Utus, Ahmet; University Faculty of Health Sciences, Malatya, Türkiye
Ozyilmaz, Semiramis; Selçuk, Engin Burak et al

BMC pulmonary medicine,2026 Aug 05

• Background: The aim of this study was to objectively evaluate the presence of allergic reactions and pulmonary function in individuals working in small container-like confined spaces in Malatya following the February 6, 2023, Kahramanmaraş-centered earthquakes, and to examine their associations with physical activity, sleep quality, grip strength, and quality of life. Given the well-established association between respiratory impairment and systemic effects on peripheral muscle strength, sleep architecture, and functional capacity, grip strength, sleep quality (PSQI), and physical activity (IPAQ-SF) were included as secondary outcomes to capture the broader functional burden of working in confined environments.
• Methods: This cross-sectional and descriptive study included 90 volunteers (aged 25-55 years) working in container-like spaces for at least two years. Pulmonary function was assessed using portable spirometry (FEV₁, FVC, FEV₁/FVC) according to the 2019 ATS/ERS guidelines, performed by trained physiotherapists. Physical activity was evaluated with IPAQ-SF, sleep quality with PSQI, quality of life with SF-36, and grip strength with a digital dynamometer. Multiple linear regression analyses were performed to identify independent predictors of respiratory function, controlling for age, smoking status, BMI, height, grip strength, and fatigue.
• Results: Of 90 participants (92.2% male, mean age 39.0 ± 9.5 years), FEV₁% (68.9 ± 12.4) and FVC% (64.1 ± 11.3) were relatively low with a preserved FEV₁/FVC ratio (0.86 ± 0.06). mMRC dyspnea grade was significantly associated with FEV₁% and FVC% (p < 0.001). Multiple linear regression revealed that fatigue was a significant independent predictor of FEV₁% (β=-0.945, p = 0.044) and FEV₁ (L) (β=-0.053, p = 0.029) after controlling for confounders. Grip strength showed a positive trend with FEV₁% (β = 0.282, p = 0.082) and FVC% (β = 0.242, p = 0.092) that approached significance, consistent with the physiological link between respiratory and peripheral muscle function. The overall regression models were statistically significant (p < 0.01 for all models).
• Conclusion: Individuals working in small container-like spaces showed a tendency toward reduced ventilatory capacity without overt obstruction, and dyspnea was strongly associated with objective respiratory function loss. Fatigue emerged as an independent predictor of respiratory function. These findings highlight the importance of early screening strategies and further research with longitudinal designs, environmental measurements, and control groups to establish causal relationships.

Glaab, Thomas; Pneumologische Gemeinschaftspraxis, Deutschland, Düsseldorf.
Fritsch, Jürgen; Greiwing, Andreas; et al

Pneumologie (Stuttgart, Germany),2026 Oct 27

Abstract: As an integrative exercise test of the pulmonary-cardiovascular-muscular system, cardiopulmonary exercise testing (CPET) represents the gold standard for assessing exercise capacity and exertional dyspnea. Surprisingly, there are currently no recommendations on the standardised performance of CPET published in medical journals in Germany. This paper aims to address this issue by providing interdisciplinary recommendations on the preparation, implementation and documentation of CPET in adults. This manual outlines the latest best practice guidance from current literature and guideline recommendations for medical and non-medical personnel. All the key steps for preparation, conduct and follow-up are presented in a structured and practical manner. An additional chapter contains recommendations for a uniform basic setting of the CPET software and for automated reporting. The aim of this document is to help achieve as uniform a procedure as possible for performing CPET in order to improve comparability, time expenditure, quality and thus also acceptance of the test and to adapt it to currently valid standards. Mnemonics and practical tips, flowcharts and tables facilitate rapid application in everyday clinical practice.

Vignati, Carlo; Centro Cardiologico Monzino, Milan, Italy.
Agostoni, Piergiuseppe;Pezzuto, Beatrice

Journal of cardiovascular development and disease [J Cardiovasc Dev Dis] 2026 Oct 20; Vol. 13 (10).
Date of Electronic Publication: 2026 Oct 20.

