Special Issue "Cardiovascular Rehabilitation"

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

Deadline for manuscript submissions: closed (31 May 2020).

Special Issue Editor

Dr. Filippo M. Sarullo
Website
Guest Editor
Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Via Messina Marine 197, 90123, Palermo, Italy
Interests: acute and chronic heart failure; acute and chronic ischemic heart diseases; exercise physiology; cardiovascular rehabilitation

Special Issue Information

Dear Colleagues,

In developed countries, cardiovascular disease (CVD) remains the main cause of death and disability, despite the gradual decline in disease rates experienced over the last few decades. The way in which CVD is treated has huge implications for patients, health professionals, and policymakers. In fact, once a person has a cardiac event, such as a heart attack, the prevention of further heart attacks, or death, is crucial. Secondary prevention through cardiac rehabilitation (CR) is a key component of the ongoing care of these patients immediately following discharge from a hospital. Today, CR is widely accepted as a proven program that provides health benefits and long-term management of cardiac conditions. CR programs offer a cost-effective, multidisciplinary, and comprehensive approach to addressing risk factors and restoring individuals to their optimal physiological, psychosocial, nutritional, and functional status, thereby reducing morbidity and mortality and improving health and wellness.

In this Special Issue, we will examine more closely recent innovations and advancements in cardiac rehabilitation, especially in heart failure patients and in heart cardiac surgery patients. Moreover, we will also address best practices from across the global community, establishing key examples and/or predictors of success in cardiac rehabilitation settings. Through this Special Issue, we will point out the most relevant evidence on health and wellness benefits associated with cardiac rehabilitation, and the key predictors of success.

Dr. Filippo M. Sarullo
Guest Editor

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Keywords

  • cardiac rehabilitation
  • cardiopulmonary exercise stress testing
  • cardiac rehabilitation in chronic heart failure
  • cardiac rehabilitation in peripheral artery disease
  • primary and secondary prevention of chronic disease
  • cardiac rehabilitation in heart surgery patients
  • prescription of exercise
  • lifestyle intervention

Published Papers (12 papers)

