The aim of this study was to determine which stage of the Talk Test (TT) represents the most appropriate workload for prescribing aerobic exercise in cardiovascular rehabilitation. Individuals with cardiovascular disease underwent a 3-day evaluation. Day 1: cardiopulmonary exercise test; day 2: 2 incremental TT (conventional and with gas analysis); day 3: 2 constant workload TT (CWTT) based on the intensities of the stages last positive (LPTT) and first equivocal (EQTT). Friedman's test was used to compare the heart rate (HR) and oxygen uptake ( ) from the CWTT with the first and second ventilatory thresholds (VT1 and VT2). The association between HR and of VT and CWTT was analyzed using Spearman's correlation coefficient. Chi-square test was used to analyze the proportion of individuals who reached the moderate intensity zone during the CWTTs, considering HR, HR reserve (HRR), and . Thirty-two individuals (23 male, 61 ± 10 years) were included. Heart rate in LPTT was similar to VT1 and lower than VT2 ( P < .001). The HR in EQTT was higher than the VT1 ( P = .002) and lower than VT2 ( P < .001). The during CWTT was similar to VT1 and lower than VT2 ( P < .001). The EQTT showed a higher proportion of individuals with HR and between the VT (HR: 70% vs 53%, P = .026; : 48% vs 31%, P = .023), as well as with HRR in the moderate intensity zone ( P = .025). Exercise intensity similar to the EQTT promotes HR and responses more consistent with the recommended exercise intensity (moderate). This stage represents the most appropriate workload for aerobic exercise prescription in cardiovascular rehabilitation.

Canadian Association of Cardiovascular Prevention and Rehabilitation (CACPR) 2026 Spring Conference Abstracts.

Cardiovascular disease is a leading cause of morbidity globally, particularly in low-resource settings. The effectiveness of cardiac rehabilitation (CR) is well-established; however, the nature of services in low-resource settings differs. This study sought to investigate program characteristics associated with lower all-cause morbidity among CR participants from low-resource settings. This was a prospective observational study analyzing the International Council of Cardiovascular Prevention and Rehabilitation's International CR Registry. Programs with annual assessment data at the time of study were included, and their characteristics were assessed in a survey. Self and program-reported patient morbidity included all- and cardiac-cause hospitalization, emergency department visits, cardiovascular disease events, and procedures 1 year from initial assessment. A multilevel modified Poisson regression model was used to account for clustering of patients within CR programs, estimating the adjusted incidence rate ratios (IRR) for morbidity. Of the 690 patients from programs in 6 countries across 4 regions (Colombia, Iran, Malaysia, Mexico, Pakistan, and Qatar), 637 (92%) were retained, of which 479 (75%) had morbidity data. Seven patients died and 93 suffered morbidity; this was most commonly noncardiac hospitalization (29 events) and emergency department visits (18 events). The regression analysis revealed a significantly lower incidence of morbidity associated with the following program factors: higher number of risk factors assessed (IRR = 0.55: 95% CI, 0.39-0.77), greater number of CR health care professionals (IRR = 0.76: 95% CI, 0.65-0.89), and CR located in academic/tertiary care institution (IRR = 0.61: 95% CI, 0.50-0.75). Globally, CR programs could benefit from prioritizing comprehensive risk assessment and strengthening CR teams to potentially reduce morbidity.

