Chronic obstructive pulmonary disease (COPD) is marked by persistent airflow limitation. Blood eosinophilia has emerged as a potential biomarker for predicting the risk of exacerbations as well as response to inhaled corticosteroids (ICS). However, its impact on lung function in stable COPD remains uncertain. This study aimed to assess the prevalence of blood eosinophilia in stable COPD patients and explore its relationship with lung function, exercise capacity and exacerbation history. A total of 60 stable COPD patients were included in this cross-sectional study, selected according to specific inclusion and exclusion criteria. Blood eosinophil counts were measured, with eosinophilia defined as ≥2%. Lung function was evaluated through spirometry, while exercise capacity was assessed using the 6-minute walk test (6MWT). Statistical tests were applied to compare data between the eosinophilic and non-eosinophilic groups. Eosinophilia was present in 21.67% of patients. Eosinophilic patients had a higher rate of exacerbations (53.85%) and a lower FEV1 (mean 39.46% predicted) as compared to non-eosinophilic patients (17.02% and 50.79%, respectively). The 6MWT distance was shorter in eosinophilic patients (249.38 meters) as compared to non-eosinophilic patients (274.17 meters). Eosinophilic inflammation in COPD significantly impacts exacerbation risk, lung function and exercise capacity . Eosinophil counts may prove to be a useful biomarker for identifying COPD patients who are more likely to benefit from targeted treatments, such as inhaled corticosteroids (ICS).

Dyspnea and fatigue in Long-COVID: definition of risk factors and of DLCO-based phenotypes in a multicenter study of 765 patients from Italy.

Physical function in lung transplant recipients: Clinical implications and rehabilitation strategies.

Heart failure (HF) is the leading cause of morbidity and mortality in adults with congenital heart disease (ACHD), yet evidence-based pharmacological options remain limited. Sodium-glucose cotransporter 2 inhibitors (SGLT2I) have demonstrated robust benefits across the heart failure spectrum in acquired cardiovascular disease. This review is summarizing emerging data on the use of SGLT2I in ACHD, a population characterized by unique pathophysiology and unmet therapeutic needs. Recent literature, predominantly comprising case reports, retrospective cohorts, and small prospective studies, suggests that SGLT2I are generally safe and well tolerated in adult congenital heart disease heart failure (ACHD-HF). Across heterogeneous ACHD populations, including those with a systemic right ventricle (SRV) and Fontan circulation, SGLT2I use has been associated with improvements in natriuretic peptides, functional status, exercise capacity, and reductions in HF hospitalizations. Early data support favourable safety and low discontinuation rates. The use of SGLT2I in ACHD-HF is feasible, well tolerated and with potential clinical benefit. Further ACHD-specific randomized clinical trials to define efficacy, optimal patient selection, and long-term outcomes are warranted.

Efficacy of Aficamten in Hypertrophic Cardiomyopathy Patients With Very-High Left Ventricular Outflow Tract Gradients.

Beyond the lungs: The role of extrapulmonary manifestations in the quality of life of Indians with chronic airway diseases.

Cardiopulmonary Outcomes and Exercise Capacity in DCD and DBD Heart Transplant Recipients

Feasibility and acceptability of remote ischemic conditioning combined with low-intensity resistance training in older adults with mobility impairments: A randomized controlled pilot trial protocol.

This study evaluated multimodal perioperative prehabilitation-combining exercise, nutrition, and psychological interventions-on functional capacity (6MWT distance, reflecting cardiopulmonary fitness) and clinical outcomes (postoperative complications, hospital stay, mortality, and readmission rates) in gastrointestinal cancer surgery. We conducted a systematic review and meta-analysis of 12 prospective trials (n=1229) identified via the PubMed, Web of Science, Cochrane Library, and Embase databases from their inception to March 20, 2025. Heterogeneity was evaluated with I2 and Q tests; random- or fixed-effects models were applied. Multimodal prehabilitation significantly improved the 6MWT preoperatively [mean difference (MD): 30.1m; 95% CI: 14.8-45.4] and at 4 weeks (MD: 21.5m; 95% CI: 14.1-28.9) and 8 weeks postoperatively (MD: 38.7m; 95% CI: 1.9-75.4). It was associated with a 0.86-day (95% CI: -1.43 to -0.30) shorter hospital stay and lowered overall [risk ratio (RR) 0.67; 95% CI: 0.57-0.79] and severe complications (RR: 0.77; 95% CI: 0.61-0.97), with no effect on operative time, mortality, or readmission. This study shows that patients receiving multimodal prehabilitation achieve better functional recovery (6MWT) and fewer complications, supporting its integration into perioperative care.

