Schellenberg J; Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, Ulm 89075, Germany.
& School of Sport Science, UiT the Arctic University of Norway, Tromsø, Norway.
Matits L; Kersten J; Bizjak DA; SKirsten J; Fremo T;Tjønna AE; Skovereng K; Sandbakk Ø; Aksetøy IA; Langlo KAR; Dalen H; Letnes JM;

European heart journal. Imaging methods and practice [Eur Heart J Imaging Methods Pract] 2025 Oct 30; Vol. 3 (4), pp. qyaf138.
Date of Electronic Publication: 2025 Oct 30 (Print Publication: 2025)

Aims: Left ventricular (LV) enlargement is a common training-induced adaptation in athletes, particularly in endurance sports. Previous research indicates that indexing LV volumes and mass to absolute peak oxygen uptake (VO₂ _peak ) better reflects physiological adaptation than traditional indexing to body surface area (BSA). Therefore, we investigated whether indexing LV end-diastolic volume (LVEDV) and mass to VO _2peak could eliminate differences in LV size among athletes from different sport categories (endurance, mixed, power, and technical).
Methods and Results: This analysis included 70 athletes from the multicenter COSMO-S in Germany and 15 elite endurance athletes from Norway. All participants (29 ± 8 years, 52 male) underwent echocardiography and cardiopulmonary exercise testing. In regression analyses, VO _2peak (L/min) accounted for a significantly greater proportion of the variance in LVEDV than BSA (R ² 0.64 vs. 0.19, P < 0.001), while this difference was not significant for LV mass (R ² 0.54 vs. 0.36, P = 0.06). When indexed to BSA, both LVEDV and LV mass revealed significant differences across sports (both P ≤ 0.019), that disappeared when indexed to VO₂ _peak (all P ≥ 0.40). In a cohort of 12 dilated cardiomyopathy (DCM) patients serving as a pathological reference group, indexing LVEDV and LV mass to VO _2peak better differentiated DCM patients from athletes than indexing to BSA.
Conclusion: Indexing LV size to VO₂ _peak may provide a more physiological interpretation of cardiac adaptations in athletes and reduce sport-specific differences due to better consideration of training-induced adaptations. These findings should be replicated in larger cohorts and tested for the ability to detect subtle pathologies.

Looby M; Academic Surgery, Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.; Southampton Complex Cancer and Exenteration Team (SCCET), University Hospital Southampton, Southampton, UK.
Matthews L; West CT; Khan K; Ansell G;Donovan K; Wood L;  Tapley P; Lewis R; Stoddard K; Grocott MPW; Jack S; Yano H; Levett D;Mirnezami A; West MA;

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2025 Nov; Vol. 27 (11), pp. e70298.

Aim: Locally advanced pelvic malignancies, such as colorectal and anal cancers, can only be cured through multimodal cancer treatment including multi-visceral exenterative resections, which carry a high mortality and morbidity risk. Despite strong predictive abilities in other cancer cohorts, the combined prognostic value of body composition and cardiopulmonary exercise testing (CPET) for major in-hospital morbidity in patients undergoing exenterative surgery for advanced pelvic cancers has not been evaluated.
Method: A locally advanced colorectal and anal cancer cohort was derived from a prospectively maintained quaternary database. CPET was undertaken preoperatively, according to national guidelines. Skeletal muscle index (SMI) and radiation attenuation (SM-RA) were obtained from analysing L3 slices from preoperative computed tomography scans using SliceOmatic 5.0 and classified using predefined thresholds. Major morbidity was defined as Clavien-Dindo classification 3a or greater.
Results: From 247 patients (58% male, median age 60 years), 62.4% and 35.5% had locally advanced or recurrent disease respectively. Physical fitness variables were significantly reduced in low SMI or low SM-RA patients. In multivariate linear regression, SMI was strongly predictive of oxygen uptake at the anaerobic threshold (B = 0.013, p = 0.001) and at peak (B = 0.015, p = 0.002). 17.3% of all patients experienced a major postoperative complication. In multivariate analysis, reduced peak power output (<1.5 W kg ^-1 ) was significantly associated with an increased risk of postoperative major morbidity (OR = 2.6, p = 0.012).
Conclusion: CPET may be predictive of in-hospital major morbidity in this cohort. The association of CPET with body composition necessitates further evaluation and external validation in a larger patient cohort, specifically interrogating their combined role in morbidity prediction and as a target for prehabilitation interventions.

