Endothelial progenitor cells (EPCs) play a vital role in protecting endothelial dysfunction and cardiovascular disease (CVD). Physical exercise stimulates the mobilization of EPCs, and along with vascular endothelial growth factor (VEGF), promotes EPC differentiation, and contributes to vasculogenesis. The present meta-analysis examines the exercise-induced EPC mobilization and has an impact on VEGF in patients with CVD and healthy individuals. Database research was conducted (PubMed, EMBASE, Cochrane Library of Controlled Trials) by using an appropriate algorithm to indicate the exercise-induced EPC mobilization studies. Eligibility criteria included EPC measurements following exercise in patients with CVD and healthy individuals. A continuous random effect model meta-analysis (PROSPERO-CRD42019128122) was used to calculate mean differences in EPCs (between baseline and post-exercise values or between an experimental and control group). A total of 1460 participants (36 studies) were identified. Data are presented as standard mean difference (Std.MD) and 95% confidence interval (95% CI). Aerobic training stimulates the mobilization of EPCs and increases VEGF in patients with CVD (EPCs: Std.MD: 1.23, 95% CI: 0.70–1.76; VEGF: Std.MD: 0.76, 95% CI:0.16–1.35) and healthy individuals (EPCs: Std.MD: 1.11, 95% CI:0.53–1.69; VEGF: Std.MD: 0.75, 95% CI: 0.01-1.48). Acute aerobic exercise (Std.MD: 1.40, 95% CI: 1.00–1.80) and resistance exercise (Std.MD: 0.46, 95%CI: 0.10–0.82) enhance EPC numbers in healthy individuals. Combined aerobic and resistance training increases EPC mobilization (Std.MD:1.84, 95% CI: 1.03–2.64) in patients with CVD. Adequate exercise volume (>60%VO_2max >30 min; P = 0.00001) yields desirable results. Our meta-analysis supports the findings of the literature. Exercise volume is required to obtain clinically significant results. Continuous exercise training of high-to-moderate intensity with adequate duration as well as combined training with aerobic and resistance exercise stimulates EPC mobilization and increases VEGF in patients with CVD and healthy individuals.

Background/Objective: Early mobilization (EM) of critically ill patients is a feasible and safe intervention that limits the implications of bed rest and improves lung function. However, its limited implementation suggests a gap between the research evidence and clinical practice. It is widely accepted that early mobilization faces a variety of barriers. This study aimed to investigate the perceptions of Greek physiotherapists on EM barriers and record their knowledge and practices. Methods: We conducted an electronic survey using the online platform “Microsoft Forms”, among critical care physiotherapists in 66 hospitals that had an Intensive Care Unit (ICU) department in Greece in 2024. We administered a questionnaire, developed based on valid and reliable international questionnaires, with the following domains: education and knowledge on early mobilization, practices, perception regarding EM, and perceived barriers to early mobilization. Results: A total of 126 Greek physical therapists participated. The majority of them worked in urban area hospitals and in a rotation schedule around all departments. Most physical therapists stated that early mobilization is a priority for the patient’s rehabilitation and an important factor in preventing the complications of bed rest. Yet, they do not use specific protocols. Most had knowledge of what EM involved and the international guidelines. The most common barriers reported were the hemodynamic instability and the incoherence with the ventilator. Dedicated physiotherapists singled out certain barriers like the presence of delirium and the lack of communication among ICU staff. Additionally, physiotherapists with more years of experience did not acknowledge tubes, connections, femoral lines and Body Mass Index (BMI) as barriers. Conclusions: Most Greek physiotherapists believe that early mobilization is crucial for the rehabilitation of critically ill patients. A significant percentage know the guidelines, yet they do not follow a specific protocol. Various barriers prevent its implementation, which depends on the patients, healthcare providers, and the overall process. Yet, It is recognized that practices and perceived barriers are influenced by experience and work schedule. Establishing clinical protocols is essential to facilitate the implementation of early mobilization and support patient rehabilitation. Future efforts should focus on designing strategies and EM protocols for physiotherapy in Greek ICUs. Also, we need to monitor changes in perceived barriers across other countries as focus on the matter via published studies and clinical seminars could lead to significant changes.

Endothelial progenitor cells (EPCs) constitute a cell population that enters the circulation during aerobic exercise and facilitates vascular function. In a similar action, hematopoietic progenitor cells (HPCs) are also released into circulation in response to exercise. Peripheral vascular dysfunction is frequently present in patients with heart failure. Whether acute interval exercise performed with high intensity induces EPC and HPC mobilization and affects microcirculation remains under investigation. The study population consisted of nineteen male patients with chronic heart failure (CHF) and eleven age-matched healthy individuals who underwent a high-intensity interval exercise session. Blood was drawn before, immediately after exercise, and 40 min after exercise to identify the numbers of circulating EPCs and HPCs by flow cytometry. Microcirculatory assessment was performed using near-infrared spectroscopy before and after exercise. Vascular endothelial growth factor (VEGF) change was also assessed before and after exercise in patients with CHF using flow cytometry. The interval exercise protocol revealed significant effects (p < 0.05) on EPC and HPC mobilization and systemic microcirculation (p < 0.05) in patients with CHF and healthy individuals. No significant differences were observed between patients with CHF and healthy individuals during interval exercise. VEGF did not reveal any changes immediately after interval exercise in CHF patients. Acute high-intensity interval training was associated with increased EPC and HPC mobilization and changes in microcirculation in patients with CHF and healthy individuals.

