BACKGROUND:Developing clinical reasoning is a critical component of physiotherapy education. Active strategies such as simulation- and digital-based learning have been proposed to enhance these skills. However, their effectiveness, but also the best modalities remain largely unknown. Therefore, this systematic review aimed to evaluate the effectiveness of various educational strategies on clinical reasoning among physiotherapy students and clinicians. METHODS:A systematic search of PubMed, Scopus, PsycINFO, and ProQuest Central was conducted for studies published between January 1, 2015 and February 28, 2026. Eligible designs included randomized controlled trials, controlled before - after studies, pre - post studies, and quasi-experimental designs. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) for quantitative studies and the Mixed Methods Appraisal Tool (MMAT) for qualitative or mixed-methods studies. Data were narratively synthesized by grouping studies into three pedagogical categories: (i) simulation- and digital-based learning, (ii) active and case-based learning methods, and (iii) structured educational programs and training. RESULTS:Thirty four studies (n = 3,048 participants) of moderate-to-high methodological quality were included in this study. Participants ranged from entry-level physiotherapy students to licensed clinicians. Simulation- and digital-based approaches, such as standardized patients, virtual reality, mobile applications, and computer-assisted learning, showed consistent improvements in clinical decision-making and performance, as well as gains in self-efficacy and motivation. Active and case-based learning strategies, including problem-based learning and concept mapping, were associated with increased satisfaction, reflective practice, and usability. Structured programs, such as residencies, workshops, and mentorship models, produced notable benefits in decision-making, self-efficacy, and professional attitudes. Overall, simulation-, digital-based and structured programs demonstrated the most consistent evidence of effectiveness across studies. CONCLUSION:Simulation, digital technologies, active learning, and structured programs effectively foster clinical reasoning in physiotherapy education. Simulation-based and active approaches appear particularly impactful. Future research should emphasize high-quality randomized trials and long-term outcomes, including patient-related measures.

Systemic sclerosis-associated interstitial lung disease (SSc-ILD) significantly impacts exercise capacity and contributes to morbidity and mortality in affected individuals. Inspiratory muscle training (IMT) has demonstrated benefits in improving inspiratory muscle strength and respiratory efficiency in various cardiopulmonary conditions, including interstitial lung disease. This case-control study hypothesises that IMT can enhance inspiratory muscle strength and exercise capacity in patients with SSc-ILD, likely through improved ventilatory patterns during exercise. In this randomised, placebo-controlled trial, 24 patients with SSc-ILD (4 males, 20 females) were randomly assigned to the IMT (n=12) or sham (n=12) groups. The IMT group performed training at 60% of maximal inspiratory pressure (MIP) for 5 weeks, while the sham group received a placebo intervention at 5% MIP. Baseline and post-intervention assessments included pulmonary function tests, 6-min walk test (6MWT) with combined wearable metabolic system to measure minute ventilation (V'E), respiratory frequency (f R), tidal volume (V T) and ventilatory equivalent for CO2 (V'E/V'CO2 ). At rest, IMT increased MIP and prolonged expiratory time. The IMT group showed significant improvements in 6-min walking distance and oxygen uptake during the 6MWT. An increase in V'E was observed primarily through an enhanced V T. These improvements are likely mediated by optimised breathing patterns, potentially reducing physiological dead space thanks to increased V T during exercise. Further studies are needed to evaluate the long-term effects of IMT on functional outcomes.