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Research

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Open AccessArticle
Sacubitril/Valsartan Improves Autonomic Function and Cardiopulmonary Parameters in Patients with Heart Failure with Reduced Ejection Fraction
J. Clin. Med. 2020, 9(6), 1897; https://doi.org/10.3390/jcm9061897 - 17 Jun 2020
Abstract
Background: Heart rate recovery (HRR) is a marker of vagal tone, which is a powerful predictor of mortality in patients with cardiovascular disease. Sacubitril/valsartan (S/V) is a treatment for heart failure with reduced ejection fraction (HFrEF), which impressively impacts cardiovascular outcome. This study [...] Read more.
Background: Heart rate recovery (HRR) is a marker of vagal tone, which is a powerful predictor of mortality in patients with cardiovascular disease. Sacubitril/valsartan (S/V) is a treatment for heart failure with reduced ejection fraction (HFrEF), which impressively impacts cardiovascular outcome. This study aims at evaluating the effects of S/V on HRR and its correlation with cardiopulmonary indexes in HFrEF patients. Methods: Patients with HFrEF admitted to outpatients’ services were screened out for study inclusion. S/V was administered according to guidelines. Up-titration was performed every 4 weeks when tolerated. All patients underwent laboratory measurements, Doppler-echocardiography, and cardiopulmonary exercise stress testing (CPET) at baseline and at 12-month follow-up. Results: Study population consisted of 134 HFrEF patients (87% male, mean age 57.9 ± 9.6 years). At 12-month follow-up, significant improvement in left ventricular ejection fraction (from 28% ± 5.8% to 31.8% ± 7.3%, p < 0.0001), peak exercise oxygen consumption (VO2peak) (from 15.3 ± 3.7 to 17.8 ± 4.2 mL/kg/min, p < 0.0001), the slope of increase in ventilation over carbon dioxide output (VE/VCO2 slope )(from 33.4 ± 6.2 to 30.3 ± 6.5, p < 0.0001), and HRR (from 11.4 ± 9.5 to 17.4 ± 15.1 bpm, p = 0.004) was observed. Changes in HRR were significantly correlated to changes in VE/VCO2slope (r = −0.330; p = 0.003). After adjusting for potential confounding factors, multivariate analysis showed that changes in HRR were significantly associated to changes in VE/VCO2slope (Beta (B) = −0.975, standard error (SE) = 0.364, standardized Beta coefficient (Bstd) = −0.304, p = 0.009). S/V showed significant reduction in exercise oscillatory ventilation (EOV) detection at CPET (28 EOV detected at baseline CPET vs. 9 EOV detected at 12-month follow-up, p < 0.001). HRR at baseline CPET was a significant predictor of EOV at 12-month follow-up (B = −2.065, SE = 0.354, p < 0.001). Conclusions: In HFrEF patients, S/V therapy improves autonomic function, functional capacity, and ventilation. Whether these findings might translate into beneficial effects on prognosis and outcome remains to be elucidated. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Open AccessArticle
Validation of FRIEND and ACSM Equations for Cardiorespiratory Fitness: Comparison to Direct Measurement in CAD Patients
J. Clin. Med. 2020, 9(6), 1889; https://doi.org/10.3390/jcm9061889 - 17 Jun 2020
Abstract
The regression equation of the American College of Sports Medicine (ACSM) was a preferred method for estimating maximal oxygen consumption (VO2max). Recently, a more precise equation from the fitness registry and the importance of exercise national database (FRIEND) for healthy people was developed. [...] Read more.
The regression equation of the American College of Sports Medicine (ACSM) was a preferred method for estimating maximal oxygen consumption (VO2max). Recently, a more precise equation from the fitness registry and the importance of exercise national database (FRIEND) for healthy people was developed. This study compared VO2max estimated by the ACSM and FRIEND equations to VO2max directly measured in coronary artery disease (CAD) patients. Overall, 293 CAD patients who participated in cardiac rehabilitation between June 2015 and December 2018 were analyzed. Directly measured VO2max values were compared to the ACSM and FRIEND equations. The directly measured VO2max was significantly different from the estimated VO2max by ACSM equation (24.16 vs. 28.7 mL/kg/min, p < 0.001), which was overestimated by 20% in men and 16% in women. However, there was no statistically significant difference between the directly measured VO2max and the estimated VO2max by the FRIEND equation. (24.16 vs. 24.15 mL/kg/min, p = 0.986). In CAD patients, the estimated VO2max from the ACSM equation was significantly higher than the directly measured VO2max. In addition, estimated cardiorespiratory fitness (CRF) by the FRIEND equation showed similar results with directly measured CRF. As a result, the FRIEND equation can predict CRF more accurately than the ACSM. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Open AccessArticle
