Cardiac rehabilitation (CR) is a central component of optimized secondary prevention. Since their inception, CR programmes have progressively evolved. These incorporate several components in a multidisciplinary setting, aimed at addressing the diverse needs of the complex cardiovascular patient. From ischaemic heart disease to heart failure and cardio-oncology, CR has shown its relevance across various moments of the cardiovascular continuum. Notably, data has underscored the importance of an individualized assessment coupled to programme tailoring according to patient characteristics, to harness the full benefits of CR while ensuring safety. Against this background, current guidelines have endorsed CR in different clinical settings. Despite this, several challenges concerning CR implementation remain, including suboptimal referral and compliance rates, as well as underrepresentation of specific patient subgroups. In this article, we provide an overview concerning current paradigms for CR in contemporary clinical practice, while also exploring novel developments and future perspectives on this pivotal field.

BACKGROUND:Patients with head and neck cancer (HNC) initially scheduled for definitive chemoradiotherapy (CRT) often experience early functional decline and deterioration in health-related quality of life (HRQoL) even before treatment initiation. Evidence for prehabilitation in this non-surgical setting remains limited. This study evaluated whether exercise prehabilitation (EP) initiated before CRT improves functional capacity compared with usual care (UC). METHODS:FIT4TREAT (ClinicalTrials.gov: NCT05418842) was a prospective, single-center, randomized clinical trial. Adults with HNC proposed for definitive CRT were randomly assigned (1:1) to EP or UC. EP consisted of supervised combined aerobic and resistance exercise performed three times per week from baseline until radiotherapy initiation. The primary outcome was the six-minute walk distance (6MWD) at the end of the pre-treatment period. Secondary outcomes included muscle strength, lower-limb functionality, body composition, and HRQoL assessed using the EORTC QLQ-C30 and QLQ-HN43. RESULTS:Between May 2021 and February 2025, 47 patients were enrolled; 40 were included in the primary analysis. After adjustment for baseline 6MWD and the randomization stratification variables, EP resulted in a significantly greater pre-treatment 6MWD than UC (adjusted between-group difference, 28.6 m; 95 % CI, 4.1-53.1; P = 0.023). EP also improved lower-limb functionality (P < 0.001) and was associated with better preservation in the QLQ-C30 summary score (P = 0.008), social functioning (P = 0.038) and body image (P = 0.011). CONCLUSION:EP before definitive CRT improves functional capacity and may help preserve HRQoL in patients with HNC, supporting its potential integration into routine oncology care.

Cardiovascular disease and cancer have a major interplay across different contexts, with mental health being an important component when assessing both patients with cardiovascular disease and cancer. Over the years, cardio-oncology rehabilitation programs have evolved to encompass comprehensive multidisciplinary interventions, aiming to address several facets of cardiovascular disease among cancer survivors. Psychosocial support is a core element of contemporary programs, underscoring the relevance of this area. In this article, an overview of core concepts, current paradigms, and challenges in cardio-oncology rehabilitation is provided, with a background focused on mental health.

Head and neck cancer (HNC) is a diagnosis with substantial lifelong implications. Most patients diagnosed with HNC undergo treatments—typically surgery, radiotherapy, and/or chemotherapy—that negatively affect function and quality of life. As cancer survival rates improve, there is a growing focus on mitigating the related morbidity and addressing rehabilitation needs, including exercise. Exercise is a safe and effective intervention across the cancer continuum, with demonstrated benefits for physical and psychosocial outcomes in cancer populations. However, patients with HNC often present disease- and treatment-specific conditions—such as feeding-tube use, laryngectomy or tracheostomy, musculoskeletal impairments, xerostomia, and donor-site morbidity following free-flap reconstruction—that may require additional clinical precautions. This narrative review synthesizes evidence and clinical insights on these key domains specific to locally advanced HNC, identified through a structured literature search and informed by multidisciplinary expertise. Evidence reinforces the presence of recurring clinical challenges in HNC, underscoring the need for individualized and carefully adapted exercise programs. By outlining disease-specific considerations and functional sequelae, this review provides guidance for safe and evidence-informed exercise prescription, emphasizing that head and neck cancers are complex diagnoses requiring expertise not only in oncological treatment but also in supportive care.

