Scoubeau, Corentin; Faculty of Human Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium.
Carpentier, Julie; Baudry, Stéphane; Faoro, Vitalie; et al;

Physiological reports,2025 Apr

This study investigated body composition, cardiorespiratory, and neuromuscular adaptations induced by three high intensity trainings easy to fit into daily routine. Thirty-seven adults participated in one of the following 8-week interventions: vigorous intensity continuous training (VICT; 28 min at 70% of peak oxygen uptake [VO ₂ peak]), long interval high intensity interval training (LI-HIIT; 6 × 2 min at 85% VO ₂ peak), or short interval HIIT (SI-HIIT; 12 × 30 s at 125% maximal power output). Heart rate (HR) and rating of perceived exertion (RPE) were measured during sessions. Pre- and post-intervention assessments included fat and lean mass, cardiopulmonary exercise testing, knee extensors maximal isometric torque, voluntary activation, and endurance during a submaximal contraction. Compared to SI-HIIT and VICT, LI-HIIT sessions were characterized by a shorter duration, a similar time spent above 90% HR _max , but a higher RPE (p < 0.05). VO ₂ peak and muscle endurance increased respectively by 14% and 12%, while knee extensors torque, voluntary activation, and lean mass increased to a lesser extent (1%-3%) after the interventions (ANOVA time-effect, all p < 0.05). There was no significant difference between the modalities (intervention × time interaction, all p > 0.05). In conclusion, comparable body composition, cardiorespiratory, and neuromuscular adaptations were induced by the three high intensity training protocols, while RPE was higher during LI-HIIT sessions.

Willixhofer, Robin; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Mapelli, Massimo; Baracchini, Nikita; Campana, Nicola; et al;

Heart (British Cardiac Society),2025 Apr 16

• Background: Cardiopulmonary exercise testing (CPET) is essential for assessing patients with hypertrophic cardiomyopathy (HCM), but the role of pulmonary function testing (PFT) in refining patient stratification remains underexplored. This study investigates the relationship between PFT and CPET parameters in patients with HCM.
• Methods: In this prospective two-centre study, 102 clinically stable patients with HCM underwent PFT and CPET. Spearman’s correlation and multiple linear regression were used to assess relationships between PFT (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV _₁ )) and CPET variables, adjusting for confounders.
• Results: Patients exhibited preserved lung function (mean FVC: 90.7%; FEV ₁ : 92.5%). Strong correlations were observed between PFT and CPET metrics, including peak VO _₂ (FVC: r=0.649, p<0.001; FEV _₁ : r=0.691, p<0.001) and peak ventilation (FVC: r=0.682, p<0.001; FEV _₁ : r=0.688, p<0.001). Regression analysis confirmed independent associations between PFT and CPET performance (all p<0.001).
• Conclusion: PFT metrics strongly correlate with CPET parameters in HCM, suggesting that PFT could complement CPET for a more comprehensive assessment of exercise capacity and patient stratification.

Collins, Sophie É; Research Institute of the McGill University Health Centre,  Québec, Canada.
Phillips, Devin B;Stickland, Michael K

Autonomic neuroscience : basic & clinical,2025 Apr 05

• Rationale: Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are characterized by exaggerated carotid chemoreceptor (CC) sensitivity and exercise intolerance. We tested the hypothesis that participants with elevated CC sensitivity would have the greatest improvement in exercise tolerance with CC inhibition, secondary to increased vascular conductance, and lower ventilatory requirements, dyspnea and leg discomfort.
• Methods: Data from healthy controls, and patients with CHF or COPD were included in this secondary analysis of results from 2 randomized placebo-controlled double-blind crossover trials. Assessments included pulmonary function, incremental cardiopulmonary exercise test, and basal CC sensitivity assessment. High CC sensitivity was defined as either a stepwise hypoxic ventilatory response (HVR) or transient HVR greater than one SD above the mean in healthy controls. Participants received 2 μg/kg/min dopamine or placebo infusions (randomized) during 2 separate constant work-rate exercise tests to examine exercise endurance time (EET) and cardiopulmonary responses.
• Results: Among 33 adults, 17 were categorized to normal HVR (11 controls/3 COPD/3 CHF), and 16 to high HVR (1 control/7 COPD/8 CHF). Participants with high HVR experienced significant dopamine-induced improvements in EET (p _interaction  = 0.011), and reduced leg discomfort at the 4-min isotime (p _interaction  = 0.024). Those with improved vascular conductance and leg discomfort had the greatest improvements in EET (p = 0.042 and p = 0.021, respectively).
• Conclusions: CC inhibition with dopamine in participants with high HVR was associated with improvement in EET. These findings suggest that high HVR is related to exercise limitation, and that improvement in EET is associated with a CC-mediated increase in vascular conductance and leg discomfort.