Heart Rate Response during Exercise Predicts Exercise Capacity and Heart Failure Events in Patients Post Left Ventricular Assist Device Implantation

Childhood growth restriction can lead to lasting developmental changes, increasing susceptibility to chronic diseases and neurodegenerative conditions in adulthood. High-intensity interval training (HIIT) elevates brain-derived neurotrophic factor (BDNF) levels more effectively than moderate-intensity continuous exercise, supporting neuroplasticity. Building on these findings, this study aimed to determine whether HIIT could enhance neuroplasticity-related protein expression in the brains of postnatally growth-restricted (PNGR) mice. Friend leukemia virus B mouse pups born to normal-protein and low-protein-fed dams were cross-fostered at postnatal day (PN) 1 to establish two groups: PNGR mice and control mice (CON). At PN 21, all pups were weaned onto a normal-protein diet and assigned to either a HIIT group (training group [TRD]) or a sedentary group (SED). At PN 45, a maximal exercise performance test was conducted to determine HIIT intensities. Based on these results, mice performed treadmill HIIT 5 d·wk -1 for 4 wk, with alternating intervals of 8 min at 85% and 2 min at 50% of maximal exercise capacity, totaling 60 min per session. At PN 73, all mice were euthanized, and cerebrum tissue was collected for Western blot analysis of BDNF, tropomyosin receptor kinase B, growth-associated protein 43, and synaptophysin protein expression. Despite significant body mass reductions observed in both CON and PNGR groups after HIIT, neuroplasticity-related protein expression did not increase in PNGR mice. The PNGR group exhibited consistently lower tropomyosin receptor kinase B and reduced BDNF and growth-associated protein 43 levels compared with CON mice, indicating a limited neuroplastic response to exercise. Contrary to expectations, HIIT did not elevate neuroplasticity markers in PNGR mice, highlighting the lasting impact of early-life growth restriction on brain plasticity and suggesting the need for alternative interventions.

Impaired Lung BCAA Metabolism Promotes Ferroptosis and Resultant Pulmonary Arterial Hypertension-Associated Hepatopathy.

The optimal therapeutic approach for early-stage NSCLC (I-II, and, in some specific cases, IIIa) is lung resective surgery with mediastinal lymphadenectomy. However, it should be remarked that lung resection surgery further negatively affects respiratory muscle function and health-related quality of life (HRQoL). It is well known that exercise interventions may improve pulmonary function but the optimal approach has not been determined yet. The aim of the present study is to investigate the results obtained by administering a specific athletic/physical protocol to a cohort of patients who undergo lung surgery after NSCLC diagnosis. Among patients who underwent a surgical treatment of NSCLC and followed in our Institution, those with the highest scores of performance status, defined after multidisciplinary evaluation by Interdisciplinary Group for Thoracic Neoplasms (GINT) will be addressed to the Interdipartimental Centre in Motor and Sport Activities, Sport Medicine Centre, University of Pavia for a work protocol based on mesocycles of 3times/week for 6 months. Respiratory function, cardiopulmonary exercise capacity, caloric expenditure expressed as metabolic equivalents (METs), and health-related quality of life will be assessed at baseline, 3 months, and 6 months in a prospective single-arm pilot cohort. Caloric consumption will be measured by metabolic equivalents (MET). A quality of life (QoL) questionnaire and a spirometry will be administered to patients at the same intervals. The primary exploratory endpoint will be the change in CPET-derived VO₂peak from baseline to 6 months; secondary endpoints will include changes in FEV₁, DLCO, MIP/MEP, METs, muscle power, and EORTC QLQ-C30 scores. For each patient, written informed consent will be obtained before the enrollment. Our study is, to the best of our knowledge the first perspective clinical trial encompassing athletic programs for patients with surgical treatment of NSCLC. The study is designed to provide preliminary data on feasibility, safety, and functional outcomes of a structured post-surgical athletic intervention in carefully selected patients with early-stage NSCLC.