Impact of Improvement in Walking Speed on Hospitalization and Mortality in Females with Cardiovascular Disease
J. Clin. Med. 2020, 9(6), 1755; https://doi.org/10.3390/jcm9061755 - 05 Jun 2020
Abstract
Cardiovascular disease (CVD) is the principal cause of death in women. Walking speed (WS) is strongly related with mortality and CVD. The rate of all-cause hospitalization or death was assessed in 290 female outpatients with CVD after participation in a cardiac rehabilitation/secondary prevention [...] Read more.
Cardiovascular disease (CVD) is the principal cause of death in women. Walking speed (WS) is strongly related with mortality and CVD. The rate of all-cause hospitalization or death was assessed in 290 female outpatients with CVD after participation in a cardiac rehabilitation/secondary prevention program (CR/SP) and associated with the WS maintained during a moderate 1 km treadmill-walk. Three-year mortality rates were 57%, 44%, and 29% for the slow (2.1 ± 0.4 km/h), moderate (3.1 ± 0.3 km/h), and fast (4.3 ± 0.6 km/h) walkers, respectively, with adjusted hazard ratios (HRs) of 0.78 (p = 0.24) and 0.55 (p = 0.03) for moderate and fast walkers compared to the slow walkers. In addition, hospitalization or death was examined four to six years after enrollment as a function of the change in the WS of 176 patients re-assessed during the third year after baseline. The rates of hospitalization or death were higher across tertiles of reduced WS, with 35%, 50%, and 53% for the high (1.5 ± 0.3 km/h), intermediate (0.7 ± 0.2 km/h), and low tertiles (0.2 ± 0.2 km/h). Adjusted HRs were 0.79 (p = 0.38) for the intermediate and 0.47 (p = 0.02) for the high tertile compared to the low improvement tertile. Improved walking speed was associated with a graded decrease in hospitalization or death from any cause in women undergoing CR/SP. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Open AccessArticle
Preliminary Pilot Study of Combined Effects of Physical Activity and Achievement of LDL-Cholesterol Target on Coronary Plaque Volume Changes in Patients with Acute Coronary Syndrome
J. Clin. Med. 2020, 9(5), 1578; https://doi.org/10.3390/jcm9051578 - 22 May 2020
Abstract
Background: We investigated the combined effects of physical activity (PA) and aggressive low-density lipoprotein cholesterol (LDL-C) reduction on the changes in coronary plaque volume (PV) in patients with acute coronary syndrome (ACS) using volumetric intravascular ultrasound (IVUS) analysis. Methods: We retrospectively analyzed data [...] Read more.
Background: We investigated the combined effects of physical activity (PA) and aggressive low-density lipoprotein cholesterol (LDL-C) reduction on the changes in coronary plaque volume (PV) in patients with acute coronary syndrome (ACS) using volumetric intravascular ultrasound (IVUS) analysis. Methods: We retrospectively analyzed data from two different prospective clinical trials that involved 101 ACS patients who underwent percutaneous coronary intervention (PCI) and assessed the non-culprit sites of PCI lesions using IVUS at baseline and at the follow-up. After PCI, all the patients participated in early phase II comprehensive cardiac rehabilitation. Patients were divided into four groups based on whether the average daily step count, measured using a pedometer, was 7000 steps of more and whether the follow-up LDL-C level was <70 mg/dL. At the time of follow-up, we examined the correlation of changes in the PV with LDL-C and PA. Results: The baseline characteristics of the four study groups were comparable. At the follow-up, plaque regression in both the achievement group (PA and LDL-C reduction) was higher than that in the other three groups. In addition, plaque reduction independently correlated with increased PA and reduction in LDL-C level. Conclusions: Combined therapy of intensive PA and achievement of LDL-C target retarded coronary PV in patients with ACS. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Open AccessArticle
Assessment of Measurement Reliability for the IPN Test in Cardiac Patients
J. Clin. Med. 2020, 9(5), 1552; https://doi.org/10.3390/jcm9051552 - 21 May 2020
Abstract
Cardiological diagnostics use maximal and submaximal tests with increasing load. Maximal stress tests are currently considered the gold standard. The Institut für Prävention und Nachsorge, Cologne (IPN) test may be an alternative when maximal patient load is not indicated. The universality of the [...] Read more.
