Rattley, Catherine A; Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK.
Felton, Malika;Ansdell, Paul;Dewhurst, Susan;+1 more

Climacteric : the journal of the International Menopause Society,2025 Dec

BACKGROUND Maintaining fitness throughout menopause is crucial for sustaining functional capacity and supporting healthy aging. Declines in physical activity and changes in physiology threaten cardiovascular health in menopause. Aerobic capacity is an indicator of current health status that can be measured directly, by maximal rate of oxygen uptake (V̇O _{2 max} ), or using submaximal predictive methods that require fewer resources.
AIMS This study aimed to establish the validity of these predictive methods for midlife women.
METHODS Forty-four women (age 52 ± 4 years) completed three predictive cycle ergometer protocols (YMCA, Astrand-rhyming and Ekblom-Bak) and an incremental cycle ergometer V̇O _{2 max} test. Predicted V̇O _{2 max} scores were compared for agreement with directly measured V̇O _{2 max} .
RESULTS All methods evidenced moderate correlations with V̇O _{2 max} . The mean V̇O _{2 max} value derived from the YMCA (35.6 ± 9.7 ml·kg- ¹ ·min- ¹ ) and Astrand-Rhyming (35.5 ± 8.8 ml·kg- ¹ ·min- ¹ ) tests was no different to measured V̇O _{2 max} (34.5 ± 7.2 ml·kg- ¹ ·min- ¹ ), but the Ekblom-Bak test (37.5 ± 7.2 ml·kg- ¹ ·min- ¹ , p < 0.01) overpredicted V̇O _{2 max} .
CONCLUSIONS All methods showed wide limits of agreement, suggesting variability in the accuracy of predictions.
When measuring aerobic capacity or prescribing exercise using these predictive methods, the results should be interpreted with caution. Where possible, direct measurement of aerobic capacity should be utilized for prescription of exercise intensity in menopausal women.

McMurtry, Michael Sean; The Canadian journal of cardiology,2025 Dec
Skow, Rachel J;Foulkes, Stephen J;Moulson, Nathaniel;+3 more

Thoracic aortic diseases, including aortic aneurysm and aortic dissection, are disorders that frequently require cardiac surgical intervention. Current clinical practice guidelines recommend cardiac rehabilitation for patients after thoracic aortic surgery. However, the evidence to support these recommendations remains limited, and there is a notable absence of individualized approaches for resuming regular exercise. In this narrative review the literature on cardiovascular rehabilitation after thoracic aortic surgery for inherited and acquired thoracic aortic disease is examined, a clinical case to illustrate limitations in the current approach is presented, and how exercise-based magnetic resonance imaging to assess aortic wall stress might support a more personalized and precise exercise prescription is explored. Further research on the safety and efficacy of exercise training in patients after thoracic aortic surgery-particularly randomized controlled trials-are needed.

Piechowiak, Christiane; University Hospital Magdeburg, Magdeburg, Sachsen-Anhalt, Germany.
Müller, Patrick;Moyano, Jose Bernal;Kunz, Naomi Alice; et al

