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Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Exercise and Health-Related Quality of Life".

Deadline for manuscript submissions: 30 June 2027 | Viewed by 4587

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Editors

Dr. Lucieli Teresa Cambri

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Guest Editor

Postgraduate Program in Physical Education, Federal University of Mato Grosso, Cuiabá 78060-900, Brazil
Interests: obesity; blood pressure; family history of chronic diseases; stress reactivity; physical exercise; aerobic fitness; aerobic exercise; autonomic cardiac modulation; occupational health

Dr. Ana Carolina Ghezzi

E-Mail Website1 Website2
Guest Editor

Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA
Interests: obesity; type 2 diabetes mellitus; insulin resistance; high blood pressure; metabolic syndrome; aging; epigenetic pathways; physical activity; aerobic exercise

Special Issue Information

Dear Colleagues,

Cardiovascular diseases are the leading cause of death worldwide. The main risk factors include high blood pressure, high cholesterol, diabetes mellitus, obesity, a sedentary lifestyle, poor diet, stress, and family history/genetics. Physical activity and regular exercise represent a non-pharmacological strategy for the prevention and control of most cardiovascular risk factors and are widely recommended by medical and scientific guidelines around the world. Physical activity and exercise have been recognized as essential for promoting, maintaining, and restoring cardiovascular and metabolic health. In recent years, research has increasingly focused on understanding the mechanisms through which physical activity and exercise programs influence various health outcomes. This Special Issue aims to compile research that examines the effects of physical activity and exercise on individuals with risk factors for cardiovascular diseases. Contributions may include experimental designs, cross-sectional studies, longitudinal studies, systematic reviews, meta-analyses, and methodological innovations that deepen our understanding of the role of physical activity and exercise in cardiovascular and metabolic health. Ultimately, this Special Issue aims to provide an up-to-date overview of the evidence supporting physical activity and exercise as key strategies for enhancing metabolic and cardiovascular health.

Dr. Lucieli Teresa Cambri
Dr. Ana Carolina Ghezzi
Guest Editors

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Keywords

aerobic exercise
behavioral interventions
blood pressure
environmental factors
non-communicable diseases
obesity
physical activity
physical exercise
prevention
trainning
tratament

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Published Papers (5 papers)

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Research

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15 pages, 998 KB

Open AccessArticle

Perceived Exertion Is Associated with Cardiovascular Strain but Not Glycemic Response to Gym-Based Exercise in Adults with Type 1 Diabetes: An Exploratory Randomized Crossover Trial

by José Adevalton Feitosa Gomes, Anthony Rodrigues de Vasconcelos, José Roberto Andrade do Nascimento Júnior, Ysadora Verena Ribeiro de Souza, Fabiana Oliveira dos Santos Camatari, Bruno Bavaresco Gambassi, Manoel da Cunha Costa, Paulo Adriano Schwingel and Jorge Luiz de Brito Gomes

Int. J. Environ. Res. Public Health 2026, 23(6), 814; https://doi.org/10.3390/ijerph23060814 - 19 Jun 2026

Viewed by 321

Abstract

Adults with type 1 diabetes mellitus (T1DM) face elevated cardiovascular risk, and regular exercise is a key non-pharmacological mitigation strategy. However, safe prescription requires cardiovascular and glycemic monitoring, often unfeasible in real-world gyms. Low-cost psychophysiological tools (ratings of perceived exertion—RPE and enjoyment) may offer practical alternatives. This exploratory randomized crossover trial examined whether post-session RPE and enjoyment are associated with acute heart rate (HR) and capillary blood glucose (BG) responses to gym-based aerobic and resistance training. Twelve adults with T1DM (29.8 ± 7.8 years; HbA1c 7.7 ± 1.6%; LDL-c 119.5 ± 24.4 mg/dL) completed three ~30 min sessions: aerobic interval training (AE) and two resistance protocols (STA, STB). HR and BG were measured pre-, immediately post-, and 20 min post-exercise; RPE and enjoyment, post-session. Multiple linear regression, controlling for exercise session type, examined associations of RPE and enjoyment with resting HR, BG, and percentage of heart rate reserve (%HR). RPE was higher after STA and STB than AE (p < 0.001; η²p = 0.529), while enjoyment and %HR were similar across sessions. Neither variable was associated with resting HR or BG (all adjusted R² < 0; all p > 0.05). Controlling for exercise session type, RPE was a significant positive predictor of %HR (β = 0.44, p = 0.044), whereas enjoyment was not (β = −0.06, p = 0.719); however, the overall %HR model did not reach statistical significance (adjusted R² =0.119; F(4,31) = 2.183; p = 0.094). These exploratory findings suggest that RPE, but not enjoyment, may serve as a low-cost adjunct intensity marker to inform exercise prescription in adults with T1DM at elevated cardiovascular risk; however, replication in larger samples is needed before clinical recommendations can be drawn. Direct BG monitoring remains essential for safety. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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24 pages, 586 KB