Although chemosensitivity plays a role in exercise-induced hyperventilation in cardiopulmonary disorders, the integration of the underlying reflexes with cardiac hemodynamics is not fully understood. We aimed to explore the interplay between right- and left-heart pressure overload, right ventricular-pulmonary arterial (RV-PA) coupling, cardiovascular autonomic modulation, and ventilatory response in patients with cardiopulmonary disorders. Forty patients underwent echocardiography, cardiopulmonary exercise testing, and right heart catheterization. Spectral analysis of heart rate variability (HRV) was used to assess cardiovascular autonomic modulation of low- (LF) and high-frequency (HF) components, with LF/HF ratio as an index of sympathovagal interaction. Heart rate recovery (HRR) quantified vagal reactivation. RV-PA coupling was calculated through the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (PAPs) ratio, and V̇e/V̇co2 slope defined ventilatory inefficiency. Patients were classified as NoPH (no pulmonary hypertension, n = 13), PCPH (precapillary pulmonary hypertension, n = 15), and LVDD (left ventricular diastolic dysfunction, n = 12). V̇e/V̇co2 slope was higher in PCPH than LVDD and NoPH (53.9 vs. 43.7 vs. 42.2, P < 0.01). The LF/HF ratio was similar in PCPH and LVDD but higher in NoPH (P < 0.01), whereas HRR was significantly blunted in PCPH compared with LVDD and NoPH (P < 0.01). TAPSE/PAPs was significantly reduced in PCPH and LVDD vs. NoPH and was significantly correlated with all HRV parameters. Our findings support a tight interconnection between left- and right-heart hemodynamics, pulmonary circulation, sympathovagal control, and ventilatory response during exercise. Although additional mechanisms are involved, cardiopulmonary efficiency, captured by RV-PA coupling, emerges as a key determinant linking cardiopulmonary hemodynamics to autonomic modulation and ventilatory inefficiency.NEW & NOTEWORTHY The results underscore a multifaceted interaction among cardiopulmonary hemodynamics, right heart pressures, ventilatory response, and autonomic regulation. In particular, altered RV-PA coupling correlated with heightened sympathetic drive, indicating that cardiopulmonary efficiency and hemodynamics may influence central autonomic outputs. This suggests that mechanical stress or overload in the right heart could modulate sympathovagal balance, thereby contributing to altered autonomic responses during exercise in patients with cardiopulmonary disorders.

Abstract Quantifying biological motion is fundamentally tied to quantifying the biological structures that produce that motion. Yet, this dependence makes it essential to decouple motion from static morphology to enable general, comparable analyses across individuals and conditions. In this work, we present a methodological pipeline to study biological motion data obtained from experimental motion capture of human breathing kinematics before and after maximal exercise (gold‐standard optoelectronic plethysmography markers). We used four‐dimensional geometric morphometrics (4DGM; 3D shape through time) to characterize breathing patterns while standardizing torso shape and expiratory and inspiratory times. Results showed not only differences in breathing pattern before and after maximal exercise, but also differences in motion pattern associated with BMI and torso shape. Specifically, we found higher thoracoabdominal asynchrony in low‐BMI subjects compared with high‐BMI subjects. We also found a strong covariation between torso shape and the 3D trajectory of motion, demonstrating the power of the method to detect a shape‐to‐function signal even with a small sample size. This method is proposed as a flexible tool to separate biological motion from its underlying structure, which is particularly useful for studying complex systems. In the case of breathing pattern, it is proposed to investigate possible applications in clinical settings to test whether it detects differences between healthy and pathological kinematics, in sport sciences to attempt to link respiratory function to performance, and in evolutionary studies as a possible tool for inferring respiratory function in extinct morphologies.

Acute exercise induces a marked increase in blood flow to active muscles, elevating mechanical forces on the vascular wall, most notably fluid shear stress and circumferential stretch. These stimuli are sensed by endothelial and vascular smooth muscle cells, triggering intracellular signaling cascades that, over time, drive vascular remodeling and long-term functional adaptation. Although growing evidence supports the role of hemodynamic forces in vascular remodeling, the precise mechanistic pathways and their relative contributions remain incompletely defined. This narrative review synthesizes current knowledge on peripheral vascular responses to exercise increased hemodynamic mechanical forces, with particular emphasis on cellular mechanotransduction. Further, it also describes long term vascular adaptations, which differ according to vessel type and function, thereby shaping overall vascular structure.

