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Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health
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Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 20 May 2024 | Viewed by 2842

Special Issue Editor

Dr. Barak Zafrir

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Guest Editor
Lady Davis Carmel Medical Center, Cardiology Department, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 7 Michal St., Haifa, Israel
Interests: cardiorespiratory fitness; metabolic syndrome; lipids; atherosclerotic cardiovascular disease; heart failure

Special Issue Information

Dear Colleagues,

Physical inactivity and low cardiorespiratory fitness are associated with modifiable risk factors for chronic non-communicable diseases, and are strong predictors of poor cardiovascular health. In contrast, regular physical activity improves cardiometabolic risk factors and lead to significant reduction in the risk of cardiovascular diseases. In patients following acute coronary syndromes or with symptomatic heart failure, structured exercise training, as part of a multidisciplinary cardiac rehabilitation program, improves functional capacity, fitness, and quality of life, reducing risk for cardiovascular events, re-hospitalizations, and mortality. It is therefore considered an important guideline-recommended intervention in this patient population.

Exercise testing, in its various forms, provides valuable diagnostic and prognostic information regarding the risk for developing cardiovascular and pulmonary diseases. It provides insight into the patient’s physical capacity, fitness, and ability to perform daily activities, and enables the assessment of cardiorespiratory function and discriminate between cardiac, ventilatory, and musculoskeletal limitations during exercise. It also aids in determining the modes and intensity of exercise and monitoring the effectiveness and safety of physical training and response to therapeutic interventions.

Despite the vast benefits of exercise on cardiovascular health and the importance of exercise testing in the evaluation of various aspects of health and disease, they are often underutilized in daily clinical practice as part of the approach for the evaluation, treatment, and prevention of cardiovascular disorders, as well as in risk stratification and prediction of prognosis. In this Journal Special Issue, we aim to highlight novel clinical insights regarding physical activity, exercise, and cardiorespiratory fitness in the context of cardiovascular health and disease. We look forward for receiving original research and reviews regarding the impact of cardiorespiratory fitness, exercise prescriptions, training modalities, and cardiac rehabilitation on cardiovascular disease and prognosis.

Dr. Barak Zafrir
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiorespiratory fitness
  • exercise testing
  • cardiac rehabilitation
  • risk factors
  • metabolic syndrome
  • heart failure
  • cardiovascular outcomes

Published Papers (3 papers)