Cardiological diagnostics use maximal and submaximal tests with increasing load. Maximal stress tests are currently considered the gold standard. The Institut für Prävention und Nachsorge, Cologne (IPN) test may be an alternative when maximal patient load is not indicated. The universality of the test is well-documented in sport, but the reliability of this test is unknown. The aim of this study was to assess between-trial and between-day reliability for parameters assessed by the IPN stress test in cardiological patients.: In a study of 24 patients aged 39 to 79 years with cardiovascular diseases, the IPN cycle ergometer short test was performed (submaximal performance test). The reliability of heart rate, systolic and diastolic pressure, absolute power at submaximal load, relative performance at submaximal load and target heart rate were assessed. Good (Interclass Correlation Coefficient (ICC) values ranged from 0.832 to 0.894) and excellent (ICC values ranged from 0.904 to 0.969) between-trial reliability was noted. Between-day reliability was good (ICC values from 0.777 to 0.895) and excellent (ICC values from 0.922 to 0.950). The obtained results suggest that the IPN test may be a reliable tool for use in the assessment of cardiological patients, avoiding the implementation of maximal efforts when excessive patient load is not recommended. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
Open AccessArticle
Association between Very Low-Density Lipoprotein Cholesterol (VLDL-C) and Carotid Intima-Media Thickness in Postmenopausal Women Without Overt Cardiovascular Disease and on LDL-C Target Levels
J. Clin. Med. 2020, 9(5), 1422; https://doi.org/10.3390/jcm9051422 - 11 May 2020
Abstract
Background: atherosclerotic process inexorably advances in patients reaching low-density lipoprotein cholesterol (LDL-C) targets. An attractive hypothesis is that lipoprotein particles (very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL)), could contribute to residual risk. The present study aims to investigate the relationship between carotid intima-media [...] Read more.
Background: atherosclerotic process inexorably advances in patients reaching low-density lipoprotein cholesterol (LDL-C) targets. An attractive hypothesis is that lipoprotein particles (very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL)), could contribute to residual risk. The present study aims to investigate the relationship between carotid intima-media thickness (IMT) and different lipoprotein subfractions in a cohort of healthy postmenopausal women. Methods: 75 postmenopausal women, at LDL-C target levels without overt cardiovascular disease, underwent biochemical analyses (including subfraction assay of plasma lipoproteins) and carotid ultrasound examination. Results: a statistically significant correlation between VLDL and carotid IMT (p < 0.001) was found. No significant correlation was found between carotid IMT and LDL-C (p = 0.179), IDL-C (p = 0.815), high-density lipoprotein (HDL) (p = 0.855), and LDL score (p = 0.240). Moreover, IMT is significantly correlated to LDL particle diameter (p = 0.044). After adjusting for age, systolic blood pressure, body mass index, smoking habits, glucose plasma concentration, and Lipoprotein(a) (Lpa) levels, multivariate analysis showed that women in the third tertile of VLDL-C, compared with those in the first tertile, were significantly associated to the highest IMT (p = 0.04). Conclusions: in this cohort of postmenopausal women, VLDL-C was significantly associated to carotid IMT, independent of main cardiovascular risk factors. These findings pave the way for targeting circulating concentrations of VLDL-C to reduce cardiovascular events in patients with target LDL-C levels. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Open AccessArticle
Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure
J. Clin. Med. 2020, 9(4), 952; https://doi.org/10.3390/jcm9040952 - 30 Mar 2020
Abstract
Respiratory muscle weakness, frequently observed in patients with heart failure (HF), is reported as a predictor for poor prognosis. Although increased respiratory muscle strength ameliorates exercise tolerance and quality of life in HF patients, the relationship between changes in respiratory muscle strength and [...] Read more.
