Special Issue "Functional Evaluation and Exercise Prescription in Chronic Diseases"

Special Issue Editors

Dr. Andrea Ermolao
E-Mail Website
Guest Editor
Sport and Exercise Medicine Division, Department of Medicine, University of Padova, 35122 Padova, Italy
Interests: cardiopulmonary exercise testing; cardiovascular screening; functional evaluation; exercise prescription; chronic diseases; exercise physiology; high altitude physiology
Dr. Daniel Neunhaeuserer
E-Mail Website
Assistant Guest Editor
Sport and Exercise Medicine Division, Department of Medicine, University of Padova, 35122 Padova, Italy
Interests: physical activity; cardiopulmonary exercise testing; functional evaluation; exercise prescription; exercise training; chronic diseases
Dr. Francesca Battista
E-Mail Website
Assistant Guest Editor
Department of Medicine, University of Padova, 35122 Padova, Italy
Interests: functional evaluation; physical activity; exercise prescription; cardiovascular risk; cardiovascular prevention; chronic diseases; cardiopulmonary exercise testing

Special Issue Information

The literature clearly demonstrates that cardiorespiratory fitness is a main predictor for patients’ all-cause mortality risk and that physical exercise training is one of the most important medical treatment options we have for different chronic diseases. However, in a real-world setting and in clinical routine, the “exercise pill” still remains an unfilled prescription. Moreover, this medical therapy must be individually prescribed with regard to training modality, intensity, dosage, and frequency, just as with drug prescriptions. Thus, specific professional education and training is needed to perform adequate functional evaluations and subsequent exercise training prescription. Indeed, professional knowledge with regard to physical exercise and training prescription must be integrated with know-how in internal medicine, cardiology, and pneumology as well as in conservative orthopedics. Furthermore, the aging of society, the increasing prevalence of chronic diseases, and the economical need for cost-effective treatment modalities will lead to a huge request for medical professionals who engage in the prevention and cost-saving treatment of chronic diseases. Thus, functional evaluation and exercise prescription will become more and more important in the immediate future, because physical exercise training is an important pillar of an evidence-based disease prevention strategy and a highly effective and cost-saving treatment option in different chronic diseases.

Dr. Andrea Ermolao
Dr. Daniel Neunhaeuserer
Dr. Francesca Battista
Guest Editors

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Keywords

  • physical activity
  • endurance training
  • strength training
  • flexibility
  • balance
  • cardiopulmonary exercise testing
  • aging
  • cost-effectiveness

Published Papers (4 papers)

