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Insights and Innovations in Sports Cardiology
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Insights and Innovations in Sports Cardiology

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Sports Medicine".

Deadline for manuscript submissions: 20 July 2026 | Viewed by 9708

Special Issue Editor

Dr. Garyfallia K. Pepera

E-Mail Website
Guest Editor
Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
Interests: sports cardiology; pediatric fitness and cardiovascular assessment; cardiac rehabilitation; mobile health technologies; cardiovascular screening; sudden cardiac death prevention; exercise prescription; personalized exercise medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Sports cardiology is a dynamic and rapidly evolving field that bridges cardiovascular medicine and athletic performance. With growing participation in recreational and competitive sports across all ages, there is an increasing need to optimize cardiovascular health, manage inherited and acquired heart diseases, and provide safe return-to-play strategies. Innovations in diagnostic imaging, mobile health technologies, personalized exercise prescriptions, and preventive cardiology are transforming the landscape. Furthermore, the focus is expanding toward cardiac rehabilitation in athletes and differentiation of athlete’s heart from pathology.

A particularly important and emerging area of interest is pediatric fitness, where early cardiovascular assessment and promotion of physical activity in children and adolescents are crucial for lifelong heart health. Research into pediatric exercise testing, sports participation guidelines, and risk stratification for inherited cardiac conditions in young athletes is shaping preventive strategies and personalized interventions.

This Special Issue will explore the latest advancements and future directions in sports cardiology through original research, reviews, and clinical insights. Our goal is to enhance understanding, promote individualized care, and inspire innovation at the intersection of cardiovascular science, pediatric health, and sports medicine.

Topics will include the following:

  • Cardiovascular screening in athletes;
  • Management of arrhythmias in sports;
  • Mobile health and remote monitoring;
  • Personalized cardiac rehabilitation for athletes;
  • Sudden cardiac arrest and prevention strategies;
  • Exercise prescription in special cardiac populations;
  • Pediatric fitness and cardiovascular health.

Dr. Garyfallia K. Pepera
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • sports cardiology
  • athlete heart
  • cardiovascular screening
  • arrhythmias
  • sudden cardiac death
  • cardiac rehabilitation
  • exercise prescription
  • mobile health
  • preventive cardiology
  • personalized medicine
  • pediatric fitness

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Published Papers (5 papers)