Cardiovascular diseases are the leading cause of mortality worldwide. Nutritional counseling is a key component of cardiac rehabilitation (CR) but often faces challenges in patients' adherence, particularly in low-resource settings. To evaluate the adherence to nutritional recommendations among patients enrolled in a CR program and to assess the impact of individualized nutritional counseling on dietary intake. Randomized controlled clinical trial. Outpatient CR clinic at the Hospital das clinicas of Universidade Federal de Minas Gerais. A total of 98 adults (mean age 60.4 ± 10.9 y; 57.1% male) with diagnosed cardiovascular conditions referred to CR randomly assigned to intervention (n = 46) or control (n = 52) groups. The intervention group received individualized dietary plans and monthly nutritional counseling over 4 mo, while the control group received standard care without nutritional guidance during the study period. The primary outcome was the adherence to nutritional recommendations based on analysis of 3-d dietary records (caloric intake, macronutrients, sodium, fiber). Adherence was defined as meeting or improving toward dietary recommendations. At baseline, sodium intake showed the highest adherence (89.8%), and fiber intake the lowest (8.2%). After 4 mo, the intervention group had a significant increase in protein intake (P < 0.05) and a 27.5% higher adherence to protein recommendations compared to the control group (P = 0.008). No significant differences were observed for other nutrients. Individualized nutritional counseling within CR programs improves adherence to dietary protein recommendations, emphasizing its importance in secondary prevention of cardiovascular disease. Integrating structured nutritional strategies into CR may enhance clinical outcomes and support comprehensive care.

2026 Update of the Core Components of Cardiovascular Rehabilitation: A Position Statement From the Australian Cardiovascular Health and Rehabilitation Association (ACRA).

BackgroundVirtual reality (VR) is a promising tool to deliver medical treatments easily and safely. However, clear evidence on the effectiveness of these devices in cardiovascular rehabilitation is still lacking. The aim of this study was to test the efficacy of integrating the use of an immersive VR system based on driving simulation in cardiovascular rehabilitation.MethodsA randomized controlled trial (ClinicalTrial.gov NCT07195279) was conducted with 60 subjects undergoing a cardiovascular rehabilitation program. The experimental virtual reality group (VRG) followed an experimental therapy through virtual car driving simulation sessions, while the control group attended a conventional program of calisthenics. In both groups, the above two interventions were formed by sessions of 20 min in addition to conventional therapy, so the two groups received the same amount of therapy time. Hospital Anxiety and Depression Scale, the Short Form 12 (SF-12) questionnaire for quality of life, and other clinical scales were administered to assess the efficacy of integrating VR into the rehabilitative intervention.ResultsPerceived quality of life SF-12 (p < 0.02) significantly improved only in the VR group, whereas other parameters such as pain, perceived exertion, and oxygen saturation improved in both groups.ConclusionVR resulted in improving some patients’ conditions, likely due to its high level of engagement. When assessing the effects of a VR system, it is important to consider the specific software with the exergame and the tasks administered: in this study, we selected a car driving simulation, which yielded positive effects.

To evaluate how accurately the updated AHA/AACVPR Scientific Statement prescribes moderate-intensity exercise based on percentage of heart rate reserve (%HRR), by comparing it with heart rate (HR) at ventilatory thresholds in patients with cardiometabolic disease (CMD). This retrospective multicentre study included 2,554 individuals from 12 centres across nine countries. HR at the first and second ventilatory thresholds (VT1, VT2), obtained by cardiopulmonary exercise testing (CPET), was compared with HR estimated from the guideline-defined moderate-intensity range (40-59% HRR). Agreement was assessed using Bland-Altman analysis, calibration using Passing-Bablok regression, and prediction error using mean absolute error. HR at VT1 closely approximated the lower limit (40% HRR), with minimal bias and a mean absolute error of 6.4 bpm. In contrast, HR at VT2 was substantially higher than the upper limit (59% HRR), with a negative bias (-11.4 bpm) and greater prediction error (mean absolute error of 12.0 bpm). Calibration analysis showed minor deviation at VT1 but marked systematic and proportional bias at VT2, indicating miscalibration at higher intensities. These findings were consistent across subgroup analyses. The AHA/AACVPR %HRR-based recommendations accurately reflect the lower boundary of moderate-intensity exercise but underestimate the transition to higher intensities. Aligning %HRR-based prescriptions with CPET-derived physiological thresholds are likely to improve the precision and effectiveness of exercise prescription in cardiac rehabilitation, while also strengthening methodological rigor and supporting more accurate interpretation of research findings.