Open AccessArticle

Effects of a Synchronous Telehealth Exercise Program on Clinical, Functional, and Psychosocial Outcomes in Individuals with Type 2 Diabetes Mellitus (RED Study): A Randomized Clinical Trial

by Samara Nickel Rodrigues, Bruno Veiga Guterres, Maurício Tatsch Ximenes Carvalho, Rodrigo Sudatti Delevatti and Cristine Lima Alberton

Int. J. Environ. Res. Public Health 2026, 23(6), 773; https://doi.org/10.3390/ijerph23060773 - 8 Jun 2026

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Abstract

Individuals with type 2 diabetes mellitus (T2D) are at increased cardiovascular risk. Although exercise is an important strategy for reducing cardiometabolic risk, accessible and scalable intervention delivery strategies, such as synchronous telehealth programs, remain underexplored. This randomized clinical trial (RED Study; NCT05362071) investigated the effects of a 12-week synchronous telehealth exercise program on clinical, functional, and psychosocial outcomes in adults with T2D. Thirty-three participants (55.8 ± 10.1 years) were randomized to an intervention group (INT; n = 17), which performed supervised combined aerobic and resistance exercise via video calls (2–3 sessions/week), or a control group (CON; n = 16). Glycated hemoglobin (HbA1c) was the primary outcome. Secondary outcomes included capillary blood glucose, blood pressure, functional performance, and psychosocial parameters. Assessments were conducted at baseline and post-intervention by blinded evaluators, and analyses were conducted using linear mixed-effects models in an intention-to-treat analysis. No significant interaction effect was observed for HbA1c (p > 0.05). However, significant group × time interactions favored the INT for functional performance outcomes, including the 30 s Chair Stand (p = 0.02), Arm Curl (p < 0.001), Timed Up and Go (p = 0.01), and 2-Minute Step Test (p = 0.01), as well as sleep quality (p < 0.001). Depressive symptoms decreased over time (p = 0.03) in both groups. Additionally, the INT showed reductions in post-session capillary blood glucose across mesocycles 1, 2, and 4 (p = 0.03). The synchronous telehealth exercise program was not superior to the control condition in reducing HbA1c; however, it improved functional performance, enhanced sleep quality, and promoted acute reductions in glycemic levels in individuals with T2D. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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12 pages, 427 KB

Open AccessArticle

Moderate-Intensity Aerobic Exercise Induces Ambulatory Hypotension in Young Adults with a Family History of Hypertension

by Marilene Gonçalves Queiroz, Karen Dennise Lozada Tobar, Amílcar Sabino Damazo and Lucieli Teresa Cambri

Int. J. Environ. Res. Public Health 2026, 23(5), 602; https://doi.org/10.3390/ijerph23050602 - 2 May 2026

Viewed by 585

Abstract

This randomized crossover study aimed to evaluate the effect of a single session of aerobic exercise on 24 h ambulatory blood pressure (BP) and heart rate variability (HRV) in young adults with a family history of hypertension, FHH⁺ (participant with at least one hypertensive parent). Twenty non-hypertensive individuals (four females, sixteen males, 24.84 ± 4.15 years, 23.97 ± 3.28 kg·m⁻²) underwent a control (non-exercise) and an experimental (aerobic exercise) session in a randomized order, with a minimum interval of 72 h between them. Baseline anthropometric and metabolic parameters included body fat percentage, abdominal circumference, and blood glucose. The aerobic session consisted of 30 min cycling at 50–60% of heart rate reserve (142 ± 5 bpm; 68 ± 23 W). Twenty-four-hour BP and HRV were assessed by ambulatory monitoring. Two-way repeated-measures ANOVA showed a significant main effect of session (exercise vs. control) for systolic (p = 0.026, η² = 0.084) and diastolic (p = 0.022, η² = 0.088) BP, with no session × time (awake vs. asleep) interaction. For HRV indices, there were no significant (p > 0.05) main effects of session, nor any interaction between session and time. In summary, aerobic exercise induced 24 h ambulatory hypotension during both awake and sleep periods in non-hypertensive individuals with FHH⁺, without altering ambulatory HRV. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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11 pages, 665 KB

