Tailored exercise with telehealth monitoring improves adherence and global health in kidney transplant recipients.

Introduction: Tailored exercise prescription is a crucial intervention for kidney transplant recipients (KTRs). This longitudinal study investigates the impact on long-term effectiveness of exercise prescriptions over one year follow-up, implementing telehealth tools for exercise administration and adherence monitoring. Materials and methods: KTRs were evaluated with clinical assessments including body composition, blood and urinary parameters, physical performance and quality of life at baseline (T0), after six (T6) and twelve (T12) months. The adherence to prescribed exercise training was monitored via video call interviews until T6 when the sample was divided into a group monitored via wearables (WG) and a group continuing video calls (VG) until T12. Results: Twenty-six KTRs completed the study. No changes in body composition and kidney function were reported. KTRs showed an improvement in lipid profile, systolic blood pressure, cardiorespiratory fitness and quality of life. WG showed no clinical differences compared to VG except for reported higher quality of life. Discussion: A good adherence to the exercise prescription was obtained with both monitoring methods (232 vs 253 min/week). This study reinforces the inclusion exercise training for KTRs to enhance physical fitness and reduce cardiovascular risk factors. These results emphasize the role of telehealth monitoring methods as motivators for adherence to long-term exercise prescriptions.

Sport climbing performance determinants and functional testing methods: A systematic review.

BACKGROUND: Sport climbing is becoming incredibly popular both in the general population and among athletes. No consensus exists regarding evidence-based sport-specific performance evaluation; therefore, this systematic review is aimed at analyzing determinants of sport climbing performance and evaluation methods by comparing climbers of different levels. METHODS: PubMed, Scopus, and Web of Science were searched up to December 20, 2022. Studies providing the self-reported climbing ability associated with different functional outcomes in groups of climbers of contiguous performance levels were eligible. RESULTS: 74 studies were finally included. Various methods have been proposed to evaluate determinants of sport climbing performance. Climbing-specific assessments were able to discriminate climbers of different levels when compared to general functional tests. Test validity resulted high for climbing-specific cardiorespiratory endurance as well as muscular-strength, -endurance, and -power; similarly, reliability was good except for cardiorespiratory endurance. Climbing-specific flexibility assessment resulted in high reliability but moderate validity, whereas balance showed low validity. Considerable conflicting evidence was found regarding anthropometric characteristics. CONCLUSION: The present analysis identified cardiorespiratory endurance as well as muscular-strength, -endurance, and -power as determinants of sport climbing performance. In contrast, balance, flexibility, and anthropometric characteristics seem to count less. This review also proposes an evidence-based Functional Sport Climbing test battery for assessing performance determinants, which includes tests that have been identified to be valid, reliable, and feasible. While athletes and coaches should rely on evidence-based and standardized evaluation methods, researchers may design specific large-scale trials as a resource for providing additional, homogenous, and comparable data to improve scientific evidence and professionalism in this popular sport discipline.

Serial cardiopulmonary exercise testing in young patients after one-and-half ventricle repair and Fontan procedure: a comparative study.

BACKGROUND: The Fontan procedure is the palliative surgical treatment for different congenital heart diseases (CHD) with a univentricular heart, but it has been associated with decreased exercise capacity, cardiovascular morbidity, and premature mortality. The one-and-half ventricle repair (1.5VR) was introduced as an alternative to the Fontan procedure, specifically for selected patients with borderline hypoplastic right ventricle (HRV), aiming for a more physiological circulation. Despite these efforts, the benefit of 1.5VR over Fontan circulation comparison on clinical and functional outcomes remains unclear. The aim of this study was to investigate and compare young patients with HRV after 1.5VR with those with functional single right or left ventricles (FSRV or FSLV) after Fontan palliation over a 10-year follow-up period. METHODS: In this retrospective observational study, serial cardiopulmonary exercise tests (CPETs) performed in patients with 1.5VR and Fontan circulation between September 2002 and March 2024 have been analyzed. Only patients with at least 10 years of follow-up were considered. RESULTS: A total of 41 patients were included (age at baseline 8.6 ± 2.6 years): 21 with FSLV, 12 with FSRV, and 10 with 1.5VR. No differences in cardiorespiratory fitness and efficiency were shown at the first CPET assessment among the three groups. At 10-year follow-up, 1.5VR had higher cardiorespiratory fitness and efficiency compared to FSLV and FSRV patients. CONCLUSIONS: These findings suggest that the 1.5VR may provide superior long-term functional outcomes than the Fontan procedure in patients with borderline HRV. Further studies are needed to evaluate the impact on hard clinical endpoints.

Comparison of Cardiorespiratory Fitness Prediction Equations and Generation of New Predictive Model for Patients with Obesity.

PURPOSE: Cardiorespiratory fitness (CRF) is a critical marker of overall health and a key predictor of morbidity and mortality, but the existing prediction equations for CRF are primarily derived from general populations and may not be suitable for patients with obesity. METHODS: Predicted CRF from different non-exercise prediction equations was compared with measured CRF of patients with obesity who underwent maximal cardiopulmonary exercise testing (CPET). Multiple linear regression was used to develop a population-specific nonexercise CRF prediction model for treadmill exercise including age, sex, weight, height, and physical activity level as determinants. RESULTS: Six hundred sixty patients underwent CPET during the study period. Within the entire cohort, R2 values had a range of 0.24 to 0.46. Predicted CRF was statistically different from measured CRF for 19 of the 21 included equations. Only 50% of patients were correctly classified into the measured CRF categories according to predicted CRF. A multiple model for CRF prediction (mL·min -1 ) was generated ( R2 = 0.78) and validated using two cross-validation methods. CONCLUSIONS: Most used equations provide inaccurate estimates of CRF in patients with obesity, particularly in cases of severe obesity and low CRF. Therefore, a new prediction equation was developed and validated specifically for patients with obesity, offering a more precise tool for clinical CPET interpretation and risk stratification in this population.

