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).

Purpose: This study aimed to assess the agreement between ventilatory thresholds (VT1 and VT2), and heart rate variability (HRV) thresholds (HRVT1 and HRVT2) based on the alpha 1 index of detrended fluctuation analysis (DFA a1) in patients with chronic heart failure (CHF). Validating HRV-based thresholds could provide a cost-effective alternative for individualised exercise intensity prescription, improving safety and efficacy in exercise-based cardiac rehabilitation (CR) programmes. Methods: Twenty CHF patients (13 males, 7 females) performed a cardiopulmonary exercise test (CPET) on a cycle ergometer. Ventilatory thresholds were identified using a mixed method, while HRV thresholds were determined at DFA a1 values of 0.75 (HRVT1) and 0.5 (HRVT2). Threshold values for oxygen consumption (VO ₂ ), heart rate (HR), and power output (PO) were compared with paired t test or Wilcoxon test. Agreement was assessed using correlation coefficients (Pearson’s r and Spearman’s rho ), intraclass correlation coefficient (ICC), and Bland–Altman analysis. Results: HRVT2 showed moderate-to-strong associations with VT2 for VO ₂ ( rho = 0.88, ICC = 0.86), for HR ( r = 0.88, ICC = 0.81) and for PO ( r = 0.82, ICC = 0.85). Mean biases were small and limits of agreement (LoA) narrow. HRVT1 correlated only modestly with VT1 for VO ₂ ( rho = 0.67, ICC = 0.43) and weakly for HR ( r = 0.43, ICC = 0.37) and PO ( r = 0.49, ICC = 0.35), with wide LoA. Conclusion: In CHF patients, HRVT2 appears to be a valid, practical surrogate for VT2 and may facilitate personalised intensity prescription where full CPET is unavailable. HRVT1 showed insufficient agreement with VT1 and should be used with caution. Larger cohorts and protocol refinements are warranted to confirm these observations and to explore strategies for improving HRVT1 accuracy. Graphical

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: Substance use disorders pose unique challenges, affecting individuals physiologically and socially. This study addresses the fundamental question of how adherence to exercise programs impacts those with substance use disorders, examining both in-person and online interventions. Methods: A 12-week analysis involving 26 participants assessed physical fitness, strength, and quality of life. Participants were categorized into in-person and online exercise groups, with their adherence tracked through attendance and a dedicated app. Results: The in-person group exhibited higher adherence rates and significant improvements, in contrast to the challenges encountered by the online groups, particularly in substance use disorder cohorts. Statistical analyses highlighted these differences, emphasizing the pivotal role of the exercise program delivery format. Conclusions: This research advocates for hybrid models, blending professional supervision with online flexibility, recognizing the distinct challenges of substance use disorders. Insights from this study will contribute to shaping more effective, personalized interventions in the complex landscape of substance use disorders, offering guidance for advancing treatment strategies.

The verification phase (VP) has been proposed as an alternative to the traditional criteria used for the determination of the maximum oxygen uptake (VO₂ max) in several populations. Nonetheless, its validity in patients with heart failure with reduced ejection fraction (HFrEF) remains unclear. Therefore, the aim of this study was to analyse whether the VP is a safe and suitable method to determine the VO₂ max in patients with HFrEF. Adult male and female patients with HFrEF performed a ramp-incremental phase (IP), followed by a submaximal constant VP (i.e., 95% of the maximal workload during the IP) on a cycle ergometer. A 5-min active recovery period (i.e., 10 W) was performed between the two exercise phases. Group (i.e., median values) and individual comparisons were performed. VO₂ max was confirmed when there was a difference of ≤ 3% in peak oxygen uptake (VO₂ peak) values between the two exercise phases. Twenty-one patients (13 males) were finally included. There were no adverse events during the VP. Group comparisons showed no differences in the absolute and relative VO₂ peak values between both exercise phases (p = 0.557 and p = 0.400, respectively). The results did not change when only male or female patients were included. In contrast, individual comparisons showed that the VO₂ max was confirmed in 11 patients (52.4%) and not confirmed in 10 (47.6%). The submaximal VP is a safe and suitable method for the determination of the VO₂ max in patients with HFrEF. In addition, an individual approach should be used because group comparisons could mask individual differences.

This study investigated the applicability of the short‐term scaling exponent alpha 1 of detrended fluctuation analysis (DFA‐a1) as a marker of internal load during constant‐load cycling. The aim was to explore DFA‐a1 dynamics across the moderate, heavy, and severe intensity domains and assess its utility for both monitoring and prescribing exercise intensity. Sixteen untrained adults (3 women) performed an incremental cycling stage test and three constant‐load sessions (moderate, heavy, and severe). Gas exchange kinetics, blood lactate concentration, and heart rate (HR) were measured. Ventilatory (VTs), lactate, and HR variability (HRV) thresholds were determined and used to define training zones. A two‐factor repeated‐measures ANOVA and the Friedman test assessed intensity‐ and method‐related effects. Significant intensity × time interactions were observed for all variables ( p < 0.001). DFA‐a1 remained stable without crossing the first HRV threshold throughout moderate exercise, while in the heavy and severe domains, it showed a drift over time, mirroring the behaviour of traditional markers. In the moderate session, DFA‐a1‐based prescription maintained > 94% session time and 87%–100% of participants within the desired zone, outperforming HR methods based on VTs (71% time, 50%–81% participants; p < 0.05). In the heavy and severe domains, corresponding values were > 23% and > 50%, whereas gas exchange or lactate prescriptions exceeded 44% and 65%, respectively ( p < 0.01). DFA‐a1 appears to be a suitable tool for monitoring internal load, especially in moderate intensity exercise. It offers a non‐invasive, integrative measure sensitive to both intensity and duration, providing a valuable complementary perspective on systemic regulation.