Background: Exercise-based cardiac rehabilitation (CR) programs are used for improving prognosis and quality of life in patients with cardiovascular disease (CVD). Nonetheless, adherence to these programs is low, and exercise-based CR programs based on virtual reality (i.e., exergaming) have been proposed as an alternative to conventional CR programs. However, whether exergaming programs are superior to conventional CR programs in patients with CVD is not known. Objective: This systematic review with meta-analysis was conducted to explore whether exergaming enhances exercise capacity, quality of life, mental health, motivation, and exercise adherence to a greater extent than conventional CR programs in patients with CVD. Method: Electronic searches were carried out in PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases up to June 2021. Meta-analyses were performed using robust variance estimation with small-sample corrections. The effect sizes were calculated as the mean differences (MD) or standardized mean differences (SMD) as appropriate. The SMD magnitude was classified as trivial (<0.20), small (0.20–0.49), medium (0.50–0.79), or large (≥0.80). Heterogeneity was interpreted based on the I² statistics as low (25%), moderate (50%), or high (75%). Results: Pooled analyses showed no differences between exergaming and conventional CR programs for enhancing exercise capacity (i.e., distance covered in the six-minute walk test) (MD₊ = 14.07 m (95% confidence interval (CI) −38.18 to 66.32 m); p = 0.426) and mental health (SMD₊ = 0.17 (95% CI −0.36 to 0.70); p = 0.358). The results showed a small, statistically nonsignificant improvement in quality of life in favor of exergaming (SMD₊ = 0.22 (95% CI = −0.37 to 0.81); p = 0.294). Moderate heterogeneity was found for exercise capacity (I² = 53.7%), while no heterogeneity was found for quality of life (I² = 3.3%) and mental health (I² = 0.0%). Conclusions: Exergaming seems not to be superior to conventional CR programs for improving exercise capacity, quality of life, or mental health in patients with CVD.

Background: Exercise-based cardiac rehabilitation (CR) is considered an effective treatment for enhancing endothelial function in patients with heart failure (HF). However, recent studies have been published and the optimal “dose” of exercise required to increase the benefits of exercise-based CR programmes on endothelial function is still unknown. Objectives: (a) To estimate the effect of exercise-based CR on endothelial function, assessed by flow-mediated dilation (FMD), in patients with HF; (b) to determine whether high-intensity interval training (HIIT) is better than moderate-intensity training (MIT) for improving FMD; and (c) to investigate the influence of exercise modality (i.e. resistance exercise vs. aerobic exercise and combined exercise vs. aerobic exercise) on the improvement of endothelial function. Methods: Electronic searches were carried out in PubMed, Embase, and Scopus up to February 2022. Random-effects models of between-group mean differences were estimated. Heterogeneity analyses were performed by means of the chi-square test and I² index. Subgroup analyses and meta-regressions were used to test the influence of potential moderator variables on the effect of exercise. Results: We found a FMD increase of 3.09% (95% confidence interval [CI] = 2.01, 4.17) in favour of aerobic-based CR programmes compared with control groups in patients with HF and reduced ejection fraction (HFrEF). However, the results of included studies were inconsistent (p < .001; I² = 95.2%). Higher FMD improvement was found in studies which were randomised, reported radial FMD, or performed higher number of training sessions a week. Moreover, HIIT enhanced FMD to a greater extent than MIT (2.35% [95% CI = 0.49, 4.22]) in patients with HFrEF. Insufficient data prevented pooled analyses for the effect of exercise in patients with HF and preserved ejection fraction and the influence of exercise modality on the improvement of endothelial function. Conclusion: Aerobic-based CR is a non-pharmacological treatment for enhancing endothelial function in patients with HFrEF. However, higher training frequency and HIIT induce greater adaptation of endothelial function in these patients, which should betaken into consideration when designing exercise-based CR programmes. Trial registration The protocol was prospectively registered on the PROSPERO database (CRD42022304687).