Inspiratory muscle training (IMT) is a respiratory based intervention capable of increasing maximal inspiratory pressure (MIP) and modulating cardiovascular autonomic control. This systematic review and meta-analysis aimed to synthesize and quantitatively evaluate the effects of IMT on cardiorespiratory interactions and autonomic outcomes. Clinical trials assessing MIP and autonomic markers, including heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and muscle sympathetic nerve activity (MSNA), were included. Searches were conducted in PubMed, Scopus, and Europe PMC up to June 2025. Risk of bias was evaluated using the Risk of Bias 2 tool, and random effects meta-analyses were performed. Twelve clinical studies involving 274 participants were included in the quantitative synthesis. IMT protocols varied in duration and intensity. IMT significantly increased MIP, corresponding to an approximate 41% improvement compared with 9% in control groups. Subgroup analyses demonstrated consistent effects across training durations and intensities. Regarding autonomic outcomes, IMT increased the high frequency normalized component of HRV, indicating enhanced vagal mediated cardiac modulation, with no observed heterogeneity. In addition, two studies demonstrated reductions in MSNA following IMT, whereas no significant effects were observed for BRS. Approximately 62.5% of studies were classified as low risk of bias, and no high-risk studies were identified. IMT improves inspiratory muscle strength and enhances cardiac vagal modulation, supporting its role as a non-pharmacological strategy to modulate cardiovascular autonomic control. The review was registered in PROSPERO CRD420251021003.

Background Occupational biomass pollutant exposure as observed in charcoal workers may have significant cardiovascular effects. This study aims to ascertain the prevalence and risk factors of hypertension and high pulse pressure (HPP), a marker of arterial stiffness, in charcoal workers compared with a control group of agricultural workers from the Democratic Republic of Congo. Methods and Results The charcoal worker and agricultural worker groups (n=485; median age, 35–40 years) were composed of male charcoal producers (n=229), charcoal saleswomen (n=72), male farmers (n=118), and vegetable saleswomen (n=66). We assessed workplace air pollution, sociodemographic parameters, self‐reported physical activity, body composition, exhaled air carbon monoxide, and blood pressure. Hypertension and HPP prevalences were determined. Logistic regression, adjusted for confounding variables was used to identify the risk factors. Charcoal workplaces were more polluted than agricultural workplaces (P<0.01). Charcoal producers performed higher levels of physical activity (P=0.018) and demonstrated higher levels of exhaled air carbon monoxide (P<0.0001) and pulse pressure (P=0.006), and higher prevalence of grade 1 hypertension (P=0.007), isolated systolic hypertension (P=0.04), and HPP (P=0.02) than farmers. Overall, hypertension (adjusted odds ratio [aOR], 11.76 [95% CI, 6.26–22.13]), level of particulate matter <10 μm pollutants (aOR, 1.001 [95% CI, 1.0002–1.0017]), smoking (aOR, 2.21 [95% CI, 1.15–4.24]) and low education (aOR, 2.14 [95% CI, 1.10–4.17]) were independently associated with HPP. The level of particulate matter <1.0 μm pollutants (aOR, 1.0009 [95% CI, 1.0002–1.0015]), male sex (aOR, 2.09 [95% CI, 1.21–3.64]), and job seniority (aOR, 1.022 [95% CI, 1.004–1.044]) were independently associated with isolated systolic hypertension. Conclusions Charcoal producers appear to develop isolated systolic hypertension and HPP more, both indices of cardiovascular events in which occupational biomass particles seem to play an early significant role.

Systemic sclerosis-associated interstitial lung disease (SSc-ILD) impacts cardiopulmonary systems and exercise capacity serves as a marker of disease severity. While the six-minute walking test (6MWT) is widely used to assess physical performance, its limitations to assess the cardiopulmonary function remain unresolved in SSc-ILD patients. This study aimed to investigate cardiorespiratory adaptations during the 6MWT, hypothesizing that ventilatory inefficiency is related to exercise capacity in SSc-ILD patients. We recruited 23 female SSc-ILD patients and 13 age- and sex-matched healthy controls (HC). Inclusion criteria included SSc diagnosis (limited or diffuse cutaneous subset) with mild-to-moderate associated ILD. Participants performed 6MWT with combined cardiopulmonary exercise testing (CPET) assessment using a wearable metabolic system to measure ventilatory and gas exchange parameters, including minute ventilation (VE), respiratory frequency (Rf), tidal volume (Vt), and ventilatory equivalent for CO2 (VE/VCO2). SSc-ILD patients exhibited increased Rf and VE during the initial minutes of exercise and during recovery compared to HC. Despite similar walking distances, SSc-ILD demonstrated higher VE/VCO2 during the 6MWT. VE/VCO2 was negatively correlated with 6MWT distance (6MWD) in SSc-ILD but not in HC. Patients walking more than 474 m (median) presented higher VE/VCO2 than HC with same 6MWD. SSc-ILD patients showed a general impaired ventilatory efficiency during 6MWT. The main result suggests that exercise capacity is not only linked to global cardiovascular adaptation but also to ventilatory performance. These findings underscore the importance of incorporating CPET metrics to cardiorespiratory assessments to improve clinical understanding and assessment of SSc-ILD.

