Hollingsworth K; Yale University School of Medicine, New Haven, Connecticut. USA
Zhao Y; Charchaflieh JG; Carr ZJ

A&A Practice. 20(3):e02160, 2026 Mar 01.

The Duke Activity Status Index (DASI) overestimates peak VO2 compared to
cardiopulmonary exercise testing (CPET). This study examined
anthropometric/demographical differences in 226 participants >60 years old
undergoing submaximal CPET (smCPET). Both sexes overestimated DASI versus
smCPET-derived peak oxygen uptake (VO2; males: 5.9 +/- 7.7 mL kg-1 min-1;
females: 7.2 +/- 7.1, P < .001), with no bias differences (P = .224). Body
mass index (BMI) was a primary predictor (beta = .295, P = .001), showing
progressive overestimation: normal/underweight (4.9 +/- 7.5 mL kg-1
min-1), overweight (4.3 +/- 8.5), obese I (6.4 +/- 6.5), obese II+ (9.2
+/- 6). A correction factor was developed: VO2 corrected = 34.08 + 0.153 x
DASIsum-0.382 x BMI-0.123 x age + 1.962 x (1 for males, 0 for females).

Shen T; Department of Cardiology, Peking University Third Hospital,
Li J; Song Y; Ren C; Zhao W

Cardiology Journal. 33:e00226002, 2026.

BACKGROUND: There has been insufficient research on the assessment of
exercise capacity in patients with coronary heart disease (CHD) following
percutaneous coronary intervention (PCI) who exhibit inspiratory muscle
weakness (IMW).

METHODS: A retrospective cohort study involving CHD patients who
underwent PCI at Peking University Third Hospital Heart Rehabilitation
Center between January 2019 and December 2021 was conducted. Patients who
had undergone inspiratory muscle testing and cardiopulmonary exercise
testing (CPET) were included, and their clinical data were collected and
analyzed.

RESULTS: A total of 571 post-PCI CHD patients were included in the study.
The average age was 60.8 +/- 4.3 years, and 479 male patients (83.9%) were
included. The average maximal inspiratory pressure (MIP) of the enrolled
patients was 90.7 +/- 26.1 cm H2O, with 56 patients (9.8%) presenting with
IMW. The IMW group had lower peak oxygen uptake (VO2peak) (17.4 +/- 4.2
vs. 19.3 +/- 5.1 mL/ /min/kg, p < 0.001) and oxygen uptake efficiency
slopes (OUES) (1464.7 +/- 368.5 vs. 1619.2 +/- 400.4, p = 0.004). MIP
correlated with VO2peak (r = 0.719, p < 0.001) and OUES (r = 0.622, p <
0.001). Multivariate regression analysis revealed that VO2peak (OR =
0.917, 95% CI = 0.858 ~ 0.980) and history of chronic obstructive
pulmonary disease (COPD) (OR = 1.705, 95% CI = 0.934~ 3.112) were
independent risk factors for IMW.

CONCLUSIONS: After PCI, CHD patients exhibiting IMW, especially those
with comorbid COPD, demonstrated reduced exercise tolerance and oxygen
uptake efficiency.

Fujiwara, Takayuki; The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
Amiya, Eisuke; Takahashi, Masao; Nakayama, Atsuko; Konishi, Yuto; Taya, Masanobu;
Hyodo, Kanako; Takayama, Naoko; Komuro, Issei; Takeda, Norihiko.

Physiological Reports. 14(4):e70768, 2026 Feb.

