Category Archives: Abstracts

Blumberg Y; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA.
de Monts C; Montalvo S; Tang WJ; Hageman N; Sanchis-Gomar F; Ashley EA; Amar D; Myers J; Wheeler MT; Day JW; Duong T; Christle JW;

Journal of clinical medicine [J Clin Med] 2025 Jun 12; Vol. 14 (12).
Date of Electronic Publication: 2025 Jun 12.

Background: Individuals with neuromuscular diseases (NMDs) have low physical activity levels and an increased risk of cardiovascular and pulmonary diseases. Respiratory gas kinetics obtained during cardiopulmonary exercise testing (CPET) may provide valuable insights into disease mechanisms and cardiorespiratory fitness in individuals with NMD. Recovery from exercise is an important marker of exercise performance and overall physical health, and impaired recovery is strongly associated with poor health outcomes. This study evaluates recovery metrics in individuals with NMD after performing maximal exertion during CPET.
Methods: A total of 34 individuals with NMD and 15 healthy volunteers were recruited for the study. CPET was performed using a wearable metabolic system and a wheelchair-accessible total body trainer to peak exertion. Recovery metrics assessed were (i) the time to reach 50% O ₂ recovery compared with peak exercise and (ii) the ratios of ventilation and respiratory gases between peak exercise and the highest values observed during recovery (overshoot).
Results: The NMD group had a significantly longer time to reach 50% O ₂ recovery (T1/2 VO ₂ : 105 ± 43.4 vs. 76 ± 36.4 s, p = 0.02), lower respiratory overshoot (17.1 ± 13.0% vs. 28.8 ± 9.03%), and lower ventilation/VO ₂ (31.9 ± 28.3 vs. 52.2 ± 23.5) compared to the control group.
Conclusions: This study observes significantly impaired recovery metrics following peak exercise in individuals with NMD compared to controls. These insights may improve the understanding of exercise recovery and mechanics, thus improving prognostication and optimizing exercise prescriptions for individuals with NMD.

Power and Endurance: Polar Opposites or Willing Partners?

Ferguson C; The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA.
Furrer R; Murach KA; Hepple RT; Rossiter HB;

Medicine and science in sports and exercise [Med Sci Sports Exerc] 2025 Jun 23.
Date of Electronic Publication: 2025 Jun 23.

Abstract: Introduction. Peak neuromuscular power and endurance are distinct qualities of dynamic exercise performance. Dynamometry is used to assess peak neuromuscular power, often during performance across a single joint e.g., isotonic or isokinetic torque, while aptitude for endurance exercise may be inferred by measurement of critical power/speed or cardiopulmonary exercise testing to determine e.g., gas exchange threshold (GET), maximum oxygen uptake (V̇O2max) and exercise economy. Specificity is a critical component of any training program, but oversimplification of the specificity principle has contributed to the view that training adaptations to increase peak neuromuscular power or the ability to endure high power outputs are mutually exclusive, due to: (i) differences in the types of motor units recruited and their patterns of activation; and (ii) induction of distinct, antagonistic molecular signaling pathways in response to resistance and endurance exercise training (the “interference effect”).
Methods, Results and Conclusion. This review explores evidence for reciprocation between peak neuromuscular power and endurance performance in sport, aging and among general and clinical populations. We also review the molecular events that mediate peak neuromuscular power and endurance training adaptations and their interactions. Finally, we describe the musculo-cardio-pulmonary exercise test (mCPET) to demonstrate that peak neuromuscular power and aerobic mediators of endurance performance are less polar opposites and more willing partners.
Competing Interests: Conflict of Interest and Funding Source: Carrie Ferguson is supported by a grant from NIH (R01HL166850; 5UH3HL155798). She is involved in contracted clinical research with United Therapeutics, Genentech, Regeneron, Respira Therapeutics and Mezzion. She reports consulting fees from Respira Therapeutics. Kevin Murach is supported by NIH R00 AG063994 and R01 AG080047. Russell Hepple is supported by grants from NIH (R21AR084591, R01AG059416, and R01AG076490). Harry Rossiter is supported by grants from NIH (R01HL151452, R01HL166850, R01HL153460, P50HD098593, R01DK122767), Tobacco Related Disease Research Program (T31IP1666) and Department of Defense / USAMRAA (HT9425-24-1-0249). He reports consulting fees from the NIH RECOVER-ENERGIZE working group (1OT2HL156812), and is involved in contracted clinical research with Astellas, GlaxoSmithKline, Genentech, Intervene Immune, Mezzion, Regeneron, Respira, Roche, and United Therapeutics.

Comparison of cardiorespiratory responses between treadmill and bicycle ergometer exercise.