Major surgery imposes physiological stress requiring coordinated adaptation of the cardiovascular, respiratory, hematological, and musculoskeletal systems. Conventional preoperative assessment remains essential but may underestimate heterogeneity in physiological reserve because resting measurements incompletely capture the response to increasing metabolic demand. Cardiopulmonary exercise testing (CPET) provides an integrated assessment of oxygen transport and utilization, linking pulmonary ventilation and gas exchange to cardiovascular performance and peripheral oxygen extraction. This narrative review examines the role of CPET in preoperative assessment, from prognostic testing to physiological phenotyping and personalized perioperative care. We summarize the physiological basis of key variables, including peak oxygen uptake, anaerobic threshold, oxygen pulse, ventilatory efficiency, end-tidal carbon dioxide, breathing reserve, and exercise kinetics, and discuss how integrated interpretation can identify patterns suggestive of haemodynamic, ventilatory, pulmonary vascular, or peripheral limitations. Evidence across major surgical populations is critically appraised, with attention to isolated thresholds and the distinction between prognostic association and clinical effectiveness. The current data support selective rather than universal use of CPET, particularly when functional capacity is uncertain or physiological information may alter management. We propose a phenotype-oriented framework in which CPET findings identify potentially modifiable impairments and inform cardiovascular optimization, respiratory treatment, nutritional support, exercise training, and prehabilitation. Emerging approaches combining complex CPET, non-invasive haemodynamic assessment, wearable technologies, and artificial intelligence may enable personalized profiling, although prospective validation remains necessary. CPET should therefore be considered not simply a risk-prediction tool, but an in vivo interrogation of physiological reserve that can contribute to mechanism-oriented perioperative assessment.

Schön, Patrick; Department of Health Sciences and Technology, Zurich, Switzerland.
Boyle, Kyle G P J M; Beltrami, Fernando G;

International journal of cardiology. Congenital heart disease,2026 Aug 27

• Introduction: A decreased peripheral oxygen saturation (SpO₂ ) is common in Fontan patients. We aimed to determine whether these patients experience greater nocturnal desaturation (ΔSpO_2,noct ), and to which extent this may impact sleep quality and exercise performance, compared to healthy controls.
• Methods: 16 adult Fontan patients and 16 healthy, individually matched controls completed questionnaires on quality of life, sleep quality, and daytime sleepiness, performed measurements of lung function and diffusion capacity (DLCO), and cycled in a cardiopulmonary exercise test to volitional exhaustion. Sleep quality was assessed with a wrist-worn actigraph and nocturnal SpO₂ was measured with a pulse oximeter during six nights.
• Results: Fontan patients experienced greater ΔSpO_2,noct (-3.4 ± 0.8%-points, n = 14) compared to their controls (-2.5 ± 0.6%-points, n = 14, p = 0.001). In patients, ΔSpO_2,noct correlated with baseline SpO₂, DLCO, and exercise performance. Fontan patients had a longer sleep onset latency (22.8 ± 9.6 vs. 10.8 ± 6.0 min, p < 0.001) and lower self-perceived physical functioning (91 ± 7 vs. 100 ± 0 points, p < 0.001), but similar subjective sleep quality (4.2 ± 1.5 vs. 3.4 ± 1.4 points, p = 0.121) and daytime sleepiness (6.1 ± 4.3 vs. 6.3 ± 2.8 points, p = 0.884) compared to controls. In patients, daytime sleepiness correlated with the total number of desaturation events (r = 0.74, p = 0.003).
• Conclusion: Indices of nocturnal SpO₂ were related to daytime sleepiness and reduced exercise performance, and may therefore be a contributing factor to exercise limitation in adult Fontan patients. Enhancing nocturnal SpO₂ may thus be a promising target to improve daytime sleepiness and exercise performance in adult Fontan patients.

Howden, Erin J; Baker Heart and Diabetes Institute, Melbourne, Australia.;
Sesa-Ashton, Gianni;Foulkes, Stephen J; et al

American journal of physiology. Heart and circulatory physiology,2026 Oct 12

Purpose. Post-acute sequelae of COVID-19 syndrome (PASC) is widely attributed to dysautonomia, although sympathetic outflow has rarely been measured directly. We tested whether exercise and orthostatic intolerance in PASC reflect impaired cardiac reserve or abnormal muscle sympathetic nerve activity (MSNA) and its reflex control.
Methods. Adults with PASC (n=35; symptoms >3 months, no significant comorbidity) and age- and sex-matched recovered controls (n=12) underwent cardiopulmonary exercising testing (CPET), echocardiogram, resting and exercise cardiac MRI and peroneal microneurography recordings of MSNA in supine and during graded head up tilt to 60º.
Results. PASC participants had lower peak VO₂ indexed to lean mass (43.0±7.8 vs 52.2± 8.2ml/lean body mass kg/min, p=0.009) and whole-body mass (26.1± 7.5 v 34.9± 10.2ml/kg/min, p=0.006), lower heart rate reserve (84 ± 25 vs 98 ± 13 beats/min, p=0.019) and impaired ventilatory efficiency. Cardiac structure and biventricular contractile reserve were normal. Supine MSNA burst frequency, burst incidence, sympathetic baroreflex gain and neurovascular transduction did not differ between groups, and MSNA and mean arterial pressure increased similarly during tilt (time P <0.0001; group x time P =0.78). Despite this, 12 of 29 PASC participants (41%) terminated the tilt protocol due to orthostatic symptoms or pre-syncope (Kaplan-Meier P =0.0178). Eight participants (27%) met POTS criteria and had lower MSNA than non-POTS participants (P =0.045).
Conclusion. Orthostatic intolerance occurred despite normal recruitment of MSNA and maintained arterial pressure, and exercise intolerance despite preserved contractile reserve. Symptoms are therefore unlikely to originate in the efferent sympathetic limb or myocardium, and more likely reflect afferent reflex dysregulation or impaired cerebral perfusion.

