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Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health

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

Deadline for manuscript submissions: closed (20 May 2024) | Viewed by 9530

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Special Issue Editor

Dr. Barak Zafrir

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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

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Keywords

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

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Published Papers (7 papers)

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Editorial

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5 pages, 176 KiB

Open AccessEditorial

Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health

by Ina Volis and Barak Zafrir

J. Clin. Med. 2024, 13(19), 5865; https://doi.org/10.3390/jcm13195865 - 1 Oct 2024

Viewed by 936

Abstract

A vast amount of data from numerous studies conducted in recent decades consistently show that increased physical activity has a favorable impact on cardiovascular health [...] Full article

(This article belongs to the Special Issue Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health)

Research

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13 pages, 775 KiB

Open AccessArticle

Physical Fitness Is Directly Related to Exercise Capacity and Ventilatory Response to Exercise in Men with HFrEF

by Olga Kisiel-Sekura, Magdalena Wójciak, Agnieszka Siennicka, Michał Tkaczyszyn, Marcin Drozd, Ewa A. Jankowska, Adrian Doroszko, Waldemar Banasiak and Kinga Węgrzynowska-Teodorczyk

J. Clin. Med. 2024, 13(12), 3465; https://doi.org/10.3390/jcm13123465 - 13 Jun 2024

Viewed by 915

Abstract

Background: Heart failure (HF) patients experience reduced functional fitness level (determining the performance of routine, daily activities) and diminished exercise capacity (linked to more effortful activities). Aim: The aim of the study is to assess this relationship using functional fitness tests compared to peak VO2 and VE/VCO2 slope in the context of exercise capacity and ventilatory response to exercise. Methods: A total of 382 men with stable HFrEF (age: 61 ± 10, NYHA class I/II/III/IV: 16/50/32/2%, LVEF: 30.5 ± 8.3%) underwent cardiopulmonary exercise testing (CPX) and a Senior Fitness Test (SFT). Afterwards, the patients were divided according to the 2capacity with peak VO2 ≥ 18 mL/kg/min, those with higher or lower ventilatory responses (VE/VCO2 slope ≥ 35 vs. <35) to the exercise were compared. Results: Patients who covered shorter distances in the 6 min walking test showed worse results in the functional tests (‘stand up and go’, ‘chair stand’ and ‘arm curl’) and CPX (lower peak VO2, shorter exercise time and higher VE/VCO2 slope). Subjects classified into Class D demonstrated the worst results in all elements of SFT; those in Class A demonstrated the best results. Significant differences that were analogous occurred also between classes B and C. Among the participants who reached peak VO2 ≥ 18 mL/kg/min (n = 170), those with VE/VCO2 slope ≥ 35 were characterized by worse physical fitness as compared to those with VE/VCO2 < 35. Conclusion: Reduced exercise tolerance led to worsening physical function in patients with HFrEF. Moreover, limitations in physical fitness seem to be distinctive for those patients showing excessive ventilatory response to exercise slope VE/VCO2 (≥35). The Senior Fitness Test may be considered as a useful tool for assessing comprehensive functional and clinical status and risk stratification in patients with HFrEF, especially those with extremely low exercise capacity. Full article

(This article belongs to the Special Issue Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health)

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12 pages, 1081 KiB

Open AccessArticle

Cardiac Adaptation in Power Athletes: Differential Impact of Judo and Weightlifting

by Giuseppe Di Gioia, Armando Ferrera, Viviana Maestrini, Sara Monosilio, Maria Rosaria Squeo, Erika Lemme, Antonio Nenna, Sofia Calaciura Clarich, Simone Crotta and Antonio Pelliccia

