Chronic Obstructive Pulmonary Disease (COPD) is a global health concern. Mind-body exercises like Tai Chi and Yoga are suggested as non-pharmacological interventions for COPD management. This meta-analysis evaluates mind-body exercises\' impact on lung function and exercise capacity in stable COPD patients, aiming to assess their effectiveness in rehabilitation. A systematic search across various databases identified relevant randomized controlled trials until April 2024. Primary outcomes included lung function tests (FEV1, FVC, FEV1/FVC, FEV1%) and Six-Minute Walk Test (6MWT) results. The Standardized Mean Difference (SMD) measured intervention effects. Fifteen studies with 1047 participants were analyzed. Mind-body exercises significantly improved FEV1 (SMD = 0.87), FEV1/FVC (SMD = 0.19), FEV1% (SMD = 0.43), and 6MWT (SMD = 1.21) compared to standard care. Sensitivity and subgroup analyses confirmed result stability despite some heterogeneity.In conclusion, Mind-body exercises enhance lung function and exercise capacity in stable COPD patients. Integrating them into comprehensive rehabilitation programs is advisable. Further research should explore the specific impacts of different exercise types and intensities.

UNASSIGNED: Exercise capacity reflects the cardiovascular risk after myocardial infarction (MI). The study aims to evaluate the impact of sleep-disordered breathing (SDB) on exercise capacity after MI.
UNASSIGNED: Consecutive patients referring to outpatient cardiac rehabilitation up to 28 days after MI and participating in the Polish Managed Care after Acute Myocardial Infarction (MC-AMI) program were included. On admission, we assessed the presence and the severity of SDB using the home sleep apnea test (HSAT), patients\' maximum exercise capacity on a treadmill exercise stress test (EST), and a 6-minute walk test (6MWT), as well as the effect of SDB on the results obtained. In the multivariate analysis, we verified the strength of the observed associations concerning age, anthropometric parameters, and left ventricular ejection fraction (LVEF).
UNASSIGNED: A total of 254 patients aged 60.00 (interquartile range 51.00-67.00), including 39 (15.4%) women, with technically adequate HSAT, constituted the study group. Mild SDB was found in 82 (32.3%), moderate in 54 (21.3%), and severe in 51 (20.1%) patients. Among those diagnosed with SDB, obstructive sleep apnea (OSA) was dominant in 167 (89.8%). With the worsening of SDB, the distance in 6MWT and the maximum physical exertion achieved in EST, expressed in metabolic equivalents (METs) and maximal heart rate (MHR), decreased. The linear regression analysis confirmed the following: (1) inversely proportional relationship between the respiratory event index and METs, MHR, and 6MWT distance (p = 0.005, p = 0.008, and p = 0.004), and the maximum apnea duration and MET and 6MWT distance (p = 0.042 and p = 0.002); and (2) directly proportional relationship between mean arterial oxygen saturation ( SpO 2 ) during sleep and MET, MHR, and 6MWT distance (p = 0.019, p = 0.006, and p = 0.013), and minimum SpO 2 and MET and MHR (p = 0.040 and p < 0.001). However, the independent risk factors for impaired exercise capacity, determined using multivariable regression analysis, were age, female sex, higher body mass index (BMI), and decreased LVEF, but not SDB parameters.
UNASSIGNED: SDB negatively impacts exercise capacity after MI. However, the strength of this association may be less pronounced due to the interaction of risk factors common for SDB and impaired exercise capacity, e.g., sex, age, BMI, and LVEF.