Cancer is a leading cause of morbidity and mortality worldwide, with millions of survivors facing long-term health complications, particularly cardiovascular diseases (CVD). Treatments such as chemotherapy and radiation therapy can induce cardiotoxicity, resulting in significant cardiovascular morbidity. As cancer survival rates improve, the need for effective management strategies to address the cardiovascular health of cancer survivors has become increasingly critical. This study aimed to develop a smartphone-based application for cardiovascular rehabilitation in cancer survivors. This research was conducted in two phases. In the first phase, users' requirements were investigated by using a questionnaire. The participants were 31 cardio-oncologists. In the second phase, a prototype of the application was designed and implemented, and its usability was evaluated quantitatively by 27 cancer survivors with cardiovascular complications and eight cardio-oncologists using a QUIS questionnaire (version 5.5). The statistical analysis was conducted using SPSS software, version 28. Most of the proposed educational content, data elements, and application features, including necessary steps to prevent cardiovascular complications in cancer survivors, risk factors for cardiovascular complications in cancer survivors, guidance on quitting smoking and exercise training, the ability to track personal and clinical data, fatigue and anxiety assessments, and communication with physicians, were considered essential items for the application. Ultimately, users evaluated the application's usability, resulting in an average mean score of 8.19 out of 9 from patients' perspectives and 8.22 out of 9 from cardio-oncologists, indicating a "good" level of user satisfaction. The development of a smartphone-based application for cardiovascular rehabilitation in cancer survivors represents a significant step toward improving cardiovascular health management in this vulnerable population. However, more research is needed to compare the effects of remote education versus face-to-face rehabilitation on improving health literacy and patient exercise adherence.

Sestrin1 mediates the anti-inflammatory effects of aerobic exercise in atherosclerosis.

Implementation of an ETP program for patients with heart failure and reduced ejection fraction in cardiovascular rehabilitation

Official proceeding from the 2025 ITACARE-P National Meeting, Rome, October 21-22 2025: The added value of Cardiovascular Rehabilitation in heart failure management: clinical scenarios and expert opinion from a centres network of the Italian Alliance for Cardiovascular Rehabilitation and Prevention (ITACARE-P).

To characterize global variation in cardiac rehabilitation (CR) staffing, indications, and prescribed dose by country income classification, and compare findings with the International Council of Cardiovascular Prevention and Rehabilitation's (ICCPR) 2016 Global Audit. Cross-sectional REDCap survey of phase II/post-discharge CR programs (May-September 2025). Outcomes were multidisciplinary team size/composition, accepted cardiac and non-cardiac indications, and centre-based CR dose. Comparisons were made across World Bank country income classifications and Audit decade (2016 vs 2025). Of 7,025 programs identified globally, 1,505 (median program response rate=62%/country) initiated a survey, from 90/113 (80%) countries with CR. CR was delivered by a multidisciplinary team of 7 (median; P25-P75=5-8; nurses, physiotherapists, cardiologists, and dietitians most common); teams were smaller in low-income countries (median=4; p<0.001), and physician specialty varied. Non-low-income programs consistently accepted (≥90%) patients with acute coronary syndrome, with programs in low-income countries less often accepting related interventions (e.g., surgery: low-income 0% vs high-income 97%; p<0.01), but non-cardiac indications were more frequently accepted (e.g., primary prevention, diabetes, lung disease). Acceptance of heart failure increased compared with the previous Audit (70% vs 87%; p<0.001). Centre-based programs prescribed a median of 20 hours (P25-P75=12-30), typically two sessions/week over eight weeks. Globally, 65 (72%) countries prescribed a median ≥12 sessions/program. Programs in upper-middle-income countries prescribed more sessions (median=24, P25-P75=12-36; p<0.001). Dose did not differ meaningfully between Audits (p=0.07). CR programs globally are offered by small, but multidisciplinary teams. They accept guideline-indicated patients, with applicable variation by context. Insufficient dose in one-quarter of countries underscores investment need.

