Journal of Clinical Medicine

Editorial

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4 pages, 192 KiB

Open AccessEditorial

It’s Time to Run!

by Gaia Cattadori, Anna Picozzi and Silvia Di Marco

J. Clin. Med. 2023, 12(17), 5758; https://doi.org/10.3390/jcm12175758 - 04 Sep 2023

Cited by 1 | Viewed by 721

Abstract

Several epidemiological studies have consistently reported inverse associations between cardiorespiratory fitness and the risks of cardiovascular disease and mortality [...] Full article

(This article belongs to the Special Issue New Insights from Cardiopulmonary Exercise Testing and Cardiac Rehabilitation)

Research

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16 pages, 1075 KiB

Open AccessArticle

High-Load and Low-Load Resistance Exercise in Patients with Coronary Artery Disease: Feasibility and Safety of a Randomized Controlled Clinical Trial

by Tim Kambic, Nejc Šarabon, Vedran Hadžić and Mitja Lainscak

J. Clin. Med. 2022, 11(13), 3567; https://doi.org/10.3390/jcm11133567 - 21 Jun 2022

Cited by 7 | Viewed by 1788

Abstract

Resistance exercise (RE) remains underused in cardiac rehabilitation; therefore, there is insufficient evidence on safety, feasibility, and hemodynamic adaptations to high-load (HL) and low-load (LL) RE in patients with coronary artery disease (CAD). This study aimed to compare the safety, feasibility of HL-RE [...] Read more.

Resistance exercise (RE) remains underused in cardiac rehabilitation; therefore, there is insufficient evidence on safety, feasibility, and hemodynamic adaptations to high-load (HL) and low-load (LL) RE in patients with coronary artery disease (CAD). This study aimed to compare the safety, feasibility of HL-RE and LL-RE when combined with aerobic exercise (AE), and hemodynamic adaptations to HL and LL resistance exercise following the intervention. Seventy-nine patients with CAD were randomized either to HL-RE (70–80% of one-repetition maximum [1-RM]) and AE, LL-RE (35–40% of 1-RM) and AE or solely AE (50–80% of maximal power output) as a standard care, and 59 patients completed this study. We assessed safety and feasibility of HL-RE and LL-RE and we measured 1-RM on leg extension machine and hemodynamic response during HL- and LL-RE at baseline and post-training. The training intervention was safe, well tolerated, and completed without any adverse events. Adherence to RE protocols was excellent (100%). LL-RE was better tolerated than HL-RE, especially from the third to the final mesocycle of this study (Borgs’ 0–10 scale difference: 1–2 points; p = 0.001–0.048). Improvement in 1-RM was greater following HL-RE (+31%, p < 0.001) and LL-RE (+23%, p < 0.001) compared with AE. Participation in HL-RE and LL-RE resulted in a decreased rating of perceived exertion during post-training HL- and LL-RE, but in the absence of post-training hemodynamic adaptations. The implementation of HL-RE or LL-RE combined with AE was safe, well tolerated and can be applied in the early phase of cardiac rehabilitation for patients with stable CAD. Full article

(This article belongs to the Special Issue New Insights from Cardiopulmonary Exercise Testing and Cardiac Rehabilitation)

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12 pages, 4288 KiB

Open AccessArticle

Prognostic Utility of a New Risk Stratification Protocol for Secondary Prevention in Patients Attending Cardiac Rehabilitation

by Ignacio Cabrera-Aguilera, Consolació Ivern, Neus Badosa, Ester Marco, Xavier Duran, Diana Mojón, Miren Vicente, Marc Llagostera, Nuria Farré and Sonia Ruíz-Bustillo

J. Clin. Med. 2022, 11(7), 1910; https://doi.org/10.3390/jcm11071910 - 30 Mar 2022

Cited by 2 | Viewed by 2048

Abstract

Several risk scores have been used to predict risk after an acute coronary syndrome (ACS), but none of these risk scores include functional class. The aim was to assess the predictive value of risk stratification (RS), including functional class, and how cardiac rehabilitation [...] Read more.

