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Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients’ physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus statement focuses on the importance and the characteristics of prevention and rehabilitation designed for HTx recipients.

In Austria, exercise therapy is an accredited profession that requires academic training on the university master’s level. However, exercise therapy is not listed in the service plans of health and medical insurance funds and is therefore not reimbursed as a health service for patients. This position paper aims to compile the scientific evidence of the efficacy and effectiveness of exercise therapy as a treatment component in medical care. It also informs about the skills and competencies that exercise therapists acquire during their university studies in sport science. Thus, the necessity to include exercise therapy as a health service for patients is argued. Additionally, legal parity for exercise therapists within the healthcare professions offering evidence-based treatment methods is advocated. Numerous studies confirm that exercise therapy clearly leads to improvements in musculoskeletal, internal, neurological, psychiatric, and psychosomatic diseases. Exercise therapy is a highly evidence-based, low-side-effect component of prevention, treatment, and rehabilitation measures for almost all chronic diseases. It has a positive impact on pathogenesis, symptoms, fitness, quality of life, morbidity, and mortality of affected patients. The five-year academic training in sport science for exercise therapists conveys medical, theoretical knowledge, and practical skills on training and exercise, communication-related, sports-, and movement-related skills, as well as a profound education in scientific methodology. Consequently, the integration of exercise as therapeutic treatment into the healthcare system is highly indicated from a medical, societal and economic perspective. A new legal framework offering self-employment regulations for exercise therapists is required.

IntroductionDespite the well-known benefits of exercise-based cardiac rehabilitation for the secondary prevention of cardiovascular disease, participation in cardiac rehabilitation programmes and adherence to secondary prevention recommendations remain limited. Digital technologies have the potential to address low participation and adherence but attempts at implementing digital health interventions in real-life clinical practice frequently encounter various barriers. Studies about patients' experiences and perspectives regarding the use of digital technology can assist developers, researchers and clinicians in addressing or pre-empting patient-related barriers. This study was therefore conducted to investigate the experiences and perspectives of cardiac rehabilitation patients in Austria with regard to using digital technology for physical activity and exercise.MethodsTwenty-five current and former cardiac rehabilitation patients (18 men and 7 women, age range 39 to 83) with various cardiac conditions were recruited from a clinical site in Salzburg, Austria. Semi-structured qualitative interviews were audio-recorded and transcribed verbatim. The analysis followed a descriptive phenomenological approach, applying the framework analysis method.ResultsThe sample was diverse, including interviewees who readily used digital devices to support their physical activity, exercise and health monitoring, and interviewees who did not. Simplicity, convenience and accessibility were highlighted as important facilitators for the use of digital technology, while annoyance with digital devices, concerns about becoming dependent on them, or simply a preference to not use digital technology were commonly stated reasons for non-use. Interviewees' views on data protection, data sharing and artificial intelligence revealed wide variations in individuals' prior knowledge and experience about these topics, and a need for greater accessibility and transparency of data protection regulation and data sharing arrangements.DiscussionThese findings support the importance that is attributed to user-centred design methodologies in the conceptualisation and design of digital health interventions, and the imperative to develop solutions that are simple, accessible and that can be personalised according to the preferences and capabilities of the individual patient. Regarding data protection, data sharing and artificial intelligence, the findings indicate opportunity for information and education, as well as the need to offer patients transparency and accountability in order to build trust in digital technology and digital health interventions.