Nunes Silva, Rebeca; Cardiopulmonary Physiotherapy Laboratory, Brazil
Crisci, Giulia; Losito, Maurizio; et al

European journal of preventive cardiology [Eur J Prev Cardiol] 2026 Oct 29.
Date of Electronic Publication: 2026 Oct 29.

• Aims: To characterize the pattern of chronotropic incompetence (CI) response to exercise in patients with heart failure (HF) across distinct phenotypes of the left ventricular ejection fraction and to explore the extent to which heart rate (HR) response should be prioritized as a therapeutic target within personalized HF management strategies.
• Methods: Patients with HF with preserved ejection fraction (HFpEF), HF with reduced ejection fraction (HFrEF), and healthy controls underwent incremental exercise testing with simultaneous gas exchange and echocardiography assessments. Stroke volume (SV), HR, cardiac output (CO), and arteriovenous oxygen difference [C(a-v)O2] were assessed from rest to peak exercise. Graphical analyses explored relationships amongst determinants of oxygen uptake (V̇O2).
• Results: Both HF phenotypes exhibited CI and a blunted increase in CO during exercise compared with controls. Peak HR was similarly reduced by 20% in HFpEF and 23% in HFrEF. HFpEF, however, exhibited a steeper HR-VO2 relationship. HFrEF demonstrated a greater compensatory increase in peripheral O2 extraction, with peak C(a-v)O2 73% higher than controls and 21% higher than HFpEF. In contrast, HFpEF showed limited ability to augment C(a-v)O2 and presented the lowest relative peak V̇O2 (-39% vs. controls and -16% vs. HFrEF), despite similar peak V̇O2%pred between HF phenotypes.
• Conclusion: CI can contribute to exercise intolerance in both HF phenotypes, with distinct compensatory mechanisms. An integrated cardiopulmonary exercise testing-echocardiography approach may support identifying phenotype-specific physiological profiles that might address therapeutic strategies targeting CI, SV reserve, and peripheral O2 utilization to improve functional capacity in HF. Addressing the kinetics of HR slope and ΔHR metrics seems relevant to implement knowledge on the fundamental CI contribution in HF phenotypes.

Marinho, Maria de Fátima Duarte; University of Sao Carlos (UFSCar), SP, Brazil.
Schafauser-Segundo, Nathany Souza; Hurst, John R;

Respiratory medicine [Respir Med] 2026 Oct 29; Vol. 264, pp. 109251.
Date of Electronic Publication: 2026 Oct 29.

• Background: Chronic respiratory diseases (CRD) are accompanied by coexisting chronic conditions, which may occur individually or as multimorbidity burden or patterns. These conditions may contribute to exercise intolerance, a determinant of prognosis. However, their association with exercise capacity remains unclear. This study aimed to evaluate, in individuals with CRD, the association between one or more other chronic conditions (multimorbidity) and exercise capacity and to quantify this relationship through meta-analysis.
• Methods: Searches were conducted in PubMed, Scopus, Embase, Web of Science, Virtual Health Library, and CINAHL until July 2025. Observational studies evaluating exercise capacity in adults with CRD, with coexisting chronic conditions, using field- or laboratory-based tests were included. Methodological quality was assessed using Joanna Briggs Institute checklists. Meta-analyses were performed using random-effects models.
• Results: A total of 49 studies were included in the qualitative synthesis (n = 28,972 participants), and 23 contributed to the quantitative synthesis. Most studies involved individuals with chronic obstructive pulmonary disease. Sensitivity analyses excluding outliers yielded clinically meaningful reductions in 6-min walk distance for metabolic (MD -34.26 m; 95% CI -46.98 to -21.53; I²  = 5.91%), cardiovascular (MD -27.18 m; 95% CI -39.59 to -14.78; I²  = 16.19%), and mental health conditions (MD -29.52 m; 95% CI -54.89 to -4.15; I²  = 0%).
• Conclusions: In individuals with CRD, multimorbidity is associated with reduced exercise capacity, with clinically meaningful reductions particularly in the presence of metabolic and cardiovascular conditions. Although the certainty of evidence is very low, these findings highlight the importance of considering multimorbidity when interpreting exercise limitation in CRD.