Kwon Y; Department of Physical Therapy, Yeungnam University College, Daegu, Korea.
Nam KS; Chang JS; DepartKang KW;

The talk test (TT) is a subjective, self-administered method used to gauge aerobic exercise intensity based on a person’s ability to speak comfortably during physical activity. This study aimed to validate the TT by examining its relationship with physiological markers collected during cardiopulmonary exercise testing (CPX) on both a treadmill and stationary bicycle in healthy adults. Twenty-two healthy participants (17 males and 5 females), with no known musculoskeletal, cardiovascular, or pulmonary conditions, completed two exercise sessions-one on a treadmill and another on a stationary bicycle. Each session was structured into three stages of increasing intensity based on the TT. During each stage, various psychophysiological and cardiorespiratory variables were measured, including heart rate, rating of perceived exertion, metabolic equivalents, arterial oxygen saturation, respiratory rate, minute ventilation, oxygen uptake, carbon dioxide production, respiratory exchange ratio, and ventilatory threshold. Significant differences were found across the three TT stages for all measured variables, with values increasing linearly as intensity progressed. However, no significant differences were observed between exercise modalities (treadmill vs. bicycle) or in the interaction between TT stages and modality. The findings support the TT as a valid indicator of exercise intensity, correlating well with physiological responses measured during CPX. The consistency across both exercise modalities suggests that TT is a practical, effective tool for guiding aerobic exercise intensity, particularly in clinical and rehabilitation settings.

Cardiopulmonary Exercise Testing in the Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE) III.

Morris MJ; Drs. Morris, Anderson, McInnis, Gonzales, Mr. Barber, Ms. Murillo, and Dr. Walter are affiliated withPulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, Texas, USA.
Holley AB; Dr. Holley is affiliated withMedStar Washington Hospital Center, Pulmonary/Critical Care, Washington, District of Columbia, USA.
Anderson JT; McInnis IC;Gonzales MA; Rosas MM; Dr. Barber BS; Murillo CG; Aden JK; Huprikar NA; Walter RJ;

Respiratory care [Respir Care] 2025 Jun 30.
Date of Electronic Publication: 2025 Jun 30.

Background: Chronic respiratory symptoms are reported after military deployment in support of combat operations. The spectrum of clinical lung diseases was initially defined by the STudy of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE) III study. Does cardiopulmonary exercise testing (CPET) performed during this evaluation demonstrate differences based on established clinical diagnoses? Methods: Military personnel with chronic respiratory symptoms underwent a standardized evaluation as reported in the STAMPEDE III study. CPET was performed on a treadmill using a Bruce protocol, and all participants exercised to maximal exertion. Standard cardiac and respiratory CPET parameters were compared based on diagnosis, pulmonary function testing, and underlying comorbidities. Historical control patients included asymptomatic, nondeployed military personnel with normal imaging and spirometry who previously performed identical CPET testing.
Results: In total, 356 participants from STAMPEDE III (38.3 ± 8.7 years) completed a single CPET study during the standardized evaluation. Values were compared with 108 nondeployed controls (28.8 ± 3.9 years). Participants versus controls demonstrated a significant reduction in exercise capacity based on time (10:09 ± 1:51 vs 12:58 ± 2:11, P < .001), metabolic equivalents (10.9 ± 1.7 vs 12.8 ± 1.7, P < .001), and V̇ _{O 2} peak (mL/kg/min) (37.3 ± 7.1 vs 46.7 ± 6.9, P < .001). In the comparison of respiratory parameters, both minute ventilation/maximum voluntary ventilation (0.80 ± 0.18 vs 0.69 ± 0.15) and breathing reserve percentage (20.3 ± 17.5 vs 25.9 ± 13.1) identified significant differences ( P < .05) driven by asthma and lower airway categories, whereas breathing frequency and tidal volume/inspiratory capacity were not different. Differences in exercise capacity were influenced by the presence of post-traumatic stress disorder/traumatic brain injury, mental health disorders, and body mass index >30 kg/m ² .
Conclusions: The use of CPET for postdeployment pulmonary diagnoses showed a decrease in exercise capacity compared with normal controls. Although several ventilatory parameters were elevated in asthma and lower airway diseases, individuals diagnosed with only exertional dyspnea did not demonstrate changes. Propensity matching confirmed that CPET does not suggest undiagnosed respiratory disease during a normal postdeployment pulmonary evaluation.

Feasibility and inter-reporter variability of submaximal outcomes derived from cardiopulmonary exercise testing in people with advanced cystic fibrosis lung disease.

Urquhart DS; Royal Hospital for Children and Young People, Edinburgh, UK.; & other European Hospitals
Jamieson P; Burns P; Braun J; Hebestreit H; Radtke T;

ERJ open research [ERJ Open Res] 2025 Jun 30; Vol. 11 (3).
Date of Electronic Publication: 2025 Jun 30 (Print Publication: 2025).