Cardiac rehabilitation (CR) improves exercise capacity, but frequent
cardiopulmonary exercise testing (CPET) is impractical. The AESCULON mini
enables non-invasive hemodynamic monitoring, though its role in CR remains
unclear. Eleven patients (6 myocardial infarction, 3 angina pectoris, 2
dilated cardiomyopathy) undergoing outpatient CR at the University of
Tokyo Hospital were studied. Hemodynamics were measured using the AESCULON
mini before and after 20 min of aerobic exercise at the anaerobic
threshold. CPET and brain natriuretic peptide (BNP) were assessed within 2
weeks. Stroke volume, cardiac output, and cardiac index tended to
increase, and thoracic fluid content (TFC) decreased post-exercise. TFC
before (r = 0.767, p = 0.006) and after (r = 0.711, p = 0.014) correlated
with BNP. Changes in stroke volume and cardiac output correlated with peak
VO2, percent predicted peak VO2, and DELTAVO2/DELTAWR. Patients with
increased cardiac output during exercise had higher peak VO2 and
DELTAVO2/DELTAWR. Non-invasive hemodynamic data from the AESCULON mini
correlated with BNP and exercise capacity, suggesting its usefulness for
detecting heart failure progression and estimating exercise capacity in
CR.

Kim M; University College of Medicine, Seoul,  Korea.
Lee J; Yang T; Oh J; Kang SM; Lee CJ

International Journal of Obesity. 50(2):338-345, 2026 Feb.

BACKGROUND: High-grade glioma (HGG) patients experience enormous disease
burden both from tumor- and treatment-related symptoms. Exercise can
improve physical fitness and quality of life (QoL); yet experience in
neuro-oncology, especially with high-intensity exercise, remains limited.
This study evaluated feasibility, safety, and efficacy of the intensive,
structured 16-week strength and endurance program, “Active in
Neuro-Oncology” (ActiNO) for HGG patients undergoing chemotherapy.

METHODS: In this prospective, oligocentric, single-arm proof-of-concept
trial, 54 HGG patients participated in ActiNO, with twice-weekly
supervised exercise sessions. The primary endpoint was cardiorespiratory
fitness, assessed via physical working capacity (PWC75%)-the workload
(W/kg body weight) achieved at 75% of age-adjusted maximum heart rate
during a maximal cardiopulmonary exercise test. Secondary endpoints
included peak oxygen uptake (VO2peak), peak power output (Ppeak), and QoL
(EORTC QLQ-C30). Analyses focused on within-subject changes from pre- to
post-intervention. Additionally, comparisons to normative data were
performed. Feasibility was assessed via accrual, adherence, and attrition;
safety via adverse event monitoring (CTCAE).

RESULTS: Program tolerance was high, with few exercise-related adverse
events (all CTCAE grade 1-2). Over 16 weeks, significant improvements were
observed in PWC75% (1.023-1.256 W/kg BW, +23%), VO2peak (23.04-26.09
ml/min/kg BW, +13%), and Ppeak (1.771-2.104 W/kg BW, +19%). QoL, including
global health and physical functioning, improved, reaching normative
values. Adherence was high (85%), though attrition was 48%, mainly due to
disease progression or physical constraints.

CONCLUSIONS: High-intensity exercise is feasible and safe in HGG patients
undergoing chemotherapy. The observed improvements in physical fitness and
QoL support incorporating structured exercise into neuro-oncology care.

Cabuk R; Ondokuz Mayis University, Samsun, Turkiye
Alp E; Murias JM; Karsten B

Scandinavian Journal of Medicine & Science in Sports. 36(2):e70226,
2026 Feb.