Several risk scores have been used to predict risk after an acute coronary syndrome (ACS), but none of these risk scores include functional class. The aim was to assess the predictive value of risk stratification (RS), including functional class, and how cardiac rehabilitation (CR) changed RS. Two hundred and thirty-eight patients with ACS from an ambispective observational registry were stratified as low (L) and no-low (NL) risk and classified according to exercise compliance; low risk and exercise (L-E), low risk and control (no exercise) (L-C), no-low risk and exercise (NL-E), and no-low risk and control (NL-C). The primary endpoint was cardiac rehospitalization. Multivariable analysis was performed to identify variables independently associated with the primary endpoint. The L group included 56.7% of patients. The primary endpoint was higher in the NL group (18.4% vs. 4.4%, p < 0.001). After adjustment for age, sex, diabetes, and exercise in multivariable analysis, HR (95% CI) was 3.83 (1.51–9.68) for cardiac rehospitalization. For RS and exercise, the prognosis varied: the L-E group had a cardiac rehospitalization rate of 2.5% compared to 26.1% in the NL-C group (p < 0.001). Completing exercise training was associated with reclassification to low-risk, associated with a better outcome. This easy-to-calculate risk score offers robust prognostic information. No-exercise groups were independently associated with the worst outcomes. Exercise-based CR program changed RS, improving classification and prognosis. Full article

(This article belongs to the Special Issue New Insights from Cardiopulmonary Exercise Testing and Cardiac Rehabilitation)

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16 pages, 1208 KiB

Open AccessArticle

Increased Oxygen Extraction by Pulmonary Rehabilitation Improves Exercise Tolerance and Ventilatory Efficiency in Advanced Chronic Obstructive Pulmonary Disease

by Akito Miyazaki, Keisuke Miki, Ryoji Maekura, Kazuyuki Tsujino, Hisako Hashimoto, Mari Miki, Hiromi Yanagi, Taro Koba, Takuro Nii, Takanori Matsuki and Hiroshi Kida

J. Clin. Med. 2022, 11(4), 963; https://doi.org/10.3390/jcm11040963 - 12 Feb 2022

Cited by 4 | Viewed by 1736

Abstract

Background: In cardiopulmonary exercise testing (CPET), oxygen uptake (V’_O2) is calculated using the product of minute ventilation (V’_E) and the difference between inspiratory and expiratory O₂ concentrations (ΔFO₂). However, little is known about the [...] Read more.

Background: In cardiopulmonary exercise testing (CPET), oxygen uptake (V’_O2) is calculated using the product of minute ventilation (V’_E) and the difference between inspiratory and expiratory O₂ concentrations (ΔFO₂). However, little is known about the response of ΔFO₂ to pulmonary rehabilitation (PR). The aim of the present study was (1) to investigate whether PR increases peak V’_O2, based on whether ΔFO₂ or V’_E at peak exercise increase after PR, and (2) to investigate whether an improvement in ΔFO₂ correlates with an improvement in ventilatory efficiency. Methods: A total of 38 patients with severe and very severe COPD, whose PR responses were evaluated by CPET, were retrospectively analyzed. Results: After PR, peak V’_O2 was increased in 14 patients. The difference in ΔFO₂ at peak exercise following PR correlated with the difference in peak V’_O2 (r = 0.4884, p = 0.0019), the difference in V’_E/V’_CO2-nadir (r = −0.7057, p < 0.0001), and the difference in V’_E–V’_CO2 slope (r = −0.4578, p = 0.0039), but it did not correlate with the difference in peak V’_E. Conclusions: The increased O₂ extraction following PR correlated with improved exercise tolerance and ventilatory efficiency. In advanced COPD patients, a new strategy for improving O₂ extraction ability might be effective in those in whom ventilatory ability can be only minimally increased. Full article

