Importance of physical capacity and the effects of exercise in heart transplant recipients

One of the most important prognostic factors in heart failure patients is physical capacity. Patients with very poor physical performance and otherwise eligible, may be listed as candidates for heart transplantation(HTx). After such surgery, life-long immunosuppression therapy is needed to prevent rejection of the new heart. The dark side of immunosuppression is the increased risk of infections, kidney failure, cancer and advanced atherosclerosis(cardiac allograft vasculopathy), with the two latter conditions as the main causes of later mortality. In a worldwide perspective, 50% of the HTx patients survive past 10 years. Poor aerobic capacity prior to graft deterioration is not only limited to the failing heart, but also caused by peripheral factors, such as limited function in the skeletal muscles and in the blood vessels walls. Exercise rehabilitation after HTx is of major importance in order to improve physical capacity and prognosis. Effects of high-intensity interval training(HIT) in HTx recipients is a growing field of research attracting worldwide focus and interest. Accumulating evidence has shown that HIT is safe and efficient in maintenance HTx recipients; with superior effects on physical capacity compared to conventional moderate exercise. This article generates further evidence to the field by summarizing results from a decade of research performed at our center supported by a broad, but not strict formal, literature review. In short, this article demonstrates a strong association between physical capacity measured after HTx and long-term survival. It describes the possible "HITeffect" with increased levels of inflammatory mediators of angiogenesis. It also describes long-term effects of HIT; showing a positive effect in development of anxiety symptoms despite that the improved physical capacity was not sustained, due to downregulation ofexercise and intensity. Finally, our results are linked to the ongoing HITTS study, which investigates safety and efficiency of HIT in de novo HTx recipients. Together with previous results, this study may have the potential to change existing guidelines and contribute to a better prognosis for the HTx population as a whole.

Walking and Aerobic Capacity in Old Adults after Concentric and Eccentric Endurance Exercise at Self-Selected Intensities

Self-selected exercise intensity can be a useful exercise prescription tool for older adults;however, it is not known if it can elicit improvements in walking and aerobic capacity. In older adults, effects of concentric or eccentric endurance exercise at self-selected walking speed were examined on 1-mile indoor walk performance, predicted maximum oxygen uptake and physiological parameters. Twenty-four older adults (67 ± 4 years) completed 3 × 30 min treadmill walks per week for 12-weeks on level (LTW, n = 11, 0%) or downhill (DTW, n = 13, ﹣10%) treadmill gradient at a self- selected speed, which progressed every 4 weeks. Maximal oxygen uptake was predicted using a 1-mile walk at 4-week intervals with physiological responses recorded using a portable metabolic system. One-mile walking speed increased from baseline following 8- and 12-weeks (12 weeks: LTW: 13% ± 6%, DTW: 14% ± 9%,

Poor Wheel-Running Exercise Can Decrease Blood Pressure through Hormonal Control and Increase Endurance Exercise Capacity in Middle-Aged Normal Rats

The aim of this study was to examine the effects of voluntary wheel-running (WR) on body weight (BW), waist circumference, mesenteric fat mass (MFM), adipocyte size, circulating cytokines/hormones, blood pressure (BP) and exercise endurance capacity in 11-month-old normal rats. Three-week WR with about 0.2 km of daily running distance caused a gradual loss in BW despite an increased intake of food/water. MFM decreased as daily running distance increased. Moreover, there was a positive correlation between MFM and BW, waist circumference or adipocyte size. On the other hand, WR significantly decreased systolic/diastolic BPs, and increased endurance exercise capacity. WR rat sera contained lower concentrations of angiotensin II, aldosterone, vasopressin and endothelin-1 and higher concentration of brain natriuretic peptide compared with sedentary rat sera. Thus, WR-induced reduction in resting BPs may be accomplished by attenuated vasoconstriction, enhanced vasodilatation and reduction in blood volume. In addition, circulating vascular endothelial growth factor and interleukin-6 were higher in WR rats, suggesting angiogenesis, anti-inflammation and insulin-sensitization. These results support a prevalent idea that daily light-exercise is a potential strategy for preventing metabolic syndrome.

