Cognitive skills are relevant predictors of academic achievement, employability, socioeconomic success, health, and longevity

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

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.

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.

BACKGROUND Heart failure is a growing global health concern. Exergaming is a promising alternative to conventional exercise programs for patients with heart failure (HF). However, existing research has limitations, and the integration of exergaming into clinical practice remains challenging. OBJECTIVE The aims of this study were to design and develop an exergaming prototype (i.e., HEFMOB), which encompasses a lower limb aerobic exercise game and an upper limb coordination and mobilization game, and to assess the usability of the prototype. METHODS The usability evaluation had two phases: the initial assessment by the researchers, and the user-rated analysis of a single session by 10 patients (4 women) with HF. The sessions were recorded and individually evaluated by two researchers using the Serious Game Usability Evaluator (SGUE) 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. Participants reported more negative events (e.g., confusion [n = 76]) than neutral (n = 49) and positive events (n = 11). RESULTS The mean ± standard deviation (SD) SUS score was 71.5 ± 17.8 and the mean ± SD IMI score was 25.1 ± 3.5, showing a good user-rated usability and high level of interest, respectively. CONCLUSIONS HEFMOB represents a significant initial step in developing an exergaming prototype customized for CHF. HEFMOB seems usable, and participants experienced satisfaction in a single session. Future research is required to conclusively demonstrate the efficacy and effectiveness of HEFMOB.