(This article belongs to the Special Issue New Insights from Cardiopulmonary Exercise Testing and Cardiac Rehabilitation)

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14 pages, 1123 KiB

Open AccessArticle

Aerobic Threshold Identification in a Cardiac Disease Population Based on Correlation Properties of Heart Rate Variability

by Bruce Rogers, Laurent Mourot and Thomas Gronwald

J. Clin. Med. 2021, 10(18), 4075; https://doi.org/10.3390/jcm10184075 - 09 Sep 2021

Cited by 9 | Viewed by 2526

Abstract

An index of heart rate (HR) variability correlation properties, the short-term scaling exponent alpha1 of detrended fluctuation analysis (DFA a1) has shown potential to delineate the first ventilatory threshold (VT1). This study aims to extend this concept to a group of participants with [...] Read more.

An index of heart rate (HR) variability correlation properties, the short-term scaling exponent alpha1 of detrended fluctuation analysis (DFA a1) has shown potential to delineate the first ventilatory threshold (VT1). This study aims to extend this concept to a group of participants with cardiac disease. Sixteen volunteers with stable coronary disease or heart failure performed an incremental cycling ramp to exhaustion PRE and POST a 3-week training intervention. Oxygen uptake (VO₂) and HR at VT1 were obtained from a metabolic cart. An ECG was processed for DFA a1 and HR. The HR variability threshold (HRVT) was defined as the VO₂, HR or power where DFA a1 reached a value of 0.75. Mean VT1 was reached at 16.82 ± 5.72 mL/kg/min, HR of 91.3 ± 11.9 bpm and power of 67.8 ± 17.9 watts compared to HRVT at 18.02 ± 7.74 mL/kg/min, HR of 94.7 ± 14.2 bpm and power of 73.2 ± 25.0 watts. Linear relationships were seen between modalities, with Pearson’s r of 0.95 (VO₂), 0.86 (HR) and 0.87 (power). Bland–Altman assessment showed mean differences of 1.20 mL/kg/min, 3.4 bpm and 5.4 watts. Mean peak VO₂ and VT1 did not change after training intervention. However, the correlation between PRE to POST change in VO₂ at VT1 with the change in VO₂ at HRVT was significant (r = 0.84, p < 0.001). Reaching a DFA a1 of 0.75 was associated with the VT1 in a population with cardiac disease. VT1 change after training intervention followed that of the HRVT, confirming the relationship between these parameters. Full article

(This article belongs to the Special Issue New Insights from Cardiopulmonary Exercise Testing and Cardiac Rehabilitation)

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12 pages, 3340 KiB

Open AccessFeature PaperArticle

Is the Training Intensity in Phase Two Cardiovascular Rehabilitation Different in Telehealth versus Outpatient Rehabilitation?

by Ladislav Batalik, Garyfallia Pepera, Jannis Papathanasiou, Sebastian Rutkowski, David Líška, Katerina Batalikova, Martin Hartman, Marián Felšőci and Filip Dosbaba

J. Clin. Med. 2021, 10(18), 4069; https://doi.org/10.3390/jcm10184069 - 09 Sep 2021

Cited by 22 | Viewed by 2661

Abstract

Telehealth cardiac rehabilitation (CR) is a feasible and effective alternative to conventional outpatient CR. Present evidence is limited on the comparison of exercise intensity adherence in telehealth and outpatient CR. The purpose of the study was to evaluate and compare training intensity adherence [...] Read more.