Incorporating Exercise Efficiency to Evaluate the Accessibility and Capacity of Medical Resources in Tibet, China

Accessibility and capacity of medical resources are key for the health care and emergency response, while the efficiency of the medical resources is very much limited by hypoxia in Tibet, China.Through introducing exercise efficiency, this study explores the accessibility of township residence to county-ship medical resources in Tibet using weighted mean travel time(WMT), and evaluates the medical capacity accordingly.The results show that: 1) the average travel time of township residence to county-level hospital is around2 h by motor vehicle in Tibet.More than half of the population can not reach the county-ship hospital within 1 h, 33.24% of the population can not reach within 2 h, and 3.75% of the population can not reach within 6 h.2) When considering the catchment of the medical resources and the population size, the WMT of the county-ship medical resources ranges from 0.25 h to 10.92 h.3) After adjusted by travel time and exercise efficiency, the county-ship medical capacity became more unequal, with 38 out of 74 counties could not meet the national guideline of 1.8 medical beds per 1000.4) In total, there are 17 counties with good WMT and sufficient medical resources,while 13 counties having very high WMT and low capacity of medical resources in Tibet.In the end, suggestions on medical resources relocation and to improve the capacity are provided.This study provides a method to incorporate exercise efficiency to access the accessibility and evaluate medical capacity that can be applied in high altitude ranges.

Impact of community-based exercise program participation on aerobic capacity in women with and without breast cancer

BACKGROUND Evidence for exercise as an efficacious strategy to improve aerobic capacity of breast cancer survivors(BCS)has come largely from intervention studies conducted in laboratory settings.There is an increasing need to translate to community-type settings,but the efficacy of those interventions using gold standard evaluation is not well-established.AIM To investigate whether similar improvement in aerobic capacity(maximal oxygen consumption[VO2])measured with gold standard testing can be achieved through a community-based setting in BCS.METHODS A peak cardiopulmonary exercise test(VO2peak),6-min walk test(6MWT),and timed up and go test(TUG)were assessed pre-and post-16 wk of progressive intensity aerobic and strength training exercise at a community center.RESULTS The sample consisted of 31 early BCS(<1 year since treatment completion)and 15 controls(CTLs).Both groups significantly improved VO2peak(+1.2 mL/kg/min;P=0.030),6MWT(+35 meters;P<0.001),and TUG(-0.44 s;P<0.01)following training.Both groups improved peak cycling power during the cardiopulmonary exercise test with BCS improving by+10 watts more than the CTLs(P=0.020).Average exercise attendance was 71%(34 of 48 possible days),but compliant days averaged only 60%of total days for aerobic,and<40%for strength in both groups.CONCLUSION Community-based exercise programs can be an effective strategy to improve aerobic capacity and physical function for early-stage BCS but potentially not to the same extent observed in laboratory-based randomized controlled trials.Further research is needed to explore barriers and facilitators of exercise engagement in community-based centers to maximize training benefits for adults with cancer.

Effects of Facial Isometric Exercise on Antioxidant Capacity

Background: Facial isometric exercise is a static contraction of facial muscles without any visible movement in the angle of the joints. To examine the effects of facial isometric exercise on subjective stress and oxidative stress/antioxidant capacity. Methods: In this study, we included 13 participants (6 males, 7 females;average age, 44.8 ± 19.6 years;age range: 20 - 74 years) who were exposed to constant temperature and humidity in a room. Fifteen minutes after entering the room, the force was measured before and after facial isometric exercise of the target muscles: upper lip levator, small zygomatic, large zygomatic, levator animus, laughing, buccal, muzzle, mental, temporal, masseter, and cervical muscles), and further evaluated by comparing the facial isometric exercise group and control (non-facial isometric exercise) group (crossover test). Results: Subjective stress significantly improved by 8.7 ± 16.3 in the facial isometric exercise group, and no significant difference in oxidative stress level was observed in both the groups. However, the antioxidant capacity significantly increased by 126.8 ± 168.1 μmol/l in the facial isometric exercise group. Conclusion: The results of this study suggest that facial isometric exercise is an exercise therapy that can provide mental stability and antiaging effects due to improvement in subjective stress and biological antioxidant potential.

