption) showed significant improvements after simultaneous training (ES = 3.03; 95% CI: 1.88, 4.19).

The research shows that concurrent training, including strength and aerobic exercises, promotes significant improvements in body mass, body mass index, muscle strength, and cardiorespiratory fitness. However, the effectiveness of the training depends on the intensity, duration and frequency of the exercise, as well as the individualization of the programs.

Cardiopulmonary exercise testing (CPET) is a crucial tool for assessing cardiorespiratory function, providing invaluable insights into individual physiological capacities. This review explores the clinical indications of CPET, its contraindications, as well as a comprehensive protocol for its execution. Additionally, it highlights key parameters measured during CPET and their interpretation, as well as the role of CPET in the prescription of aerobic training in cardiac rehabilitation. This review aims to provide a comprehensive, up-to-date synthesis of advances in the field of CPET and their clinical implications.

Some relevant key messages from the first presentation of the 2024 ESC Guidelines for the management of elevated blood pressure (BP) and hypertension.Image 1.

Vigorous intermittent lifestyle physical activity (VILPA) are bursts of incidental vigorous activity that occur during day-to-day activities outside of the exercise-domain. Vigorous intermittent lifestyle physical activity has shown promise in lowering risk of mortality and chronic disease. However, there is an absence of an empirically derived definition. Using physiological and effort-based metrics commonly used to define vigorous intensity, we investigated the minimum time needed to elicit physiological and perceived exertion responses to standardized activities of daily living.

Seventy adults (age = 58.0 ± 9.6 yr; 35 female) completed 9 VILPA activities of daily living in a randomized order, which included fast walking, fast incline walking, stair climbing, stationary cycling, and carrying external weight equal to 5% and 10% of body weight. Metabolic rate (by continuous indirect calorimetry), heart rate (telemetry) and perceived effort (Borg Scale) were measured during exercise. Time to reach VILPA was assessed using %V̇O 2max , %HRmax, and rating of perceived exertion thresholds.

The mean time to elicit VILPA ranged from 65 to 95 s (mean ± sd = 76.7 ± 3.8 s) for %V̇O 2max , 68 to 105 s (mean ± sd = 82.8 ± 6.8 s) for %HRmax, and 20 to 60 s (mean ± sd = 44.6 ± 6.7 s) for rating of perceived exertion. For each of the three indices, there was no difference in the time to elicit VILPA responses by sex or age ( P > 0.08), and times were also consistent between activities of daily living tasks. For example, for females and males, the average time to elicit vigorous responses while walking on a flat surface was 85.8 s (±16.9 s) and 80 s (±13.9 s), respectively, and for stair climbing while carrying 10% of body weight the duration was 78.4 s (±17.6 s) and 76.9 (±17.7 s).

When participants undertook activities of daily living, VILPA elicited a physiological response at an average of 77 to 83 s for %V̇O 2max and %HRmax, and 45 s for perceived exertion. The absence of a difference in the time to reach VILPA between sex and age suggests that a consistent behavioral VILPA translation can be used in interventions and population-based studies designed to assess the health effects of incidental physical activity.

Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs).

We conducted a cross-sectional, international 30-item survey through e-mails.

In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors.

Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.