Telehealth cardiac rehabilitation (CR) is a feasible and effective alternative to conventional outpatient CR. Present evidence is limited on the comparison of exercise intensity adherence in telehealth and outpatient CR. The purpose of the study was to evaluate and compare training intensity adherence through 12-week phase II CR in telehealth and outpatient CR. A sample of 56 patients with coronary artery disease (CAD) with a mean age of 56.7 ± 7.1 entering comprehensive secondary prevention phase II was randomized into telehealth CR (n = 28) and control outpatient CR (n = 28) groups. The primary outcome was a comparison of training intensity adherence in both CR models and heart rate (HR) response from individual CR sessions, expressed by the HR reserve percentage. As a result, the parameter HR reserve percentage as the total average of the training intensity during the telehealth intervention and the outpatient CR did not differ statistically (p = 0.63). There was no death case, and all severe adverse cases required medical admission throughout an exercise training session in study subjects in both groups. This research evidence demonstrated that the telehealth CR model is similar in training intensities to the conventional outpatient CR in CAD patients with low to moderate cardiovascular risk. Full article

(This article belongs to the Special Issue New Insights from Cardiopulmonary Exercise Testing and Cardiac Rehabilitation)

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8 pages, 225 KiB

Open AccessArticle

Inpatient Cardiac Rehabilitation after Transcatheter Aortic Valve Replacement Is Associated with Improved Clinical Performance and Quality of Life

by Pawel Kleczynski, Jaroslaw Trebacz, Maciej Stapor, Robert Sobczynski, Janusz Konstanty-Kalandyk, Boguslaw Kapelak, Krzysztof Zmudka and Jacek Legutko

J. Clin. Med. 2021, 10(10), 2125; https://doi.org/10.3390/jcm10102125 - 14 May 2021

Cited by 12 | Viewed by 2110

Abstract

Cardiac rehabilitation (CR) provides multifactorial support and intervention for cardiac patients and improves quality of life (QoL). We aimed to assess clinical performance and QoL changes in patients undergoing transcatheter aortic valve replacement (TAVR) scheduled directly to inpatient CR (CR group) and those [...] Read more.

Cardiac rehabilitation (CR) provides multifactorial support and intervention for cardiac patients and improves quality of life (QoL). We aimed to assess clinical performance and QoL changes in patients undergoing transcatheter aortic valve replacement (TAVR) scheduled directly to inpatient CR (CR group) and those who were discharged home (DH group). The following patient-related outcomes were recorded: 5 m walk time (5MWT), 6 min walk test (6MWT), handgrip strength (HGS) with dynamometer, Katz index of Independence of Activities in Daily Living (KI of ADL), Hospital Anxiety and Depression Scores (HADS) Score. Quality of life was evaluated with Kansas City Cardiomyopathy Questionnaire (KCCQ). Baseline data, 30-day and 6- and 12-month data were assessed. The CR group consisted of 52 patients and 53 were in the discharged home (DH group). When we compared outcomes between the groups, the 5MWT, 6MWT, HGS KI of ADL, and KCCQ were significantly better in the CR group at 30 days (p = 0.03, p = 0.01, p = 0.02, p = 0.048, respectively), and no difference was found in HADS scores. At 6 months, the effect of CR was sustained for 6MWT, HGS, KI of ADL, and KCCQ (p = 0.001, p = 0.001, p = 0.03, p = 0.003, respectively) but not for 5MWT. Interestingly, at 12 months, the CR group had better performance only in 6MWT and HGS compared with the DH group (p = 0.04, p = 0.03, respectively). We showed that inpatient CR is strongly associated with better clinical performance and QoL in patients undergoing TAVR. All patients may benefit from CR after TAVR. The most important aspect of inpatient CR after TAVR from the patient’s perspective may be better performance in daily activities; however, performance was attenuated after 1 year. Full article

(This article belongs to the Special Issue New Insights from Cardiopulmonary Exercise Testing and Cardiac Rehabilitation)

Review

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10 pages, 980 KiB

Open AccessReview

Exercise Training in Post-COVID-19 Patients: The Need for a Multifactorial Protocol for a Multifactorial Pathophysiology

by Gaia Cattadori, Silvia Di Marco, Massimo Baravelli, Anna Picozzi and Giuseppe Ambrosio

J. Clin. Med. 2022, 11(8), 2228; https://doi.org/10.3390/jcm11082228 - 15 Apr 2022

Cited by 31 | Viewed by 6135

Abstract

The battle against COVID-19 has entered a new phase with Rehabilitation Centres being among the major players, because the medical outcome of COVID-19 patients does not end with the control of pulmonary inflammation marked by a negative virology test, as many patients continue [...] Read more.