INTRODUCTION AND OBJECTIVES:Pragmatic validated instruments are needed to assess quality of life (QoL) in the real-world care of heart failure (HF) patients. This study aimed to validate the Minnesota Living with Heart Failure Questionnaire (MLHFQ) in European Portuguese and to search for associations with other patient-reported outcomes (PROs). METHODS:This is a single-center prospective study with two samples of HF patients, used for MLHFQ translation, cultural adaptation and validation. Validation sample included patients managed in a multidisciplinary HF clinic between February 29, 2016, and February 29, 2020. RESULTS:The validation sample included 294 HF patients, with a median age of 78 years, 53.1% female sex, 45.2% with reduced left ventricle ejection fraction (LVEF) and 43.9% with preserved LVEF. The principal component analysis identified three components, representing three groups of questions from the MLHFQ, each related to one domain and subscore: physical, emotional and social. The validated version showed a reliable general factor and good internal consistency. MLHFQ total score was associated with all the other variables studied. All the scores were strongly associated with NYHA functional class. Associations were found between the physical score and both the Borg fatigue score and the six-minute walking distance. Emotional score was associated with both anxiety and depression scores from Hospital Anxiety and Depression Scale. CONCLUSIONS:This study validated the MLHFQ in Portuguese and revealed the existence of three subscores. It enables the pragmatic assessment of the QoL of Portuguese HF patients, particularly of those with preserved LVEF, and future research concerning PROs.

Magalhães, Sandra MD; Santos, Mário PhD; Viamonte, Sofia PhD; Teixeira, Manuel MSc; Ribeiro, Fernando PhD; Cyrne-Carvalho, Henrique PhD Author Information

BACKGROUND:Peripheral artery disease (PAD), usually caused by atherosclerosis, is linked to high cardiovascular mortality. In this setting, a multidimensional cardiovascular rehabilitation program (CRP) comprising supervised exercise training can improve cardiovascular risk factors (CRF) control. This study compares the effects of an arm-ergometry supervised exercise training (AEx) with a standard treadmill protocol (TEx) on CRF. METHODS:The ARMEX trial (ISRCTN54908548) was a single-center, single-blinded, parallel groups, noninferiority randomized clinical trial enrolling symptomatic PAD patients referred to a CRP. Participants were randomized (1:1) either to a 12-week AEx or TEx. Changes in blood pressure, lipid profile, glycated hemoglobin, body composition, physical activity levels, sedentary time and number of cigarettes smoked after the CRP were assessed. RESULTS:Fifty-six patients (66±8.4 years; 87.5% male) were included: AEx (N.=28) and TEx (N.=28). Systolic and diastolic blood pressure decreased in both groups without significant between-group differences. Total cholesterol and low-density lipoprotein cholesterol decreased significantly only in the AEx group, without significant between-group differences. Weight, body mass index, waist circumference, waist/hip ratio and physical activity levels improved in both groups, without significant between-group differences. Smoking reduction was also similar between groups. CONCLUSIONS:A multidimensional CRP, whether involving arm-ergometry or treadmill exercise, improved CRF control in symptomatic PAD patients. Both exercise modalities were equally effective, supporting their use as part of a comprehensive approach in this complex population.