UNASSIGNED: Exercise capacity serves as a direct representation of cardiac function. The Duke Activity Status Index (DASI), a self-administered 12-item questionnaire, covers aspects of daily living, household tasks, sexual function, and physical activity. Although widely used to evaluate exercise capacity, its validation in Chinese cardiovascular disease (CVD) patients has not been thoroughly explored. Considering the significant cultural and lifestyle differences between China and Western countries, which may influence Chinese patients\' comprehension and responses to DASI, our objective is to culturally adapt DASI for Chinese patients with CVD to ensure its precision in assessing exercise capacity.
UNASSIGNED: The cultural adaptation of the original DASI questionnaire into Chinese followed a rigorous process to ensure its validity, reliability, and sensitivity to Chinese CVD patients. The study included 107 outpatients diagnosed with CVD who completed the DASI and cardiopulmonary exercise testing (CPET). Cronbach\'s alpha, Spearman correlation, and factor analysis were utilized to test reliability and validity. Receiver operating characteristic (ROC) curve analysis was employed to assess the prognostic utility of the DASI.
UNASSIGNED: Participants had a mean DASI score of 39.40 ± 10.75 and a peak oxygen uptake (Peak VO 2 ) of 19.53 ± 5.89 mL/min/kg. The Chinese version of the DASI exhibited satisfactory reliability and validity in CVD patients, with a Chronbach\'s alpha coefficient of 0.706. The DASI score demonstrated a moderate correlation with Peak VO 2 measured by CPET (r = 0.67, p < 0.001). Factor analysis yielded three factors, accounting for 56.76% of the total variance, with factor 1 contributing to 26.38% of the variance. ROC curve analysis demonstrated that the DASI exhibited discriminative utility in the identification of patients with improved long-term prognosis (p < 0.001). The ROC curve had an area of 0.788 [95% confidence interval (CI) = 0.704-0.871]. The DASI score ≥ 36.85 served as the optimal threshold for enhanced long-term prognosis, exhibiting a sensitivity of 0.80 and a specificity of 0.69.
UNASSIGNED: The culturally adapted DASI questionnaire is a straightforward and efficient tool for reasonably evaluating exercise capacity in Chinese CVD patients.

UNASSIGNED: To assess the clinical effectiveness of Yangxinshi (YXS) tablets on exercise capacity and symptoms of anxiety and depression in patients with coronary heart disease (CHD).
UNASSIGNED: A randomized, double-blind, placebo-controlled, multicenter clinical trial was performed to assess the effects of YXS tablets on exercise capacity and quality of life in patients with CHD. A total of 82 patients were included in this trial. Compared with the placebo group, the YXS group showed significant improvement in peak VO 2 (0.22 L/min vs 0.01 L/min; difference 0.1, 95% confidence interval (CI) 0.04-0.16, p = 0.000), peak Mets (0.58 vs 0.09; difference 0.3, 95% CI 0.12-0.47, p = 0.005), anaerobic threshold (AT) VO 2 (0.23 L/min vs 0.04 L/min; difference 0.12, 95% CI 0.07-0.18, p = 0.000), AT Mets (0.62 vs 0.16; difference 0.35, 95% CI 0.2-0.5, p = 0.001), and 6 minutes walking test (6MWT) (50.05 m vs 11.91 m; difference 29.92, 95% CI 18.78-41.07, p = 0.000). There were no differences in Hamilton anxiety rating scale (HAM-A score (1.97 vs 2.07; difference 2.03, 95% CI 0.99-3.06, p = 0.926) and Hamilton depression rating scale (HAM-D) score (1.06 vs 1.7; difference1.42, 95% CI 0.24-2.6, p = 0.592).
UNASSIGNED: In patients with CHD, YXS tablets, compared with placebo, could improve exercise capacity, without beneficial effects on anxiety and depression symptoms.

BACKGROUND: Pulmonary arterial hypertension (PAH)-specific therapies are generally ineffective in patients with pulmonary hypertension associated with lung disease (PH-LD). The aim of this preliminary study was to evaluate the potential efficacy of selexipag, titrated according to individual tolerance, in patients with PH-LD.
METHODS: Consecutive patients diagnosed with PH-LD between October 2016 and March 2019, who received selexipag treatment, were retrospectively evaluated. Specific parameters, including changes in hemodynamic parameters, 6-min walk distance (6MWD), and partial pressure of atrial oxygen/fraction of inspiratory oxygen (PaO2/FiO2) were evaluated. Patients whose 6MWD improved ≥20 m were defined as responders.
RESULTS: Eight patients with PH-LD were included, comprising four with chronic obstructive pulmonary disease (COPD), two with interstitial lung disease (ILD) related to rheumatoid arthritis, one with ILD related to systemic sclerosis, and one with pulmonary Langerhans cell histiocytosis. No statistically significant improvements in hemodynamic parameters and 6MWD were noted following selexipag treatment. However, four patients showed improvements in 6MWD ≥20 m at follow-up and were considered responders. They had a higher body mass index (BMI) and lower PaO2/FiO2 at baseline than non-responders (p = 0.02 and p = 0.04, respectively). No Grade 3 or 4 adverse events were observed.
CONCLUSIONS: Selexipag was effective in half of the PH-LD cases, emphasizing higher BMI and lower PaO2/FiO2 as possible indicators for favorable response. Since selexipag starting at a low dose with subsequent titration may reduce the risk of early adverse events, it can be considered a treatment option for PH-LD. Further large-scale studies are warranted to confirm these findings.