Respiratory exchange ratio overshoot during exercise recovery: a promising prognostic marker in HFrEF.

BACKGROUND AND AIMS: Transient increases (overshoot) in respiratory gas analyses have been observed during exercise recovery, but their clinical significance is not clearly understood. An overshoot phenomenon of the respiratory exchange ratio (RER) is commonly observed during recovery from maximal cardiopulmonary exercise testing (CPET), but it has been found reduced in patients with heart failure with reduced ejection fraction (HFrEF). The aim of the study was to analyze the clinical significance of these RER recovery parameters and to understand if these may improve the risk stratification of patients with HFrEF. METHODS: This cross-sectional study includes HFrEF patients who underwent functional evaluation with maximal CPET for the heart transplant checklist at our Sports and Exercise Medicine Division. RER recovery parameters, including RER overshoot as the percentual increase of RER during recovery (RER mag), have been evaluated after CPET with assessment of hard clinical long-term endpoints (MACEs/deaths and transplant/LVAD-free survival). RESULTS: A total of 190 patients with HFrEF and 103 controls were included (54.6 ± 11.9 years; 73% male). RER recovery parameters were significantly lower in patients with HFrEF compared to healthy subjects (RER mag 24.8 ± 14.5% vs 31.4 ± 13.0%), and they showed significant correlations with prognostically relevant CPET parameters. Thirty-three patients with HFrEF did not present a RER overshoot, showing worse cardiorespiratory fitness and efficiency when compared with those patients who showed a detectable overshoot (VO2 peak: 11.0 ± 3.1 vs 15.9 ± 5.1 ml/kg/min; VE/VCO2 slope: 41.5 ± 8.7 vs 32.9 ± 7.9; ΔPETCO2: 2.75 ± 1.83 vs 4.45 ± 2.69 mmHg, respectively). The presence of RER overshoot was associated with a lower risk of cardiovascular events and longer transplant-free survival. CONCLUSION: RER overshoot represents a meaningful cardiorespiratory index to monitor during exercise gas exchange evaluation; it is an easily detectable parameter that could support clinicians to comprehensively interpreting patients' functional impairment and prognosis. CPET recovery analyses should be implemented in the clinical decision-making of advanced HF.

The Fragmented QRS Complex in Lead V1: Time for an Update of the Athlete's ECG?

Differentiating between ECG patterns related to athletes' heart remodeling and pathological findings is a challenge in sports cardiology. As the significance of fragmented complex in athletes remains uncertain, this study aimed to assess the presence of fragmented QRS in lead V1 (fQRSV1) among young athletes and its association with heart adaptations and arrhythmias. Young athletes referred for annual pre-participation screening receiving a maximal exercise testing and transthoracic echocardiography from January 2015 to March 2021 were included. The study included 684 young athletes. The prevalence of fQRSV1 was 33%. Subjects with fQRSV1 had higher exercise capacity and indexes of right ventricular function and remodeling. Among highly trained athletes, the fQRSV1 group demonstrated also increased left ventricular wall thickness. No significant association existed between fQRSV1 and exercise-induced arrhythmias, even in highly trained athletes. The high prevalence of fQRSV1 in young athletes is associated with training-induced heart adaptations but not exercise-induced ventricular arrhythmias.

The "Aging Effect" of BMI on Cardiorespiratory Fitness: A New Insight on Functional Evaluation in Obesity.

Cardiorespiratory fitness (CRF) is a strong predictor of morbidity and mortality in patients with obesity. This study investigates the CRF range and its clinical determinants in patients with obesity. Moreover, a practical proposal for CRF interpretation is provided. In this study, 542 patients (69% females) with BMI ≥ 30 kg/m2 performed an incremental cardiopulmonary exercise test (CPET). Patients had a median (IQR) age of 47.0 (6.2) years with a mean BMI of 41.7 ± 6.7 kg/m2. Normal values curves of VO2peak/kg showed a median (IQR) of 20.3 (37.6) mL/min/kg. The lower-quartile threshold of VO2peak/kg was at 17.9 mL/min/kg. Analysis of covariance revealed that VO2peak/kg inversely correlates with age and BMI with a significant age × BMI interaction effect (all p < 0.0001); as BMI class increases, CRF decreases, but a smaller age-related decline in VO2peak/kg is observed. A multivariate logistic regression demonstrated that belonging to the lower quartile of VO2peak/kg was independently determined by age (OR 2.549, 95% CI 1.205-5.392, p < 0.0001) and BMI (OR 5.864, 95% CI 2.920-11.778, p < 0.0001) but not by comorbidities. At very high BMI, the effect of age on functional capacity is lower, suggesting that BMI acts as an "aging factor" on CRF. Age and BMI, but not comorbidities, are independent determinants of low VO2peak/kg.