Duarte ACB; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases Federal University of Sao Paulo; Brazil.
Lafetá ML; Verrastro CGY;Mancuso FJ; Tanni SE;Oliveira RKF; Ota-Arakaki JS; Ferreira EVM;

Pulmonary circulation [Pulm Circ] 2025 Nov 14; Vol. 15 (4), pp. e70198.
Date of Electronic Publication: 2025 Nov 14 (Print Publication: 2025).

During the COVID-19 pandemic, Brazil was one of the most affected countries. Patients presented higher risk of acute venous thromboembolism (VTE), in particular, pulmonary embolism (PE). However, long-term implications of these events remain unknown. A retrospective analysis from the FENIX study was conducted, and patients with COVID-19-related VTE during hospitalization were included. Further analysis, up to 6 months after the acute event, was performed exclusively in patients with PE. Persistence of dyspnea and exercise intolerance was evaluated through imaging, rest, and exercise functional tests. Cumulative incidence of VTE during hospitalization among COVID-19 survivors followed at the outpatient clinic was 17.7% ( n  = 75/423) and of acute PE was 9.9% ( n  = 42/423). Patients with PE were mostly male (66%), 56 ± 16 years old, and mainly classified as intermediate-low risk (74%). Dyspnea (mMRC≥ 1) up to 6 months of PE was present in 56% ( n  = 19/34), with a borderline association with parenchymal lung sequelae on chest CT scan ( p  = 0.069). Symptomatic patients upon follow-up presented lower FEV1 and FVC, as well as increased peak VD/VT ratio and ventilatory inefficiency. No signs of pulmonary hypertension (PH) were identified on echocardiogram (ECHO) and cardiopulmonary exercise testing (CPET). Persistence of dyspnea among post-PE related to COVID-19 was high. However, no cases of PH were found; follow-up findings may be related to pulmonary parenchymal and microvascular injury. Also, we cannot exclude association with long-COVID, in which pathophysiological mechanisms are multifactorial, involving chronic inflammatory changes and multiorgan dysfunction, highlighting the need for comprehensive evaluation of exercise intolerance through invasive CPET.

Williams ZJ; Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.
Cenerini G; Orton CM; Garner JL; Chan LT; Tana A; Shah PL; Hull JH;

Journal of applied physiology (Bethesda, Md. : 1985) [J Appl Physiol (1985)] 2025 Nov 17.
Date of Electronic Publication: 2025 Nov 17.

Introduction: Continuous bronchoscopy during exercise (CBE) allows assessment of large airway dynamics during ambulatory exercise, however, it is not yet clear if the bronchoscope alters cardiopulmonary and ventilatory parameters. Accordingly, we aimed to evaluate the impact of bronchoscopy on parameters measured during cardiopulmonary exercise testing (CPET).
Methods: Ten healthy participants (33% female) completed two randomised CPETs to exhaustion on a treadmill using an incremental protocol, with and without bronchoscopy set-up (5.0mm bronchoscope inserted via modified facemask). Breath-by-breath gas exchange and ventilatory data including oxygen uptake (V̇O ₂ ) and carbon dioxide output (V̇CO ₂ ), minute ventilation (V̇ _E ), and respiratory exchange ratio (RER) were assessed between CPET conditions.
Findings: Nine participants completed both CPET assessments to volitional exhaustion; one participant terminated the CPET-B test early due to scope-associated throat discomfort. Exercise duration was shorter (mean diff -52seconds, p=0.02) and heart rate (HR) values were lower (-7BPM, p=0.001) in CPET-B compared to CPET. Peak exercise V̇ _E (median diff. -13L.min⁻¹, p=0.004) was lower during CPET-B, yet breathing frequency and tidal volume values did not differ between CPET conditions. No differences were found in peak exercise V̇O ₂ , V̇CO ₂ , RER values, nor parameters measured at an equivalent absolute duration (iso-time).
Conclusion: In healthy adults, performing CPET with bronchoscopy does not alter peak exercise oxygen uptake or carbon dioxide output but results in a lower overall minute ventilation, despite no differences in breathing frequency or tidal volume. It is likely these discrepancies arise due to slightly lower exercise duration in the CPET with bronchoscopy trials.