Cardiac rehabilitation (CR) patients often do not sustain physical activity (PA) behaviour in the long run, once they progress into a self-management stage of secondary prevention. This study aimed to explore former CR patients' PA preferences, determinants (i.e., influencing factors) and motivation for sustained PA engagement. We conducted a cross-sectional multi-centre survey using an original questionnaire based on prior qualitative interviews with cardiac patients. Five CR centres in Austria posted 500 questionnaires to former CR patients who had completed CR approximately three years prior, and 117 patients (23%) responded. Descriptive analysis was used to analyse closed-ended questions, and self-determination theory (SDT) was applied as a qualitative framework to analyse open-ended questions concerning motivation for PA engagement. Patients were generally physically active, but the majority (75.3%) did not fulfil the World Health Organisation's recommendations for aerobic PA and muscle strengthening. Most patients preferred being physically active outdoors (70%), engaging in aerobic-related (95%), individual and non-competitive exercises, with cycling (52%), walking (32%) and hiking (25%) among the most popular activities. Main determinants of PA were health, pain and motivation for 80%, 68%, 67% of patients, respectively. A subset of patients (77%) expanded on their motivations behind PA. According to SDT, most reasons (90%) were regulated by autonomous motivation (either extrinsically autonomously-regulated or intrinsic motivation) and stemmed mostly from health-related goals (e.g., fitness, general health, weight control), future quality-of-life aspirations (e.g., self-sufficiency in old age, presence for loved ones, preserving mobility) and enjoyment of PA. Patients' responses underscore the importance of promoting not only general PA, but also muscle strengthening training in CR interventions to maximise optimal health benefits. Our data further suggest that interventions which are aligned to patients' health goals and foster autonomous motivation may be particularly beneficial in increasing adherence to PA in the long-term.

BackgroundShared decision making (SDM) between healthcare professionals and persons with CVD can have a positive impact on motivation, adherence, or sustainability regarding long-term goals and integration of cardiovascular disease (CVD) rehabilitation in the everyday lives of persons with CVD. SDM can foster the transition between regular heart-healthy activity at rehabilitation facilities and more independent activity at home, but it is often challenging to implement SDM given limited time and resources, e.g., in the daily practice of rehabilitation. Digital tools can help but must be appropriately tailored for situated use and user needs.ObjectiveWe aimed to (1) describe in how far SDM is manifested in the situated context when using a digital tool developed by our group, and, based on that, (2) reflect on how digital health tools can be designed to facilitate and improve the SDM process.MethodsIn the context of a field study, we investigated how SDM is already naturally applied and manifested when using a digital tool for joint physical activity planning in cardiac rehabilitation in clinical practice. In a two-week qualitative study, we collected data on expectations, experiences and interactions during the use of a digital health tool by seven persons with CVD and five healthcare professionals. Data was collected by means of observations, interviews, questionnaires and a self-reported diary, and analysed with a particular focus on episodes related to SDM.ResultsWe found that SDM was manifested in the situated context to limited extent. For example, we identified high improvement potential for more structured goal-setting and more explicit consideration of preferences and routines. Based on mapping our findings to temporal phases where SDM can be adopted, we highlight implications for design to further support SDM in clinical practice. We consider this as “SDM supportive design in digital health apps,” suggesting for example step-by-step guidance to be used during the actual consultation.ConclusionThis study contributes to further understanding and integration of SDM in digital health tools with a focus on rehabilitation, to empower and support both persons with CVD and healthcare professionals.

Objective Digital health technologies offer great potential to improve access and adherence to cardiovascular disease secondary prevention measures such as regular physical activity (PA). However, the use and perceptions of digital technology (DT) among cardiac rehabilitation (CR) patients are not well understood. The aim of this study was therefore to explore the use of DT in former CR patients’ daily lives, for PA and for health information; and to gain insight into patient perceptions of DT for PA, including barriers, facilitators and requested features. Methods A cross-sectional postal survey was conducted between May 2022 and January 2023. Five Austrian CR centres contacted 500 former patients who had completed a phase 2 CR programme from January 2019 onwards. One-hundred seventeen patients (mean [SD] age, 69 ± 10 years, 22% female) responded. Descriptive and thematic analyses were conducted for closed and open-ended questions, respectively. Results Results indicated high DT usage for communication and informational aspects, and to a large extent also for PA and health information seeking. Main facilitators of DT use for PA were attributed to health and behavioural monitoring. Main barriers were lack of perceived need, lack of interest and poor usability. Most frequently requested features included pulse and blood pressure measurement, step count and compatibility to other devices. Conclusions Patients generally used and perceived DT as beneficial in daily life and for secondary prevention purposes such as PA. The survey identified facilitators, barriers and feature requests, which may inform the design and implementation of digital health interventions for CR patients.