National Italian Olympic Committee (CONI), Institute of Sport and Science Medicine, Rome, Italy.
Squeo, Maria Rosaria; Menichini, Ilaria; Morviducci, Matteo; Spinelli, Alessandro; et al;

Physiological reports,2025 Apr

Ventilatory efficiency during cardiopulmonary exercise testing (CPET) is obtained by relating minute ventilation (V’ _E ) to CO ₂ output (V’CO ₂ ). Limited information is available regarding exercise ventilatory efficiency in young elite athletes. We assessed ventilatory efficiency in elite athletes; evaluating the influence of sex and/or ESC sport categories; evaluating the agreement between the V’ _E /V’CO ₂ slope and nadir in measuring ventilatory efficiency; evaluating differences between subgroups of athletes stratified by ventilatory efficiency. A cohort of 443 elite athletes prospectively underwent CPET. The slope (s ₁ ) and the intercept of the linear region of the V’ _E /V’CO ₂ relationship, the V’ _E /V’CO ₂ value at the lactate threshold and the V’ _E /V’CO ₂ nadir were used to assess ventilatory efficiency. Male athletes and endurance athletes, both males and females, had higher exercise ventilatory efficiency (p < 0.001). A strong positive correlation was observed between V’ _E /V’CO ₂ s ₁ and nadir (p < 0.001). Of note, both high (V’ _E /V’CO ₂ s ₁ < 24) and very high (V’ _E /V’CO ₂ s ₁ < 22) levels of ventilatory efficiency were associated with greater exercise tolerance (i.e., peak oxygen uptake, maximal power; p < 0.001). The results of our study emphasize the need to include the measurement of ventilatory efficiency in the evaluation of elite athletes, potentially refining their training strategies.

Lv H; Institute of Cardiovascular Diseases of PLA,  (Third Military Medical University), Chongqing, P.R. China.
Liu Z; Sun M; Yu S; Hu M; Bian S; Ye X;Wang K; Dong H; Yang B; Zhou C; Huang L; Yang J;

IScience [iScience] 2025 Feb 27; Vol. 28 (3), pp. 112112.
Date of Electronic Publication: 2025 Feb 27 (Print Publication: 2025).

The dynamic characteristics of cardiorespiratory fitness during high-altitude acclimatization and deacclimatization are not well elucidated, and whether ubiquinol exerts beneficial effects on cardiorespiratory fitness remains debated. In this trial, 41 volunteers were randomized to receive oral ubiquinol or placebo administration, 14 days before departure to highlands. All individuals were carried to 3900 m by air and then returned to 300 m after 7 days. Cardiopulmonary exercise testing was performed at baseline, on the third day after arrival in the highlands, and on the seventh day after return. This trial revealed the dynamic characteristics of cardiorespiratory fitness during the entire high-altitude acclimatization and deacclimatization process. The short-term journey to the highlands did not significantly affect cardiorespiratory fitness or physical performance capacity after the return. Cardiovascular and respiratory recoveries were desynchronized after returning from the highlands. Ubiquinol supplementation maintained the physical performance capacity in the highlands and facilitated acclimatization to hypoxia

Bork J; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.
Markus MRP; Ewert R; Nauck M; Templin C; Völzke H; Kastenmüller G; Artati A; Adamski J; Dörr M; Friedrich N; Bahls M;

Scandinavian journal of medicine & science in sports [Scand J Med Sci Sports] 2025 Mar; Vol. 35 (3), pp. e70034.

High cardiorespiratory fitness (CRF) is associated with better overall health. This study aimed to find a metabolic signature associated with CRF to identify health-promoting effects. CRF based on cardiopulmonary exercise testing, targeted and untargeted metabolomics approaches based on mass spectrometry, and clinical data from two independent cohorts of the Study of Health in Pomerania (SHIP) were used. Sex-stratified linear regression models were adjusted for age, smoking, and height to relate CRF with individual metabolites. A total of 132 (SHIP-START-2: 483 men with a median age of 58 years and 450 women with a median age of 56 years) and 118 (SHIP-TREND-0: 341 men and 371 women both with a median age of 51 years) metabolites were associated with CRF. Lipids showed bidirectional relations to CRF independent of sex. Specific subsets of sphingomyelins were positively related to CRF in men (SM (OH) C14:1, SM(OH)C22:2 SM C16:0, SM C20:2 SM(OH)C24:1) and inversely in women (SM C16:1, SM C18:0, SM C18:1). Metabolites involved in energy production (citrate and succinylcarnitine) were only associated with CRF in men. In women, xenobiotics (hippurate, stachydrine) were related to CRF. The sex-specific metabolic signature of CRF is influenced by sphingomyelins, energy substrates, and xenobiotics. The greater effect estimates seen in women may emphasize the important role of CRF in maintaining metabolic health. Future research should explore how this profile changes with different types of exercise interventions or diseases in diverse populations and how these metabolites could be implemented in primary prevention settings.