This study examined whether constant-workload verification trials
performed at intensities below, at, and above the ramp-incremental peak
power output (PPO) contribute to confirming maximal oxygen uptake
(VO2max). Fifteen trained to well-trained male cyclists (VO2max: 63.6 +/-
5.6 mL.kg-1.min-1) completed maximal ramp testing followed by seven
randomized verification trials (80%-110% PPO at 5% intervals) on separate
days. Differences in VO2 responses were analyzed using linear
mixed-effects models. Effect size was calculated using Hedges’ g. The peak
VO2 attained during the verification trials was expressed relative to the
ramp-derived VO2max and classified as lower (< 95%), within normal
variability (95%-105%), or higher (> 105%). The peak VO2 values at 80%,
105%, and 110% PPO were significantly lower than ramp-derived VO2max (p <
0.05), whereas no significant differences were observed at 85%, 90%, and
95% PPO. Effect sizes were small at 85%-95% PPO (Hedges’ g = 0.29-0.32),
medium at 100%-105% PPO (Hedges’ g = 0.63-0.66), and large at 80% and 110%
PPO (Hedges’ g = 1.21-1.34). Of 105 verification trials, 81 were within
+/-5% of ramp VO2max, 22 were lower (mainly at 80% and 110% PPO), and two
exceeded ramp VO2max (at 85% and 95% PPO). Although verification trials
did not meaningfully contribute to the verification of VO2max, trials
performed at 85%-95% PPO provided the best chances of confirming VO2max in
trained individuals. Interpretation of verification trials relative to
ramp-derived PPO is protocol dependent, which may limit generalizability
across different ramp designs.

Vitturi N; University Hospital of Padova, Padova, Italy.
Gugelmo G; Gasperetti A; Duregon F; Dalmonico A; Lenzini L;
Sponchiado S; Carraro G; Marchi G; Cominacini M; Momente C; Baciga F;
Baschirotto C; Caccia F; Girelli D; Ermolao A; Fadini GP; Battaglia Y

Journal of Cachexia, Sarcopenia and Muscle. 17(1):e70233, 2026 Feb.

BACKGROUND: Fabry disease (FD) is a rare, X-linked lysosomal storage
disorder affecting multiple organs, including the musculoskeletal system.
The physical status of FD patients remains poorly characterized. This
multicentre cross-sectional study aimed to evaluate physical fitness and
function in FD patients and investigate associations with sex, FD
phenotype and treatment status.

METHODS: Adults (aged >= 18 years) with genetically confirmed FD were
recruited. Demographic and laboratory data were collected. Physical
fitness was assessed using cardiopulmonary exercise testing (VO2 peak) and
body composition parameters (fat-free mass index [FFMI], fat mass index
[FM] and phase angle [PA]) via bioelectrical impedance analysis. Physical
function was evaluated with performance tests (6-min walk test, handgrip
strength test, 30-s chair-stand test, short physical performance battery),
muscle strength tests (isometric and isokinetic knee strength) and
self-report fatigue questionnaires. Statistical analyses were stratified
by sex, phenotype (classic vs. late-onset/Variants of Uncertain
Significance [VUS]) and treatment status (enzyme replacement therapy
[ERT]/chaperone-treated versus untreated).

RESULTS: Forty-two FD patients (13 males; mean age 46 +/- 13.9 years)
were enrolled. VO2 < 85% of predicted was more frequent in classic
phenotype patients (53.8%) than in late-onset/VUS (11.5%; p < 0.01). FFMI
was lower in classic than late-onset/VUS (16.8 +/- 1.0 vs. 18.6 +/- 2.1
kg/m2; p = 0.01). Treated males had lower PA than untreated males
(4.8degree +/- 1.0degree vs. 7.6degree +/- 0.9degree; p = 0.04), and PA
correlated with VO2 peak (r = 0.879; p = 0.01). Among classic phenotype
males, 74.3% scored below the 50th percentile in handgrip strength (26.1
+/- 7.8 kg), and 60.9% performed below predicted values in the 30-s
chair-stand test (12.4 +/- 4.3 repetitions). Self-reported fatigue scores
were higher in classic versus late-onset/VUS patients (p = 0.05) and in
treated patients compared to untreated patients (p = 0.02).

CONCLUSIONS: Classic FD phenotype, particularly in males, was associated
with reduced exercise capacity, muscle mass and physical performance.
These findings support the integration of cardiopulmonary exercise
testing, physical functional assessments and body composition analysis
into the routine evaluation of FD patients.

Guerreiro I; Division of Pneumology, Geneva, Switzerland.
Bringard A; Weber P; Leverington V; Kharat A; Genecand L;
Taboni A; Lador F

Respiratory Physiology & Neurobiology. 341:104543, 2026 Apr.