Aims: Physical activity (PA) is an important target for improving clinical outcomes in heart failure (HF) patients. Nonetheless, assessing the daily PA profile in this population is a challenging task, traditionally performed using self-report questionnaires such as the International PA Questionnaire Short Form (IPAQ-SF). This study aimed to evaluate the concurrent validity of the IPAQ-SF and accelerometer-assessed PA using six published cut-points in patients with HF and reduced or mildly reduced ejection fraction. Methods and results: The concordance between the IPAQ-SF and a hip-worn accelerometer regarding daily time spent performing moderate to vigorous PA in bouts of at least 10 min was assessed in 53 participants for seven consecutive days using six different cut-points (Barnett, Dibben, Mark, Sanders, Troiano, and Vaha-Ypya). Spearman's correlation and Bland–Altman plots were used to evaluate concurrent validity between methods. Regressions were used to study the association between patient variables, wear protocol (waking hour or 24 h), and absolute bias. The kappa index was used to evaluate the concordance between IPAQ-SF and accelerometry for classifying patients as active or non-active. All analyses were re-run using non-bouted metrics to investigate the effect of bouted versus non-bouted analysis. The IPAQ-SF and accelerometry showed low to negligible correlation (ρ = 0.12 to 0.37), depending on the cut-point used. The regression analysis showed that the absolute bias was higher in participants following the waking-hour protocol at all cut-points except Dibben's (P ≤ 0.007). The concordance between the two methods to classify patients as active and non-active was low when using Mark (κ = 0.23) and Barnett (κ = 0.34) cut-points and poor for the remaining cut-points (κ = 0.03 to 0.18). The results of the sensitivity analysis showed negligible to low correlation using non-bouted metrics (ρ = 0.27 to 0.33). Conclusions: Moderate to vigorous PA measures using IPAQ-SF and accelerometers are not equivalent, and we do not encourage researchers to use IPAQ-SF alone when assessing PA in HF patients. Moreover, applying personalized collection and processing criteria is important when assessing PA in HF patients. We recommend following the 24 h protocol and selecting cut-points calibrated in patients with cardiovascular diseases. Finally, it is necessary to develop a new tailored questionnaire that considers walking intensity and is adjusted to the current World Health Organisation recommendations, which use non-bouted metrics.

Aims: Endothelial dysfunction is a hallmark of cardiovascular disease (CVD). Exercise effectively improves endothelial function, yet the impact of different modalities and intensities remains unclear. This study evaluated the effect of aerobic (AE), resistance (RE), and combined exercise (CE) on endothelial function measured by flow-mediated dilation (FMD). Methods and results: A systematic review and frequentist network meta-analysis of randomized and non-randomized trials in adults with coronary artery disease or chronic heart failure was conducted. Electronic databases were searched up to April 2025. Interventions were classified as usual care (UC), moderate-intensity AE (MAE), high-intensity interval AE (HIIE), moderate-intensity RE (MRE), high-intensity RE (HRE), moderate-intensity CE (MCE), and high-intensity CE (HCE). Mean differences (MD) with 95% confidence intervals (CI) were used as effect size index, and interventions were ranked using surface under the cumulative ranking curve (SUCRA). Thirty-seven studies (80 groups; n = 6818) were included. Compared with UC, MAE (2.04%; 95% CI: 1.01–3.07), HIIE (3.47%; 95% CI: 2.02–4.92), MCE (2.71%; 95% CI: 0.05–5.36), and HCE (8.25%; 95% CI: 3.18–13.32) significantly improved brachial FMD, whereas MRE did not. HIIE outperformed MAE (1.43%; 95% CI: 0.09–2.78). Although HCE showed the highest surface under the cumulative ranking curve (SUCRA: 98.2%), this relied on a single group. Crucially, sensitivity analyses confirmed HIIE as the most robust high-performing intervention (84.0%) compared with MRE (61.6%) and MCE (61.3%). Conclusion: Exercise significantly enhances endothelial function in patients with CVD. HIIE emerged as the most robust and evidence-based modality, demonstrating superior efficacy over moderate continuous exercise. While high-intensity combined protocols (HCE) show significant theoretical potential, randomized trials are urgently needed to confirm their efficacy. Current evidence supports HIIE as a primary strategy for vascular adaptation in cardiac rehabilitation.