Change in Hemoglobin (Hgb) vs Improved Exercise Capacity in Sotatercept-Treated Patients with Pulmonary Arterial Hypertension (PAH) in the Phase 3 STELLAR Trial

Dietary nitrate (NO₃-) supplementation has been shown to improve vascular function and exercise capacity in chronic obstructive pulmonary disease and in pulmonary hypertension. In a double-blind, placebo-controlled crossover study in 20 patients with idiopathic pulmonary fibrosis who desaturated on exercise, endurance shuttle walk test improved by a median (IQR) difference of 31 s (-9.5 to 100.0; (p=0.043)), following a single dose of 140 mL NO₃- rich beetroot juice, as did brachial artery flow mediated dilatation; +4.25% (95% CI -0.71% to 8.45%; p=0.036), compared with following placebo NO₃- depleted placebo juice. Longer-term studies are needed to see if these acute effects translate into sustained benefit.ISRCTN14888729 Registration date 14 July 2015, https://doi.org/10.1186/ISRCTN14888729.

Combined Effects of Nicorandil and Enhanced External Counterpulsation on Coronary Microcirculation and Exercise Capacity in Patients With Coronary Slow Flow Phenomenon: A Randomized, Controlled, 3-Arm Trial.

Postoperative pulmonary complications (PPCs) after esophageal cancer surgery remain a major concern. Preoperative exercise capacity has emerged as an important predictor. This study examined the clinical use of practical predictors-the 30-s chair stand test (CS-30) and the 6-min walk test (6MWT). We retrospectively analyzed patients with esophageal cancer from three institutions who underwent preoperative physical therapy between July 2021 and June 2023. Data completeness for the CS-30 and 6MWT was compared using McNemar's test. Three logistic regression models predicting PPCs were developed: Model 1 (established risk factors), Model 2 (risk factors plus CS-30), and Model 3 (risk factors plus 6MWT). PPCs were defined as pneumonia or sputum retention requiring intervention (Clavien-Dindo grade ≥ 2). Model performance was evaluated using the area under the curve (AUC), and incremental predictive value was assessed using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Among 213 patients (median age 68years; 83% male), PPCs occurred in 57 (26.8%). Data completeness was significantly higher for the CS-30 (195/213, 91.5%) than the 6MWT (178/213, 83.6%; p < 0.001). The AUCs (95% confidence interval) were 0.775 (0.708-0.842) for Model 1, 0.786 (0.716-0.857) for Model 2, and 0.779 (0.712-0.846) for Model 3. NRI and IDI analyses showed that adding the CS-30 significantly improved reclassification and discrimination abilities. The CS-30 was more feasible than the 6MWT and significantly improved PPCs prediction. A perioperative management model for high-risk patients based on the CS-30 is recommended.

The cofactors potentially affecting exercise performance after COVID-19 are still incompletely investigated. The contribution of several clinical and demographic variables to the exercise capacity measured with the 6-min walk test was assessed in multivariable analyses that used the absolute distance walked in 6min (6MWD) and an impaired performance (6MWD < 60% of the predicted value) as study outcomes. The variables considered were age, sex, preexisting comorbidities, COVID-19 severity, pandemic phase, treatments administered in acute phase, SARS-CoV-2 vaccination, reinfection, time from acute infection, and presence of 30 persisting symptoms. The mean 6MWD recorded among 686 patients at a mean interval of 184days from COVID-19 was 474m, with 8.3% of them presenting values below 60% of the predicted value. 6MWD was affected by sex, comorbidities, COVID-19 severity, and some persisting symptoms. The estimated effect sizes were -29.9m for severe/critical acute disease, between -26 and -87m for six comorbidities (atrial fibrillation, renal failure, chronic liver disease, chronic pulmonary disease, ischemic heart disease, diabetes) and between -21 and -99m for four persisting symptoms (nausea/vomiting, paresthesia, depressed mood, dyspnea). The 6MWD increased by 2.6m per month elapsed from acute infection. A 6MWD < 60% was associated with female sex, more intensive respiratory support, four comorbidities (atrial fibrillation, renal failure, chronic pulmonary disease and ischemic heart disease), and two persisting symptoms (nausea/vomiting and palpitations/tachycardia). Exercise performance after COVID-19 is affected by multiple factors, with estimated effect sizes that are clinically relevant. The results also suggest some spontaneous improvement over time.

