Objectives: To compare the elicited exercise responses at ventilatory thresholds (VTs: VT1 and VT2) identified by cardiopulmonary exercise testing (CPET) in patients with cardiovascular disease (CVD) with the guideline-directed exercise intensity domains; to propose equations to predict heart rate (HR) at VTs; and to compare the accuracy of prescription methods. Methods: A cross-sectional study was performed with 972 maximal treadmill CPET on patients with CVD. First, VTs were identified and compared with guideline-directed exercise intensity domains. Second, multivariate linear regression analyses were performed to generate prediction equations for HR at VTs. Finally, the accuracy of prescription methods was assessed by the mean absolute percentage error (MAPE). Results: Significant dispersions of individual responses were found for VTs, with the same relative intensity of exercise corresponding to different guideline-directed exercise intensity domains. A mathematical error inherent to methods based on percentages of peak effort was identified, which may help to explain the dispersions. Tailored multivariable equations yielded r² of 0.726 for VT1 and 0.901 for VT2. MAPE for the novel VT1 equation was 6.0%, lower than that for guideline-based prescription methods (9.5 to 23.8%). MAPE for the novel VT2 equation was 4.3%, lower than guideline-based methods (5.8%–19.3%). Conclusion: The guideline-based exercise intensity domains for cardiovascular rehabilitation revealed inconsistencies and heterogeneity, which limits the currently used methods. New multivariable equations for patients with CVD were developed and demonstrated better accuracy, indicating that this methodology may be a valid alternative when CPET is unavailable.

Purpose: This study aimed to propose reference standards for cardiorespiratory fitness (CRF) for Brazil from a pooled analysis and to compare peak oxygen uptake (V˙o _2peak) in Brazilian, United States (US), and Norwegian samples, exploring possible national and international differences. Methods: Reference values for treadmill V˙o _2peak in three different Brazilian regions were assessed from previous publications. We analyzed available samples to assess possible differences, generate weighted average data for Brazil, and compared them with US and Norwegian data. Results: Brazilian reference values had a lower V˙o _2peak value for the Northeast region and a higher V˙o _2peak value for the Southeast region for all sex and age groups. International comparisons with the Brazilian pooled data (n = 26661) revealed higher values for the Norwegian sample (n = 3810) and lower values for the US sample (n = 16278). The observed heterogeneity in CRF is possibly related to differences in anthropometric (weight, height) and socioeconomic factors, which differed among the samples. Also, Brazilian data showed a curvilinear V˙o _2peak age reduction trend rather than the linear characteristic commonly utilized, and the regression curves were different from those for US and Norwegian data. Conclusion: This study provides new CRF reference standards for Brazil. After pooling data from three Brazilian regions, a comparison revealed notable differences between regions, evidencing a negative gradient from Southern to Northern regions. Similarly, the international comparisons between Brazil, US, and Norway data revealed CRF heterogeneity, with differences in the V˙o _2peak values and in the age relationship patterns. These findings reinforce the importance of using national- or regional-specific V˙o _2peak reference values, ensuring proper CRF evaluation.

Aims: Low cardiorespiratory fitness (CRF) is associated with functional disability, heart failure, and mortality. Left ventricular (LV) end-diastolic volume (LVEDV) has been linked with CRF, but its utility as a diagnostic marker of low CRF has not been tested. Methods and results: This multi-centre international cohort examined the relationship between LV size on echocardiography and CRF [peak oxygen uptake (peak VO2) from cardiopulmonary exercise testing] in individuals with LV ejection fraction ≥50%. Absolute and body surface area–indexed LVEDV (LVEDVi) were tested as predictors of low CRF and functional disability (peak VO2 <1100 mL/min or <18 mL/kg/min) and compared against candidate measures of cardiac structure and function. A total of 2876 individuals (309 endurance athletes, 251 healthy non-athletes, 1969 individuals with unexplained dyspnoea, and 347 individuals with heart failure with preserved ejection fraction) were included. For the entire cohort, LVEDV had the strongest univariable association with peak VO2 [R2 = 0.45, standardized (std) β = 0.67, P < 0.001] and remained the strongest independent predictor of peak VO2 after adjusting for age, sex, and body mass index (std β = 0.30, P < 0.001). Left ventricular end-diastolic volume was better in identifying low CRF than most established echocardiographic measures [LVEDV area under the receiver operating characteristic curve (AUC) 0.72; LVEDVi AUC 0.71], but equivalent to the E/eʹ ratio. The probability of achieving a peak VO2 below the functional independence threshold was highest for smaller ventricular volumes, with LVEDV and LVEDVi of 88 mL and 57 mL/m2 providing the optimal cut-points, respectively. Conclusion: Small resting ventricular size is associated with a higher probability of low CRF and functional disability. Left ventricular size is the strongest independent echocardiographic predictor of CRF across the health–disease continuum.

Sumário Parte 1 – Indicações, Aspectos Legais e Formação em Ergometria 08 1. Introdução 08 […] Diretriz Brasileira de Ergometria em População Adulta – 2024 Sumário Parte 1 – Indicações, Aspectos Legais e Formação em Ergometria 08 1. Introdução 08 […] Diretriz Brasileira de Ergometria em População Adulta – 2024

Aims: The aim of the study is to evaluate the effectiveness of combining centre-based cardiac rehabilitation (CR) with shared decision-making (SDM) based telerehabilitation (TR) on patients’ quality of life, cardiorespiratory fitness, and physical activity level. Methods and results: A randomized controlled trial (NCT05026957) was conducted with 80 patients with heart disease recruited from Jessa Hospital, Hasselt. Patients were randomized to either a control group receiving standard CR or an intervention group receiving standard CR with additional SDM-based TR via the SharedHeart smartphone application. Primary outcome was quality of life (HeartQoL), while secondary outcomes included cardiorespiratory fitness (VO2peak) and physical activity levels. Data were analysed using a linear mixed model. The intervention group showed a greater improvement in quality of life [4.15 points, 95% confidence interval (CI): 0.7–7.6; P = 0.02], peak oxygen uptake (VO2peak) (1.1 mL/kg/min, 95% CI: 0.04–2.1; P = 0.04), and number of step count [14 788 more steps/7 days (95% CI: 4,2–25,3; P < 0.01)] over a 12-week intervention, compared with the control group. Conclusion: This study demonstrated that the addition of SDM-based TR programme to centre-based CR significantly improved patients’ quality of life, cardiorespiratory fitness, and physical activity levels compared with centre-based CR alone. The SharedHeart study stands out as one of the first to integrate a digitally supported SDM approach in CR, empowering patients to take an active role in their rehabilitation. Future research should focus on the long-term impact of digital interventions, particularly in reducing adverse cardiovascular events and enhancing patient self-management.