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Research

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15 pages, 513 KB  
Article
Comparisons of Respiratory Function and Cardiorespiratory Responses Induced by the Modified Shuttle Walk Test in Children Finswimmers and Age-Matched Sedentary Non-Athletes
by Theano Michailidou, Aspasia Mavronasou and Eleni A. Kortianou
J. Clin. Med. 2026, 15(7), 2806; https://doi.org/10.3390/jcm15072806 - 7 Apr 2026
Viewed by 311
Abstract
Background: Regular aerobic exercise during childhood promotes critical physiological adaptations in the cardiovascular and respiratory system. Finswimming, a unique aquatic sport, requires high-intensity demands and specific breathing patterns. The present study aimed to compare respiratory function and cardiorespiratory responses between young male [...] Read more.
Background: Regular aerobic exercise during childhood promotes critical physiological adaptations in the cardiovascular and respiratory system. Finswimming, a unique aquatic sport, requires high-intensity demands and specific breathing patterns. The present study aimed to compare respiratory function and cardiorespiratory responses between young male finswimmers and sedentary age-matched non-athletes. Methods: Thirty-two boys aged 8 to 12 years old were stratified into the finswimmers group (FSG, n = 16) and the non-athletes group (NAG, n = 16). Assessments included pulmonary function (spirometry) and respiratory muscle strength (Maximum Inspiratory Pressure, MIP/Maximum Expiratory Pressure, MEP). Exercise capacity was evaluated using the modified shuttle walk test (MSWT). Results: The FSG exhibited significantly higher pulmonary function (Forced Vital Capacity, Forced Expiratory Volume in 1 s, Maximum Voluntary Ventilation; p < 0.05) and superior MIP compared to the NAG (105.3 ± 24.8 versus 87.3 ± 24.7 cmH2O; p = 0.022). During the MSWT, FSG covered substantially greater distances (746.6 ± 97.2 versus 591.1 ± 86.4 m; p < 0.001) with lower levels of leg fatigue (Borg 0–10) (0.53 ± 0.39 versus 2.13 ± 1.93; p = 0.004) and demonstrated lower heart rate recovery time (4.47 ± 0.68 versus 5.75 ± 0.68 min; p < 0.001) compared to NAG. At the iso-level (8th level of MSWT), FSG scored lower levels of leg fatigue (0.13 ± 0.12 versus 2.02 ± 2.0; p = 0.001) compared to NAG, indicating better peripheral oxygen % saturation (100 ± 0.0 versus 98.14 ± 1.16; p < 0.001). Conclusions: Systematic exercise training enhances profound cardiorespiratory and peripheral muscle adaptations in children. Enhanced cardiorespiratory function allows young athletes to achieve higher workloads and recover faster than sedentary peers, highlighting the sport’s role in establishing a robust cardiorespiratory fitness. Full article
(This article belongs to the Special Issue Insights and Innovations in Sports Cardiology)
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16 pages, 727 KB  
Article
Prolonging the Warm-Up Effect by Using Additional Respiratory Dead Space Volume After the Cessation of Warm-Up Exercise
by Paulina Hebisz, Rafał Hebisz and Natalia Danek
J. Clin. Med. 2025, 14(19), 7049; https://doi.org/10.3390/jcm14197049 - 6 Oct 2025
Cited by 2 | Viewed by 1166
Abstract
Background: After a warm-up and before the start of sports competition, athletes often take a break. During this break, the effects of the warm-up (e.g., capillary vasodilation) may diminish. The aim of this study was to compare cardiorespiratory responses during high-intensity physical [...] Read more.
Background: After a warm-up and before the start of sports competition, athletes often take a break. During this break, the effects of the warm-up (e.g., capillary vasodilation) may diminish. The aim of this study was to compare cardiorespiratory responses during high-intensity physical exercise, either preceded or not preceded by post-warm-up breathing, using an additional respiratory dead space volume mask (ARDSv). Methods: The study included 20 trained cyclists. Each participant completed two 3 min tests at an intensity of 110% of their maximal power, determined during a progressive test. A standardised warm-up preceded each 3 min test. Following the warm-up, there was an 8 min passive rest period. During this break, participants either breathed using ARDSv or breathed normally (non-ARDSv). The volume of the ARDSv mask was 1000 mL. Cardiorespiratory parameters were measured during the tests, including mean: oxygen uptake (VO2av), respiratory exchange ratio (RERav), respiratory rate (RRav), tidal volume (TVav), stroke volume (SVav), and rating of perceived exertion (RPE). Results: VO2peak was higher in participants breathing using ARDSv compared to non-ARDSv (4.22 ± 0.40 [CI: 4.03–4.41] vs. 3.98 ± 0.42 [CI: 3.79–4.18]; p = 0.002; t = 3.56; d = 0.585). Additionally, RERav (1.08 ± 0.06 [CI: 1.06–1.11] vs. 1.13 ± 0.06 [CI: 1.11–1.16]; p = 0.008; t = 2.96; d = 0.833) and RPE (18.0 ± 1.7 [CI: 17.3–18.8] vs. 18.9 ± 1.1 [CI: 18.4–19.4]; p = 0.009; Z = 2.61; r = 0.583) were lower in participants breathing using ARDSv compared to non-ARDSv. Conclusions: Breathing using ARDSv between warm-up and high-intensity exercise increases oxygen uptake and reduces perceived exertion, likely through peripheral mechanisms. These effects suggest practical applications in competitive sports and provide directions for further mechanistic research. Full article
(This article belongs to the Special Issue Insights and Innovations in Sports Cardiology)
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Review