This document presents, in a continuous, scientific, and formal manner, the central elements of the 2025 Clinical Practice Guidelines of the Mexican Society of Heart Care (SOMECCOR) and the Mexican Society of Cardiology (SMC) on cardiovascular rehabilitation and prevention: therapeutic exercise training and a heart-healthy lifestyle. The narrative includes physiological, epidemiological, psychological, clinical, and methodological foundations that support the importance of cardiovascular rehabilitation as a broad, robust, and essential discipline in modern healthcare.

BackgroundCardiac rehabilitation is an evidence-based, multidisciplinary intervention integrating therapeutic exercise, patient education, nutritional counseling, optimized pharmacological management, and psychological support. It reduces cardiovascular mortality and improves functional capacity and quality of life. However, real-world implementation remains suboptimal due to limited accessibility, high dropout rates, and urban-rural inequities. Traditional center-based models rely on in-person supervision, limiting scalability and long-term monitoring beyond structured phases. These limitations are particularly evident during the transition from supervised rehabilitation to long-term self-management, when sustained cardiovascular risk control and maintenance of healthy behaviors are essential. Cardiovascular prevention and cardiac rehabilitation should therefore be understood as interconnected components of a continuum of care. Within this framework, digital health innovations—particularly wearable technologies and artificial intelligence (AI)—offer opportunities to bridge supervised rehabilitation and long-term prevention. Wearables enable continuous remote monitoring of physiological and behavioral parameters, facilitating early detection of adverse events and personalized feedback. AI enhances these capabilities through advanced analysis of clinical and sensor-derived data, supporting risk stratification, prediction of adherence and disease progression, and individualized decision-making across the care pathway.ObjectiveThis protocol outlines a planned scoping review that will systematically map and characterize the application of AI and wearable technologies across the cardiovascular care continuum—from primary prevention to cardiac rehabilitation—identifying key use cases, technological approaches, research clusters, and knowledge gaps.MethodsThe review will follow the Joanna Briggs Institute methodology for scoping reviews and adhere to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligibility criteria are structured according to the Population, Concept, and Context framework. A comprehensive, iteratively developed thesaurus of key terms has been prepared to guide structured searches in PubMed, Web of Science Core Collection, IEEE Xplore, and CINAHL. Two reviewers will independently screen titles, abstracts, and full texts, with disagreements resolved by consensus. A third reviewer will intervene if disagreements persist. Data will be charted using a standardized extraction form and synthesized through narrative synthesis and structured tabulation.ResultsAt the time of manuscript submission, the review has not yet commenced. However, a comprehensive thesaurus of key terms has been developed to guide and structure the forthcoming literature search. A preliminary PubMed search retrieved 1255 records; additional database searches are expected to increase this number. No participant recruitment or primary data collection is required. The literature search is planned for April-June 2026, followed by study selection. Results are expected to be available for publication in November 2026.ConclusionsThis review will provide a comprehensive mapping of AI and wearable integration in cardiovascular prevention and rehabilitation, offering an evidence-based foundation for future research and informing digital health strategies aimed at improving long-term cardiovascular outcomes.International Registered Report Identifier (IRRID)PRR1-10.2196/89602

Studies performed in humans and animals using exercise have yielded many insights into cardiovascular physiology and mechanisms by which the heart, the myocardium, and the vessels respond to exercise stress. One of the clinical interests of stress echocardiography (SE) is to find slight dysfunctions that cannot be seen during routine exams at rest. The main steps of this SE protocol begin with patient preparation (e.g., hold caffeine, beta-blockers 24 h before SE, no contraindications) and a baseline assessment, including resting echocardiographic images (2D, Doppler, and optional strain imaging) in standard views (parasternal, apical, and subcostal). Then, the stress phase follows, using exercise on a dedicated bicycle with continuous monitoring of ECG, blood pressure, symptoms, and echocardiographic images. Immediately after peak stress, post-stress imaging is performed to rapidly acquire the same views, comparing wall motion, contractility, and Doppler-derived parameters to detect changes (e.g., ischemia, wall motion abnormalities, pressures). Another interest in measuring cardiovascular function during exercise is to better understand how the heart, the myocardium, and the vessels adapt in response to stress. SE also combines functional and imaging data that can improve heart failure phenotyping, and personalized treatment to improve patient care. To maximize the reliability of future studies using exercise, it is important to provide standardized methods allowing the measurement of cardiovascular function during exercise and to provide standardized exercise protocols. In this context, the present paper will focus on patients with heart failure. The objectives of the paper are to describe the stress echocardiography method and report the practical and clinical applications and discuss the relevance of this method for clinicians and patients.