6MWD lower than 440 m in PAH patients probaly indicates very limited haemodynamic adpatation to exercise, and is linearly associated with higher V̇ E/V̇ CO2 , suggesting more altered chemo-, baro- or metabo-reflex sensitivity in those patients https://bit.ly/3QKQ51b.

Increase in aerobic exercise capacity (VO2max) by moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) are related to improvement of maximal oxygen transport (cardiac output, Q) and of peripheral oxygen use [1]. However, no clear consensus has been reached on which exercise improve better maximal cardiac output [2],[3] , although HIIT appears to result in greater peripheral adaptations [4]. The aim of our study is to determine how Q during exercise contributes to the improvement of aerobic performance and to what extent Qmax contributes to these improvements. Fifteen participants trained during 8 weeks by MICT (n=8, 34 min at 65% of maximal heart rate (HRmax), moderate) or HIIT (n=7, seven 2-min intervals at 90%HRmax (high) followed by 2-min at 65%HRmax (low)). Q was measured by rebreathing method (Innocor) [5] during the 3rd and the 24th training sessions at rest and, at the end of MICT or during the final low- and high- intervals of HIIT. Training improvement was evaluated by cardiopulmonary exercise tests (CPET) with measurement of maximal Q. Training intensity and Q (figure 1) increased by training. Compared to MICT, HIIT showed a greater increase in VO2max (28±18% vs. 16±6%, p=0.034), maximal workload (22±12% vs. 10±6%, p=0.006), and maximal oxygen pulse (30±23% vs. 15±8%, p=0.039). Anaerobic threshold (AT) was not modified by MICT, however HIIT improved VO2 at AT (1.78±0.46 L/min vs 2.11±0.46 L/min, p=0.047) and oxygen pulse at AT (13.1±3.2 ml/bpm vs 15.4±3.6 ml/bpm, p=0.034). Qmax increased similarly with MICT and HIIT (14±7% and 16±6%, p=0.21), and, calculated arteriovenous oxygen difference increased in the HIIT group only (14±2 to 16±2 mlO2/100ml, p=0.035). Qmax and VO2max correlated at baseline (r=0.743, p<0.001) and after training (r=0.823, p<0.001). Our study demonstrates that HIIT, unlike MICT, improves VO2 at AT, and yields greater improvements in VO2max. Despite similar increases in maximal cardiac output between the two methods, the results suggest higher peripheral adaptations by HIIT. Indeed, the calculated oxygen extraction was higher with HIIT (arterio-venous oxygen difference) that may be due to greater mitochondrial content [6], nitric oxide bioavailability[7], and/or capillary density[8].Cardiac output throughout training

Exposure to charcoal biomass (CB) pollutants affects the cardiorespiratory system. We assessed cardiopulmonary responses (CPR) to exercise in charcoal producers (CPs) compared to farmers and evaluated the prevalence of exercise‐induced bronchoconstriction (EIB). Forty‐five CPs and 36 farmers, healthy males aged 23–39, completed a 15‐m Incremental Shuttle Walk and Run Test (15‐m ISWRT). Air quality index (AQI) and CO intoxication were measured, CPR was assessed through heart rate (HR), blood pressures (SBP, DBP), and spirometry at rest, peak exercise, and during recovery at 5 and 15 min. Aerobic capacity (VO 2 max) was estimated from the distance covered during the 15‐m ISWRT, and EIB was defined as a >10% decrease in FEV1 from baseline values. AQI was worse in charcoal workplaces, and CPs had higher CO intoxication than farmers ( p < 0.0001). Both groups reached maximal exercise %HRmax: 84 (82–89) versus 84 (80–89), p = 0.37 and showed similar predicted VO 2 max 36.2 (31.1–43.1) versus 38.9 (32.2–43.7) mL/kg/min, p = 0.60. However, after ISWRT, CPs had lower FEV1 than farmers (2.9 ± 0.6 vs. 3.3 ± 0.6 L, p < 0.003) and slower recovery. EIB prevalence was higher in CPs (60.0% vs. 27.8%, p = 0.006). Chronic exposure to CB increases EIB in healthy CPs, suggesting heightened airway hyperreactivity.