Alzheimer’s & dementia : the journal of the Alzheimer’s Association,2025 Dec

• Background: Physical activity has been shown to reduce the risk of dementia and the pathological accumulation of amyloid in both animals and humans. One potential explanation for this outcome is that physical activity enhances glymphatic function. In this study we investigated whether a single session of physical exercise, could alter the glymphatic system, operationalized here as the visibility of perivascular spaces (PVS) on magnetic resonance imaging (MRI).
• Method: In this prospective cohort study, we included 20 young participants (mean age 25.8±3.5 years, female 50%), who underwent repeated MRI scans at three different time points: baseline, immediately after cardiopulmonary exercise testing until exhaustion, and 24 hours later (Figure 1). We estimated PVS volumes in the centrum semiovale (CSO) and basal ganglia (BG) using a well-validated software. For each subject, we first aligned all T2-weighted images using FreeSurfer’s mri_robust_template tool. Using SynthSeg on T1-weighted images, we obtained white matter parcellations and aggregated them to create time-point-specific BG and CSO ROI masks. To ensure consistency across time points, we limited the analysis to regions that were consistent across all time points. We then segmented PVS on T2-weighted images using the RORPO filter followed by thresholding. All segmentations were visually assessed and manually corrected. We tested for differences using the Wilcoxon signed-rank test.
• Result: PVS volumes measured at the three time points had high agreement with one another (Lin’s concordance in BG ROI > 0.94 and in CSO ROI > 0.98). Average BG-PVS volumes at baseline were 133.38 mm ³ [95%-CI: 109.19,157.57]. Following acute exercise, these decreased to 123.10 mm ³ [95%-CI: 99.62,146.57], showing a significant reduction of 10.28 mm ³ [95%-CI: 3.24,17.33] (Figure 2; W=181, p = 0.003). After 24 hours, BG-PVS volumes increased to 130.34 mm ³ [95%-CI: 107.96,152.72], similar to baseline levels (Figure 2; W=107, p = 0.644). CSO-PVS volumes, on the other hand, showed no significant changes between baseline and after exercise or 24 hours later (Figure 2).
• Conclusion: Our work indicates that a single bout of physical exercise can exert subtle yet measurable volumetric changes on PVS in young participants. Whether this change reflects enhanced cerebrovascular or glymphatic function or not remains unclear, but will be explored in future research.

Polito, Luís Felipe Tubagi; Center of Excellence in Exercise Physiology and Training-NEFET, São Paulo, SP, Brazil.
Carneiro, Yago de Moura;Biaggioni, Danilo de Figueiredo;Brolin Vieira Nascimento, Thomas; et al

Frontiers in cardiovascular medicine,2025 Dec 12

• Introduction: This study examined cardiac adaptations in futsal athletes to determine how sport-specific training influences cardiac morphology and function across different competitive levels.
• Methods: Male athletes from under-18, under-20, and adult categories underwent electrocardiogram, transthoracic echocardiogram, and cardiopulmonary exercise testing. Measured parameters included VO₂max, ventricular and atrial dimensions, wall thickness, and cardiac mass index. Group differences were analyzed using one-way ANOVA with Tukey’s post-hoc test ( p < 0.05).
• Results: Under-20 athletes showed significantly higher VO₂max compared to adults (mean difference: +4.87 mL·kg ^-1 ·min ^-1 ; p = 0.014). Adult players exhibited greater interventricular septal (+0.68 mm; p = 0.048) and inferolateral left ventricular wall thickness (+0.75 mm; p = 0.016), alongside higher left atrial volume (+27.4 mL vs. U18; p < 0.001) and indexed left atrial volume (+14.6 mL/m² vs. U18; p < 0.001). Conversely, the right ventricular end-diastolic diameter was larger in under-18 athletes compared to under-20 (+10.9 mm; p < 0.001) and adult players (+14.3 mm; p < 0.001). Ejection fraction, left ventricular end-diastolic diameter, and ventricular mass index remained consistent among groups, confirming preserved systolic function across all athletes.
• Conclusion: Progressive futsal training promotes selective cardiac remodeling characterized by increased wall thickness and chamber dilation in adult athletes without compromising function. These adaptations reflect physiological remodeling associated with chronic high-intensity intermittent training, emphasizing the need for longitudinal monitoring to distinguish normal adaptation from early pathological changes.

Salisbury, Dereck L; University of Minnesota, Minneapolis, MN, USA.
Lin, Feng Vankee;Yu, Fang