Background: Cardiomyopathy and heart failure remain major global health challenges, with many patients continuing to experience breathlessness, reduced exercise capacity, and poor quality of life despite advances in pharmacological and device-based therapies. Inspiratory muscle weakness is an often overlooked contributor to these limitations. Respiratory muscle training, particularly inspiratory muscle training, has emerged as a promising adjunctive intervention; however, existing evidence is constrained by small sample sizes, heterogeneous protocols, and limited long-term follow-up data, restricting broader clinical applicability and generalizability. Objective: To evaluate the clinical relevance, therapeutic potential, and future research directions of inspiratory muscle training as an adjunct therapy in patients with cardiomyopathy and heart failure. Discussion: This narrative synthesis reviews current literature on inspiratory muscle training, focusing on its effects on functional capacity, symptom burden, cardiovascular and autonomic regulation, and clinical outcomes. It also identifies key evidence gaps, including a lack of standardized training protocols, limited long-term follow-up, and insufficient data on cost-effectiveness, adherence, and implementation strategies in diverse healthcare systems and populations. Evidence indicates that inspiratory muscle training is a safe and feasible intervention that can improve inspiratory muscle strength, reduce dyspnea, and enhance exercise tolerance and quality of life. However, uncertainty persists regarding the durability of benefits, optimal training parameters, and their impact on hospitalization rates, survival outcomes, and underlying physiological mechanisms. Conclusion: Cardiomyopathy and heart failure continue to be significant challenges for patients and healthcare systems worldwide. Despite advances in drugs and device-based treatments, many patients still struggle with symptoms like breathlessness, exercise intolerance, and reduced quality of life. In this context, respiratory muscle training, especially inspiratory muscle training, has emerged as a promising additional therapy aimed at addressing an often overlooked contributor to functional limitation, inspiratory muscle weakness. The evidence reviewed in this narrative highlights several consistent findings.

Exercise intolerance is a hallmark of heart failure (HF), and skeletal muscle abnormalities and abdominal obesity are important noncardiac factors contributing to this limitation. This study aimed to investigate the mediating roles of skeletal muscle strength and waist-to-height ratio (WtHR) in the relationship between muscle mass and exercise capacity in individuals with HF. This cross-sectional study included 110 patients with HF aged over 18 years who were classified as New York Heart Association (NYHA) functional class II or III. Exercise capacity, skeletal muscle mass, muscle strength, and WtHR were assessed using the six-minute walk test, a Tanita device, a Jamar hydraulic handgrip dynamometer, and a tape measure, respectively. Mediation effects were evaluated using the bootstrapping method with a 95% confidence interval and parallel multiple mediation models. Mediation was considered significant when the intervals did not include zero. A significant correlation was observed between muscle mass and exercise capacity, with both muscle strength and WtHR acting as partial mediators in this relationship. After adjusting for age, sex, and NYHA class, the mediating effect of WtHR was greater (30.6%) than that of muscle strength (17.9%). Despite these mediating effects, muscle mass maintained a direct effect of 51.5% on exercise capacity. In individuals with HF, muscle mass is associated with exercise capacity both directly and indirectly through muscle strength and WtHR. Assessing these characteristics together may help account for the impact of abdominal obesity, which is associated with reduced exercise capacity in this population.