Tucker S; Department of Pediatric Cardiology, Texas Children’s Hospital, Houston, TX, USA.
Wang A; Griffith G; Ward K; Desai L; Gambetta K; Husain N;

Pediatric cardiology [Pediatr Cardiol] 2025 Nov 22.
Date of Electronic Publication: 2025 Nov 22.

Multiparametric cardiac magnetic resonance (CMR) is increasingly used for rejection and coronary artery vasculopathy (CAV) surveillance in pediatric heart transplant recipients (PHTR). There is limited data regarding how graft assessment by multiparametric CMR may reflect functional capacity in PHTR. To explore the relationship between multiparametric CMR and markers of exercise capacity in PHTR. PHTR who underwent CMR within 1 year of cardiopulmonary exercise testing (CPET) were retrospectively reviewed. Those with submaximal effort on CPET (respiratory exchange ratio < 1.10), depressed function (left ventricular ejection fraction (LVEF) < 50% and/or right ventricular ejection fraction (RVEF) < 45%), or significant clinical events (rejection, new or worsening CAV, cardiac hospitalizations) between CMR and CPET were excluded. CMR variables included biventricular volumes, ejection fraction, cardiac index (CI), myocardial T2, T1/extracellular volume fraction (ECV), and myocardial perfusion reserve index (MPRI). CPET variables were VO _2peak , O ₂ pulse, percent age-predicted maximum heart rate (APMHR), HR reserve, and exercise duration. Relationships between variables were studied using correlations and regression. Forty-seven PHTR were included. Time between CPET and CMR was 5.5 ± 3.4 months. CI correlated positively with O ₂ pulse (R = 0.642, p < 0.001). Global T1 correlated negatively with both APMHR (R = - 0.538, p < 0.001) and HR reserve (R = - 0.598, p < 0.001). Global T2 correlated negatively with APMHR (R = - 0.335, p = 0.049), HR reserve (R = - 0.488, p = 0.003), and VO _2peak (R = - 0.327, p = 0.045). In PHTR with normal LV function, CMR-derived tissue characteristics have correlations with exercise capacity. Larger studies are needed to understand the role of multiparametric CMR in the functional surveillance of PHTR.

Baracchini N; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy.;
& Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy.
Mapelli M; Agostoni PG; Sinagra G;

European journal of preventive cardiology [Eur J Prev Cardiol] 2025 Nov 20.
Date of Electronic Publication: 2025 Nov 20.

No abstract available

Kamigaichi A; Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Tsutani Y; Tsuchiya A; Utsunomiya H;Miyata Y; DMimae T; DeTsubokawa N; Nakano Y;Okada M;

JTO clinical and research reports [JTO Clin Res Rep] 2025 Sep 12; Vol. 6 (11), pp. 100903.
Date of Electronic Publication: 2025 Sep 12 (Print Publication: 2025).