INTRODUCTION: Dysfunctional breathing (DB) can be defined as a change in
breathing pattern associated with respiratory and/or systemic symptoms,
after ruling out underlying respiratory or cardiac disease. Recent
evidence suggests that DB contributes to dyspnea in post-COVID-19 syndrome
(PCS), as demonstrated by ventilation analysis during cardiopulmonary
exercise testing (CPET). Nevertheless, the lack of a standardized
classification for the different subtypes of DB poses challenges for
accurate diagnosis and effective management. We hypothesized that
analyzing the evolution of breathing parameters during CPET may help
classify DB into three patterns.

METHODS: We analyzed 79 CPETs performed between July 2020 and May 2022 on
patients with persistent respiratory symptoms at least three months after
COVID-19 infection. We classified patients into three different categories
based on abnormal breathing patterns: hyperventilation (HYPV), erratic
breathing (ERBR), and flattening (FLAT).

RESULTS: Age, BMI, gender and peak O2 uptake (VO2) were similar between
patterns. Compared to normal pattern (N), we found higher VE – VCO2 slope
in HYPV and FLAT, and a lower VT/ VE slope in FLAT and ERBR. The FLAT
pattern was also characterized by a higher breathing frequency at peak
exercise compared to the other patterns. ERBR and FLAT were associated
with higher symptom scores (Nijmegen Questionnaire and Dyspnea-12)
compared to N.

CONCLUSION: Analyzing the evolution of ventilatory parameters during
incremental exercise enables the classification of dysfunctional breathing
into three distinct breathing patterns: hyperventilation, erratic
breathing, and flattening.

Harris EA; Center for Pulmonary Heart Disease, Boston,  United States.
Waxman AB

Respiratory Physiology & Neurobiology. 341:104550, 2026 Apr.

Unexplained dyspnea and exertional intolerance are common, burdensome
clinical problems that may persist despite routine resting cardiopulmonary
testing. Invasive cardiopulmonary exercise testing (iCPET) integrates
breath-by-breath gas exchange with invasive hemodynamic and blood gas
assessment during incremental exercise, enabling evaluation of physiologic
abnormalities that may be unapparent at rest. This review summarizes
practical considerations for iCPET performance (including upright cycle
ergometry, catheter-based pressure measurements, direct Fick cardiac
output, and symptom assessment using separate visual analog Modified Borg
ratings for dyspnea and leg fatigue at peak exercise), and presents a
structured approach to interpretation using pressure-flow relationships
and age-related reference ranges. Emphasis is placed on how characteristic
iCPET patterns inform mechanistic contributors to exertional dyspnea by
identifying upstream physiologic triggers-such as abnormal rises in
pulmonary arterial wedge pressure (exercise-HFpEF), abnormal pulmonary
vascular pressure-flow responses (exercise-PAH), impaired preload
augmentation associated with autonomic dysfunction, and impaired
peripheral oxygen extraction consistent with mitochondrial myopathy. The
review also highlights evolving applications in post-pulmonary embolism
syndromes and acknowledges that exercise hemodynamic thresholds and
protocols vary across centers, underscoring the need for broader
standardization.

Ordine L; School of Medicine, Naples, Italy.
Canciello G; Di Napoli S; Polizzi R; Pacella D; Lombardi R;
Esposito G; Losi MA

ESC heart failure. 13(1), 2026 Feb 03.

INTRODUCTION: Hypertrophic cardiomyopathy (HCM) is a heterogeneous
myocardial disorder characterized by left ventricular hypertrophy. The
role of cardiopulmonary exercise testing (CPET) in predicting major
adverse cardiac events (MACE) remains incompletely understood,
particularly over long-term follow-up and independently of baseline
symptoms.