Functional Capacity and Psychosocial Correlates of Exercise in Nigerian Patients with Hypertension

Objectives: Psychosocial factors are important determinants of cardiovascular health outcomes in rehabilitation. However, the relationship between exercise performance and individual factors remained poorly understood. This study investigated the relationship between functional capacity and psychosocial correlates of exercise in Nigerian patients with hypertension. Study Design and Setting: This quasi-experimental study recruited 120 patients with hypertension (≥140/90 ≤ 179/109 mmHg) from the Cardiac Care Unit of a Nigerian university teaching using purposive sampling technique. Functional capacity was assessed using the 6-minute walk test and maximum oxygen consumption (VO2 max) was estimated. Participants also underwent a 30-minute self-paced walking exercise. Thereafter, psychosocial correlates of exercise including exercise self-efficacy (ESE), social support (SoS), perceived exercise barrier (PEB) and socio-economic status (SES) were assessed using validated questionnaires. Descriptive and inferential statistics were used to analyze data. Alpha level was set at p < 0.05 of significance. Results: A majority of the participants demonstrated high ESE (75.0%), moderate SoS (60.9%) and low PEB (71.7%). More than half (58.4%) of the participants were in the middle SES. Male and female participants were comparable in ESE scores (p = 0.554), SoS (p = 0.362) and six-minute walk distance (6-MWD) (p = 0.194) except in body mass index (p < 0.05). The mean 6-MWD and VO2 max were 350.6 ± 54.7 m and 9.74 ± 1.5 ml/kg/min respectively. There were significant correlations between functional capacity and each of ESE (r = 0.184;p = 0.026) and SoS (r = 0.374;p = 0.021). Conclusions: Psychosocial correlates of exercise including self-efficacy and social support were significantly associated with functional capacity among Nigerian patients with mild to moderate hypertension.

The impact of inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure patients:a meta-analysis

Objective:To systematically evaluate the therapeutic effects of inspiratory muscle training(IMT)on cardiopulmonary functions in patients with heart failure.Methods:PubMed,EMbase,the Cochrane Library,Web of Science,CBM,WanFang Data,VIP,and CNKI databases were searched to collect randomized controlled trials about the effects of IMT on cardiopulmonary function in patients with heart failure.Meta-analysis was performed using RevMan 5.3 software after two researchers independently screened the literatures,extracted the data,and evaluated the risk of bias.Results:A total of 20 articles with 1,415 patients were included.Meta-analysis showed that IMT was able to increase the 6-minute walking distance(mean difference(MD)=59.41,95%confidence interval(CI)(51.02–67.80),P<0.001)and maximum inspiratory pressure(MD=15.59,95%CI(12.96–18.21),P<0.001)in patients with heart failure compared with the control group.But there was no statistical difference in peak oxygen uptake(MD=1.37,95%CI(?0.57–3.30),P=0.17),first second forced expiratory volume(MD=?5.79,95%CI(?12.23–0.65),P=0.08)and forced vital capacity(MD=?0.45,95%CI(?6.39–5.49),P=0.88)between the control and the experimental group.Conclusion:Available evidence suggested that IMT seemed to be a useful strategy for improving exercise capacity and inspiratory muscle strength in heart failure patients.Limited by the quantity and quality of the included studies,the above conclusions need to be verified by more high-quality studies.