Dog walking is emerging as a potential intervention in cardiovascular health. Meta-analyses and cohort studies suggest an association between dog walking and reduced cardiovascular mortality in patients with established diseases. Beyond physical activity, human-animal interactions favorably influence stress regulation, neuroendocrine balance, exercise motivation, and social connectedness. These synergistic mechanisms remain incompletely quantified, relying on observational associations. Dog walking represents a relevant, low-cost, and sustainable complement to conventional phase III cardiovascular rehabilitation strategies. This review synthesizes the available evidence and discusses its clinical implications in secondary prevention.

While kinesiophobia is a recognised phenomenon in global cardiovascular rehabilitation, its prevalence and characteristics remain unexplored in the specific and growing population of patients hospitalised with atrial fibrillation and heart failure (AFHF). This study aims to investigate the prevalence of kinesiophobia and to identify its associated factors among hospitalised AFHF patients in China, thereby contributing to a broader understanding of this barrier to physical activity in a critical patient subgroup worldwide. In this cross-sectional study, participants were recruited through convenience sampling from a grade A general hospital in Hangzhou, Zhejiang Province, China. Participants completed questionnaires that included measures of kinesiophobia, self-efficacy, symptoms, depression, anxiety, medical coping strategies, social support, and demographic information. A total of 212 inpatients with AFHF (age: 21-91, mean age: 65.22 ± 10.30 years, 60.4% male) were included in the study, including 128 males (60.4%) and 84 females (39.6%). The findings revealed that a significant majority (71.2%) of patients experienced kinesiophobia (mean score: 40.60 ± 5.771). The results of multiple linear regression (MLR) analysis showed that the main variables associated with kinesiophobia in patients with AFHF were previous hospitalisation for heart disease, New York Heart Association (NYHA) classification, depression,medical coping styles, self-efficacy, and occupation, with six variables together explaining 44.2% of the total variation. Kinesiophobia was found to be common in patients with AFHF in China, influenced by various factors. We recommend that early evaluation of kinesiophobia be considered in patients with AFHF.

An Ounce of Prevention and a Pound of Cardiac Rehabilitation.

Interpretation of the 2025 American Association of Cardiovascular and Pulmonary Rehabilitation scientific statement: optimization strategies for aerobic exercise volume on cardiac rehabilitation outcomes

Hospital discharge is a pivotal stage in the continuum of care, marking the transition from the acute clinical episode to subsequent therapeutic management. Rather than being a purely administrative procedure, discharge is a multifaceted process that requires structured planning, clear communication, and the coordinated participation of all healthcare stakeholders, with the patient playing a central role. Inadequate discharge processes may adversely affect clinical outcomes and increase hospital readmission rates, resulting in sub-optimal utilization of healthcare resources. This issue is particularly relevant in the context of an ageing and increasingly frail population, characterized by a high burden of comorbidities and complex clinical needs. In this setting, discharge planning should be treated as an integral component of the care pathway, embedded within a comprehensive, coordinated model of care. This document proposes an updated, practical framework for hospital discharge management, grounded in current scientific evidence and multidisciplinary expertise. Its primary objective is to enhance continuity of care, support individualized treatment strategies, and ultimately improve patient outcomes. Specifically, this paper aims to provide clinical cardiologists with a structured reference tool for discharge management, including actionable recommendations to strengthen physician-patient communication, optimize therapeutic regimens, and promote better health outcomes.