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Research

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16 pages, 2767 KiB  
Article
Evaluating the Effects of an Enhanced Strength Training Program in Remote Cardiological Rehabilitation: A Shift from Aerobic Dominance—A Pilot Randomized Controlled Trial
by Irene Nabutovsky, Roy Sabah, Merav Moreno, Yoram Epstein, Robert Klempfner and Mickey Scheinowitz
J. Clin. Med. 2024, 13(5), 1445; https://doi.org/10.3390/jcm13051445 - 01 Mar 2024
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Abstract
(1) Background: Cardiac rehabilitation often emphasizes aerobic capacity while overlooking the importance of muscle strength. This study evaluated the impact of an enhanced remote strength training program (RCR-ST) on cardiac rehabilitation. (2) Methods: In this randomized prospective study (RCT registration number SMC-9080-22), 50 [...] Read more.
(1) Background: Cardiac rehabilitation often emphasizes aerobic capacity while overlooking the importance of muscle strength. This study evaluated the impact of an enhanced remote strength training program (RCR-ST) on cardiac rehabilitation. (2) Methods: In this randomized prospective study (RCT registration number SMC-9080-22), 50 patients starting cardiac rehabilitation were assessed for muscle strength, aerobic capacity, and self-reported outcomes at baseline and after 16 weeks. Participants were divided into two groups: the RCR-ST group received a targeted resistance training program via a mobile app and smartwatch, while the control group received standard care with general resistance training advice. (3) Results: The RCR-ST group demonstrated significant improvements in muscle endurance, notably in leg extension and chest press exercises, with increases of 92% compared to 25% and 92% compared to 13% in the control group, respectively. Functional assessments (5-STS and TUG tests) also showed marked improvements in agility, coordination, and balance. Both groups improved in cardiorespiratory fitness, similarly. The RCR-ST group reported enhanced physical health and showed increased engagement, as evidenced by more frequent use of the mobile app and longer participation in the rehabilitation program (p < 0.05). (4) Conclusions: Incorporating a focused strength training regimen in remote cardiac rehabilitation significantly improves muscle endurance and patient engagement. The RCR-ST program presents a promising approach for optimizing patient outcomes by addressing a crucial gap in traditional rehabilitation protocols that primarily focus on aerobic training. Full article
(This article belongs to the Special Issue Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health)
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10 pages, 2243 KiB  
Article
Cardiorespiratory Fitness and Risk of Cardiovascular Events and Mortality in Middle Age Patients without Known Cardiovascular Disease
by Amir Aker, Walid Saliba, Fadel Bahouth, Ibrahim Naoum and Barak Zafrir
J. Clin. Med. 2023, 12(22), 7011; https://doi.org/10.3390/jcm12227011 - 09 Nov 2023
Viewed by 753
Abstract
Background: Low cardiorespiratory fitness is an established risk predictor for chronic non-communicable diseases. We aimed to investigate the prognostic significance of fitness level on the risk of major adverse cardiac events (MACE, the composite of myocardial infarction, stroke, or all-cause death), in a [...] Read more.
Background: Low cardiorespiratory fitness is an established risk predictor for chronic non-communicable diseases. We aimed to investigate the prognostic significance of fitness level on the risk of major adverse cardiac events (MACE, the composite of myocardial infarction, stroke, or all-cause death), in a contemporary cohort of middle-aged subjects without cardiovascular disease. Methods: Retrospective analysis of patients aged 40–60 years without a history of cardiovascular disease. Degree of fitness was determined according to a graded, maximal treadmill exercise stress testing (EST) time achieved, classified into age- and sex-specific quintiles (Q), and categorized as low (Q1), moderate (Q2–Q4) or high (Q5) fitness groups. A multivariable Cox proportional hazard regression model was used to assess the association of fitness level with the risk of MACE. Results: A total of 6836 patients were included, of which 44.5% were women, and the mean age was 52 years. Overall, 289 MACE events occurred during a median follow-up of 7 years. Level of fitness was inversely associated with the presence of cardiovascular risk factors. The multivariable adjusted hazard ratio (95% confidence interval) for MACE was 1.65 (1.12–2.44) and 2.17 (1.40–3.38) in those at moderate and low fitness levels, compared to the high-fitness group (reference), respectively. For each decrease of one metabolic equivalent (MET) unit achieved at peak exercise, the relative risk for MACE increased by 18%. The association between low fitness and MACE was not modified by other risk factors (P-for-interaction non-significant). Conclusions: Low fitness level, as captured by a maximal treadmill EST, is an independent risk predictor for MACE among middle-age individuals without known cardiovascular disease. The association of low fitness with high burden of cardiometabolic risk factors highlight the importance of lifestyle intervention in this patient population. Full article
(This article belongs to the Special Issue Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health)
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Other

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16 pages, 1768 KiB  
Systematic Review
Effects of Olympic Combat Sports on Cardiorespiratory Fitness in Non-Athlete Population: A Systematic Review of Randomized Controlled Trials
by Cristopher Muñoz-Vásquez, Jordan Hernandez-Martinez, Francisco Ramos-Espinoza, Tomas Herrera-Valenzuela, Braulio Henrique Magnani Branco, Eduardo Guzman-Muñoz, Sibila Floriano Landim, Jessica Mondaca-Urrutia and Pablo Valdés-Badilla
J. Clin. Med. 2023, 12(23), 7223; https://doi.org/10.3390/jcm12237223 - 22 Nov 2023
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Abstract
This systematic review aimed to assess the available body of published peer-reviewed articles related to the effects of Olympic combat sports (OCS) on cardiorespiratory fitness (CRF) in the non-athlete population. The methodological quality and certainty of evidence were evaluated using PRISMA, TESTEX, RoB, [...] Read more.
This systematic review aimed to assess the available body of published peer-reviewed articles related to the effects of Olympic combat sports (OCS) on cardiorespiratory fitness (CRF) in the non-athlete population. The methodological quality and certainty of evidence were evaluated using PRISMA, TESTEX, RoB, and GRADE scales. The protocol was registered in PROSPERO (code: CRD42023391433). From 4133 records, six randomized controlled trials were included, involving 855 non-athletes (mean age = 27.2 years old). The TESTEX scale reported all studies with a ≥ 60% (moderate-high quality) score. The GRADE scale indicated moderate to low certainty of evidence. It was only possible to perform a meta-analysis on direct methods to maximum oxygen consumption (VO2max). The main results indicated significant differences in favor of OCS compared to active/passive controls in VO2max (SMD = 4.61; 95%CI = 1.46 to 7.76; I2 = 99%; p = 0.004), while the individual results of the studies reported significant improvements in favor of the OCS on the indirect methods of the CRF. OCS improved CRF in a healthy non-athlete population of different ages, specifically showing a significant improvement in VO2max with direct tests, such as cardiopulmonary tests. However, moderate to low certainty of evidence is reported, so no definitive recommendations can be established. Full article
(This article belongs to the Special Issue Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health)
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