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.

BACKGROUND Non-adherence to antihypertensive therapy is a major contributor to poor blood pressure control, increased cardiovascular risk, and higher healthcare costs. Behavioral economics suggests that financial incentives and mobile-based interventions may support behavior change, yet evidence for such strategies in Central Europe is limited. OBJECTIVE The COLLABREE study evaluates whether a multi-faceted mobile application with behavioral economic principles—including reminders, gamification, and financial incentives—improves medication adherence in patients with hypertension compared to standard of care. METHODS This multi-center, randomized, open-label trial will include 180 outpatients with hypertension taking four or more pills daily. Participants will be randomized into three groups (n = 60 per group): (A) Collabree app with contingent financial incentives, (B) Collabree app without incentives, and (C) standard of care. All participants will receive a Medication Event Monitoring System (MEMS) to objectively track adherence. The primary endpoint is the difference in mean adherence between Group A and the control group at 90 days. A co-primary endpoint compares adherence in the final vs. initial month of the intervention. Secondary outcomes include changes in blood pressure, self-reported adherence, and patient-reported feedback on the app. RESULTS Currently, participant inclusion has been nearly completed. We are undergoing data clearing and are planning data analysis. These steps are planned for autumn 2025. CONCLUSIONS This study will provide evidence on whether a multi-faceted digital intervention—with or without financial incentives—can improve medication adherence in hypertensive patients. The findings may support the implementation of mobile health strategies in routine hypertension care. CLINICALTRIAL SNCTP000004345; ClinicalTrials.gov Identifier: NCT04708756

Background: Thoracic aortic aneurysms are often incidental findings that require close follow-up monitoring and eventual surgical or endovascular treatment to prevent life-threatening dissection. Their complex relationship with physical activity requires further research to balance cardiovascular risk reduction against the dangers of acute blood pressure peaks. Case summary: A 75-year-old male endurance athlete was evaluated in a sports cardiology clinic to assess the safety of intensive exercise with a known ascending thoracic aortic aneurysm (ATAA). He had adopted an active lifestyle at 65 and completed over thirty 70.3 Ironman races. In 2019, at the age of 75, echocardiography revealed an ATAA measuring 52 mm, along with a bicuspid aortic valve and moderate regurgitation. The patient declined surgery and wished to continue endurance training. After shared decision-making, continued training and racing were allowed under predefined limits for blood pressure and heart rate, with regular imaging surveillance. Over 6 years of follow-up using magnetic resonance imaging, computed tomography, and echocardiography, aneurysm size remained stable, with an aortic wall thickness of 2.5 mm. Based on Laplace’s law, the calculated circumferential wall stress stayed below rupture thresholds during exercise. Exercise counselling should consider not only aneurysm diameter but also blood pressure, wall thickness, and wall stress. Discussion: In accordance with current guidelines, watchful waiting and a temporary restriction of physical activity are recommended in this case of aortic dilatation. However, because factors such as increased aortic wall thickness may allow for a more favourable distribution of wall stress, an individualized risk assessment can refine these recommendations. In the present case, a shared decision-making approach revealed that controlled physical exertion did not critically increase wall stress and potentially conferred a long-term protective effect against aneurysm progression, underscoring the value of individualized therapeutic strategies.

Background and Aims: Non-adherence to antihypertensive therapy is a major contributor to poor blood pressure (BP) control, increased cardiovascular risk, and higher healthcare costs. Behavioral economics suggests that financial incentives and mobile-based interventions may support behavior change, yet evidence for such strategies in central Europe is limited. Objective: The BEHAVE-HTN study evaluates whether a multi-faceted medication adherence mobile application (mApp) with behavioral economic principles—including reminders, gamification, and financial incentives—improves medication adherence in patients with hypertension compared to standard of care. Methods: This multi-center, randomized, open-label trial will include 180 outpatients with hypertension taking four or more pills daily. Participants will be randomized into three groups (n = 60 per group): (A) mApp with contingent financial incentives, (B) mApp without incentives, and (C) standard of care. All participants will receive a Medication Event Monitoring System (MEMS) dispenser to objectively track adherence. The primary endpoint is the difference in mean MEMS adherence between group A and the control group at 90 days. A co-primary endpoint compares MEMS adherence in the final vs. initial month of the intervention. Secondary outcomes include changes in BP, app-reported adherence, and patient-reported feedback on the mApp. Results: Currently, participant inclusion has been nearly completed. We are undergoing data clearing and are planning data analysis. These steps are planned for autumn 2025. Conclusion: This study will provide evidence on whether a multi-faceted medication adherence mobile App — with or without financial incentives—can improve medication adherence in hypertensive patients. The findings may support the implementation of mobile health strategies in routine hypertension care. Trial Registration: SNCTP000004345; ClinicalTrials.gov Identifier: NCT04708756