J. Clin. Med. 2024, 13(11), 3336; https://doi.org/10.3390/jcm13113336 - 5 Jun 2024

Viewed by 1091

Abstract

Background: According to the ESC guidelines, sport disciplines are classified in relation to the predominant component (skill, power, mixed and endurance), including a wide range of disciplines with different isometric/isotonic exercises and exercise-induced heart remodeling. The aim of our study was to evaluate differences in morpho-functional cardiac adaptations in power athletes, comparing judokas with weightlifters. Methods: We enrolled 55 Olympic athletes (38 judokas, 17 weightlifters), aged 24.5 ± 3.8 years, 25 (45.4%) of whom were males, and they underwent a pre-participation evaluation, including a physical examination, ECG, transthoracic echocardiogram, and exercise stress test. Results: The judokas presented significant differences in cardiac adaptations, with larger left ventricle (LV) end-diastolic and end-systolic volumes indexed (LVEDVi, p = 0.002 and LVESVi, p = 0.004) and higher LVMass values indexed (p = 0.033), but similar LV wall thicknesses (p = 0.093) and LV ejection fractions (p = 0.981). Also, the left atrium (LA) dimension (p = 0.0002) and volume indexed (p < 0.0001) were higher in the judokas, as were the larger right ventricle (RV) areas. Finally, the judokas showed higher VO₂max (p = 0.012), O₂ pulse (p = 0.007), VE/O2 LT1 (p = 0.041) and VE/O2 LT2 (p = 0.036) values, with a lower resting heart rate (p = 0.031) and higher exercise capacity (p = 0.011). Conclusions: The judokas showed substantial differences in cardiac morpho-functional adaptations from the weightlifters, and, accordingly, judo should be more properly considered not a pure strength sport but more similar to mixed disciplines of the ESC classification. Full article

(This article belongs to the Special Issue Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health)

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13 pages, 5009 KiB

Open AccessArticle

Moderate-Intensity Constant and High-Intensity Interval Training Confer Differential Metabolic Benefits in Skeletal Muscle, White Adipose Tissue, and Liver of Candidates to Undergo Bariatric Surgery

by Matías Ruíz-Uribe, Javier Enríquez-Schmidt, Manuel Monrroy-Uarac, Camila Mautner-Molina, Mariana Kalazich-Rosales, Maximiliano Muñoz, Francisca Fuentes-Leal, Carlos Cárcamo-Ibaceta, Daniel J. Fazakerley, Mark Larance, Pamela Ehrenfeld and Sergio Martínez-Huenchullán

J. Clin. Med. 2024, 13(11), 3273; https://doi.org/10.3390/jcm13113273 - 31 May 2024

Viewed by 1232

Abstract

Background/Objectives: Bariatric surgery candidates require presurgical physical training, therefore, we compared the metabolic effects of a constant moderate-intensity training program (MICT) vs. a high-intensity interval training (HIIT) in this population. Methods: Seventeen participants performed MICT (n = 9, intensity of 50% of heart rate reserve (HRR) and/or 4–5/10 subjective sensation of effort (SSE)) or HIIT (n = 8, 6 cycles of 2.5 min at 80% of the HRR and/or 7–8/10 of SSE, interspersed by 6 cycles of active rest at 20% of the FCR) for 10 sessions for 4 weeks. After training, tissue samples (skeletal muscle, adipose tissue, and liver) were extracted, and protein levels of adiponectin, GLUT4, PGC1α, phospho-AMPK/AMPK, collagen 1 and TGFβ1 were measured. Results: Participants who performed MICT showed higher protein levels of PGC-1α in skeletal muscle samples (1.1 ± 0.27 vs. 0.7 ± 0.4-fold change, p < 0.05). In the liver samples of the people who performed HIIT, lower protein levels of phospho-AMPK/AMPK (1.0 ± 0.37 vs. 0.52 ± 0.22-fold change), PGC-1α (1.0 ± 0.18 vs. 0.69 ± 0.15-fold change), and collagen 1 (1.0 ± 0.26 vs. 0.59 ± 0.28-fold change) were observed (all p < 0.05). In subcutaneous adipose tissue, higher adiponectin levels were found only after HIIT training (1.1 ± 0.48 vs. 1.9 ± 0.69-fold change, p < 0.05). Conclusions: Our results show that both MICT and HIIT confer metabolic benefits in candidates undergoing bariatric surgery; however, most of these benefits have a program-specific fashion. Future studies should aim to elucidate the mechanisms behind these differences. Full article

(This article belongs to the Special Issue Clinical Insights into Physical Activity, Fitness, and Cardiovascular Health)

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16 pages, 2767 KiB

Open AccessArticle

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 - 1 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 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

Open AccessFeature PaperArticle

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 - 9 Nov 2023

Cited by 2 | Viewed by 1290

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 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

Open AccessSystematic 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

Viewed by 1730

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, 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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