Respiratory muscle weakness, frequently observed in patients with heart failure (HF), is reported as a predictor for poor prognosis. Although increased respiratory muscle strength ameliorates exercise tolerance and quality of life in HF patients, the relationship between changes in respiratory muscle strength and patient prognosis remains unclear. A total of 456 patients with HF who continued a 5-month cardiac rehabilitation (CR) were studied. We measured maximal inspiratory pressure (PImax) at hospital discharge as the baseline and five months thereafter to assess the respiratory muscle strength. Changes in PImax during the 5-month observation period (⊿PImax) were examined. We investigated the composite multiple incidence of all-cause death or unplanned readmission after 5-month CR. The relationship between ⊿PImax and the incidence of clinical events was analyzed. Over a median follow-up of 1.8 years, 221 deaths or readmissions occurred, and their rate of incidence was 4.3/100 person-years. The higher ⊿PImax was significantly associated with lower incidence of clinical event. In multivariate Poisson regression model after adjustment for clinical confounding factors, ⊿PImax remained a significant and independent predictor for all-cause death/readmission (adjusted incident rate ratio for ⊿PImax increase of 10 cmH2O: 0.77, 95% confidence interval: 0.70–0.86). In conclusion, the changes in respiratory muscle strength independently predict the incidence of clinical events in patients with HF. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Open AccessArticle
Reference Values for Cardiorespiratory Fitness in Healthy Koreans
J. Clin. Med. 2019, 8(12), 2191; https://doi.org/10.3390/jcm8122191 - 12 Dec 2019
Cited by 1
Abstract
We investigated reference values for cardiorespiratory fitness (CRF) for healthy Koreans and Koreans with coronary heart disease (CHD) and used them to identify inter-ethnic differences in CRF, differences over time in CRF, and differences in CRF between the healthy population and patients with [...] Read more.
We investigated reference values for cardiorespiratory fitness (CRF) for healthy Koreans and Koreans with coronary heart disease (CHD) and used them to identify inter-ethnic differences in CRF, differences over time in CRF, and differences in CRF between the healthy population and patients with CHD. The study population for healthy Koreans was derived from the database of KISS FitS (Korea Institute of Sports Science Fitness Standards) between 2014 and 2015. The study population for Koreans with CHD was derived from the database of the Korea University Guro Hospital Cardiac Rehabilitation Registry between June 2015 and December 2018. In healthy Koreans, there was a significant difference between sex and age groups for VO2 max. The VO2 max of healthy Koreans differed from that of Westerners in age-related reference values. Our results were not significantly different from those of the Korean population in the past, except for a small decline in the young population. There seemed to be a clear inter-ethnic difference in CRF. We could also identify signs of small change in CRF in younger age groups. Therefore, CRF should be assessed according to ethnic or national standards, and it will be necessary to establish a reference for each nation or ethnicity with periodic updates. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Open AccessArticle
Fat Mass Index Better Identifies Metabolic Syndrome: Insights from Patients in Early Outpatient Cardiac Rehabilitation
J. Clin. Med. 2019, 8(12), 2147; https://doi.org/10.3390/jcm8122147 - 05 Dec 2019
Abstract
Body mass index (BMI) does not differentiate fat and lean mass or the distribution of adipose tissue. The purpose of this study was to examine the prevalence of metabolic syndrome (MetS) among patients entering outpatient cardiac rehabilitation (CR) across fat mass index (FMI) [...] Read more.
Body mass index (BMI) does not differentiate fat and lean mass or the distribution of adipose tissue. The purpose of this study was to examine the prevalence of metabolic syndrome (MetS) among patients entering outpatient cardiac rehabilitation (CR) across fat mass index (FMI) categories compared with BMI. This retrospective cross-sectional study evaluated dual-energy x-ray absorptiometry in 483 CR patients from 1 January 2014, through 31 December 2017. Clinical data were extracted from the electronic health record. Patients were grouped by FMI and BMI categories. Mean (SD) age of patients was 64.3 (14) years. The normal FMI category had 15 patients; excess fat, 74; and obese, 384. In contrast, 93, 174, and 216 were in the normal, overweight, and obese BMI categories, respectively. Prevalence of MetS was 0 (0%) in normal, 5 (1%) in excess fat, and 167 (54%) in obese FMI, with 97% in the obese category. MetS prevalence was 4 patients (0.8%) in normal, 39 (8%) in overweight, and 129 (27%) in obese BMI categories, with 75% of MetS in the obese category. FMI more accurately classified CR patients with metabolically abnormal fat (p < 0.001). FMI is a more sensitive index than BMI for metabolically abnormal fat of outpatient CR patients. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Review