Mapelli M; Centro Cardiologico Monzino, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Mattavelli I; Salvioni E; Capra N; Mantegazza V; Garlaschè A; Campodonico J; Rubbo FM; Paganin C; Capovilla TM; Nepitella AA; Caputo R; Gugliandolo P; Vignati C; Pezzuto B; De Martino F; Grilli G; Scatigna M;Bonomi A; Sinagra G; Muratori M; Agostoni P;

Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2025 Mar 17; Vol. 12, pp. 1542870.
Date of Electronic Publication: 2025 Mar 17 (Print Publication: 2025).

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) are standard therapy for heart failure (HF). We performed a holistic evaluation of dapagliflozin, including its effects on exercise performance, left ventricle (LV) reverse remodeling, cardiac biomarkers, fluid retention, and renal and pulmonary function.
Methods: We enrolled HF reduced ejection fraction (LVEF) outpatients (EF &lt;40%) eligible for SGLT2-i and performed cardiopulmonary exercise tests (CPET), pulmonary function tests, bioelectrical impedance vector analysis, and laboratory and echocardiographic assessments at baseline ( T  = 0), after 2-4 weeks (T1), and after 6 months of treatment (T2).
Results: None of the patients interrupted SGLT2-i for adverse events albeit follow-up was completed by 67 of 75 enrolled patients. At T2, mean LVEF increased (from 34.6 ± 7.8 to 37.5 ± 9.2%; p  &lt; 0.001) while end-diastolic (EDV) and end-systolic (ESV) volumes decreased [EDV: 186 (145-232) vs. 177 (129-225) mL, ESV: 113 (87-163) vs. 110 (76-145) mL; p  &lt; 0.001]. Peak oxygen intake was unchanged [peakVO ₂ : 16.2 (13.4-18.7) vs. 16.0 (13.3-18.9) mL/kg/min; p  = 0.297], while exercise ventilatory efficiency (VE/VCO ₂ slope) improved [from 34.2 (31.1-39.2) to 33.7 (30.2-37.6); p  = 0.006]. Mean hemoglobin increased (from 13.8 ± 1.5 to 14.6 ± 1.7 g/dL; p  &lt; 0.001), while renal function did not change after a transient worsening at T1. NT-proBNP, ST-2, and hs-TNI did not change as overall body fluids and quality of life assessed by KCCQ. NYHA class improved ( p =0.002), paralleled by a decrease of MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) score, from 3.3% (1.9-8.0) to 2.8% (1.2-5.7), suggestive of a positive impact on 2 years prognosis ( p  &lt; 0.001).
Conclusions: Dapagliflozin induced positive LV remodeling, improvement of exercise ventilatory efficiency, and NYHA class but without peakVO ₂ fluid status and cardiac biomarkers changes.

James MD; Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON, Canada.
Phillips DB;Domnik NJ; Neder JA;

Respiratory physiology & neurobiology [Respir Physiol Neurobiol] 2025 Mar 29, pp. 104423.
Date of Electronic Publication: 2025 Mar 29.

Physical activity is a leading trigger of dyspnea in chronic cardiopulmonary diseases. Recently, there has been a renewed interest in uncovering the mechanisms underlying this distressing symptom. We start by articulating a conceptual framework linking cardiorespiratory abnormalities with the central perception of undesirable respiratory sensations during exercise. We specifically emphasize that exertional dyspnea ultimately reflects an imbalance between (high) demand and (low) capacity. As such, the symptom arises in the presence of a heightened inspiratory neural drive – the will to breathe – secondary to a) increased ventilatory output relative to the instantaneous ventilatory capacity (excessive breathing) and/or b) its impeded translation into the act of breathing due to constraints on tidal volume expansion (constrained breathing). In patients with chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and interstitial lung disease (ILD), constrained breathing assumes a more dominant role as the disease progresses. Excessive breathing due to heightened wasted ventilation in the physiological dead space is particularly important in the initial stages of COPD, while alveolar hyperventilation has a major contributory role in hypoxemic patients with ILD. Hyperventilation is also a leading driver of dyspnea in heart failure (HF) with reduced ejection fraction (EF), while high physiological dead space is the main underlying mechanism in HF with preserved EF. Similarly, wasted ventilation in poorly perfused lung tissue dominates the scene in pulmonary vascular disease. New artificial intelligence-based approaches to expose the contribution of excessive and constrained breathing may enhance the yield of cardiopulmonary exercise testing in investigating exertional dyspnea in these patients.