The battle against COVID-19 has entered a new phase with Rehabilitation Centres being among the major players, because the medical outcome of COVID-19 patients does not end with the control of pulmonary inflammation marked by a negative virology test, as many patients continue to suffer from long-COVID-19 syndrome. Exercise training is known to be highly valuable in patients with cardiac or lung disease, and it exerts beneficial effects on the immune system and inflammation. We therefore reviewed past and recent papers about exercise training, considering the multifactorial features characterizing post-COVID-19 patients’ clinical conditions. Consequently, we conceived a proposal for a post-COVID-19 patient exercise protocol as a combination of multiple recommended exercise training regimens. Specifically, we built pre-evaluation and exercise training for post-COVID-19 patients taking advantage of the various programs of exercise already validated for diseases that may share pathophysiological and clinical characteristics with long-COVID-19. Full article

(This article belongs to the Special Issue New Insights from Cardiopulmonary Exercise Testing and Cardiac Rehabilitation)

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Other

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29 pages, 2515 KiB

Open AccessEditor’s ChoiceSystematic Review

Effectiveness of Home-Based Cardiac Rehabilitation, Using Wearable Sensors, as a Multicomponent, Cutting-Edge Intervention: A Systematic Review and Meta-Analysis

by Varsamo Antoniou, Constantinos H. Davos, Eleni Kapreli, Ladislav Batalik, Demosthenes B. Panagiotakos and Garyfallia Pepera

J. Clin. Med. 2022, 11(13), 3772; https://doi.org/10.3390/jcm11133772 - 29 Jun 2022

Cited by 46 | Viewed by 3883

Abstract

Exercise-based cardiac rehabilitation is a highly recommended intervention towards the advancement of the cardiovascular disease (CVD) patients’ health profile; though with low participation rates. Although home-based cardiac rehabilitation (HBCR) with the use of wearable sensors is proposed as a feasible alternative rehabilitation model, [...] Read more.

Exercise-based cardiac rehabilitation is a highly recommended intervention towards the advancement of the cardiovascular disease (CVD) patients’ health profile; though with low participation rates. Although home-based cardiac rehabilitation (HBCR) with the use of wearable sensors is proposed as a feasible alternative rehabilitation model, further investigation is needed. This systematic review and meta-analysis aimed to evaluate the effectiveness of wearable sensors-assisted HBCR in improving the CVD patients’ cardiorespiratory fitness (CRF) and health profile. PubMed, Scopus, Cinahl, Cochrane Library, and PsycINFO were searched from 2010 to January 2022, using relevant keywords. A total of 14 randomized controlled trials, written in English, comparing wearable sensors-assisted HBCR to center-based cardiac rehabilitation (CBCR) or usual care (UC), were included. Wearable sensors-assisted HBCR significantly improved CRF when compared to CBCR (Hedges’ g = 0.22, 95% CI 0.06, 0.39; I² = 0%; p = 0.01), whilst comparison of HBCR to UC revealed a nonsignificant effect (Hedges’ g = 0.87, 95% CI −0.87, 1.85; I² = 96.41%; p = 0.08). Effects on physical activity, quality of life, depression levels, modification of cardiovascular risk factors/laboratory parameters, and adherence were synthesized narratively. No significant differences were noted. Technology tools are growing fast in the cardiac rehabilitation era and promote exercise-based interventions into a more home-based setting. Wearable-assisted HBCR presents the potential to act as an adjunct or an alternative to CBCR. Full article

(This article belongs to the Special Issue New Insights from Cardiopulmonary Exercise Testing and Cardiac Rehabilitation)

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