Introduction: Balancing the well-documented benefits of regular exercise, particularly its positive impact on cardiovascular risk factors like hypertension, with the potential risks for patients with aortic aneurysms presents a significant challenge. This narrative review aims to summarize the current evidence and guidelines to assist clinicians in making informed exercise and sports recommendations for patients with aortic aneurysms or post-aortic repair. Methods: Nine clinical trials on the effect of exercise on abdominal aortic aneurysms (AAAs) were identified, including one study on cardiopulmonary exercise testing (CPET) in AAA patients. As no clinical trials on exercise in thoracic aortic aneurysms (TAAs) were found, we extrapolated data from other studies on exercise in aortic diseases, including data from patients who have had an aortic dissection, as well as three studies on cardiac rehabilitation (CR) and one study on CPET after proximal aortic repair. Review articles and guidelines were also incorporated to ensure a comprehensive overview of the topic. Results: Currently, no clear correlation exists between intense sports activities and the development of aortic aneurysms or dissections. Conclusions: Light to moderate physical activity appears safe and beneficial for patients with aortic aneurysms and post-aortic repair. Given the lack of evidence linking athletic activity to aortic complications, caution is warranted in restricting such activities for athletes, underscoring the importance of shared decision-making. Regular follow-up and optimal management of cardiovascular risk factors are essential.

Background: Heart failure with reduced ejection fraction (HFrEF) markedly impairs quality of life (QoL) and life expectancy. The main therapeutic goals are to reduce mortality, improve functional capacity, and enhance QoL. Exercise training is an evidence-based, non-pharmacological component of standard care that improves functional capacity and clinical outcomes in HFrEF. This review examines the effects of endurance and resistance training on peak oxygen uptake (VO₂peak), ventilatory efficiency (VE/VCO₂ slope), health-related QoL, and cardiovascular outcomes in patients with HFrEF. Methods: A structured narrative review was conducted using comprehensive searches of PubMed, EMBASE, and the Cochrane Library for English-language studies published between January 2004 and October 2024. Eligible studies included adult HFrEF populations undergoing aerobic and/or resistance training with reported effects on VO₂peak, ventilatory efficiency, QoL, or clinical outcomes. Given the heterogeneity of interventions, comparators, and outcome metrics, data were synthesized descriptively. Results: Across 18 studies (plus one sub-analysis) including 3401 patients, 17 trials assessed VO₂peak and 16 reported significant improvements, with an average increase of approximately 2 mL·kg⁻¹·min⁻¹. Six studies assessed ventilatory efficiency, and five demonstrated reductions in VE/VCO₂ slope averaging 4.4 units. Eleven studies analyzed QoL, and nine reported significant improvements corresponding to an ≈5-point decrease in the Minnesota Living with Heart Failure Questionnaire (MLHFQ). In the largest trial, exercise training was associated with modest but statistically significant reductions in all-cause mortality or hospitalization (HR 0.89) and cardiovascular mortality or heart-failure hospitalization (HR 0.85) after adjustment for baseline prognostic factors. Conclusions: Structured exercise training improves aerobic capacity, ventilatory efficiency, and QoL in patients with HFrEF, with supportive evidence for reduced morbidity and mortality. These findings underscore the value of structured exercise as a core component of modern HFrEF management.

Introduction: The impact of loop versus thiazide diuretics on aerobic endurance and health-related quality of life during exercise-based cardiac rehabilitation (EBCR) remains largely unknown.Methods and Results: We analyzed patients attending inpatient EBCR in Switzerland (2022–2024) with a median stay of 20 days (Q1-Q3, 20–27). Patients were categorized by loop or thiazide use at admission, and therapy modifications were recorded as escalation or de-escalation which was defined as dose adjustment or addition/discontinuation of diuretics. Treatment outcomes were assessed using aerobic endurance (6-minute walking distance, 6MWD) results and the modified MacNew Heart questionnaire (MNH) at admission and discharge. Among 865 included patients (22% women, mean age 64±11 years), 274 (32%) were treated with loop diuretics, 43 (5%) with thiazides, and 13 (2%) with both at admission. Changes in 6MWD, MNH scores, and body mass did not differ significantly between loop and thiazide therapies from admission to discharge. However, compared to unmodified or treatment escalation with a change of 105m (Q1-Q3: 60.0-174.0m), de-escalation with a change of 141.0m (Q1-Q3: 84.0-204.0m) yielded a significant 33m median improvement in 6MWD (95% confidence interval [CI] 12 - 54m; p=0.006). The modified global MNH score showed no significant changes. Only loop diuretic users improved in the MNH emotional domain in considering the crude median difference (0.27 points, 95%CI 0.03 - 0.51).Conclusions: In patients undergoing EBCR, de-escalation in diuretic therapy, particularly loop diuretics, was associated with an improvement in aerobic endurance and indications of enhanced emotional well-being. No significant changes were observed between different diuretic types.