Background: Cardiopulmonary exercise testing (CPET) provides prognostic information in people with advanced cystic fibrosis lung disease (pwACFLD). This project aimed to ascertain feasibility and inter-reporter variability in the identification of submaximal CPET outcomes for pwACFLD as potential predictors of prognosis where no peak exercise data are available.
Methods: We utilised data from an international retrospective multicentre study involving pwACFLD, for whom raw CPET data were available. Two experienced operators independently reviewed and analysed CPET tests with a focus on three pre-defined measures: oxygen uptake ( V ‘ _{O 2} ) at the anaerobic threshold (AT), the breathing reserve index at the AT (BRIAT), and the slope of the minute ventilation to carbon dioxide production ratio ( V ‘ _E / V ‘ _{CO 2} -slope). We calculated intra-class correlation coefficients (ICCs) with their 95% confidence intervals (CI), and limits of agreement using the Bland-Altman method.
Results: The original cohort included 174 pwACFLD. Among those, raw CPET data were available for 101 individuals, of which 89 tests were of sufficient technical quality for submaximal analysis. In 72 out of 89 technically acceptable tests (81%), the AT could be confidently identified by both operators. Furthermore, ICCs indicated good-to-excellent inter-reporter agreement for V ‘ _{O 2} at the AT (ICC 0.79, 95% CI 0.62-0.88), the V ‘ _E / V ‘ _{CO 2} -slope (0.95, 95% CI 0.93-0.97) and BRIAT (0.76, 95% CI 0.63-0.85).
Conclusions: Submaximal CPET data can be reliably obtained in most pwACFLD by trained CPET operators. Future studies may ascertain the prognostic value of submaximal CPET outcomes in pwACFLD.

Associations between Cardiopulmonary Fitness and Cardiovascular Events in Survivors of Childhood Cancer: A Report from the St. Jude Lifetime Cohort.

Wogksch MD; Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN.
Ware ME; O’Neil ST; Nolan VG;Smeltzer MP; Mzayek F; Mulrooney DA; Ehrhardt MJ; Dixon SB; Rhea IB; Srivastava DK; Armstrong GT; Hudson MM;
Ness KK;

Medicine and science in sports and exercise [Med Sci Sports Exerc] 2025 Jul 01.
Date of Electronic Publication: 2025 Jul 01.

Purpose: Childhood cancer survivors are at increased risk of premature cardiovascular events compared to peers. Increased cardiopulmonary fitness reduces the risk of cardiovascular morbidity/mortality within the general population but are poorly described in cancer survivors. We examined the associations between fitness and cardiovascular events in childhood cancer survivors.
Methods: Participants (n = 2,433) completed a baseline, cardiopulmonary exercise test (CPET) to assess peak maximal oxygen consumption (VO2peak). Metabolic equivalents (METs) were calculated by dividing VO2peak by 3.5 ml·kg1·min and peak METs achieved on CPET was used to document cardiopulmonary fitness. Additionally, we categorized participants (based on age- and sex-matched controls) as low (<50th percentile ofachieved METs) and normal ( ≥50th percentile). Subsequent cardiovascular disease was graded with the Common Terminology Criteria for Adverse Events v. 4.03. Associations between peak METs and subsequent cardiovascular disease in survivors were evaluated with multivariable Cox-proportional hazard regression, adjusted for cancer treatment, lifestyle, baseline cardiovascular disease, and cardiovascular risk factors. Additionally, a univariate analysis was conducted to examine the peak METs achieved on the CPET in survivors who died from a cardiovascular event and those who did not.
Results: Each 1 MET increase on the survivor’s CPET performance decreased the risk of incident cardiovascular disease (Hazard Ratio [HR] 0.80, 95% Confidence interval [CI] 0.72, 0.90). Among survivors with low baseline cardiopulmonary fitness, those who achieved 1 MET higher value on their CPET had lower risk of incident cardiovascular disease (HR:0.78, 95% CI 0.65, 0.96). The average peak METs achieved was lower (5.9 ± 2.17) among survivors who died from cardiovascular disease compared to those who did not (7.6 ± 2.5).
Conclusions: Higher cardiopulmonary fitness was associated with lower risk for incident cardiovascular disease. Early identification of survivors with low cardiopulmonary fitness provides opportunities for risk mitigation through promotion of regular physical activity.
Competing Interests: Conflict of Interest and Funding Source: Support to St. Jude Children’s Research Hospital provided by the National Cancer Institute (U01 CA195547, K. Ness and M. Hudson, Principal Investigators; R01 CA157838, G. Armstrong, Principal Investigator), the Cancer Center Support (CORE) grant (P30 CA21765, C. Roberts, Principal Investigator), and the American Lebanese-Syrian Associated Charities (ALSAC).