Patients with cardiac disease exhibit exaggerated sympathoexcitation, pressor, and ventilatory responses to muscle metaboreflex activation (MMA). However, the effects of cardiac rehabilitation (CR) and especially resistance training (RT) modalities on MMA are not well known. This study investigated how CR impacts MMA in such patients, specifically examining the effects of two different resistance training (RT) protocols following 12 weeks of CR. In addition to endurance exercises, 32 patients were randomized into either a 3/7 RT modality (comprising 5 sets of 3-7 repetitions) or a control (CTRL) modality (involving 3 sets of 9 repetitions), with distinct inter-set rest intervals (15 s for 3/7 and 60 s for CTRL). MMA, gauged by blood pressure (BP) and ventilatory (Ve) responses during a handgrip exercise at 40% effort and subsequent post-exercise circulatory occlusion, demonstrated CR's significant impact. Systolic BP, initially at + 28 ± 23% pre-CR, improved to + 11 ± 15% post-CR (P = .011 time effect; P = .131 group effect). Diastolic BP showed a similar trend, from + 27 ± 23% to + 13 ± 15% (P = .099 time effect; P = .087 group effect). Ve, initially at + 60 ± 39%, reduced to + 14 ± 19% post-CR (P < .001 time effect; P = .142 group effect). Critical parameters-maximal oxygen consumption, lean mass, hand grip, and quadriceps strength-exhibited parallel increases in both 3/7 and CTRL groups (P < .05 time effect; P > .3 group effect). Ultimately, CR demonstrated comparable improvements in MMA across both RT modalities, indicating its positive influence on cardiovascular responses and physical performance in individuals with cardiac conditions.

People living with HIV (PLWH) are physically inactive and risk cardiometabolic dysfunction. Home and community exercise (HCE) is pragmatic, cost-effective and improves health in varied chronic conditions. This review aimed to synthesize evidence on the effectiveness of minimally supervised HCE for physical activity (PA), adiposity, quality of life (QoL), and other physical and psychological health indices for PLWH.

Databases were searched for studies published January 2000 to April 2023. Risk of bias in experimental and quasi-experimental studies was assessed with the Cochrane Risk-of-Bias for Randomized Trials and Risk-of-Bias in Non-Randomized Studies of Interventions tools, respectively. A random-effects meta-analysis was conducted.

From 9648 records, 13 studies (14 HCE groups) with 857 PLWH (average ages 29-56 years) were included; 12 comparator and one single group trial. Aerobic and strength HCE significantly improved PA relative to control by 0.377 units (95 %CI = 0.097, 0.657; p = 0.008) and 1097steps/day (95 %CI = 39.27, 2156.62; p = 0.042). There was a reduction from baseline in percent body fat of 3.36 % (95 %CI = -6.10, 0.42; p = 0.025), but no change in BMI (-0.21 kg/m2; 95 %CI = -0.67, 0.24; p = 0.351) relative to control. HCE improved QoL relative to control in the physical domain by 13points (95 %CI = 6.15, 19.86; p < 0.001), but not in other domains like general health (6.6points; 95 %CI = -1.19, 14.36; p < 0.097). HCE completed at moderate intensity or higher was associated with improvement in outcomes more so than lower intensity HCE. Walking-only interventions were at least as beneficial as other activities. No adverse events were recorded.

Minimally supervised HCE can improve PA, body fat, physical QoL and other health indices in PLWH.

Hierarchical management of sports risk is highly critical to ensure the safety of sports rehabilitation. Early identification, timely prevention and control of sports-related risk factors, and enhanced supervision and guidance can provide a basis for the formulation of sports programmes and the setting of sports monitoring levels.

This study aimed to retrieve, evaluate, and integrate evidence for the stratified management of motor risk in patients with a cardiac implantable electronic device (CIED).

We searched for evidence according to the "6S" model of evidence-based resources. CNKI, VIP, Wanfang Data, CBM, PubMed, Cochrane Iibrary, CINAHL, EMbase, Web of Science, BMJ Best Practice, Up To Date, and International Guidelines Collaboration Network were searched from inception to February 2024. To search for evidence on stratified management of motor risk in patients with CIEDs, this research includes guidelines, systematic reviews, meta-analyses, expert consensus, clinical decision-making, and randomized controlled trials. After methodological quality evaluation, the evidence was extracted and summarized accordingly.

According to the inclusion and exclusion criteria, 16 pieces of evidence were screened, including 5 guidelines, 1 clinical decision-making, 5 systematic reviews, 4 expert consensus, and 1 randomized controlled trial. After reading, extracting, and categorizing, 34 pieces of evidence in 4 areas were identified, namely, screening and assessment of exercise risk in CIEDs, exercise monitoring, implementation of exercise prescriptions, and prevention and management of exercise-related risks.