OBJECTIVE:To evaluate the reliability, the minimally important difference (MID), and the learning effect of the 1-minute sit-to-stand test (1STST) in assessing functional exercise capacity in patients with heart failure (HF). DESIGN:A cross-sectional study. SETTING:Two hospitals. PARTICIPANTS:Patients with an HF (N=47) diagnosis by a cardiologist following the 2021 European Society of Cardiology HF guideline. Most participants were men (60%). Most participants had a normal body mass index (62%). All participants were classified as having New York Heart Association Functional Class II or III. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Each patient performed a 6-minute walk test (6MWT) and 2 1STSTs on 2 occasions spaced 1 month apart. Test-retest reliability between occasions was evaluated using the intraclass correlation coefficient (ICC), Bland-Altman plot analysis, and linear regression. The MID was determined using a distribution-based method. To assess the learning effect, we conducted a paired t test comparing the 2 1STSTs on each occasion, and the magnitude of the learning effect was quantified using Cohen's d. The correlation between the 1STST and 6MWT was performed to confirm validity. RESULTS:The 1STST showed good test-retest reliability (ICC=0.98, P<.001) with good agreement between the 2 measurements, without proportional bias (P>.05). The MID was 1.1 repetitions. A learning effect of the 1STST was observed (P<.001) with a large effect size when repeated a month later (Cohen's d>0.8). The 1STST strongly correlated with the 6MWT (r=0.74, P=.01). CONCLUSIONS:The 1STST is a valid and reliable measure of functional exercise capacity in patients with HF. Because of the learning effect, this study recommended performing 2 trials to capture the true value.

BACKGROUND:Occupational exposure to charcoal smoke and dust is a threat to workers' respiratory systems. RESEARCH QUESTION:What is the prevalence of COPD in charcoal workers compared with that of farmers in rural areas of Democratic Republic of Congo (DRC)? STUDY DESIGN AND METHODS:This cross-sectional, comparative, and multisite study was performed in the charcoal-producing provinces of southwestern DRC. We randomly included charcoal workers and compared them with farmers (age range, 18-70 years). Air quality indexes, anthropometric features, physical activity, sociodemographic characteristics, and related medical events data were recorded. A lung function questionnaire was used to assess respiratory symptoms and spirometry was performed. COPD was defined as the presence of respiratory symptoms for > 3 months with an FEV1 to FVC ratio less than the lower limit of normal. The prevalence of COPD was calculated, and logistic regression was used to identify COPD-associated factors. RESULTS:We included 485 participants between August 2020 and July 2021. Charcoal producers (CPs; n = 229) were compared with farmers (n = 118), and charcoal saleswomen (n = 72) were compared with vegetable saleswomen (n = 66). Respective groups were similar in age, job seniority, height, and weight. The air was more polluted at charcoal workplaces. The prevalence of COPD was higher in CPs than in farmers (39.7% vs 14.4%; P < .0001) and higher in charcoal saleswomens compared with vegetable saleswomen (40.3% vs 13.6%; P < .0001). Being a charcoal worker was associated independently with COPD in the CP and farmers groups (adjusted OR, 3.54; 95% CI, 1.94-6.46) and in the saleswomen group (adjusted OR, 7.85; 95% CI, 2.85-21.5), where it was also associated independently with young age (adjusted OR, 0.85; 95% CI, 0.80-0.93) and monthly income (adjusted OR, 0.88; 95% CI, 0.83-0.96). INTERPRETATION:In rural areas of DRC, producing or selling charcoal is associated with a higher risk of COPD.