Open AccessArticle

Effects of Combined Training on Visceral Adiposity Index and Metabolic Phenotype in Obesity: A Randomized Clinical Trial

by Júlia Elena Fontana Ronsani, Mariana Papini Gabiatti, Anne Ribeiro Streb, Rodrigo Sudatti Delevatti, Giovani Firpo Del Duca and Fernanda Hansen

Int. J. Environ. Res. Public Health 2025, 22(9), 1462; https://doi.org/10.3390/ijerph22091462 - 22 Sep 2025

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Abstract

Introduction: The role of obesity in developing metabolic alterations is related to the distribution of adipose tissue, and visceral fat predisposes people to a higher risk than subcutaneous fat. The effect of different forms of periodization of combined training is still unknown in reducing cardiometabolic risk in adults with obesity. This randomized clinical trial aims to compare the effects of 16 weeks of periodized combined training with fixed and linear increase intensities on individuals with obesity, using the visceral adiposity index (VAI) and metabolic phenotype. Methods: In total, 59 adults with obesity (61.0% female) were allocated into three groups: control (CG, 34.4 ± 6.9 years; BMI, 33.0 ± 2.5 kg.m⁻²), combined training with fixed intensity (FG, 33.6 ± 8.4 years; BMI, 32.9 ± 2.3 kg.m⁻²), and linear increase intensity (LG, 34.5 ± 6.0 years; BMI, 33.4 ± 2.8 kg.m⁻²) in a 1:1:1 ratio. VAI equations were used with waist circumference, triglycerides, BMI, and HDL-c. The metabolic phenotype was defined by the presence of >3 abnormalities of the following: systolic/diastolic blood pressure, triglycerides, HDL-c, fasting blood glucose, and waist circumference, classified as metabolically healthy and unhealthy (MHO; MUO). Intra- and intergroup analyses were performed per protocol (PP) and intention-to-treat (ITT) using the Generalized Estimated Equations method. p < 0.10 was the level of significance adopted for interaction, and p < 0.05 was the level of significance for the isolated effect of time and/or group. Results: VAI decreased in FG (p < 0.001) in PP and ITT analyses, but not in LG in either analysis (p > 0.05). There was a higher number of MUO in FG compared to LG, only in PP, considering the effect of group analysis (p < 0.01), but not of time or group * time or ITT analyses (p > 0.05). Conclusions: Combined training with fixed intensity improved VAI but was insufficient to affect metabolic phenotype. These findings suggest minimal differences between fixed intensity and linear increase protocols in reducing the risk of metabolic complications during obesity treatment. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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11 pages, 578 KB

Open AccessBrief Report

Comparison of Heart Rate Variability Between Sexes: Impact of a Physically Active Lifestyle

by Reberth Magalhães Da Silva, Ariane Viana, Fernanda Monma, Fernando Alves Santa Rosa, José Robertto Zaffalon, Jr. and Kátia De Angelis

Int. J. Environ. Res. Public Health 2026, 23(6), 809; https://doi.org/10.3390/ijerph23060809 - 18 Jun 2026

Viewed by 384

Abstract

Sex differences and lifestyle factors such as physical activity play an important role in cardiovascular autonomic regulation. Heart rate variability (HRV) is a widely used marker of cardiac autonomic modulation and cardiovascular health. However, the combined influence of sex and physical activity levels on HRV in young, healthy adults has not been sufficiently explored. Therefore, this study investigated the effects of sex and a physically active lifestyle on HRV in men and women. A cross-sectional study was conducted on a cohort of young, healthy adults aged 18–30 and categorized into four groups based on: physically active men (AM; n = 37), sedentary men (SM; n = 44), and physically active women (AW; n = 31) and sedentary women (SW; n = 40). Regarding the impact of lifestyle, the AM group exhibited 41% higher total variance (VAR-RR) and 34% higher RMSSD (a parasympathetic index) than the SM group. The AW exhibited 74% and 78% higher VAR-RR and RMSSD, respectively, compared to the SW. Furthermore, the physically active groups (AM and AW) displayed a 75% and 50% lower LF/HF ratio, respectively, compared to their sedentary counterparts. Interestingly, the LF/HF ratio was 66% higher, and the RMSSD was 20% lower in the AM group than in the AW group. HRV indices demonstrated large to very large effect sizes. In conclusion, these findings demonstrate significantly advantage in cardiac autonomic modulation among physically active individuals and women. Together, these results reinforce the roles of female sex and an active lifestyle as important protective factors for cardiovascular health. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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