Alzheimer’s & dementia : the journal of the Alzheimer’s Association,2025 Dec

• Background: Cardiorespiratory fitness (CRF) has been positively associated with brain volumes and health in older adults and negatively associated with dementia onset or risk and mortality. Cardiopulmonary exercise testing (CPET) is a gold standard test for evaluating CRF for exercise prescription, but requires specialized equipment and is time- and resource-intensive, highlighting the need for more feasible and valid options for evaluating CRF. Therefore, the purpose of this study was to evaluate the validity and relationship of the shuttle walk test (SWT) distance with peak oxygen consumption (VO _2Peak ) from cycle ergometer-based CPET in persons with amnestic mild cognitive impairment (aMCI) or mild-to-moderate AD dementia.
• Method: This study used baseline data from two Phase II, single-blinded clinical trials (The ACT Trial and The FIT-AD Trial). The sample included 80 participants with aMCI and 90 with mild-to-moderate AD. Across the two studies, CRF was measured with VO _2Peak obtained from the symptom-limited peak cycle-ergometer test and the SWT. Data were analyzed with simple and multiple linear regression. Adjusted models included age, sex, cognition (Montreal Cognitive Assessment [MoCA] or Mini Mental State Examination [MMSE], and body mass index (BMI) that were significantly associated with VO _2peak .
• Result: The participants included 80 from the ACT Trial (55% male, 74.1 [5.7] years, and MoCA 23.2 [2.0]) and 90 from the FIT-AD Trial (56% males, age 77.1 [6.6] years, and MMSE 21.8 [3.4]). In persons with aMCI, SWT was positively correlated with VO _2Peak (r = .57 p < 0.01). When controlling for age, sex, MoCA, and BMI, SWT distance remained significantly and positively associated with VO _2Peak and collectively represented 54% of the variance in VO _2Peak (F (5,69) =18.37, p <0.001). In persons with AD dementia, SWT was positively correlated with VO _2Peak (r = .44 p <0.01). When controlling for age, sex, MMSE, and BMI, SWT distance remained significantly and positively associated with VO _2Peak and collectively represented 43% of the variance in VO _2Peak (F (5,77) =11.46, p <0.001).
• Conclusion: SWT distance is a significant predictor of VO _2Peak in persons with cognitive impairment and remains a significant predictor in the presence of related, clinically measured covariates including age, sex, cognition, and BMI.

Mouraux, Stéphane; Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Lechartier, Benoît;Imler, Théo;von Garnier, Christophe; et al

Chest,2025 Dec 22

• Background: Dyspnea increases mortality and remains unexplained in 15% of patients. Although obstructive sleep apnea (OSA) is linked to reduced exercise capacity during cardiopulmonary exercise testing, the association between dyspnea and OSA remains uncertain.
• Research Question: Is there an association between exertional dyspnea and OSA in the general population? What are the polysomnographic OSA-related measures associated to exertional dyspnea?
• Study Design and Methods: We used data from a prospective cohort study of general population conducted in an urban area. Participants underwent polysomnography and completed a respiratory questionnaire. Logistic regression models were used to determine the association between self-reported dyspnea (mMRC score ≥1) and OSA categories or apnea-hypopnea index (AHI) cut-offs. We performed an adjusted model for sex, BMI, age, FEV1, psychiatric disorders, cardiac and respiratory disorders and smoking history.
• Results: We included 1’200 participants (mean age 62.1 years; 54% female) of whom 515 (42.9%) reported exertional dyspnea. The adjusted model revealed a positive association between exertional dyspnea and AHI ≥ 15/h (OR 1.57, CI95 [1.13-2.19]), AHI ≥ 30/h (OR 1.72, CI95 [1.06-2.78]), moderate OSA (OR 1.60, CI95 [1.04-2.46]) and severe OSA (OR 2.25, CI95 [1.28-3.96]). Moreover, in adjusted model, dyspnea was associated with AHI, respiratory disturbance index, respiratory pulse wave drop index, sleep apnea-specific pulse-rate response, respiratory arousal index and oxygen desaturation index 3%.
• Interpretation: Exertional dyspnea is associated with moderate and severe OSA, potentially due to heightened autonomic and cortical responses to increased respiratory efforts. Further research is needed to assess the effectiveness of OSA treatment on dyspnea in OSA patients.