Effect of trimetazidine on exercise capacity of the patients with old myocardial infarction during recovery period

Objective To investigate the effect of trimeta zidine(TMZ )on ex ercise capacity of the patients with old myocardial infarction during recovery p eriod.Method28patients were administered hitra les,blockers and antipemic ag ents.30patients were administered TMZ 20mg tid.After 12weeks ,we compar ed ni trite expenditures,time to onset of angina after exercise,the time to 1 mm ST segment depression after exercise and rate pressure product.Result Nitrit e expenditures per week were s ignificantly reduced than before tr eatment and c omprehensive group(P <0.001).The rate pressure product of TMZ did n’ t change significantly(P >0.05).Conclusion TMZ may increase exercise capac ity of patients with old myocardial infa rction.

Effect of Trimetazidine on Functional Capacity in Patient with Ischaemic Cardiomyopathy (TOFCAPI)

Objective: This study aimed to evaluate the efficacy of trimetazidine on exercise capacity via a six-minute walk test in patients with ischaemic cardiomyopathy and also evaluate the effect of trimetazidine on left ventricular function via echocardiography in the same population. Methods: This prospective observational study, conducted at the National Institute of Cardiovascular Diseases in Dhaka, Bangladesh, enrolled 200 patients with ischaemic cardiomyopathy and a depressed left ventricular ejection fraction (LVEF Results: In this study (n = 200) of ischaemic cardiomyopathy patients, the mean age was 58 years, with 76% of the patients being male. All study subjects received GDMT (Guideline-Directed Medical Therapy) for angina and heart failure. Those who received the modified released form of trimetazidine developed lesions during the 1st and 2nd follow-ups, during which the LVEF, LVIDd, and six-minute walk distance significantly improved (p Conclusion: The findings of the present study demonstrated that the addition of modified-release trimetazidine to GDMT can improve exercise capacity and left ventricular function in patients with ischaemic cardiomyopathy.

The Effects of the Aerobics Exercise Program on the Cardiopulmoner Capacity and Disease Symptoms of the Patients with Primary Fibromialgia Syndrome

Backgrounds: To observe the effects of aerobic exercise program on the illness symptoms and cardiopulmonary capacity of the patients with primary Fibromyalgia Syndrome (FMS) and to find out whether there is a difference or not in terms of cardiovascular capacity among the patients with primary FMS and sedentary healthy people. Materials and Methods: The study has been done on 20 female patients with primary FMS. Before the study and after a 6-week controlled aerobic exercise program, a cardiopulmonary exercise test has been applied on all cases. The symptoms, psychological state and life quality of the cases have been evaluated before and after the exercise program. The first cardiopulmonary results of the cases with FMS have been compared with a control group of 15 sedentary healthy. Results: When the patient and control groups are compared, although maksimal oxygen uptake (VO2 max) was lower in the patient group, this was not a significant difference. VO2 max showing the aerobic condition after the exercise increased significantly in the patients. Conclusions: Aerobic exercise programs lasting six to eight weeks are quite effective for the patients with FMS. There is not any limitation in the increase of the cardiopulmonary capacity of the patients after the exercise program.

The effect of traditional Chinese medicine rehabilitation exercise(pulmonary Daoyin)in patients with chronic obstructive pulmonary disease:A systematic review and meta-analysis