Abstract Background Breast cancer is the leading non‐cardiovascular cause of death in women. In endocrine receptor positive women, aromatase inhibitors (AI) are the therapy of choice despite the fact that a decrease in systemic estrogen levels may result in endothelial dysfunction and eventually in cardiovascular disease. In this study, we assessed whether exercise training (ET), which has repeatedly shown to lead to an improvement of endothelial dysfunction, will also exert this effect in postmenopausal women with AI treated breast cancer. Methods Thirty two postmenopausal women with AI treated breast cancer were randomized to an intervention group (ET; 6 months, supervised training plus 6 months without intervention) or control group of usual care (UC; 12 months without intervention plus initial exercise counseling). Endothelial function was assessed via Reactive Hyperemia Index (RHI) measured non‐invasively with the EndoPAT‐System at baseline, 6 and 12 months. Results After 6 months of supervised ET, changes in maximal exercise capacity were significantly greater in ET than in UC (∆W: 24.1 ± 11.5 vs. 1.1 ± 8.2 watts; p

IntroductionCardiovascular diseases are the leading cause of death worldwide and are partly caused by modifiable risk factors. Cardiac rehabilitation addresses several of these modifiable risk factors, such as physical inactivity and reduced exercise capacity. However, despite its proven short-term merits, long-term adherence to healthy lifestyle changes is disappointing. With regards to exercise training, it has been shown that rehabilitation supplemented by a) home-based exercise training and b) supportive digital tools can improve adherence.MethodsIn our multi-center study (ClincalTrials.gov Identifier: NCT04458727), we analyzed the effect of supportive digital tools like digital diaries and/or wearables such as smart watches, activity trackers, etc. on exercise capacity during cardiac rehabilitation. Patients after completion of phase III out-patient cardiac rehabilitation, which included a 3 to 6-months lasting home-training phase, were recruited in five cardiac rehabilitation centers in Austria. Retrospective rehabilitation data were analyzed, and additional data were generated via patient questionnaires.Results107 patients who did not use supportive tools and 50 patients using supportive tools were recruited. Already prior to phase III rehabilitation, patients with supportive tools showed higher exercise capacity (Pmax = 186 ± 53 W) as compared to patients without supportive tools (142 ± 41 W, p

ObjectivesContinuous non-invasive monitoring of blood pressure is one of the main factors in ensuring the safety of the patient’s condition in anesthesiology, intensive care, surgery, and other areas of medicine. The purpose of this work was to analyze the current patent situation and identify directions and trends in the application of non-invasive medical sensors for continuous blood pressure monitoring, with a focus on clinical experience in critical care and validation thereof.Materials and methodsThe research results reflect data collected up to September 30, 2022. Patent databases, Google Scholar, the Lens database, Pubmed, Scopus databases were used to search for patent and clinical information.ResultsAn analysis of the patent landscape indicates a significant increase in interest in the development of non-invasive devices for continuous blood pressure monitoring and their implementation in medical practice, especially in the last 10 years. The key players in the intellectual property market are the following companies: Cnsystems Medizintechnik; Sotera Wireless INC; Tensys Medical INC; Healthstats Int Pte LTD; Edwards Lifesciences Corp, among others. Systematization of data from validation and clinical studies in critical care practice on patients with various pathological conditions and ages, including children and newborns, revealed that a number of non-invasive medical sensor technologies are quite accurate and comparable to the “gold standard” continuous invasive blood pressure monitoring. They are approved by the FDA for medical applications and certified according to ISO 81060-2, ISO 81060-3, and ISO/TS 81060-5. Unregistered and uncertified medical sensors require further clinical trials.ConclusionNon-invasive medical sensors for continuous blood pressure monitoring do not replace, but complement, existing methods of regular blood pressure measurement, and it is expected to see more of these technologies broadly implemented in the practice in the near future.