Introduction: The rationale underlying the benefits of the parenchyma-preserving nature of sublobar resection (SR) compared with lobectomy remains unclear. This study aimed to assess postoperative changes in cardiopulmonary function after lobectomy and SR using exercise stress testing.
Methods: This prospective, observational study enrolled patients scheduled for lobectomy or SR. Changes in cardiopulmonary function at 6 months postoperatively were evaluated using exercise stress echocardiography and cardiopulmonary exercise tests.
Results: Initially, 41 patients were enrolled, with 20 patients in the lobectomy group and 18 patients in the SR group (16 segmentectomies, two wedge resections) after excluding three ineligible patients. Preoperatively, all patients demonstrated well-preserved cardiopulmonary function. The systolic pulmonary artery pressure (SPAP) change at peak exercise was significantly higher for lobectomy (median 26.5%; interquartile range [IQR] 0.6-60.1) than for SR (median -8.2%; IQR -38.7-11.7; p = 0.001), despite nonsignificant differences at rest ( p = 0.599). Postoperative exercise-induced pulmonary hypertension (exPH) occurred in nine patients (45%) in the lobectomy group but none in the SR group (0%, p = 0.010). Postoperative peak oxygen consumption during exercise decreased significantly in the lobectomy group (median -14.3%; IQR -24.0 to -4.2) compared with that in the SR group (median -7.8%; IQR -13.5-8.7; p = 0.024). The postoperative increase in SPAP at peak exercise (r = 0.402, p = 0.012), prevalence of postoperative exPH (r = 0.978, p = 0.004), and postoperative decrease in peak oxygen consumption (r = -0.330; p = 0.041) were correlated with the number of resected segments.
Conclusions: Lobectomy induces increased SPAP during exercise, exPH, and effort intolerance, compared with SR. This highlights the importance of preserving lung parenchyma in lung surgery.
Clinical Trial Registration: This trial is registered in the UMIN Clinical Trials Registry under the code UMIN000053694.

Gentili F; Clinical Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy.
Cafiero G; Tranchita E; Kowalczyk J; Badolato F; Pagliari P; Leonardi B; Calcagni G; Rinelli G; Montanaro C; Drago F; Giordano U;

Journal of cardiovascular development and disease [J Cardiovasc Dev Dis] 2025 Sep 25; Vol. 12 (10).
Date of Electronic Publication: 2025 Sep 25.

Cardiopulmonary exercise testing (CPET) is recommended as part of routine care in people with congenital heart disease. A significant difference has been observed in many CPET parameters, depending on the ergometer and exercise protocol used. The aim of this study is to investigate such differences in Fontan patients. All Fontan patients (<40 years old, NYHA class I/I-II) underwent two consecutive CPETs on different ergometers (treadmill with ramped Bruce protocol versus cycle ergometer with ramp protocol) within less than 12 months. The exclusion criterion was the presence of significant clinical/anthropometric changes between the two tests. Anthropometric, surgical, clinical, electrocardiogram (ECG) and CPET data were collected. 47 subjects were enrolled (25 males, mean age 16.4 at first test). Peak heart rate (HR) tended to be higher on the treadmill ( p = 0.05 as % of predicted, p = 0.062 in absolute value). Peak oxygen consumption (VO ₂ ) (mL/min, mL/kg/min, and % of predicted) was significantly higher on the treadmill ( p < 0.01), as well the VO ₂ at the ventilatory anaerobic threshold (VAT) and the peak oxygen pulse. A different kinetics of the oxygen pulse wave was observed in the same patient comparing the two testing modalities. Maximal respiratory-exchange-ratio values (>1.1) were reached more frequently on the cycle ergometer ( p < 0.001). The minute ventilation-carbon dioxide output slope (VE/VCO ₂ slope) was not different between the two tests ( p = 0.400). Many parameters of CPET may differ depending on the ergometer used. These should be considered in clinical evaluation of Fontan patients and when exercise is to be prescribed.

Zhang ZF; Department of Rehabilitation Medicine, The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing, China.;
Sun XG; Chen JH;Xu F;Xiang MJ;Huang J; Xie B;Shi C;Zhang YF; Liu F;Li L; Xie YH;

Journal of thoracic disease [J Thorac Dis] 2025 Sep 30; Vol. 17 (9), pp. 7124-7140.
Date of Electronic Publication: 2025 Sep 26.