Background and Objectives: Robotics is commonly used in the rehabilitation of neuro-musculoskeletal injuries and diseases. While in these conditions, robotics has clear benefits, it is unknown whether robotics will also enhance the outcome of cardiac rehabilitation. This systematic review evaluates the use of robotics in cardiac rehabilitation. Methods: A systematic literature search was conducted using PubMed (MEDLINE), CINAHL, AMED, SPORTDiscus, and the Physiotherapy Evidence Database. Longitudinal interventional studies were included if they met specified criteria. Two reviewers independently conducted title, abstract, and full-text screening and data extraction. The quality assessment and risk of bias were conducted according to the PEDRO scale and Cochrane Risk of Bias tool 2, respectively. Results: Four trials were included in this review out of 60 screened studies. The quality of the included studies was good with a low risk of bias. The trials used different robotic systems: Lokomat® system, Motomed Letto/Thera Trainer tigo, BEAR, and Myosuit. It was found that interventions that included the use of robotic assistance technologies improved the exercise capacity, VO2 max/peak, left ventricular ejection fraction, QOL, and physical functioning in people with cardiac diseases. Conclusions: Robotic assistance technologies can be used in cardiac rehabilitation programs. Further studies are needed to confirm the results and determine whether the use of robotics enhances intervention outcomes above standard interventions.

Background and Objectives: In adults, 150 to 300 min a week of moderate-intensity physical activity is the recommended daily level to maintain or improve fitness. In subjects with chronic obstructive pulmonary disease (COPD), reductions in daily physical activity (DPA) amounts are related to clinically significant outcomes. In this study, we ascertain whether or not COPD patients, when clustered into active (DPA ≥ 30 min a day, 5 days a week) and inactive (DPA < 30 min a day, 5 days a week), may differ in exercise capacity, as assessed by a cardiopulmonary exercise test (CPET). Materials and Methods: A large sample of clinically stable COPD patients was retrospectively recruited and then underwent spirometry and an incremental ramp protocol 5-15 watts/min CPET. DPA was assessed by a questionnaire. Results: A total of 83 (female 25%, age range 41-85 y) active and 131 (female 31%, age range 49-83 y) inactive participants were enrolled. They were similar in age, sex distribution, body mass index (BMI) and in spirometry. The two groups were significantly different in dyspnea on exertion, as assessed by the modified Medical Research Council (mMRC), and in cardio-metabolic parameters, but not in ventilatory ones, as confirmed by the CPET. Conclusions: COPD patients experiencing physical activity of at least 30 min a day, 5 days a week, showed a greater exercise capacity and an improved cardiovascular response to exercise, when compared to inactive ones. Active and inactive participants did not differ in terms of airflow obstruction severity as well as in dynamic hyperinflation and ventilatory inefficiency during exercise. This study further suggests the benefits of regular physical activity in COPD.