This study provides the best evidence for the prevention and management of exercise risk in patients with CIEDs, clarifies the role of nurses in evaluating, monitoring, and educating patients undergoing motor rehabilitation, and provides a basis for the formulation of clinically feasible rehabilitation programs.

PROSPERO, identifier (CRD2024509622).

To develop and validate equations predicting heart rate (HR) at the first and second ventilatory thresholds (VTs) and an optimized range-adjusted prescription for patients with cardiometabolic disease (CMD). To compare their performance against guideline-based exercise intensity domains.

Cross-sectional study involving 2868 CMD patients from nine countries. HR predictive equations for first and second VTs (VT1, VT2) were developed using multivariate linear regression with 975 cycle-ergometer cardiopulmonary exercise tests (CPET). 'Adjusted' percentages of peak HR (%HRpeak) and HR reserve (%HRR) were derived from this group. External validation with 1893 CPET (cycle-ergometer or treadmill) assessed accuracy, agreement, and reliability against guideline-based %HRpeak and %HRR prescriptions using mean absolute percentage error (MAPE), Bland-Altman analyses, intraclass correlation coefficients (ICC). HR predictive equations (R²: 0.77 VT1, 0.88 VT2) and adjusted %HRR (VT1: 42%, VT2: 77%) were developed. External validation demonstrated superiority over widely used guideline-directed intensity domains for %HRpeak and %HRR. The new methods showed consistent performance across both VTs with lower MAPE (VT1: 7.1%, VT2: 5.0%), 'good' ICC for VT1 (0.81, 0.82) and 'excellent' for VT2 (0.93). Guideline-based exercise intensity domains had higher MAPE (VT1: 6.8-21.3%, VT2: 5.1-16.7%), 'poor' to 'good' ICC for VT1, and 'poor' to 'excellent' for VT2, indicating inconsistencies related to specific VTs across guidelines.

Developed and validated HR predictive equations and the optimized %HRR for CMD patients for determining VT1 and VT2 outperformed the guideline-based exercise intensity domains and showed ergometer interchangeability. They offer a superior alternative for prescribing moderate intensity exercise when CPET is unavailable.

Exercise-based cardiac rehabilitation (ExCR) programs are essential for patients diagnosed with cardiac diseases. Studies have shown that they aid in the rehabilitation process and may even facilitate a return to previous cardiorespiratory fitness. Also, patients who enroll and follow such programs have shown a lower rate of complications and mortality in the long run. The results vary depending on the type of program followed and the degree of debilitation the disease has caused. Therefore, in order to obtain optimal results, it is ideal to tailor each ExCR program to the individual profile of each patient. At the moment, the two most studied and employed training types are medium-intensity continuous training (MICT) and high-intensity interval training (HIIT). For most of the time, MICT was the first-choice program for patients with cardiovascular disease. In recent years, however, more and more studies have pointed towards the benefits of HIIT and how it better aids patients in recovering their cardiovascular fitness. Generally, MICT is more suited for patients with a severe degradation in functional capacity and who require a higher degree of safety (e.g., elderly, with a high number of comorbidities). On the other hand, while HIIT is more demanding, it appears to offer better outcomes. Therefore, this review aimed to summarize information from different publications on both types of training regimens in ExCR and assess their utility in current clinical practice.

Hypertension-induced cardiac hypertrophy is widely known as a major risk factor for increased cardiovascular morbidity and mortality. Although exercise is proven to exert overall beneficial effects on hypertension and hypertension-induced cardiac hypertrophy, there are some concerns among providers about potential adverse effects induced by intense exercise, especially in hypertensive athletes. We will overview the underlying mechanisms of physiological and pathological hypertrophy and delineate the beneficial effects of exercise in young people with hypertension and consequent hypertrophy.