Galán-Rioja, Miguel Ángel; Faculty of Sport Sciences, University of Castilla la Mancha, Toledo, Spain.
González-Mohíno, Fernando;Turner, Anthony P;González Ravé, José María

International journal of sports medicine,2025 Dec 23

AIMS This study aimed to assess the level of agreement between internal (i.e., oxygen uptake, heart rate, or ratings of perceived exertion) and external load markers (power output) at critical power intensity, compared to the first ventilatory threshold, respiratory compensation point, and maximum oxygen uptake derived from the cardiopulmonary exercise test, and estimate critical power from values derived from the cardiopulmonary exercise test in trained cyclists.
METHODS Fourteen (13 males and 1 female) road master cyclists completed a cardiopulmonary exercise test to determine the first ventilatory threshold, respiratory compensation point, and maximum oxygen uptake. On a subsequent day, they completed three maximal time-trial tests to estimate critical power and W’. Associated physiological and perceptual values at critical power were estimated from linear regressions applied to the cardiopulmonary exercise test results. Internal and external markers significantly ( p <0.05) increased from the first ventilatory threshold to the respiratory compensation point and then maximum oxygen uptake.
RESULTS There were no significant differences between internal and external markers at the respiratory compensation point vs. critical power with strong correlations between responses. However, there was a mean bias for responses at respiratory compensation point markers to overestimate some responses at critical power (power output and oxygen uptake by ~8%).
CONCLUSION This study shows that critical power can be estimated from a single cardiopulmonary exercise test. While the respiratory compensation point is not a reliable critical power substitute, predictive equations improve its estimation for more precise prescriptions in trained cyclists.

Maier, Rebecca; Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
Dunning, Joel;Wason, James;Chadwick, Thomas;

BMJ open,2025 Dec 24

• Introduction: Severe pectus excavatum (PE) may impair cardiopulmonary and physical function. The effectiveness of surgical treatment to correct PE and restore physical function is widely debated due to a lack of high-quality comparative evidence. The RESTORE trial aims to determine the clinical and cost-effectiveness of corrective surgery for severe PE compared with conservative management for the first time in a randomised controlled trial (RCT).
• Methods and Analysis: RESTORE is a pragmatic, multicentre, RCT with an embedded observational cohort. 200 participants aged ≥12 years with severe PE will be recruited at around 12 National Health Service cardiothoracic surgical centres in England. Participants will be randomised 1:1 to receive either surgery within 3 months of randomisation (intervention arm) or no surgery until after the primary outcome measurement at 1 year (comparator arm). The primary outcome is change in physical functioning from baseline to 1 year as measured by the Short Form Health Survey (SF-36v2) physical function score. The primary economic outcome is cost-effectiveness. The key secondary outcome is change in % predicted VO _2peak at 1 year measured by cardiopulmonary exercise test (CPET). Outcomes will be assessed at 1 year post-randomisation in the comparator arm and 1 year post-surgery in the intervention arm. The primary analyses will be undertaken on an intention-to-treat population using a linear mixed-effects model, adjusted for stratification variables via a binary covariate. Other secondary outcomes will include change from baseline of cardiopulmonary function (CPET and spirometry), health-related quality of life using the EuroQol 5 Dimension 5 Level (EQ-5D-5L) and SF-36v2 questionnaires, Hospital Anxiety and Depression Scale and disease specific symptoms (Phoenix Comprehensive Assessment for Pectus Excavatum Symptoms and Pectus Excavatum Evaluation Questionnaire). Adverse events, complications from surgery and operative technical success (Haller and Compression Indices from preoperative and postoperative CT scans) will also be assessed. Health economic analysis will estimate the incremental cost per quality adjusted life year at 1 year.
• Ethics and Dissemination: The trial was approved by East of Scotland Research and Ethics Service (24/ES/0034). Participants who are ≥16 years of age will be required to provide written informed consent. For participants <16 years of age who are not judged to be Gillick competent, written assent and written informed consent from a parent/guardian will be required. Results will be submitted for publication in peer-reviewed journals and shared with participants, clinicians and commissioners.