Background: Heart failure (HF) is a growing global health concern, and adherence to early cardiac rehabilitation (CR) remains suboptimal. Exergaming is a promising alternative to conventional exercise programs for patients with HF. However, existing research has limitations, and the integration of exergaming into clinical practice remains challenging. Most notably, current studies often rely on commercially available systems that are not tailored to needs specific to patients with HF, lack long-term adherence strategies, and have limited evaluation in the initial phases of cardiac rehabilitation. Objective: This study aimed to design, develop, and assess the usability of a novel exergaming prototype (ie, HEFMOB), integrating immersive virtual reality (VR), real-time biometric monitoring, and autonomous session management to support early-phase, exercise-based CR in patients with HF. Methods: A multidisciplinary team developed HEFMOB through iterative prototyping. The final system included a pedal-based VR cycling game and an upper-limb mobilization minigame, with real-time monitoring of heart rate, blood pressure, and peripheral capillary oxygen saturation. Usability was assessed in two phases: (1) an expert evaluation and refinement phase and (2) a single-session usability phase involving 10 patients with HF (4 female). The sessions were recorded and individually evaluated by 2 researchers using the Serious Game Usability Evaluator tool. After each session, the participants completed the System Usability Scale (SUS) and a subscale of Intrinsic Motivation Inventory (IMI) to rate the usability of the exergaming prototype and enjoyment, respectively. Descriptive statistics were reported. Results: The participants had a mean age of 64.8 (SD 8.4) years, BMI of 26.7 (SD 4.6) kg/m², and left ventricular ejection fraction of 40.5% (SD 7.4%). All participants completed the session without adverse events. The SUS score averaged 71.5, SD 17.8 (indicating good usability) and IMI scores indicated very high enjoyment (mean 25.1, SD 3.5). A total of 136 gameplay-related events were recorded: negative (n=76, mostly confusion), neutral (n=49), and positive (n=11). Interface-related issues (n=61) were most common, followed by design (n=52) and hardware (n=23). Conclusions: HEFMOB appears to be a promising, engaging, and well-tolerated tool for delivering tailored exergaming interventions in patients with HF. High usability and enjoyment ratings support its acceptability, while structured user experience analysis provided valuable insights for system refinement. This study marks a critical step toward integrating personalized, gamified exercise in inpatient settings, especially where early mobilization is lacking. Building on these findings, future research will assess long-term usability and clinical impact through a multicenter randomized controlled trial.

Oxidative stress is associated with playing soccer. The objective of the present report was to study the influence of different polyphenolic antioxidant-rich beverages in five-a-side/futsal players. The study was performed with a no supplemented control group (CG) and two supplemented groups with an almond-based beverage (AB) and the same beverage fortified with Lippia citriodora extract (AB + LE). At day 22, participants played a friendly futsal game. Blood extractions were performed at the beginning of intervention (day 1), before and after match (day 22) to determine oxidative stress markers and antioxidant enzyme activities in plasma, neutrophils and peripheral blood mononuclear cells (PBMCs). Malondialdehyde increased significantly in controls after the match in neutrophils, PBMCs and plasma compared to pre-match. Protein carbonyls also increased after the match in plasma in CG. In addition, malondialdehyde levels in neutrophils were significantly lower in the supplemented groups compared to controls. Post-match samples showed significant increases in neutrophil antioxidant activities in CG. Supplemented groups displayed variable results regarding neutrophil antioxidant activities, with superoxide dismutase activity significantly lower than in controls. Finally, post-match myeloperoxidase activity increased significantly in controls compared to pre-match and supplemented groups. In conclusion, polyphenolic antioxidant and anti-inflammatory supplements could be instrumental for optimal recovery after high intensity futsal games.