Multiple studies have demonstrated that exercise training, both endurance and resistance types, reduces blood pressure and ameliorates hypertrophy in hypertensives, but certain precautions are required for hypertensive athletes when allowing competitive sports: Elevated blood pressure should be controlled before allowing them to participate in high-intensity exercise. Non-vigorous and recreational exercise are always recommended to promote cardiovascular health. Exercise-induced cardiac adaptation is a benign and favorable response that reverses or attenuates pathological cardiovascular remodeling induced by persistent hypertension. Exercise is the most effective nonpharmacological treatment for hypertensive individuals. Distinction between recreational-level exercise and competitive sports should be recognized by medical providers when allowing sports participation for adolescents and young adults.

Exercise is an important physiological activity with several health benefits. In the setting of ischemic heart disease (IHD), the view toward exercise has greatly evolved throughout the years, concurrently to several major advances in the management of this complex entity. Currently, exercise training has broad applications across the IHD continuum as a powerful tool in its overall management, being a core component of comprehensive cardiac rehabilitation programs. Beyond this, exercise has also been incorporated as an integral part of contemporary methodologies aiming to provide diagnostic and prognostic data, such as cardiopulmonary exercise stress testing or stress echocardiography. In this article, we provide a pragmatic overview concerning the role of exercise in IHD, with a focus on its incorporation in cardiac rehabilitation frameworks, while also discussing some of the challenges and unmet needs concerning these interventions.

Background/Objectives: Caregivers of patients with heart disease may often feel physically, emotionally, and psychologically overwhelmed by their role. The analysis of cardiac rehabilitation (CR) components and caregivers' needs suggests that some interventions may benefit them. Therefore, this study aimed to identify a consensus on the CR components targeting caregivers of patients with heart disease. Methods: A three-round international e-Delphi study with experts on CR was conducted. In round 1, experts provided an electronic level of agreement on a set of initial recommendations originating from a previous scoping review. In round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. In round 3, the same experts were asked to re-rate items that did not reach a consensus from round 2. Results: A total of 57 experts were contacted via e-mail to participate in the Delphi panel, and 43 participated. The final version presents seven recommendations for caregivers of patients with heart disease in CR programs. Conclusions: These recommendations are an overview of the evidence and represent a tool for professionals to adapt to their context in the different stages of CR, integrating the caregiver as a care focus and as support for their sick family members. By identifying the components/interventions, there is potential to benchmark the development of a cardiac rehabilitation strategy to be used and tested by the healthcare team for optimizing the health and role of these caregivers.

Arterial hypertension remains the major cardiovascular risk worldwide. It is estimated that under 50 years of age one in every three adults is hypertensive while beyond the age of 50 the prevalence is almost 50% globally. The latest World Health Organization (WHO) Global Report on Hypertension indicated that the global number of hypertensive patients almost doubled in the last three decades, with related increasing deaths, disability, and costs annually. Because of this global increase, early diagnosis and timely treatment is of great importance. However, based on the WHO Global Report, it is estimated that up to 46% of individuals were never diagnosed. Of those diagnosed, less than 50% were on treatment, with nearly half among these at target according to the current guidelines. It is also important to note that an increasing number of hypertensive patients, despite the use of three or more drugs, still do not achieve a blood pressure normalization, thus defining the clinical scenario of resistant hypertension (RH). This condition is associated to a higher risk of hypertension-mediated organ damage and hospitalization due to acute cardiovascular events. Current guidelines recommend a triple combination therapy (renin angiotensin system blocking agent + a thiazide or thiazide-like diuretic + a dihydropyridinic calcium-channel blocker) to all patients with RH. Beta-blockers and mineralocorticoid receptor antagonists, alone or in combination, should be also considered based on concomitant conditions and potential contraindications. Finally, the renal denervation is also proposed in patients with preserved kidney function that remain hypertensive despite the use of maximum tolerated medical treatment. However, the failure of this procedure in the long term and the contraindication in patients with kidney failure is a strong call for a new therapeutic approach. In the present review, we will discuss the pharmacological novelties to come for the management of hypertension and RH in the next future.