Key elements of follow-up care after acute pulmonary embolism focusing on long term sequelae: a Delphi study among European experts.

Mali RMA; Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Ninaber MK; van Mens TE; Konstantinides SV; Klok FA;

European heart journal. Quality of care & clinical outcomes [Eur Heart J Qual Care Clin Outcomes] 2025 Jul 01.
Date of Electronic Publication: 2025 Jul 01.

Background: A considerable proportion of patients develop long-term sequelae after an acute pulmonary embolism (PE). Beyond chronic thrombo-embolic pulmonary hypertension (CTEPH), current guidelines provide limited guidance regarding a structured approach for assessment and management of these patients.
Objectives: To establish a framework of multidisciplinary follow-up care of PE-survivors.
Methods: A Delphi study was conducted among a multidisciplinary panel of PE specialists from across Europe to gather expert opinions, and where possible reach consensus, on key aspects of PE follow-up care.
Results: Two rounds of surveys were distributed among 45 venous thromboembolism (VTE) experts, with 39 completing both rounds. Consensus was reached that follow-up of PE survivors should address the entire spectrum of post-PE sequelae, i.e., CTEPH, chronic thromboembolic pulmonary disease, but also all other presentations of the post-PE syndrome. Routine assessment at three months should involve patient-reported outcome measures, including quality of life. A single, uniform protocol was preferred over locally adapted approaches. Earlier follow-up, prior to the three-month mark, to detect post-PE sequelae was not considered necessary for most patient subgroups. Right heart catheterization to confirm CTEPH should be reserved for specialized pulmonary hypertension centers, while other diagnostic modalities such as computed tomography, V/Q scan, cardiopulmonary exercise testing and transthoracic echocardiography can be performed in non-referral centers.
Conclusion: This Delphi study among a panel of VTE experts across Europe describes a consensus-based framework for structured follow-up care for PE-survivors, emphasizing the need for a standardized, multidisciplinary approach to detecting long-term sequelae of PE.

The usefulness of the modified steep ramp test as a practical exercise test for preoperative risk assessment in patients scheduled for pancreatic surgery.

Driessens H;Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, Groningen, the Netherlands.
Hoeijmakers LSM; Zwerver ODJ; Wijma AG; Hildebrand ND; Queisen RRYC; Kuikhoven M; den Dulk M; Olde Damink SWM;Klaase JM; Bongers BC;

Journal of clinical anesthesia [J Clin Anesth] 2025 Jul 04; Vol. 106, pp. 111916.
Date of Electronic Publication: 2025 Jul 04.

Background: The widespread implementation of a preoperative assessment of aerobic capacity requires a practical field test. This study investigated the validity of the modified steep ramp test (SRT) for evaluating preoperative aerobic capacity and to evaluate its usefulness for preoperative risk assessment in patients planned for pancreatic surgery.
Methods: Patients scheduled for pancreatic surgery who preoperatively performed cardiopulmonary exercise testing (CPET) and the modified SRT within 14 days were included. To assess its criterion validity, the correlation between the achieved work rate at peak exercise (WR _peak ) at the modified SRT and oxygen uptake (VO ₂ ) at peak exercise (VO _2peak ) during CPET was determined. To evaluate the ability of the modified SRT to correctly classify patients as fit or unfit, receiver operating characteristic (ROC) analyses were performed based on the CPET VO _2peak cutoff 18.0 ml.kg ^-1 .min ^-1 and VO ₂ at the ventilatory anaerobic threshold (VAT) cutoff 11.0 ml.kg ^-1 .min ^-1 .
Results: Forty-eight patients (21 females) aged 68.7 ± 7.6 years were included. Modified SRT WR _peak (W/kg) demonstrated a very strong correlation with CPET VO _2peak (ρ = 0.865, r = 0.926). The modified SRT WR _peak cutoff to most accurately classify patients as fit or unfit was 2.095 W/kg for the CPET VO _2peak cutoff (area under the curve (AUC) of 0.948) and the CPET VO ₂ at the VAT cutoff (AUC of 0.814).
Conclusions: The modified SRT is a valid short-term practical exercise test to preoperatively assess aerobic capacity in patients undergoing pancreatic surgery. A modified SRT performance below 2.1 W/kg seems clinically most suitable to select candidates for further preoperative CPET evaluation and/or prehabilitation, given its positive and negative predictive value.

Fontan Patients with a Systemic Left Ventricle Have Greater Exercise Capacity than those with a Systemic Right Ventricle: A Systematic Review and Meta-Analysis.