METHODS: We longitudinally studied 154 HCM patients (age 43 +/- 16 years;
27% female), who underwent symptom-limited CPET. At baseline, 98 patients
were in New York Heart Association (NYHA) Class I, 48 in Class II, and 8
in Class III. Septal reduction therapies (SRT), progression to end-stage
HCM (ES-HCM), sudden cardiac death (SCD), heart failure-related death
(HF), and heart transplantation (HT) represented a composite MACE
endpoint.

RESULTS: Over a mean follow-up of 12 +/- 9 years, 38 patients experienced
MACE (SRT = 9; ES-HCM = 11; SCD = 10; HF/HT = 8). In multivariable
analysis, independent predictors of MACE were percentage predicted peak
VO2 (PVO2%) < 60 [hazard ratio (HR) 4.16, 95% confidence interval (CI)
1.89-9.14; P < .001], and NYHA Class >I (HR 2.27, 95% CI 1.06-4.89; P =
.036). By using SRT as a competing risk, the only predictor of MACE became
PVO2% < 60 (HR 3.966, 95% CI 1.626-9.670; P = .002). Among asymptomatic
patients (i.e. NYHA Class I), only PVO2% < 60 remained a significant
predictor of MACE (HR 5.611, 95% CI 1.635-19.253; P = .006), with risk
divergence evident after nearly 15 years of follow-up. The result was also
confirmed in the competing risk analysis.

CONCLUSION: In this long follow-up study, CPET is a powerful prognostic
tool in HCM. A reduced peak VO2 identifies those at higher risk,
highlighting the potential for CPET to improve risk stratification, even
among patients classified as NYHA Class I.

Del Vecchio L; Southern Cross University, Lismore, Australia
Climstein M

Journal of Sports Medicine & Physical Fitness. 66(2):223-231, 2026 Feb

BACKGROUND: The oxygen uptake efficiency slope (OUES) is a submaximal,
effort-independent index derived from cardiopulmonary exercise testing
that reflects aerobic fitness. Although OUES has shown strong correlations
with maximal oxygen uptake (VO2max) in clinical populations, its validity
and relationship with habitual physical activity in healthy middle-aged
adults remain underexplored. This study aimed to evaluate OUES as a marker
of aerobic fitness and examine its association with self-reported physical
activity in this demographic.

METHODS: Twenty-one middle-aged adults (14 women, seven men; mean age
63.3+/-3.8 years) without known cardiopulmonary disease were recruited.
Participants completed the Sports Medicine Australia pre-exercise
screening questionnaire, including weekly physical activity reporting.
Each participant underwent a graded treadmill test (Bruce protocol) to
submaximal effort, with oxygen uptake (VO2) and ventilation (VE) measured
continuously using a validated portable metabolic system. OUES was
calculated from the linear regression of VO2 against the log10VE). VO2max
was estimated via a resting seismocardiography device (VentriJect
Seismofit R). Pearson’s correlations and one-way ANOVA were used to
evaluate relationships between variables and tertile-based fitness groups.
An independent-samples t-test compared OUES values by sex.

RESULTS: Mean peak VO2 was 25.2+/-4.1 mL/kg/min; mean OUES was
1629.6+/-522.0 mL/min per log L/min. OUES showed a moderate but
non-significant correlation with estimated VO2max (r=0.415, P=0.069) and
no meaningful association with self-reported physical activity (r=-0.012,
P=0.960). One-way ANOVA showed significant differences in VO2max across
VentriJect VO2 tertiles (P<0.001, eta2=0.65), but not in OUES (P=0.162).
Males had significantly higher OUES values than females (2171+/-391 vs.
1366+/-282; P<0.001), with a large effect size (Cohen’s d=2.50).

CONCLUSIONS: OUES can be reliably obtained using a brief treadmill
protocol and portable metabolic equipment in middle-aged adults. While not
associated with self-reported activity, OUES showed moderate correlations
with VO2max and differentiated higher-fitness individuals, especially by
sex. These findings support OUES as a valid submaximal marker of
cardiorespiratory fitness and underscore the importance of objective
fitness measures alongside self-report tools in health and exercise
settings.