Few comparative studies have evaluated wearable single-lead electrocardiogram (ECG) devices and standard multi-lead ECG devices during exercise testing. This study aimed to validate the accuracy of a wearable single-lead ECG monitor for recording heart rate (HR) metrics during graded exercise tests (GXTs).

A cohort of 50 patients at a tertiary hospital underwent GXT while simultaneously being equipped with wearable single- and conventional multi-lead ECGs. The concordance between these modalities was quantified using the intraclass correlation coefficient and Bland-Altman plot analysis.

The minimum and average HR readings between the devices were generally consistent. Parameters such as ventricular ectopic beats and supraventricular ectopic beats showed strong agreement. However, the agreement for the Total QRS and Maximum RR was not sufficient. HR measurements across different stages of the exercise test showed sufficient agreement. Although not statistically significant, the standard multi-lead ECG devices exhibited higher noise levels compared to the wearable single-lead ECG devices.

Wearable single-lead ECG devices can reliably monitor HR and detect abnormal beats across a spectrum of exercise intensities, offering a viable alternative to traditional multi-lead systems.

Despite the well-known health benefits of regular physical activity, sedentary behavior and physical inactivity remain a real global pandemic. Exercise is associated with increased life expectancy, improved quality of life and prevention of multiple diseases. Although less implemented in practice compared to aerobic exercise, recent evidence shows that resistance exercise (RE) is also responsible for various benefits, including improvements in body composition, control of several cardiovascular (CV) risk factors, and reduction of CV outcomes. RE increases strength and muscle mass, is effective in controlling type 2 diabetes, and improves the management of obesity, lipids, and blood pressure profiles. In this setting, clinical guidelines recommend the inclusion of RE for primary and secondary CV risk prevention, particularly in combination with aerobic exercise, in which the benefits are most pronounced. Prescription of RE should follow a methodology that includes key variables such as frequency, intensity, type, time, and progression. Despite challenges, professionals in the CV field should be familiar with RE prescription in order to maximize its referral in clinical practice. This review aims to analyze the CV effects of RE and current recommendations regarding the prescription of this type of exercise.

Physical activity (PA) measured by accelerometry is proposed as a novel trial endpoint for heart failure (HF). However, standardised methods and associations with established markers are lacking. This study aimed to examine PA measurements and accelerometer repeatability in patients with HF and age- and sex-matched controls, and study correlations with established prognostic HF markers, body composition, and quality of life (QoL).

Accelerometry was performed in 105 patients with HF with left ventricular ejection fraction (LVEF) ≤ 40% and in 46 controls. Participants also underwent dual X-ray absorptiometry, cardiopulmonary exercise testing, a six-minute walking test (6MWT), echocardiography, and NT-proBNP measurement, and completed a QoL questionnaire.

Average acceleration was markedly reduced in patients with HF compared with healthy controls (16.1 ± 4.8 mg vs 27.2 ± 8.5 mg, p < 0.001). Healthy controls spent a median daily 56 min (IQR 41-96 min) in moderate-to-vigorous PA (MVPA), whereas HF patients spent only 12 min (IQR 6-24) in MVPA. In HF patients, average acceleration correlated moderately with 6MWT (R = 0.41, p < 0.001) and maximal oxygen uptake (peak VO2) (R = 0.36, p < 0.001) but not with NT-proBNP, LVEF, or QoL. Patients in NYHA class II showed a higher average acceleration than patients in NYHA III (16.6 ± 4.9 mg vs 14.0 ± 3.6 mg, p = 0.01).

Daily PA was severely reduced in patients with HF compared with healthy controls. In HF patients, we found moderate correlations of accelerometer measurements with markers of physical capacity but not with LVEF or NT-proBNP.