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Research

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Article
Effectiveness of Text Messaging as an Incentive to Maintain Physical Activity after Cardiac Rehabilitation: A Randomized Controlled Pilot Study
Int. J. Environ. Res. Public Health 2021, 18(12), 6645; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126645 - 21 Jun 2021
Viewed by 440
Abstract
Although the efficacy of cardiac rehabilitation (CR) is proven, the need to improve patients’ adherence has emerged. There are only a few studies that have investigated the effect of sending text messages after a CR period to stimulate subjects’ ongoing engagement in regular [...] Read more.
Although the efficacy of cardiac rehabilitation (CR) is proven, the need to improve patients’ adherence has emerged. There are only a few studies that have investigated the effect of sending text messages after a CR period to stimulate subjects’ ongoing engagement in regular physical activity (PA). A randomized controlled pilot trial was conducted after CR, sending a daily PA text message reminder to an intervention group (IG), which was compared with a usual care control group (CG) during three months of follow-up. Thirty-two subjects were assessed pre- and post-study intervention with GPAQ, submaximal iso-watt exercise testing, a 30 s sit-to-stand test, a bilateral arm curl test, and a final survey on a seven-point Likert scale. A statistically significant difference in the increase of moderate PA time (Δ 244.7 (95% CI 189.1, 300.4) minutes, p < 0.001) and in the reduction of sedentary behavior time (Δ −77.5 (95% CI 104.9, −50.1) minutes, p = 0.004) was shown when the IG was compared with the CG. This was associated with an improvement in heart rate, blood pressure, and patients’ Borg rating on the category ratio scale 10 (CR10) in iso-watt exercise testing (all p < 0.05). Furthermore, only the IG did not show a worsening of the strength parameters in the follow-up leading to a change of the 30 s sit-to-stand test with a difference of +2.2 (95% CI 1.23, 3.17) repetitions compared to CG (p = 0.03). The telemedical intervention has been appreciated by the IG, whose willingness to continue with regular PA emerged to be superior compared to the CG. Text messages are an effective and inexpensive adjuvant after phase 2 CR that improves adherence to regular PA. Further studies are needed to confirm these results in a larger patient population and in the long term. Full article
(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)
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Article
Nonresponders of Physical Activity on Prescription (PAP) Can Increase Their Exercise Capacity with Enhanced Physiotherapist Support
Int. J. Environ. Res. Public Health 2021, 18(9), 4795; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18094795 - 30 Apr 2021
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Abstract
Swedish physical activity on prescription (PAP) is an evidence-based method to promote physical activity. However, few studies have investigated the effect of Swedish PAP on physical fitness, in which better cardiorespiratory fitness is associated with lower risks of all-cause mortality and diagnose-specific mortality. [...] Read more.
Swedish physical activity on prescription (PAP) is an evidence-based method to promote physical activity. However, few studies have investigated the effect of Swedish PAP on physical fitness, in which better cardiorespiratory fitness is associated with lower risks of all-cause mortality and diagnose-specific mortality. Direct measures of cardiorespiratory fitness, usually expressed as maximal oxygen uptake, are difficult to obtain. Hence, exercise capacity can be assessed from a submaximal cycle ergometer test, taking the linear relationship between heart rate, work rate, and oxygen uptake into account. The aim of this study was to evaluate exercise capacity in the long term, following PAP treatment with enhanced physiotherapist support in a nonresponding patient cohort. In total, 98 patients (48 women) with insufficient physical activity levels, with at least one component of the metabolic syndrome and nonresponding to a previous six-month PAP treatment, were randomized to PAP treatment with enhanced support from a physiotherapist and additional exercise capacity tests during a two-year period. A significant increase in exercise capacity was observed for the whole cohort at two-year follow-up (7.6 W, p ≤ 0.001), with a medium effect size (r = 0.34). Females (7.3 W, p = 0.025), males (8.0 W, p = 0.018) and patients ≥58 years old (7.7 W, p = 0.002) improved significantly, whereas a nonsignificant increase was observed for patients <58 years old (7.6 W, p = 0.085). Patients with insufficient physical activity levels who did not respond to a previous six-month PAP treatment can improve their exercise capacity following PAP treatment with enhanced support from a physiotherapist during a two-year period. Future studies should include larger cohorts with a control group to ensure valid estimations of exercise capacity and PAP. Full article
(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)
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Article
Hemodynamic Response to High- and Low-Load Resistance Exercise in Patients with Coronary Artery Disease: A Randomized, Crossover Clinical Trial
Int. J. Environ. Res. Public Health 2021, 18(8), 3905; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18083905 - 08 Apr 2021
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Abstract
Low-load resistance exercise (LL-RE) is recommended as an adjunct therapy to aerobic exercise during cardiac rehabilitation in patients with coronary artery disease. The safety and hemodynamic response to high-load (HL) RE remain unknown. The aim of this study was to evaluate the hemodynamic [...] Read more.
Low-load resistance exercise (LL-RE) is recommended as an adjunct therapy to aerobic exercise during cardiac rehabilitation in patients with coronary artery disease. The safety and hemodynamic response to high-load (HL) RE remain unknown. The aim of this study was to evaluate the hemodynamic response during both HL-RE and LL-RE prior to cardiac rehabilitation. Forty-three patients with coronary artery disease and/or percutaneous coronary intervention performed three sets of leg-press exercise using HL-RE (eight repetitions at the intensity of 80% of one repetition maximum (1-RM)) and LL-RE (16 repetitions at the intensity of 40% 1-RM) in a randomized crossover sequence. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and rating of perceived exertion were measured at baseline, after each set of RE and post-exercise. No clinically relevant changes in HR and BP or in patient-reported symptoms were recorded during HL-RE or LL-RE. Compared with baseline, HR and SBP increased during LL-RE (from 66 bpm to 86 bpm, time effect: p < 0.001; from 129 mmHg to 146 mmHg, time effect: p < 0.001) and HL-RE (from 68 bpm to 86 bpm, time effect: p < 0.001; from 130 mmHg to 146 mmHg, time effect: p < 0.001). Compared with HL-RE, the increase in HR was greater after the final set of LL-RE (32% vs. 28%, p = 0.015), without significant differences in SBP and DBP between LL-RE and HL-RE. Rating of perceived exertion was higher after the 1st set of HL-RE compared with LL-RE (median (interquartile range): 6 (5–7) vs. 6 (5–6), p = 0.010). In patients with coronary artery disease, both HL-RE and LL-RE were safe and well-tolerated. Hemodynamic changes were similar and within the physiological response to RE. Full article
(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)
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Review

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Review
Six-Minute Walk Distance in Breast Cancer Survivors—A Systematic Review with Meta-Analysis
Int. J. Environ. Res. Public Health 2021, 18(5), 2591; https://doi.org/10.3390/ijerph18052591 - 05 Mar 2021
Cited by 1 | Viewed by 846
Abstract
The six-minute walk test (6MWT) is a widely used test for the indirect measurement of cardiorespiratory fitness in various cancer populations. Although the 6MWT is a simple test, there are no normative values for breast cancer survivors (BCS) or comparisons of results with [...] Read more.
The six-minute walk test (6MWT) is a widely used test for the indirect measurement of cardiorespiratory fitness in various cancer populations. Although the 6MWT is a simple test, there are no normative values for breast cancer survivors (BCS) or comparisons of results with healthy counterparts. A systematic review with a meta-analysis was carried out, which included studies from 2007 to 2020. Ninety-one studies were found, 21 of which were included in the quantitative synthesis. Among them were 9 randomized controlled trials (RCT), 8 prospective cohort studies and 4 cross-sectional studies. A total of 1084 BCS were included. Our results revealed that healthy subjects (n = 878) covered a significantly greater distance than BCS during the 6MWT (589.9 m vs. 477.4 m, p < 0.001), and the results of the meta-regression analysis showed that the 6MWD was predicted by the participants’ BMI (p < 0.001), but not by their age (p = 0.070). After adjustment for BMI, the healthy subjects also covered greater distances than the BCS (103 m; p < 0.001). The normative values of 6MWT were presented for BCS. Besides, 6MWT distances distinguish between their healthy counterparts, therefore, the 6MWT distance is a relevant parameter for the assessment and monitoring of cardiorespiratory fitness in medical and exercise interventions for BCS. Full article
(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)
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