Abstract Background Peripheral artery disease (PAD) negatively affects walking performance, health-related quality of life (HRQoL) and mental health. Exercise training is recommended as a first-line treatment for PAD, with potential impact on all these outcomes, but the optimal program design is not completely ascertained. The aim of this study was to compare arm-ergometry (AEx) and treadmill supervised exercise training (TEx) on HRQoL and mental health in patients with PAD. Methods This was an ancillary study of the ARMEX trial, a single-center, single-blinded, parallel group, randomized clinical trial, enrolling symptomatic PAD patients referred to a cardiovascular rehabilitation program (CRP). Participants were randomized (1:1) to a 12-week AEx or TEx, along with the core components of a CRP (nutritional and psychological support). Participants completed the short form 36 Health Survey and the Hospital Anxiety and Depression scale before and after the intervention. Differences between groups in the change from baseline to the end of the study were analyzed using ANCOVA, adjusted for baseline values, or the Mann-Whitney U test. Results Fifty-six patients (66 ± 8.4 years; 87.5% male) were included: AEx (n = 28) and TEx (n = 28). Physical functioning, role-physical, bodily-pain, general health, mental health and physical component summary (PCS) significantly improved in AEx group. In the TEx group, physical functioning, role-physical, bodily-pain, vitality, social functioning, role-emotional and PCS significantly improved. Role-physical and role-emotional improved more in TEx, with no between-group differences in the other domains. Changes in PCS were significantly associated with changes in walking distances. Hospital Anxiety and Depression scale scores improved in both groups, without between-group differences. This improvement was associated with self-reported walking distance. Conclusion Both exercise protocols improved HRQoL and mental health in patients with symptomatic PAD, highlighting exercise-based programs as important treatment strategies for this population. Trial registration number ISRCTN54908548 (retrospectively registered).

Breast cancer (BC) is the most common malignancy in women under 50. Exercise is essential in BC care, yet evidence in this age group remains limited. This study assessed the feasibility, adherence, and clinical benefits of exercise across the continuum of early-stage BC in women <50 years. Post hoc analyses of three studies: MAMA MOVE GAIA on-treatment, a randomized clinical trial comparing supervised concurrent training during anthracycline therapy with usual care; CORE, a randomized clinical trial comparing center-based cardiac rehabilitation (CBCR) with community-based exercise training (CBET) in survivors at high cardiovascular risk; and MAMA MOVE GAIA after-treatment, a prospective longitudinal study enrolling women who had completed curative-intent treatment. Analyses focused on adherence and key functional and patient-reported outcomes. Patients < 50 represented 51% of MAMA MOVE GAIA on-treatment ( n = 35), 34% of CORE ( n = 17), and 19% of MAMA MOVE GAIA after-treatment ( n = 7). In MAMA MOVE GAIA on-treatment, participants improved VO 2 peak (+4.4 mL/kg/min), physical functioning (+13.3points), and fatigue (−16.3 points). In CORE, VO 2 peak improved within CBCR (+1.6 mL/kg/min), with better body mass index (−1.2 kg/m²) and quality of life (+12.2 points) versus CBET. In MAMA MOVE GAIA after-treatment, women showed gains in muscle strength. Adherence ranged from 61.0% to 90.6%. Patients < 50 years derive clinically meaningful benefits from exercise, reinforcing the importance of integrating structured interventions across the BC care continuum.

Background Peripheral artery disease (PAD) significantly affects patient prognosis, leading to a rapid decline in physical function and health-related quality of life. PAD impacts walking economy, causing higher oxygen uptake during submaximal walking, which is crucial for evaluating walking performance and aerobic endurance. Research question How do arm-ergometry supervised exercise training (AEx) and treadmill exercise training (TEx) compare in their effects on walking economy, and what clinical characteristics and outcomes influence the degree of this improvement? Methods This study is an ancillary investigation of the ARMEX trial, a single-center, single-blinded, parallel groups, noninferiority randomized clinical trial. Patients with symptomatic PAD were randomized (1:1 ratio) either to a 12-week AEx or TEx. Walking economy was measured by oxygen uptake (V̇O2) during submaximal effort during the treadmill cardiopulmonary exercise test (CPET). Results Fifty-six patients (66 ± 8.4 years; 87.5 % male) were enrolled and randomized: AEx (n = 28) and TEx (n = 28). At 12-weeks, V̇O2 at 60 until 240 s decreased only in TEx. Between-group differences were found at 60 until 240 s favoring TEx. Exercising in the TEx group and lower baseline body mass index (BMI) were independently associated with a greater improvement in walking economy. Changes in walking economy were inversely correlated with changes in V̇O2 peak and positively correlated with CPET maximum walking distance and self-reported walking distance. Significance Treadmill exercise improved walking economy more than arm-ergometry in patients with PAD. Individuals with a higher BMI experience less improvement in walking economy with exercise training and might require specialized interventions.