Objective:Previous research has demonstrated that pulmonary Daoyin could be an efficacious way to ameliorate the physical and psychological state of sufferers with chronic obstructive pulmonary disease(COPD)and bolster the quality of life.However,the results are not consistent.Thus,the objective of this research is to assess the impacts of pulmonary Daoyin in individuals with COPD.Methods:Relevant articles were searched in Web of Science,Cochrane Library,PubMed,EMBASE,SinoMed,CNKI,Wanfang,and VIP from database inception to January 2024.Results:There were a total of 15 randomized controlled trials(RCTs)included in this meta-analysis involving 1732 patients,of which 864 participated in the intervention group and 868 in the control group.When comparing with the control group,the COPD patients practicing pulmonary Daoyin demonstrated a significant improvement in 6 min walking distance(mean difference[MD]=24.53,95%confidence interval[CI][18.55,30.52],P<0.00001),forced expiratory volume in the 1 s(FEV_(1))(MD=0.39,95%CI[0.18,0.59],P=0.0002),percentage of FEV_(1)to the predicted value(FEV_(1)%)(MD=5.35,95%CI[3.22,7.48],P<0.0001),the forced vital capacity(FVC)(MD=0.39,95%CI[0.06,0.73],P=0.02),percentage of FVC to the predicted value(FVC%)(MD=7.52,95%CI[4.91,10.13],P<0.00001),the ratio of FEV_(1)/FVC(MD=4.95,95%CI[0.91,8.99],P=0.02),peak expiratory flow rate(standardized MD=0.98,95%CI[0.74,1.22],P<0.00001),modified Medical Research Council(mMRC)scale(MD=-0.47,95%CI[-0.89,-0.04],P=0.03),and Borg scale(MD=-0.65,95%CI[-0.75,-0.55],P<0.00001).Conclusions:Our findings may illuminate the influence of pulmonary Daoyin on exercise ability,breathlessness,and pulmonary function in COPD patients.More rigorous RCTs with larger samples and longer-term interventions will be required moving forward.

Cardiac rehabilitation and exercise therapy in the elderly： Should we invest in the aged？

Coronary heart disease （CHD） is the leading cause of death worldwide and becomes increasingly prevalent among patients aged 65 years and older.Elderly patients are at a higher risk for complications and accelerated physical deconditioning after a cardiovascular event,especially compared to their younger counterparts.The last few decades were privy to multiple studies that demonstrated the beneficial effects of cardiac rehabilitation （CR） and exercise therapy on mortality,exercise capacity,psychological risk factors,inflammation,and obesity among patients with CHD.Unfortunately,a significant portion of the available data in this field pertains to younger patients.A viable explanation is that older patients are grossly underrepresented in these programs for multiple reasons starting with the patient and extending to the physician.In this article,we will review the benefits of CR programs among the elderly,as well as some of the barriers that hinder their participation.

High-intensity interval training for health benefits and care of cardiac diseases——The key to an efficient exercise protocol

Aerobic capacity, which is expressed as peak oxygen consumption (VO2peak), is well-known to be an independent predictor of all-cause mortality and cardiovascular prognosis. This is true even for people with various coronary risk factors and cardiovascular diseases. Although exercise training is the best method to improve VO2peak, the guidelines of most academic societies recommend 150 or 75 min of moderate- or vigorous- intensity physical activities, respectively, every week to gain health benefits. For general health and primary and secondary cardiovascular prevention, high-intensity interval training (HIIT) has been recognized as an efficient exercise protocol with short exercise sessions. Given the availability of the numerous HIIT protocols, which can be classified into aerobic HIIT and anaerobic HIIT [usually called sprint interval training (SIT)], professionals in health-related fields, including primary physicians and cardiologists, may find it confusing when trying to select an appropriate protocol for their patients. This review describes the classifications of aerobic HIIT and SIT, and their differences in terms of effects, target subjects, adaptability, working mechanisms, and safety. Understanding the HIIT protocols and adopting the correct type for each subject would lead to better improvements in VO2peak with higher adherence and less risk.

Cardiorespiratory fitness measured with cardiopulmonary exercise testing and mortality in patients with cardiovascular disease:A systematic review and meta-analysis