Patients with cardiac disease exhibit exaggerated sympathoexcitation, pressor, and ventilatory responses to muscle metaboreflex activation (MMA). However, the effects of cardiac rehabilitation (CR) and especially resistance training (RT) modalities on MMA are not well known. This study investigated how CR impacts MMA in such patients, specifically examining the effects of two different resistance training (RT) protocols following 12 weeks of CR. In addition to endurance exercises, 32 patients were randomized into either a 3/7 RT modality (comprising 5 sets of 3–7 repetitions) or a control (CTRL) modality (involving 3 sets of 9 repetitions), with distinct inter-set rest intervals (15 s for 3/7 and 60 s for CTRL). MMA, gauged by blood pressure (BP) and ventilatory (Ve) responses during a handgrip exercise at 40

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Erasmus Hospital. Background Cardiovascular rehabilitation (CR) is a type 1A intervention for cardiovascular disease. Among the various exercise modalities, resistance training (RT) is recommended for improving cardiorespiratory fitness (volume of oxygen consumption [VO2] peak). However, different modalities of RT coexist and which modalities should be preferred is still a matter of discussion. A RT method, called 3/7, allowed in healthy young subject greater strength gains with a shorter training time. However, the feasibility, the safety and its effects have never been studied in CR. Purpose The aim was to assess the feasibility, safety and efficiency of the 3/7 method in CR to improve VO2 peak. Methods In this single center randomized clinical trial, participants underwent 12 weeks of supervised training. Intervention: Group 3/7 consisting of 5 incremental sets of 3 to 7 repetitions with 15 s of inter-set intervals of RT on leg press; leg extension, leg curl, triceps press machines. Group 3X9 (usual care) of 3 sets of 9 repetitions with 1 min of inter set intervals on the same machine and at the same intensity (70% of 1RM). Patients completed 3 sessions per week; endurance training is the same in both groups. The primary outcome was a change in VO2 peak during the cardiopulmonary exercise test from baseline to 12 weeks. Secondary outcomes were isokinetic leg strength at 60°/sec and feasibility. Results Between 2019 and 2022 101 patients (92 male) were enrolled and randomized to 3/7 (n=49) or 3x9 RT (n=52). The mean age was 62y±8 (range 34 – 85). A total of 65 participants completed testing at 12 weeks for the primary outcome, including 32 in the 3/7 group and 33 in the 3X9 group. There were similar improvements from baseline between groups, VO2 peak by 19% in 3/7 group with 17% in the 3X9 group (mean [SD] oxygen uptake: 3/7, 3.6 [4.1] mL/kg/min; 3X9, 3.3 [4.5] mL/kg/min; P = .4). 3/7 improved quadriceps strength by 12% compared with 11% in the 3X9 group (mean [SD] isokinetic leg strength: 3/7, 23 [21] N/m; 3X9, 10 [22] N/m; P = .01). We had more dropouts in the usual care group compared to the 3/7 group (19 vs 17). 3/7 group had high feasibility scores and low rates of withdrawal due to serious adverse events (1). Most dropouts were due to other conditions (Lost of follow-up [n=11], COVID-19 [n=6], other medical problems [n=6], returns to work [n=5], withdrew [n=4]). Conclusion(s) In this randomized clinical trial, a 12-week RT of the 3/7 method coupled with endurance training improved VO2 peak to the same level than the usual care in cardiac rehabilitation, but more leg strength was observed. The 3/7 method may reduce the number of dropouts compared to usual RT program because the time training is reduced for the same volume of work. Implications: These findings support inclusion of 3/7 method in cardiac rehabilitation programs as an adjunct or alternative modality to usual care.