Purpose: To compare arm-ergometry and treadmill supervised exercise training on cardiorespiratory fitness and walking distances in patients with peripheral artery disease (PAD). Methods: ARMEX was a single-center, single-blinded, parallel group, non-inferiority trial enrolling symptomatic patients with PAD. Patients were randomized (1:1 ratio) to a 12-wk arm-ergometry (AEx) or standard treadmill (TEx) supervised exercise training protocol. The powered primary end point was the change in peak oxygen uptake (VO 2 ) at 12 wk, measured on a treadmill cardiopulmonary exercise test (CPX). Secondary outcomes included changes in VO 2 at the first ventilatory threshold (VT-1), ventilatory efficiency (ratio of minute ventilation [VE] to carbon dioxide production [VCO 2 ], VE/VCO 2 ), walking distances by CPX and 6-min walking test (6MWT), and self-reported walking limitations. Results: Fifty-six patients (66 ± 8 yr; 88% male) were randomized (AEx, n = 28; TEx, n = 28). At 12 wk, VO 2peak change was not significantly different between groups (0.75 mL/kg/min; 95% CI, −0.94 to 2.44; P = .378), despite a significant increase only in AEx. VO 2 at VT-1 improved in both groups without between-group differences, and VE/VCO 2 slope improved more in AEx. The TEx attained greater improvements in walking distance by CPX (121.08 m; 95% CI, 24.49-217.66; P = .015) and 6MWT (25.08 m; 95% CI, 5.87-44.29; P = .012) and self-perceived walking distance. Conclusions: Arm-ergometry was noninferior to standard treadmill training for VO 2peak , and treadmill training was associated with greater improvements in walking distance. Our data support the use of treadmill as a first-line choice in patients with PAD to enhance walking capacity, but arm-ergometry could be an option in selected patients.

BACKGROUND:A cardio-oncology rehabilitation model among cancer survivors showed superior results comparing to a community-based exercise intervention. However, questions remain about its cost-effectiveness. AIMS:To assess the cost-effectiveness of a center-based cardiac rehabilitation (CBCR) program when compared to usual care encompassing a community-based exercise training (CBET), among cancer survivors with high cardiovascular risk. METHODS:The CORE study was a single-center, prospective, randomized controlled trial; 80 adult cancer survivors with previous exposure to cardiotoxic cancer treatment and/or with previous cardiovascular disease were assigned (1:1 ratio) to an 8-week CBCR or CBET, twice/week. Cost-effectiveness was a pre-specified secondary endpoint. Outcomes included healthcare resource use and costs, quality-adjusted life-years (QALYs) and cost-effectiveness; incremental cost-effectiveness ratio (ICER) was computed from a societal perspective. RESULTS:75 patients completed the study (CBCR N=38; CBET N=37). The CBCR had significantly higher cost per patient (477.76 ± 39.08€) compared to CBET group (339.32 ± 53.88€), with a significant between-group difference 138.44€ (95% CI, 116.82 to 160.05€, p<0.01). A between-group difference by 0.100 points in QALYs was observed, favouring the CBCR (95% CI, -0.163 to -0.037, p=0.002). When CBCR was compared with CBET, the ICER was €1,383.24 per QALY gained; at a willingness-to-pay threshold of €5,000 per QALY, the probability of CBCR being cost-effective was 99.9% (95% CI, 99.4 to 100.0). CONCLUSION:The CORE trial shows that a CBCR is a cost-effective intervention in the management of cancer survivors with high cardiovascular risk, reinforcing the potential benefits of this multidisciplinary approach in supportive care of this specific subset of cancer patients.