Introduction: It is well known that cardiovascular diseases are the leading cause of death worldwide. In Romania in 2015, cardiovascular diseases led to 153.953 deaths, representing 59.3% of deaths from all causes. Most people in Romania today have an unhealthy lifestyle, characterised mainly by a poor nutritious diet, low physical activity and a lack of medical screening. Purpose: Considering these deficits of secondary prevention in the treatment line of the Romanian cardiovascular patient, we aimed through this study to assess the current access of the Romanian population to on-site and remote cardiac rehabilitation programs as well as their opinion regarding the telemedicine for future cardiovascular care modelling. Methods: It was a prospective observational study, which was carried out by means of an online questionnaire composed of 26 items. It was dispersed in the online environment, including Social Media platforms, where it was active for ten weeks. Results: Our online evaluation questionnaire had 1115 participants, with a minimum age of 18 years old, a preponderance of female sex and a predominantly urban background. The study participants were from all educational levels, from low to superior. We observed that most participants have an internet connection at home and use at least one form of technology daily, but most have never used a telemedicine service. Conclusions: In conclusion, the access of cardiovascular patients to on-site cardiac rehabilitation services is extremely low and for remote ones, it is almost non-existent. For a middle-income country like Romania with such a high incidence of cardiovascular disease, it is almost mandatory to provide publicly funded cardiac telerehabilitation services also for the future.

Maximum oxygen uptake (V̇O2max), the gold standard measure of cardiorespiratory fitness (CRF), supports cardiovascular risk assessment and is mainly assessed during maximal spiroergometry. However, for field use, submaximal exercise tests might be appropriate and feasible. There have been no studies attempting a submaximal test protocol involving uphill hiking. This study aimed to develop and validate a 1-km cardio-trekking test (CTT) controlled by heart rate monitoring and Borg’s 6–20 rating of perceived exertion (RPE) scale to predict V̇O2max outdoors. Healthy participants performed a maximal incremental treadmill walking laboratory test and a submaximal 1-km CTT on mountain trails in Austria and Germany, and V̇O2max was assessed with a portable spirometry device. Borg’s RPE scale was used to control the exercise intensity of the CTT. All subjects wore a chest strap to measure heart rate (HR). A total of 134 participants (median age: 56.0 years [IQR: 51.8–63.0], 43.3 % males) completed both testing protocols. The prediction model is based on age, gender, smoking status, weight, mean HR, altitude difference, duration, and the interaction between age and duration (R2 = 0.65, adj. R2 = 0.63). Leave-one-out cross-validation revealed small shrinkage in predictive accuracy (R2 = 0.59) compared to the original model. Submaximal exercise testing using uphill hiking allows for practical estimation of V̇O2max in healthy adults. This method may allow people to engage in physical activity while monitoring their CRF to avert unnecessary cardiovascular events.

Purpose: Whole body vibration (WBV) triggers anabolic responses in various tissues, including tendons, without requiring high force production. In this waitlist-controlled equivalence trial, we tested its clinical effectiveness as an alternative treatment for patellar tendinopathy against conventional heavy slow resistance training (HSR).Methods: Thirty-nine patients were randomized to either 3 months of WBV training (n = 13), HSR training (n = 11), or a waitlist control (WLC) group (n = 15). In a partly cross-over design, 14 patients of the WLC group were redistributed to one of the two intervention groups (5 in WBV, 9 in HSR). Pre- and post-intervention testing included pain assessments (VAS), functional limitations (VISA-P), knee extension strength and tendon morphological, mechanical and material properties. Follow-up measurements (VAS, VISA-P) were performed in the WBV and HSR groups 6 months after the intervention.Results: Comparisons with the WLC group revealed significant improvements in VISA-P and VAS scores after HSR (41%, p = 003; 54%, p = 0.005) and WBV (22%, p = 0.022; 56%, p = 0.031) training. These improvements continued until follow-up (HSR: 43%, 56%; WBV: 24%, 37%). Pre-post improvements in VAS scores were equivalent between WBV and HSR groups but inconclusive for the VISA-P score and all pre-test to follow up comparisons. The mid-tendon cross-sectional area was significantly reduced after WBV (−5.7%, p = 0.004) and HSR (−3.0%, p = 0.004) training compared to WLC although the equivalence test between interventions was inconclusive.Conclusion: Whole body vibration improved symptoms typically associated with patellar tendinopathy. This type of intervention is as effective as HSR against maximum pain, although equivalence could not be confirmed for other variables. The beneficial responses to WBV and HSR treatments persisted for 6 months after the end of the intervention.Clinical Trial Registration:https://www.drks.de/drks_web/setLocale_EN.do, identifier DRKS00011338