Background Cardiorespiratory fitness(CRF)is inversely associated with mortality in apparently healthy subjects and in some clinical populations,but evidence for the association between CRF and all-cause and/or cardiovascular disease(CVD)mortality in patients with established CVD is lacking.This study aimed to quantify this association.Methods We searched for prospective cohort studies that measured CRF with cardiopulmonary exercise testing in patients with CVD and that examined all-cause and CVD mortality with at least 6 months of follow-up.Pooled hazard ratios(HRs)were calculated using random-effect inverse-variance analyses.Results Data were obtained from 21 studies and included 159,352 patients diagnosed with CVD(38.1%female).Pooled HRs for all-cause and CVD mortality comparing the highest vs.lowest category of CRF were 0.42(95%confidence interval(95%CI):0.28–0.61)and 0.27(95%CI:0.16–0.48),respectively.Pooled HRs per 1 metabolic equivalent(1-MET)increment were significant for all-cause mortality(HR=0.81;95%CI:0.74–0.88)but not for CVD mortality(HR=0.75;95%CI:0.48–1.18).Coronary artery disease patients with high CRF had a lower risk of all-cause mortality(HR=0.32;95%CI:0.26–0.41)than did their unfit counterparts.Each 1-MET increase was associated with lower all-cause mortality risk among coronary artery disease patients(HR=0.83;95%CI:0.76–0.91)but not lower among those with heart failure(HR=0.69;95%CI:0.36–1.32).Conclusion A better CRF was associated with lower risk of all-cause mortality and CVD.This study supports the use of CRF as a powerful predictor of mortality in this population.

Randomized Double-blind Placebo-controlled Clinical Trial andAssessment of Fermentation Product of Cordyceps Sinensis (Cs-4) inEnhancing Aerobic Capacity and Respiratory Function ofThe Healthy Elderly Volunteers

Objective:Cordyceps sinensis (CS) is a popular natural Chinese herbal medicine for invigoration, health preservation and reducing fatigue. Its natural substance has been prepared as a fermentation product of a specific strain of Cordyceps sinensis (Cs-4). Our objective was to assess the effect of Cs-4 on the exercise capacity of the healthy elderly people in a randomized, double-blind, placebo-controlled trial. Methods:Thirty-seven healthy, elderly Chinese subjects were randomly assigned to receive either Cs-4 (3 g/ day) or identical placebo capsules. Their exercise performance was tested before and after 6 weeks of treatment with a symptom-limited, incremental work rate protocol on a cycle ergometer. Maximum oxygen uptake (VO2max) was measured using a metabolic chart. Anaerobic thresholds (VO26) were identified by two observers using plots of both VCO2 vs VO2 and VE/VO2 vs time. Results: After taking Cs-4 for 6 weeks, VO2max (1 88±0.13 to 2.00±0 14 L/min; P=0.050) and VO2(1.15±0.07 to 1.30±0.09 L/min; P = 0.012) were significantly increased, whereas after placebo application they were unchanged. Conclusion: These findings support the belief held in China that Cs-4 could improve oxygen uptake or aerobic capacity and ventilation function and resistance to fatigue of elderly people in exercise.

Effects of Rhodiola rosea supplementation on mental performance,physical capacity,and oxidative stress biomarkers in healthy men

Purpose： The objective of this study was to investigate the effects of chronic Rhodiola rosea （R. rosea） supplementation on mental and physical performance, as well as hormonal and oxidative stress biomarkers. Methods： Twenty-six healthy male students received either R. rosea extract （600 mg/day; RR） or placebo （PL） in a randomized double-blind trial. Prior to supplementation （Term I） and following 4 weeks of supplementation （Term II）, the students underwent psychomotor tests for simple and choice reaction time, included in the Vienna Test System. Also, the subjects performed VO2peak test. Blood samples were obtained before and after the test to measure the hormonal profile （cortisol, testosterone, and growth hormone）, as well as the biomarkers of oxidative stress （lipid hydroperoxides, total antioxidant capacity, and superoxide dismutase） and muscle damage （creatine kinase）. Results： R. rosea ingestion shortened reaction time and total response time. Moreover, a greater relative increase in the number of correct responses was observed in RR group as compared to the PL group. No changes in endurance exercise capacity and hormonal profile were observed after R. rosea ingestion. R. rosea ingestion raised plasma total antioxidant capacity. It did not, however, affect other measured parameters. Conclusion： Chronic R. rosea ingestion does not affect physical performance, but can improve the results of some psychomotor tests （simple and choice reaction time） in young, healthy, and physically active men. The improvements in mental performance, however, at least in our study, seem not to be related to changes in cortisol release or antioxidant activity of R. rosea extract. Thus, the specific mechanisms responsible for these effects still need to be elucidated.2018 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license. （http：//creativecommons.org/licenses/by-nc-nd/4.0/）.