Head and neck cancer (HNC) patients submitted to radical chemoradiotherapy (CRT) have to deal with various physical and psychosocial problems related to cancer and its treatment, which negatively affect functional capacity and health-related quality of life (HRQoL). Thus, the aim of this work was to analyse the impact of an exercise prehabilitation (EP) program on the functional capacity and HRQoL in HNC patients. In this randomised-controlled trial (NCT05418842), 30 HNC patients proposed for radical CRT were randomly allocated to EP or usual care (UC) group. The EP group participated in an exercise program composed of a combined aerobic and resistance training program (60 minutes), three sessions/week, from randomisation to the beginning of radiotherapy (RT). Aerobic capacity (6-minute walk test, 6MWT), isometric handgrip muscle strength (dynamometer), lower limb functional capacity (30 seconds chair sit-to-stand test, STS) and HRQoL (EORTC QLQ-C30 and EORTC QLQ-HN43) were assessed at diagnosis (baseline, M0), and 1-3 days before starting RT (M1). Twenty-six patients completed both pre-treatment assessments, 12 in the EP (61.8±8.4 years, 91.7% men) and 14 in the UC (66.1±9.9 years, 92.9% men) group. The median length of the pre-treatment phase was 28 days (IQR, 24-28 days) and 29 days (IQR, 22-32 days) in EP and UC groups (p=0.786), respectively. Patients adhered on average to 66.3±34.9% of exercise sessions. No differences between groups were observed in any variable at baseline (M0). The 30 seconds STS performance improved with the EP program and remained unchanged in the UC group (EP: Δ4.4±4.6 vs UC: Δ0.1±2.5 repetitions, p=0.007). No differences between groups were observed for the change in the 6MWT (p=0.162); handgrip muscle strength (dominant hand: p=0.819; non-dominant hand, p=0.964); or any domain of HRQoL, except for body image (p=0.020) and dry mouth and sticky saliva (p=0.020) favouring the EP group. In the per-protocol analysis (i.e., adherence ≥80% of planned exercise sessions), changes in 30 seconds STS test remained significant (EP: Δ7.2±2.9 vs UC: Δ0.1±2.5 repetitions, p=0.009) while the 6MWT improved as compared in EP as compared to the UC group (EP: Δ44.7±31.5 vs UC: Δ-5.9±36.0 meters, p<0.001). No serious adverse events related to exercise were reported in the EP group. These preliminary results suggest that EP is safe and improves lower limb functionality, body image, and dry mouth and sticky saliva domains of HRQoL in HNC patients. The benefits of the 6MWT performance appear limited to those with good adherence to the planned exercise sessions.

Physical exercise has positive effects on clinical outcomes of breast cancer survivors such as quality of life, fatigue, anxiety, depression, body mass index, and physical fitness. We aimed to study its impact on immune, inflammatory, cardiometabolic, and fatty acids (FA) biomarkers. An exploratory sub-analysis of the MAMA_MOVE Gaia After Treatment trial (NCT04024280, registered July 18, 2019) was performed. Blood sample collections occurred during the control phase and at eight weeks of the intervention phase. Samples were subjected to complete leukocyte counts, cytokine, and cardiometabolic marker evaluation using flow cytometry, enzyme-linked immunoassays, and gas chromatography. Ninety-three percent of the 15 participants had body mass index ≥ 25 kg/m2. We observed a decrease of the plasmatic saturated FA C20:0 [median difference − 0.08

Exercise is an important physiological activity with several health benefits. In the setting of ischemic heart disease (IHD), the view toward exercise has greatly evolved throughout the years, concurrently to several major advances in the management of this complex entity. Currently, exercise training has broad applications across the IHD continuum as a powerful tool in its overall management, being a core component of comprehensive cardiac rehabilitation programs. Beyond this, exercise has also been incorporated as an integral part of contemporary methodologies aiming to provide diagnostic and prognostic data, such as cardiopulmonary exercise stress testing or stress echocardiography. In this article, we provide a pragmatic overview concerning the role of exercise in IHD, with a focus on its incorporation in cardiac rehabilitation frameworks, while also discussing some of the challenges and unmet needs concerning these interventions.

Importance:Cardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance. Objective:To assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk. Design, Setting, and Participants:This prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention. Interventions:Participants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week. Main Outcomes and Measures:The powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy. Results:A total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (-12.3 [11.8] mm Hg vs -1.9 [12.9] mm Hg; P < .001), diastolic BP (-5.0 [5.7] mm Hg vs -0.5 [7.0] mm Hg; P = .003), and BMI (-1.2 [0.9] vs 0.2 [0.7]; P < .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P < .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P < .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P < .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P < .001). Conclusion and Relevance:The CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy. Trial Registration:ClinicalTrials.gov Identifier: NCT05132998.