BackgroundLack of physical activity is a critical contributing risk factor to cardiovascular disease. Hence, regular physical activity is a mainstay in the primary and secondary prevention of cardiovascular disease. Despite the extensive promotion of physical activity in both primary and secondary prevention programs, including cardiac rehabilitation, physical activity levels in the cardiac population remain low. Therefore, it is crucial to understand critical determinants that influence physical activity behavior. ObjectiveThis study aims to deliver a systematic review of studies with collated observational data exploring the association between determinants and physical activity behavior in the target population. These new insights inform the design of future interventions targeted at lasting heart-healthy physical activity behavior in the cardiac population. MethodsPrimary studies with observational quantitative data on determinants and their association with physical activity behavior in the cardiac population will be included. Information on relevant primary studies will be retrieved from various databases, including Embase, CINAHL, MEDLINE, PsycInfo, and Web of Science Core Collection. Six reviewers will independently double-screen articles. Studies will be selected according to the prespecified inclusion and exclusion criteria. Data will be extracted and entered into suitable worksheets. The US-based National Heart, Lung, and Blood Institute’s Study Quality Assessment Tool for Observational Studies will be used to assess the quality of all eligible primary studies. The results will be presented in a descriptive and narrative synthesis. If the type and quality of data are suitable, meta-analyses will be conducted. Study reporting will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. ResultsData collection started in September 2020, and the literature search was updated in July 2021. Data synthesis is ongoing, and the literature search will be updated in October 2022. ConclusionsThis review will be valuable to relevant stakeholders, including clinicians and health care professionals, intervention developers, and decision makers in health care. It lays a comprehensive foundation for understanding the determinants of physical activity to inform the design of secondary prevention interventions relevant to the cardiac population. Trial RegistrationPROSPERO CRD42020206637; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206637 International Registered Report Identifier (IRRID)RR1-10.2196/39188

BackgroundHiking is one of the most popular forms of exercise in the alpine region. However, besides its health benefits, hiking is the alpine activity with the highest incidence of cardiac events. Most incidents occur due to overexertion or underestimation of the physiological strain of hiking. ObjectiveThis project will establish a standardized cardio trekking test trail to evaluate the exercise capacity of tourists within hiking areas and deliver a tool for the prevention of hiking-associated cardiac incidents. Further, individual exercise intensity for a hiking tour will be predicted and visualized in digital maps. MethodsThis cooperation study between Austria and Germany will first validate a 1-km outdoor cardio trekking test trail at 2 different study sites. Then, exercise intensity measures on 8-km hiking trails will be evaluated during hiking to estimate overall hiking intensity. A total of 144 healthy adults (aged >45 years) will perform a treadmill test in the laboratory and a 1-km hiking test outdoors. They will wear a portable spirometry device that measures gas exchange, as well as heart rate, walking speed, ventilation, GPS location, and altitude throughout the tests. Estimation models for exercise capacity based on measured parameters will be calculated. ResultsThe project “Connect2Move” was funded in December 2019 by the European Regional Development Fund (INTERREG V-A Programme Austria-Bavaria – 2014-2020; Project Number AB296). “Connect2Move” started in January 2020 and runs until the end of June 2022. By the end of April 2022, 162 participants were tested in the laboratory, and of these, 144 were tested outdoors. The data analysis will be completed by the end of June 2022, and results are expected to be published by the end of 2022. ConclusionsIndividual prediction of exercise capacity in healthy individuals with interest in hiking aims at the prevention of hiking-associated cardiovascular events caused by overexertion. Integration of a mathematical equation into existing hiking apps will allow individual hiking route recommendations derived from individual performance on a standardized cardio trekking test trail. Trial RegistrationClinicalTrails.gov NCT05226806; https://clinicaltrials.gov/ct2/show/NCT05226806 International Registered Report Identifier (IRRID)DERR1-10.2196/39038

BackgroundDigital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. ObjectiveWe used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. MethodsThe Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization. ResultsThe analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues. ConclusionsDigital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth.