NCT05063955. Registered 01 June 2021-retrospectively registered.

Exercise is an important component of rehabilitation care for people with coronary heart disease (CHD).

The aim of this study was to critically analyze and summarize the existing evidence from published systematic reviews (SRs) and meta-analyses of randomized controlled trials (RCTs) that have evaluated the effects of different types of exercise interventions on cardiorespiratory fitness, as measured by peak oxygen consumption in people with CHD.

Electronic databases (Cochrane Library, Medline/PubMed, EMBASE, and PEDro) were searched for SRs of exercise interventions of people with CHD. Two reviewers assessed the quality of SRs using the AMSTAR-2 tool and evaluated the strength of evidence quality with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system for relevant outcome measures. Mean difference (MD) and 95% confidence intervals (CIs) were calculated.

Thirty-one SRs (with 125 RCTs) met the study criteria, including 33,608 patients. Compared with usual care, continuous aerobic exercise produced an improvement in peak oxygen consumption, MD of 3.8 mL kg-1 min-1 (95% CI: 3.204.4, I2 = 67%); high-intensity interval training, MD 6.1 mL kg-1 min-1 (95% CI: 0.4-11.8, I2 = 97%); resistance training, MD of 2.1 mL kg-1 min-1 (95% CI: 0.98-3.2, I2 = 60%); combined aerobic and resistance training, MD of 3.0 mL kg-1 min-1 (95% CI: 2.5-3.4, I2 = 0%); and water-based exercise, MD of 4.4 mL kg-1 min-1 (95% CI, 2.1-6.7; I2 = 2%).

Exercise interventions improve peak oxygen consumption in people with CHD. However, there was moderate to very-low certainty for the evidence found.

Cardiopulmonary exercise testing (CPET) provides a noninvasive and integrated assessment of the response of the respiratory, cardiovascular, and musculoskeletal systems to exercise. This information improves the diagnosis, risk stratification, and therapeutic management of several clinical conditions. Additionally, CPET is the gold standard test for cardiorespiratory fitness quantification and exercise prescription, both in patients with cardiopulmonary disease undergoing cardiac or pulmonary rehabilitation programs and in healthy individuals, such as high-level athletes. In this setting, the relevance of practical knowledge about this exam is useful and of interest to several medical specialties other than cardiology. However, despite its multiple established advantages, CPET remains underused. This article aims to increase awareness of the value of CPET in clinical practice and to inform clinicians about its main indications, applications, and basic interpretation.

Ventricular assist devices represent a treatment option for patients with advanced heart failure, offering control over various haemodynamic variables. Similarly, the prescription of exercise within a cardiac rehabilitation programme for heart failure patients is recommended to reduce symptoms, and hospitalisations, improve cardiorespiratory fitness, and increase exercise tolerance. Therefore, exercise prescription can impact those with ventricular assist devices. Given the limited evidence on exercise-based cardiac rehabilitation programmes for this population, this review aims to describe the most commonly used strategies and their health benefits when physical exercise is included in a cardiac rehabilitation programme for patients with ventricular assist devices.

An exploratory review was conducted through searches in the databases: PubMed, SCOPUS, PeDro, and ScienceDirect. The search was limited to studies published between 2013 and 2023. Filters were applied independently by title, abstract, and full text. The included articles were analysed based on the description of the types of cardiac rehabilitation strategies used in patients with ventricular assist devices.

Seven articles were included. Each programme employed a cardiopulmonary exercise test before prescribing physical exercise. The most commonly used strategy was aerobic exercise, predominantly high-intensity interval training (HIIT) with intensities close to 90% of peak VO2, followed by continuous moderate-intensity exercise. Limb strength exercises were included in three programmes.

The analysed literature suggests that cardiac rehabilitation in patients with ventricular assist devices is safe and can provide benefits in cardiorespiratory fitness and exercise tolerance. High-intensity interval training is identified as an appropriate strategy for achieving results, offering short-term improvements.