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Open AccessReview
Oncology and Cardiac Rehabilitation: An Underrated Relationship
J. Clin. Med. 2020, 9(6), 1810; https://doi.org/10.3390/jcm9061810 - 10 Jun 2020
Abstract
Cancer and cardiovascular diseases are globally the leading causes of mortality and morbidity. These conditions are closely related, beyond that of sharing many risk factors. The term bidirectional relationship indicates that cardiovascular diseases increase the likelihood of getting cancer and vice versa. The [...] Read more.
Cancer and cardiovascular diseases are globally the leading causes of mortality and morbidity. These conditions are closely related, beyond that of sharing many risk factors. The term bidirectional relationship indicates that cardiovascular diseases increase the likelihood of getting cancer and vice versa. The biological and biochemical pathways underlying this close relationship will be analyzed. In this new overlapping scenario, physical activity and exercise are proven protective behaviors against both cardiovascular diseases and cancer. Many observational studies link an increase in physical activity to a reduction in either the development or progression of cancer, as well as to a reduction in risk in cardiovascular diseases, a non-negligible cause of death for long-term cancer survivors. Exercise is an effective tool for improving cardio-respiratory fitness, quality of life, psychological wellbeing, reducing fatigue, anxiety and depression. Finally, it can counteract the toxic effects of cancer therapy. The protection obtained from physical activity and exercise will be discussed in the various stages of the cancer continuum, from diagnosis, to adjuvant therapy, and from the metastatic phase to long-term effects. Particular attention will be paid to the shelter against chemotherapy, radiotherapy, cardiovascular risk factors or new onset cardiovascular diseases. Cardio-Oncology Rehabilitation is an exercise-based multi-component intervention, starting from the model of Cardiac Rehabilitation, with few modifications, to improve care and the prognosis of a patient’s cancer. The network of professionals dedicated to Cardiac Rehabilitation is a ready-to-use resource, for implementing Cardio-Oncology Rehabilitation. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Open AccessReview
Clinical Evidence for Q10 Coenzyme Supplementation in Heart Failure: From Energetics to Functional Improvement
J. Clin. Med. 2020, 9(5), 1266; https://doi.org/10.3390/jcm9051266 - 27 Apr 2020
Abstract
Oxidative stress and mitochondrial dysfunction are hallmarks of heart failure (HF). Coenzyme Q10 (CoQ10) is a vitamin-like organic compound widely expressed in humans as ubiquinol (reduced form) and ubiquinone (oxidized form). CoQ10 plays a key role in electron transport in oxidative phosphorylation of [...] Read more.
Oxidative stress and mitochondrial dysfunction are hallmarks of heart failure (HF). Coenzyme Q10 (CoQ10) is a vitamin-like organic compound widely expressed in humans as ubiquinol (reduced form) and ubiquinone (oxidized form). CoQ10 plays a key role in electron transport in oxidative phosphorylation of mitochondria. CoQ10 acts as a potent antioxidant, membrane stabilizer and cofactor in the production of adenosine triphosphate by oxidative phosphorylation, inhibiting the oxidation of proteins and DNA. Patients with HF showed CoQ10 deficiency; therefore, a number of clinical trials investigating the effects of CoQ10 supplementation in HF have been conducted. CoQ10 supplementation may confer potential prognostic advantages in HF patients with no adverse hemodynamic profile or safety issues. The latest evidence on the clinical effects of CoQ10 supplementation in HF was reviewed. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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Open AccessReview
Pilates Method Improves Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis
J. Clin. Med. 2019, 8(11), 1761; https://doi.org/10.3390/jcm8111761 - 23 Oct 2019
Cited by 2
Abstract
Cardiorespiratory fitness has been postulated as an independent predictor of several chronic diseases. We aimed to estimate the effect of Pilates on improving cardiorespiratory fitness and to explore whether this effect could be modified by a participant’s health condition or by baseline VO [...] Read more.
Cardiorespiratory fitness has been postulated as an independent predictor of several chronic diseases. We aimed to estimate the effect of Pilates on improving cardiorespiratory fitness and to explore whether this effect could be modified by a participant’s health condition or by baseline VO2 max levels. We searched databases from inception to September 2019. Data were pooled using a random effects model. The Cochrane risk of bias (RoB 2.0) tool and the Quality Assessment Tool for Quantitative Studies were performed. The primary outcome was cardiorespiratory fitness measured by VO2 max. The search identified 527 potential studies of which 10 studies were included in the systematic review and 9 in the meta-analysis. The meta-analysis showed that Pilates increased VO2 max, with an effect size (ES) = 0.57 (95% CI: 0.15–1; I2 = 63.5%, p = 0.018) for the Pilates group vs. the control and ES = 0.51 (95% CI: 0.26–0.76; I2 = 67%, p = 0.002) for Pilates pre-post effect. The estimates of the pooled ES were similar in both sensitivity and subgroup analyses; however, random-effects meta-regressions based on baseline VO2 max were significant. Pilates improves cardiorespiratory fitness regardless of the population’s health status. Therefore, it may be an efficacious alternative for both the healthy population and patients suffering from specific disorders to achieve evidenced-based results from cardiorespiratory and neuromotor exercises. Full article
(This article belongs to the Special Issue Cardiovascular Rehabilitation)
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