UNASSIGNED: This study aims to systematically assess physical exercise-related symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC or long COVID) in coronavirus disease 2019 (COVID-19) survivors.
UNASSIGNED: Eight databases were systematically searched on March 03, 2024. Original studies that compared physical exercise-related parameters measured by exercise testing between COVID-19 survivors who recovered from SARS-CoV-2 infection over 3 months and non-COVID-19 controls were included. A random-effects model was utilized to determine the mean differences (MDs) or standardized MDs in the meta-analysis.
UNASSIGNED: A total of 40 studies with 6241 COVID-19 survivors were included. The 6-min walk test, maximal oxygen consumption (VO2max), and anaerobic threshold were impaired in COVID-19 survivors 3 months post-infection compared with non-COVID-19 controls in exercise testing, while VO2 were comparable between the two groups at rest. In contrast, no differences were observed in SpO2, heart rate, blood pressure, fatigue, and dyspnea between COVID-19 survivors and non-COVID-19 controls in exercise testing.
UNASSIGNED: The findings suggest an underestimation of the manifestations of PASC. COVID-19 survivors also harbor physical exercise-related symptoms of PASC that can be determined by the exercise testing and are distinct from those observed at rest. Exercise testing should be included while evaluating the symptoms of PASC in COVID-19 survivors.

UNASSIGNED: Improved long-term survival has widened the treatment goals for adults with congenital heart disease (ACHD) by addressing parameters that impact mental well-being and exercise capacity. Depression, a frequent co-morbidity in ACHD, is linked to both. Whether successful treatment of depression also affects cardiac parameters is a matter of debate.
UNASSIGNED: This prospective, cross-sectional, longitudinal study included N = 150 ACHD (mean age 35.2 ± 11.3 years, 57% male) at baseline (t0) and N = 114 at follow-up (mean follow-up: 4.8 ± 0.6 years; t1). Patients were interviewed using a structured clinical interview, and severity of depression was assessed using the Montgomery-Asperg Depression Scale (MADRS). Additional testing was performed using self-rating questionnaires concerning depression, anxiety and quality of life (QoL). Exercise capacity (VO2max) was assessed by symptom limited exercise testing.
UNASSIGNED: Of N = 33 patients diagnosed with depression at t0, N = 18 patients remitted and N = 15 were non-remitters. Remitters displayed significantly decreased anxiety (P = 0.013), improved global QoL (P = 0.002), and preserved VO2max (P = 0.958) at t1 compared to t0. This was associated with favourable health behaviour at t1 and stable body-mass-index. Contrarily, non-remitters reported further increased anxiety (P = 0.021) and no significant improvement in QoL (P = 0.405). VO2max declined significantly (P = 0.006) and body-mass-index increased (P = 0.004). Never-depressed patients showed no significant changes in anxiety (P = 0.415) or QoL (P = 0.211). VO2max decreased significantly (P < 0.001).
UNASSIGNED: In ACHD, remission from depression is associated with better physical functioning, mental health, and QoL. The assessment and treatment of depression in ACHD emerges as an important clinical goal that should be included in a comprehensive multimodal treatment plan.

Pulmonary hypertension (PH) is a complex cardiovascular condition that is characterized by elevated pulmonary arterial pressure, which leads to significant morbidity and mortality. Among the various factors that influence the pathophysiology and progression of PH, iron deficiency has become a critical, yet often overlooked, element. In this review, the prevalence, implications, and therapeutic potential of addressing iron deficiency in patients with PH are elucidated.Iron deficiency, which is prevalent in a significant proportion of patients with PH, has been associated with worsened clinical outcomes, including diminished exercise capacity, impaired oxygen transport and utilization, and compromised right ventricular function. The pathophysiological linkages between iron deficiency and PH are multifaceted and involve alterations in oxygen sensing, endothelial function, and metabolic disturbances.In this review, the evidence from recent clinical trials and studies that assess the impact of iron supplementation, both oral and intravenous, on PH outcomes is critically analyzed. Although some studies suggest improvements in exercise capacity and hemodynamic parameters following iron repletion, the responses appear variable and are not universally beneficial. This review highlights the complexities of iron metabolism in PH and the challenges in effectively diagnosing and treating iron deficiency in this patient population.Furthermore, the potential mechanisms through which iron supplementation might influence pulmonary vascular and right ventricular function, emphasizing the need for personalized treatment approaches are discussed. In this review, the importance of recognizing iron deficiency in the management of patients with PH is highlighted, and further research is warranted to establish comprehensive, evidence-based guidelines for iron supplementation in this unique patient cohort. The ultimate goal of this review is to improve clinical outcomes and quality of life for patients suffering from this debilitating condition.