Jiang, Yumei; School of Medicine, Tongji University, Shanghai, 200065, China.
Shen, Ting;Shi, Cheng;Li, Dejie; et al

BMC cardiovascular disorders,2025 Dec 27

• Background: Acute coronary syndrome (ACS) is a major global health burden with a high risk of adverse outcomes. Existing predictive models (e.g., GRACE) primarily rely on static indicators and focus on short-term prognosis, limiting their ability to comprehensively assess patient status and predict long-term mortality. To address the need for improved long-term risk prediction in this specific patient subgroup, this study developed and validated a long-term mortality prediction model for ACS patients incorporating cardiopulmonary exercise testing (CPET) and other clinical indicators.
• Methods: This retrospective cohort study included ACS patients treated at Tongji Hospital from January 1, 2007, to December 31, 2018. Demographic data, medical histories, CPET indicators, laboratory indicators, and other baseline data were collected, and all-cause mortality was followed up until June 30, 2023. All data sets were randomly divided into derivation and validation cohorts in a ratio of 7/3. Least absolute shrinkage and selection operator regression and Cox multivariate analysis were used to identify independent risk factors and a risk prediction model was established using nomograms.
• Results: A total of 299 patients were included in this cohort (211 in the derivation cohort and 88 in the validation cohort), with an average age of 57.00 years, including 280 males (93.6%). The median follow-up time was 3821 days, and 46 cases (15.4%) reached the study endpoint. The derivation cohort identified four independent predictive factors: age, blood urea nitrogen (BUN), ejection fraction (EF), and heart rate reserve (HRR), and a Nomogram scoring model was constructed based on these factors. The model demonstrated good discrimination in the derivation cohort (C-index: 0.83) but this decreased in the validation cohort (C-index: 0.72), suggesting potential overfitting. Time-dependent calibration analysis showed poor agreement at 5 years in the validation cohort (R ² = 0.1819), but improved at 10 years (Slope = 0.8006, R ² = 0.5575) and 15 years (R ² = 0.5638). The model’s applicability is strictly limited to the studied population: a predominantly male, lower-risk subset of ACS survivors capable of completing CPET.
• Conclusions: A model based on four readily available variables-age, BUN, EF, and the key CPET parameter, HRR-may have utility for predicting long-term all-cause mortality. This model provides a preliminary tool for the long-term management of a specific subpopulation of acute coronary syndrome (ACS) survivors, namely a predominantly male, lower-risk cohort with the capacity to complete CPET. Further external validation in similar populations is required before prospective clinical application.

Lim, Kenneth; Division of Nephrology & Hypertension, Indiana University School of Medicine, Indianapolis, IN, USA.
Campos, Monique;Moe, Sharon

Kidney360,2025 Dec 15

Cardiovascular outcome trials are challenging to conduct in patients with CKD. Despite this, well-designed randomized controlled trials are critical to inform optimal management strategies and improve clinical care. Unfortunately, many cardiovascular outcome trials in nephrology have not demonstrated a treatment benefit. Contributing to this are the difficulties associated with endpoint selection and the limitations of many traditional endpoints such as resting left ventricular geometric measures and circulating biomarkers in patients with CKD, which are well known to be a major impediment to the conduct of cardiovascular trials in this population. The emergence of state-of-the-art Cardiopulmonary Exercise Testing (CPET) technology in nephrology has taken center stage in this field due to the possibilities and solutions afforded by CPET-derived functional endpoints. CPET is a powerful tool that incorporates ventilatory gas exchange measurements during graded exercise and robustly quantifies VO2Peak, the gold standard index for cardiovascular functional capacity. The use of functional endpoints such as VO2Peak is a critical mechanism to promote patient-centered clinical trials in patients with CKD. Furthermore, the Food and Drug Administration (FDA) has now approved both drugs and devices that have utilized VO2Peak as an endpoint outside of nephrology. With accumulating scientific evidence base supporting the rationale for CPET-derived endpoints in patients with CKD, the potential use of VO2Peak in clinical trials as a basis for regulatory approval creates an exciting opportunity in nephrology.