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21 pages, 544 KB  
Review
Carbon Dioxide Inhalation—Risks for Health or Opportunity for Physical Fitness Development?
by Natalia Danek
J. Clin. Med. 2026, 15(1), 364; https://doi.org/10.3390/jcm15010364 - 3 Jan 2026
Cited by 1 | Viewed by 1628
Abstract
Background: Carbon dioxide (CO2) is traditionally regarded as a metabolic by-product; however, growing evidence indicates that it plays an active regulatory role across multiple physiological systems. Acute hypercapnia elicits respiratory, cardiovascular, metabolic, immune, and neurocognitive responses, some of which may [...] Read more.
Background: Carbon dioxide (CO2) is traditionally regarded as a metabolic by-product; however, growing evidence indicates that it plays an active regulatory role across multiple physiological systems. Acute hypercapnia elicits respiratory, cardiovascular, metabolic, immune, and neurocognitive responses, some of which may transiently influence exercise performance. This narrative review summarizes current evidence on CO2 inhalation in healthy individuals and critically evaluates whether controlled hypercapnia may serve as a targeted stimulus in sport and exercise contexts. Methods: A narrative review of peer-reviewed English-language articles indexed in PubMed and Web of Science was conducted. A narrative approach was chosen due to the marked heterogeneity of study designs, hypercapnia-induction methods (e.g., CO2 inhalation, voluntary hypoventilation, increased respiratory dead space), participant characteristics, and outcome measures, which precluded systematic synthesis. The review focused on studies involving healthy or physically active individuals and examined acute or short-term hypercapnic exposure. No strict publication date limits were applied. Studies conducted exclusively in clinical populations were excluded. Results: Short-term, controlled hypercapnia reliably increases ventilation, sympathetic activation, cerebral and muscular blood flow, and metabolic stress. Certain hypercapnia-based interventions—such as voluntary hypoventilation or added respiratory dead space—may enhance buffering capacity, reduce lactate accumulation and improve maximal oxygen uptake (VO2max) during submaximal efforts and repeated-sprint performance during high-intensity, short-duration exercise. However, CO2 inhalation frequently induces dyspnea, anxiety, and cognitive disruption, and higher concentrations pose clear safety risks. Current evidence does not support long-term improvements in VO2max or long-duration endurance performance following hypercapnia-based interventions. Conclusions: Controlled, intermittent hypercapnia may provide a targeted metabolic and ventilatory stimulus that enhances tolerance to high-intensity exercise, yet its application remains experimental and context-dependent. The risks associated with CO2 inhalation in healthy individuals currently outweigh its potential benefits, and safe, effective training protocols have not been fully established. Further research is needed to clarify the mechanisms, long-term adaptations, and practical utility of hypercapnia-based training strategies. Full article
(This article belongs to the Special Issue Insights and Innovations in Sports Cardiology)
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16 pages, 1196 KB  
Review
Reference Values for Cardiopulmonary Exercise Test in Children—How to Report Them Correctly?
by Przemysław Kasiak
J. Clin. Med. 2025, 14(22), 7989; https://doi.org/10.3390/jcm14227989 - 11 Nov 2025
Cited by 3 | Viewed by 1711
Abstract
Cardiopulmonary exercise testing (CPET) is a gold standard to assess cardiorespiratory fitness (CRF). CRF varied through the lifespan, increasing in children until early adulthood and then gradually declining. Reference values for CPET are used to check whether the child’s CRF falls within the [...] Read more.
Cardiopulmonary exercise testing (CPET) is a gold standard to assess cardiorespiratory fitness (CRF). CRF varied through the lifespan, increasing in children until early adulthood and then gradually declining. Reference values for CPET are used to check whether the child’s CRF falls within the normal range. The differences between directly measured and normative age-adjusted exercise data may suggest pathology and are helpful during the diagnostic process. Deriving reference values for children is particularly challenging. Moreover, many children participate in sports, some at an advanced/elite level, which translates into specific adaptations in CPET. The ATS/ACCP statement on CPET presented a checklist that should be followed when reporting reference values. However, the checklist originally focused on adults. This aggravates the quality of reporting pediatric reference values for CPET, making between-studies comparisons difficult. This review (1) presents a step-by-step protocol to fulfill all requirements from the ATS/ACCP statement in the pediatric population, and (2) summarizes the key challenges in deriving reference values for CPET in children, especially among pediatric athletes. Additional recommendations to enrich the quality of reporting reference values for CPET in pediatric athletes were also discussed. Full article
(This article belongs to the Special Issue Insights and Innovations in Sports Cardiology)
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Other

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15 pages, 1136 KB  
Systematic Review
Validity and Reliability of the Six-Minute Walking Test Compared to Cardiopulmonary Exercise Test in Individuals with Heart Failure Systematic Review and Meta-Analysis
by Garyfallia Pepera, Varsamo Antoniou, Eleni Karagianni, Ladislav Batalik and Jing Jing Su
J. Clin. Med. 2025, 14(23), 8303; https://doi.org/10.3390/jcm14238303 - 22 Nov 2025
Cited by 3 | Viewed by 4431
Abstract
Background: Reduced cardiorespiratory fitness along with poor exercise tolerance are regarded as potential morbidity and mortality predictors within the heart failure (HF) population. Despite the reliability and accuracy of the gold-standard cardiopulmonary exercise test (CPET) for assessing cardiorespiratory fitness, its complexity and tolerability [...] Read more.
Background: Reduced cardiorespiratory fitness along with poor exercise tolerance are regarded as potential morbidity and mortality predictors within the heart failure (HF) population. Despite the reliability and accuracy of the gold-standard cardiopulmonary exercise test (CPET) for assessing cardiorespiratory fitness, its complexity and tolerability issues among HF patients mean that the 6 min walk test (6MWT) is a cost-saving and well-tolerated complementary assessment. We aimed to systematically review the validity, reliability, and safety of the 6MWT compared to CPET for patients with HF. Methods: This study is a systematic review and meta-analysis. Embase, Medline, and Scopus were searched from inception to November 2023. We applied Fisher’s z-transformation to correlation coefficients and pooled effects under a random-effects model; heterogeneity (I2), leave-one-out sensitivity, and Egger’s test were reported. Results: Twenty studies were finally included, involving 5379 HF participants. A significant moderately strong positive correlation was shown between the 6MWT distance and CPET peak oxygen consumption: (r) = 0.62, 95% CI 0.58–0.66; I2 = 56.95%; p < 0.001. The results showed an excellent test–retest reliability, with a pooled intraclass correlation coefficient of 0.93 (95% CI 0.89–0.95; I2 = 92.06%; p < 0.001). A pooled weighted mean difference of 15.5 m (95% CI 10.2–20.8) was found for the learning effect between the first and second 6MWT. Although some patients required rest stops or reported symptoms such as fatigue or dyspnea, no 6MWTs were terminated due to serious adverse events. Conclusions: Compared with CPET, the 6MWT distance demonstrated a moderately strong correlation with peak VO2, excellent test–retest reliability, and a small learning effect. The 6MWT can therefore complement CPET or serve as a pragmatic alternative when CPET is not feasible; it does not replace comprehensive CPET assessment. Full article
(This article belongs to the Special Issue Insights and Innovations in Sports Cardiology)
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