Squeo, R;
Ferrera, A; Di Gioia, G; Mango, F; et al;

High blood pressure & cardiovascular prevention :
the official journal of the Italian Society of Hypertension,2025 Mar 14

• Competing Interests: Declarations. Ethical Approval: information: the study design of the present investigation was evaluated and approved by the Ethical Committee (CET – Comitato Etico Territoriale Lazio Area 1, date of approval 06\03\2024 IRB number 0208/2024). All athletes included in this study were fully informed of the types and nature of the evaluation and signed the consent form, according to Italian Law and Institute policy. All clinical data assembled from the study population are maintained in an institutional database. Data Availability: De-identified participant data are available upon reasonable request from the corresponding author. Conflict of interest: None.
• Introduction: Olympic athletes represent a special subset of the athletic population and deserve a specialized medical approach. In view of the 2024 Paris Olympic Games, we developed and implemented a comprehensive medical protocol including (other than the standard screening with ECG, physical and history) cardiopulmonary exercise test, echocardiography and full blood and urine tests.
• Aim: Our aim was to assess the prevalence and type of cardiovascular abnormalities in athletes candidate to Paris 2024 Olympic Games, after implementation of this Olympic medical program.
• Methods: We enrolled 772 elite athletes, who underwent a comprehensive, multidisciplinary evaluation, including full panel of blood and urine tests, electrocardiography, trans-thoracic echocardiography (TTE) and a cardiopulmonary exercise test (CPET).
• Results: Of the 772 elite athletes, 363 (47%) were female. A substantial subset of 145 athletes (18.8%) showed one or more abnormalities. Specifically, either abnormal basal ECG findings (n = 26, 17.9%), abnormal TTE results (n = 45, 31%), high blood pressure (n = 2, 1.4%) or exercise induced arrhythmias (n = 49, 33.8%) were detected. 10 athletes (6.9%) showed both abnormal ECGs and exercise induced arrhythmias, and 13 athletes (9%) showed both ECG and echocardiographic abnormal findings. After further and more detailed investigations, of the 145 athletes showing cardiovascular abnormalities at the initial screening, in 4 of them were cardiac conditions implying potential risk of sudden cardiac death were identified and therefore they were withdrawn from competitive sport. Full blood test analysis identified metabolic abnormalities in 200 subjects. Of these, 165 (21%) showed hypercholesterolemia.
• Conclusions: Olympic athletes, despite the highest level of physical performance, are not exempt from cardiovascular and metabolic diseases, including a small proportion of cardiac conditions at risk of SCD. More advanced diagnostic tools, including CPET, echocardiography and full blood tests, implemented in our protocol, were required to identify hidden cardiovascular abnormalities that could have jeopardized athlete’s health and performance.

Meziab, O; Department of Pediatrics (Cardiology), University of Arizona, Tucson, USA.
Dereszkiewicz, E; Guerrero, E; Hoyer, A;

Pediatric cardiology,2025 Apr

Patients with Fontan physiology have reduced exercise performance compared to their peers as well as a higher incidence of bundle branch block (BBB). This study aims to investigate the association between BBB and exercise performance in the Fontan population through a retrospective review of the Pediatric Heart Network Fontan study public use dataset. “Low Performers” were defined as ≤ 25th percentile (for Fontan patients) for each exercise parameter at anaerobic threshold (AT) for gender and age and “Normal Performers” were all other patients. A total of 303 patients with Fontan physiology who underwent exercise testing reached AT and had complete data for BBB. BBB occurred more frequently in Low Performers for VO ₂ [OR (95% CI): 2.6 (1.4, 4.8)] and Work [OR (95% CI): 2.7 (1.4, 5.1)], suggesting that BBB in the Fontan population is associated with reduced exercise performance. This data adds to the existing clinical evidence of the adverse effects of conduction abnormalities on single ventricle cardiac output and adds support for consideration of cardiac resynchronization and multi-site ventricular pacing in this patient population.