Background/Objective: Post-COVID survivors present significant respiratory deficiency that has been associated with ongoing shortness of breath and impaired lung function. Inspiratory muscle training (IMT) is increasingly used in survivors of COVID-19 rehabilitational programs as a means to facilitate recovery of the respiratory system. Yet, its home-based effectiveness across clinically relevant outcomes remains unclear. This systematic review aimed to present current evidence on home- or tele-delivered IMT in the post-COVID-19 population. Methods: PubMed, Scopus, Cochrane library and Science Direct were systematically searched for studies evaluating home-based (or telerehabilitation) IMT, alone or as part of a respiratory muscle training program, in adults with post-COVID-19 symptoms. The primary outcome was inspiratory muscle strength. Secondary outcomes included dyspnea, pulmonary function, exercise capacity and health-related quality of life. The methodological quality of the included studies was assessed via the PEDro scale. Owing to clinical and methodological heterogeneity, we performed only a qualitative synthesis. Results: Eight studies met the inclusion criteria. Two included both inspiratory and expiratory muscles training and three included physical training as well. The methodological quality was found to be good. IMT consistently increased inspiratory muscle strength across trials. Respiratory muscle training (RMT) programs that combined inspiratory and expiratory training also improved maximal expiratory pressure. IMT reduced dyspnea versus control/sham or baseline and several studies reported improvements in exercise capacity and physical function. Spirometry/DLCO changes were small or null in most cohorts. HRQoL gains were domain-specific in anxiety and depression. Adherence was generally good. No serious adverse events attributable to IMT were reported. Conclusions: Home-based IMT for adults with post-COVID-19 conditions is safe and seems to improve inspiratory muscle strength and dyspnea, with signs of benefit for exercise capacity, physical function, and selected HRQoL domains. Effects on ventilatory efficiency and conventional lung function appear limited. Future multicenter, sham-controlled RCTs should further explore the characteristics of IMT, employ core outcome sets, include longer follow-up, and predefine phenotype-based subgroups.

Background The prevalence of respiratory disorders and abnormal breathing pattern caused by inspiratory muscle weakness is increasing among patients with chronic heart failure (CHF) leading to a decline in functional status. The study aims to evaluate the effect of inspiratory muscle training (IMT) on dysfunctional breathing and functional ability in patients with CHF. Methods Patients with stable heart failure (n = 22), who meet the inclusion criteria will be randomly assigned to two groups and receive 20 treatment sessions: (a) the experimental group (IMT & diaphragmatic breathing (DB), n = 11), and (b) the control group (DB, n = 11). Evaluation of treatment outcomes will be conducted at the beginning (week 0), and at the end (week 4) of the intervention. The main outcomes include dysfunctional breathing (Hi Lo test), diaphragm thickness (diaphragmatic ultrasonography) and functional ability (6MWT). Maximal inspiratory pressure (MIP), functional dyspnea (MRC) and quality of life (SF-12 v2) will be assessed as secondary outcomes. Discussion The study protocol aims to examine the effectiveness of IMT on dysfunctional breathing and functional ability in patients with CHF. IMT is a low-cost intervention that might improve the breathing pattern, diaphragm function, functional ability and overall quality of life in patients with CHF. Conclusion This trial will investigate the effects of IMT on breathing pattern, diaphragm function and functional ability in patients with CHF, aiming to address a significant gap in respiratory management of breathing disorders. Trial Registration: Clinical Trials gov, Trial id: NCT07104357 https://register.clinicaltrials.gov/prs/beta/studies/S000FZMT00000081/recordSummary

Background: Exercise intolerance is a common symptom in patients with chronic heart failure (CHF) and is often associated with reduced pulmonary function. Breathing exercise, including inspiratory muscle training (IMT) has been shown to alleviate respiratory symptoms in patients with pulmonary and cardiac disease. The purpose of this systematic review is to assess the impact of IMT on maximal inspiratory pressure (Pimax), diaphragm thickness, functional vital capacity (FVC), dyspnea and maximum oxygen uptake (VO_2peak) in patients with CHF. Methods: Database research was conducted (PubMed, EMBASE, Cochrane Library of Controlled Trials) by using an appropriate algorithm to indicate the IMT effect on pulmonary function studies. Eligibility criteria included pulmonary function measurements following IMT in patients with CHF. A continuous random effect model (PROSPERO-CRD420261360295) was used to calculate standard mean differences (Std.MD) in all outcomes (between an experimental and control group). Results: A total of 395 participants (13 randomized controlled trials) were identified. More studies indicate improvement in Pimax after IMT (Pimax: Std.MD: 1.07; 95%CI, 0.72–1.42; p < 0.00001). Functional vital capacity (Std.MD, 0.41; 95%CI, 0.03–0.79; p = 0.03) and dyspnea (Std.MD, 1.11; 95%CI, 0.57–1.66; p < 0.0001) were also improved. Moreover, VO_2peak assessed by cardiopulmonary exercise testing before and after IMT showed statistical significance (VO_2peak: Std.MD: 0.86; 95%CI, 0.06–1.66; p = 0.04) in trained patients with CHF compared to controls. Conclusions: The meta-analysis indicates that isolated IMT performed either as short- to medium-term intervention (4 to 8 weeks) with moderate to high intensity (40 to 90% Pimax) or long-term program (8 to 12 weeks) with low intensity (30% Pimax) promotes pulmonary function and metabolic responses. More studies are required to examine the impact of IMT on diaphragm thickness in patients with chronic heart failure.