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

Heart transplantation is the gold-standard treatment for terminal heart failure. Despite being successful, pre- and post-transplant limitations interfere with patients' functional capacity, self-care, and quality of life post-surgery. Rehabilitation is necessary to address these limitations, prevent complications, and promote a safe return home. This study analyzes the safety of a phase 1 cardiac rehabilitation protocol (RN4HTx) in heart transplant patients and its effects on self-care capacity. A quantitative, descriptive study was conducted with 19 heart transplant recipients. The protocol was implemented in collaboration with a rehabilitation professional, who monitored adverse events, hemodynamic variables, self-care capacity (Barthel) pre- and post-transplant, and functional capacity at discharge (6 min walk test). The results showed that 68.42% of recipients were men, with an average age of 50.21 years and 15 days of hospitalization post-transplant. Approximately 73.68% of recipients were transferred from other wards with changes in functional capacity. All patients progressed to the final stage of the program without adverse events. There was a notable improvement in self-care capacity before and after transplantation, with a measure of functional status of 310.035 m (6MWT). The study found that RN4HTx is a feasible cardiac rehabilitation program without adverse events in the immediate postoperative period following heart transplantation, positively impacting functional recovery and therapeutic self-care capacity, thus increasing the safety of returning home. This study was retrospectively registered on Clinical Trials-NCT06552390.

Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus.

High-intensity resistance training is known to be the most effective method for enhancing muscle strength and thickness, but it carries potential injury risks. Blood flow restriction (BFR) combined with resistance training has been proposed as a safer alternative method for improving muscle strength and thickness.

A meta-analysis was conducted, including 20 studies from five databases that met the inclusion criteria, to assess the efficacy of BFR combined with resistance training compared to traditional resistance training (NOBFR). The analysis focused on changes in muscle strength and thickness. Subgroup analysis and meta-regression were performed to explore the effects of tourniquet width and pressure.

The findings showed that BFR combined with resistance training is comparable to traditional resistance training in enhancing muscle strength [0.11, 95%CI: (-0.08 to 0.29), I 2 = 0%] and muscle thickness [-0.07, 95% CI: (-0.25 to 0.12), I 2 = 0%]. Subgroup analysis indicated no significant differences in muscle strength (P = 0.66) and thickness (P = 0.87) between low-intensity BFR training and other intensity levels. Meta-regression suggested that tourniquet width and pressure might affect intervention outcomes, although the effects were not statistically significant (P > 0.05).

BFR combined with resistance training offers a viable alternative to high-intensity resistance training with reduced injury risks. We recommend interventions of 2-3 sessions per week at 20%-40% of 1 RM, using a wider cuff and applying an arterial occlusion pressure of 50%-80% to potentially enhance muscle strength and thickness. It is also recommended to release tourniquet pressure during rest intervals to alleviate discomfort. This protocol effectively improves muscle strength with minimal cardiac workload and reduced risk of adverse events.

[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023495465], identifier [CRD42023495465].

Understanding the link between heart disease and frailty in older adults is crucial. Although medical progress has extended life, it has not fully addressed the decline in function and quality of life in frail older people. Frailty is a state of vulnerability to health stressors that needs comprehensive solutions. Its assessment within health care, especially in cardiology, is important owing to its association with worse clinical outcomes. Recent evidence and guidelines suggest that the prescription of a comprehensive exercise regimen, tailored to progressively include strength, balance, mobility, and endurance training improves adherence, functionality, and health-related quality of life, in both acute and chronic cardiovascular diseases. In addition, exercise is a vital tool that improves function, targets frailty, and holistically affects the body's systems. Still, many frail people do not exercise enough, and when they do, they usually do not follow an appropriate plan tailored for better functional outcomes. Overcoming barriers and limitations in exercise enrollment and adherence through strategies such as automated cardiac rehabilitation referral, patient education, and eHealth tools can notably improve clinical outcomes.