Relationship between exercise induced elevation of left ventricular filling pressure and exercise intolerance in patients with atrial fibrillation

Background Elevated left ventricular filling pressure （LVFP） is an important cause of exercise intolerance in patients with atrial fib- dilation （AF）. Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF. Methods This study included 145 con- secutive patients （81 men and 64 women; mean age 65.5 ± 8.0 years） with persistent non-valvular AF and normal left ventricular systolic function （left ventdcular ejection fraction 〉 50%）. All patients underwent a symptom-limited cardiopulmonary exercise test （CPET）. Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity （E） and early diastolic mitral annular velocity （e＇） were taken and averaged. E/e＇ ratio was calculated. Elevated LVFP was defined as E/e＇ 〉 9, and patients with elevated LVFP at rest were excluded. Results Patients were classified into two groups according to LVFP estimated by E/e＇ ratio after exercise： 39 （26.9%） with elevated LVFP after exercise and 106 （73.1%） with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake （VO2 peak） （21.7 ± 2.3 vs. 26.4 ± 3.8 mL/min per kilogram, P 〈 0.001）, lower anaerobic threshold （19.9 ± 2.5 vs. 26.0± 4.0 mL/min per kilogram, P 〈 0.001）, and shorter exercise time duration （6.2± 0.8 vs. 7.0 ±1.3 min, P 〈 0.001）. Multivariate analysis showed that age, gender and E/e＇ after exercise were significantly correlated with VO2peak. Conclusion Elevated LVFP estimated by E/e＇ ratio after exercise is independently associated with reduced exercise capacity in AF patients.

Exercise after heart transplantation: An overview

While life expectancy is greatly improved after a heart transplant, survival is still limited, and compared to the general population, the exercise capacity and healthrelated quality of life of heart transplant recipients are reduced. Increased exercise capacity is associated with a better prognosis. However, although several studies have documented positive effects of exercise after heart transplantation(HTx), little is known about the type, frequency and intensity of exercise that provides the greatest health benefits. Moreover, the long-term effects of exercise on co-morbidities and survival are also unclear. Exercise restrictions apply to patients with a denervated heart, and for decades, it was believed that the transplanted heart remained denervated. This has since been largely disproved, but despite the new knowledge, the exercise restrictions have largely remained, and up-to-date guidelines on exercise prescription after HTx do not exist. High-intensity, interval based aerobic exercise has repeatedly been documented to have superior positive effects and health benefits compared to moderate exercise. This applies to both healthy subjects as well as in several patient groups, such as patients with metabolic syndrome, coronary artery disease or heart failure. However, whether the effects of this type of exercise are also applicable to heart transplant populations has not yet been full yestablished. The purpose of this article is to give an overview of the current knowledge about the exercise capacity and effect of exercise among heart transplant recipients and to discuss future exercise strategies.

Effects of exercise in renal transplant recipients

Even after a successful renal transplantation, the renal transplant recipients(RTRs) keeps on suffering the consequences of the uremic sickness. Cardiovascular risk, work capacity, and quality of life do not improve according to expectations since biological and psychological problems are not completely solved by pharmacological treatment. Furthermore, post-transplant treatment, per se, induces additional problems(i.e., side effects of drugs). It becomes, indeed, very important to insert "non-pharmacological" therapies able to reverse this trend. Exercise may represent an important contribution in the solution of this problem. In fact, many studies have demonstrated, in the last two decades, that physical training is able both, to improve graft function, work capacity and quality of life, and to reduce cardiovascular risk. In conclusion, if the analysis of the available data suggests that an appropriate dose of physical training represent a useful, safe and non-pharmacologic contribution to RTR treatment, it becomes a kidney transplantologist responsibility to introduce exercise in the current therapy of RTRs.