Background: Cycle ergometer is commonly used for cardiopulmonary exercise testing (CPET), which is the objective and quantitative golden standard for functional evaluation and training, while arm CPET is less commonly used to clinically assess a patient’s overall functioning. To determine optimal CPET protocols, we studied the effect of different work rate increasing rates of arm ergometer on CPET key variables.
Methods: We recruited fourteen non-symptomatic participants without any clinical diagnosis, and first performed maximal leg CPET for functional evaluation, followed by four maximal arm ergometer CPETs using different work rate increasing rates (5, 20, 35, and 50 W/min) in random order on various days in one week (7 days). The key variables are oxygen uptake ( INLINEMATH ), heart rate (HR), minute ventilation ( INLINEMATH ), tidal volume (VT), breathing frequency (Bf), anaerobic threshold (AT), work rate, incremental exercise time (Tlim), respiratory exchange ratio (RER). One-way analysis of variance (ANOVA) with Tukey’s post-hoc test compared outcomes across the four increasing rate protocols, and a paired t-test assessed arm vs. leg differences.
Results: All participants safely finished maximal CPET using leg and arm ergometers, and they had normal leg CPET peak INLINEMATH [92.89±18.37 (73.34-143.63) %predicted]. Each arm ergometer protocol elicited similar INLINEMATH (1.37±0.31, 1.35±0.32, 1.34±0.31 and 1.33±0.30 L/min, P=0.99), HR (P=0.96), INLINEMATH (P=0.98), VT (P=0.98) and Bf (P=0.81) at peak and AT (P=0.96). However, there were significantly different peak work rate (58±11, 80±18, 95±22 and 110±22 W, P<0.001), peak RER (1.08±0.07, 1.17±0.12, 1.20±0.12 and 1.21±0.14, P=0.03) and maximal RER during recovery (1.36±0.13, 1.45±0.18, 1.49±0.13 and 1.53±0.20, P=0.04), which were positively correlated with work rate increasing rate (R2=0.985, 0.823, 0.939, respectively). There were significantly different Tlim with negative relationship (11.61±2.29, 4.02±0.91, 2.71±0.64 and 2.19±0.44 min, P<0.001, R ² =0.383).
Conclusions: The study indicates that same as leg ergometer CPET, the arm ergometer CPET also needs optimized increasing rate of incremental exercise for each subject. We preliminarily recommend a work rate increasing rate of about 10-20 W/min in arm ergometer CPET for healthy individuals, which needs further investigation for functional evaluation and training.

Xie B; Department of Rehabilitation, The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing, China.;
Sun XG;Huang J; Chen JH; Xu F; Zhang ZF; Zhou QQ; Shi C; Zhang YF;Wang JN; Liu F; Xie YH;

Journal of thoracic disease [J Thorac Dis] 2025 Sep 30; Vol. 17 (9), pp. 7098-7111.
Date of Electronic Publication: 2025 Sep 26.

Background: Type II diabetes mellitus (T2DM) is characterized by glucose metabolic dysregulation, which may be addressed through integrative physiological interventions. Guided by Holistic Integrative Physiology and Medicine (HIPM) theory, this study investigates dynamic blood glucose changes in 11 T2DM patients with chronic comorbidities before and after cardiopulmonary exercise testing (CPET)-prescribed exercise to identify optimal multifactorial glycemic control strategies.
Methods: Eleven patients with T2DM who underwent 11 T2DM patients (2020-2022, Fuwai Hospital) underwent CPET for exercise intensity prescription. Continuous ambulatory blood glucose monitoring was conducted for each participant. Various parameters, including their fasting and postprandial peak glucose levels, exercise start and end times, post-exercise relative lows, rebound peak, low before eating fruits and vegetables at lunch, blood glucose levels, and the corresponding times at which carbohydrates were eaten, were observed and recorded. The time before exercise started was considered the zero point, and the difference in blood glucose between each point and the start of exercise, as well as the percentage difference, were calculated. Analysis of variance (ANOVA) was used to compare time points and blood glucose data for the entire group. Paired samples t -tests were used to compare adjacent time points and blood glucose data.
Results: All patients exhibited post-breakfast peak fasting plasma glucose. Exercise initiation induced significant declines in blood glucose, continuing to nadir post-exercise. Levels subsequently rose slightly to a secondary peak before gradually declining to a second nadir prior to fruit/veg intake. Pre-lunch carbohydrate intake was associated with stable euglycemia (all P<0.001).
Conclusions: HIPM-based lifestyle management (exercise, nutrition, rest) rapidly modulates hyperglycemia in T2DM patients. Exercise-induced metabolic improvements enhance respiratory-circulatory homeostasis, providing a mechanistic basis for integrated chronic disease management strategies.