Introduction: In order to determine the degree of alteration in the ventilatory response to exercise in post-COVID-19 patients compared to healthy controls (CTL), we investigated the VE vs VCO2 slope (VE/VCO2sl), the membrane (Dm) and capillary (Vc) component of pulmonary diffusion capacity thought Double-Gas diffusion (DLNO/CO) at rest and after submaximal exercise. Method Twenty non-hospitalized COVID-19 patients (4±2 months post-infection) and their CTL, matched by BMI and age, underwent; quality of life questionnaires (QOL), 6-minute walk test (6MWT), lung function, DLNO/CO at rest and after 10 minutes of cycling at 85% of the maximum heart rate measured during the 6MWT. Moreover, the ten COVID-19 patients who met the definition of long-COVID underwent cardiopulmonary exercise testing. Results: QOL, 6MWT, lung function and DLNO/CO at rest and submaximal exercise did not show any differences between the groups. However in long COVID (N=10), the exercise-induced increase of Dm (14±4ml/min/mmHg, p<0.01) and predicted alveolar volume (5±3%, p<0.05) was greater in long COVID patients vs CTL (respectively: 7±5ml/min/mmHg and 1±3%). The VE/VCO2sl was higher in long COVID than CTL (32±5 vs 26±2, p<0,05) and correlated with the exercise-induced increase of Vc (6±7ml: r=0.639, p<0.05). Conclusion: Patients having long COVID infection may however show a persistent larger increase in Dm during submaximal exercise to reach the same value of Dm than controls what suggest altered diffusion capacity. Patients with long COVID exhibited an altered ventilatory efficiency at exercise that may request a greater increase in pulmonary diffusion for the same level of submaximal effort.

PURPOSE:The purpose of this study was to determine and compare the effectiveness of three different resistance training (RT) methods for cardiac rehabilitation.METHODS:Individuals with heart failure with reduced ejection fraction (HFrEF, n = 23) or coronary artery disease (CAD, n = 22) and healthy controls (CTRL, n = 29) participated in this randomized crossover trial of RT exercises at 70% of the one-maximal repetition on a leg extension machine. Peak heart rate (HR) and blood pressure (BP) were measured noninvasively. The three RT methods were five sets of increasing repetitions from three to seven (RISE), of decreasing repetitions from seven to three (DROP), and three sets of nine repetitions (USUAL). Interset rest intervals were 15 sec for RISE and DROP and 60 sec for USUAL.RESULTS:Peak HR differed on average by <4 bpm between methods in the HFrEF and CAD groups ( P < .02). Rises in systolic BP (SBP) in the HFrEF group were comparable across methods. In the CAD group, mean SBP at peak exercise increased more in RISE and DROP than in USUAL ( P < .001), but the increase was ≤10 mm Hg. In the CTRL group, SBP was higher for DROP than for USUAL (152 ± 22 vs 144 ± 24 mm Hg, respectively; P < .01). Peak cardiac output and perceived exertion did not differ between methods.CONCLUSIONS:The RISE, DROP, and USUAL RT methods induced a similar perception of effort and similar increases in peak HR and BP. The RISE and DROP methods appear more efficient as they allow a comparable training volume in a shorter time than the USUAL method.

The 3/7 resistance training (RT) method involves performing sets with increasing numbers of repetitions, and shorter rest periods than the 3x9 method. Therefore, it could induce more metabolic stress in people with heart failure with reduced ejection fraction (HFrEF) or coronary artery disease (CAD). This randomized cross-over study tested this hypothesis. Eleven individuals with HFrEF and thirteen with CAD performed high-intensity interval training (HIIT) for 30 min, followed by 3x9 or 3/7 RT according to group allocation. pH, HCO3−, lactate, and growth hormone were measured at baseline, after HIIT, and after RT. pH and HCO3− decreased, and lactate increased after both RT methods. In the CAD group, lactate increased more (6.99 ± 2.37 vs. 9.20 ± 3.57 mmol/L, p = 0.025), pH tended to decrease more (7.29 ± 0.06 vs. 7.33 ± 0.04, p = 0.060), and HCO3− decreased more (18.6 ± 3.1 vs. 21.1 ± 2.5 mmol/L, p = 0.004) after 3/7 than 3x9 RT. In the HFrEF group, lactate, pH, and HCO3− concentrations did not differ between RT methods (all p > 0.248). RT did not increase growth hormone in either patient group. In conclusion, the 3/7 RT method induced more metabolic stress than the 3x9 method in people with CAD but not HFrEF.