Coronary artery anomalies (CAA) are associated with sudden cardiac death (SCD) and the majority of those events occur during exercise. Depending on the anatomic features and severity, CAA usually provoke clinical symptoms of coronary ischemia, mainly syncope and (exertional) chest pain. Here we present a case of a female adolescent athlete with a high-risk CAA variant and an unusual clinical presentation, which delayed diagnosis 2 years after first symptoms were reported. After successful surgical management of the anomalous artery, the patient was determined eligible for competitive sports with unremarkable follow-up examinations.

ObjectiveTo assess the impact of the closure of group-based cardiac rehabilitation (CR) training during the first COVID-19 lockdown in spring 2020 on patients’ physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown.DesignMixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown.SettingOutpatient CR centre in Salzburg, Austria.ParticipantsTwenty-seven patients [six female, mean (SD) age 69 (7.4) years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020.Outcome Measure(s)Quantitative: exercise capacity (maximal ergometer test, submaximal ergometer training), cardiovascular risk (Framingham risk score, blood pressure, body mass index, lipids). Qualitative: individual semi-structured interviews.ResultsExercise capacity had significantly reduced from pre- to post-lockdown: mean (SD) power (W) in maximal ergometry 165 (70) vs. 151 (70), p < 0.001; submaximal ergometer training 99 (40) vs. 97 (40), p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 (63%) said they had been unable to maintain their exercise levels, and 15 (56%) felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity.ConclusionThis study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward.

The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)

Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Decreased oxygen saturation (SO2) at high altitude is associated with potentially life-threatening diseases, e.g., high-altitude pulmonary edema. Wearable devices that allow continuous monitoring of peripheral oxygen saturation (SpO2), such as the Garmin Fēnix® 5X Plus (GAR), might provide early detection to prevent hypoxia-induced diseases. We therefore aimed to validate GAR-derived SpO2 readings at 4559 m. SpO2 was measured with GAR and the medically certified Covidien Nellcor SpO2 monitor (COV) at six time points in 13 healthy lowlanders after a rapid ascent from 1130 m to 4559 m. Arterial blood gas (ABG) analysis served as the criterion measure and was conducted at four of the six time points with the Radiometer ABL 90 Flex. Validity was assessed by intraclass correlation coefficients (ICCs), mean absolute percentage error (MAPE), and Bland–Altman plots. Mean (±SD) SO2, including all time points at 4559 m, was 85.2 ± 6.2% with GAR, 81.0 ± 9.4% with COV, and 75.0 ± 9.5% with ABG. Validity of GAR was low, as indicated by the ICC (0.549), the MAPE (9.77%), the mean SO2 difference (7.0%), and the wide limits of agreement (−6.5; 20.5%) vs. ABG. Validity of COV was good, as indicated by the ICC (0.883), the MAPE (6.15%), and the mean SO2 difference (0.1%) vs. ABG. The GAR device demonstrated poor validity and cannot be recommended for monitoring SpO2 at high altitude.

Promoting regular physical activity (PA) and improving exercise capacity are the primary goals of cardiac rehabilitation (CR). Mobile technologies (mTechs) like smartphones, smartwatches, and fitness trackers might help patients in reaching these goals. This review aimed to scope current scientific literature on mTechs in CR to assess the impact on patients’ exercise capacity and to identify gaps and future directions for research. PubMed, CENTRAL, and CDSR were systematically searched for randomized controlled trials (RCTs). These RCTs had to utilize mTechs to objectively monitor and promote PA of patients during or following CR, aim at improvements in exercise capacity, and be published between December 2014 and December 2019. A total of 964 publications were identified, and 13 studies met all inclusion criteria. Home-based CR with mTechs vs. outpatient CR without mTechs and outpatient CR with mTechs vs. outpatient CR without mTechs did not lead to statistically significant differences in exercise capacity. In contrast, outpatient CR followed by home-based CR with mTechs led to significant improvement in exercise capacity as compared to outpatient CR without further formal CR. Supplying patients with mTechs may improve exercise capacity. To ensure that usage of and compliance with mTechs is optimal, a concentrated effort of CR staff has to be achieved. The COVID-19 pandemic has led to an unprecedented lack of patient support while away from institutional CR. Even though mTechs lend themselves as suitable assistants, evidence is lacking that they can fill this gap.