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Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention

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A special issue of Journal of Functional Morphology and Kinesiology (ISSN 2411-5142). This special issue belongs to the section "Physical Exercise for Health Promotion".

Deadline for manuscript submissions: closed (28 February 2026) | Viewed by 21376

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Prof. Dr. Giuseppe Caminiti

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1. Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, 00163 Rome, Italy
2. Cardiovascular Unit, San Raffaele IRCCS, 00163 Rome, Italy
Interests: hypertension; chronic heart failure; atrial fibrillation; exercise training; sport medicine
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Dear Colleagues,

Physical activity, mainly in the form of structured exercise training, is a key non-pharmacological intervention for the management of patients at risk of developing and/or with already-diagnosed cardiovascular diseases. Counteracting cardiovascular risk factors, such as diabetes, hypertension, and obesity, is one of the main ways in which exercise reduces cardiovascular risk and improves patient outcomes. Performing physical training is highly recommended by the World Health Organization and by European as well as American guidelines; however, while physical training is currently conceived as a large-scale intervention, aimed at the entire population, there is a growing need for developing individually tailored protocols considering the distinctive characteristics and risk profiles of patients. This is particularly true in aging societies where exercise must be adapted to elderly cardiovascular patients carrying multiple cardiovascular risk factors and a high burden of comorbidities.

To use exercise more properly in different clinical scenarios, we need to fill several gaps in the current knowledge. The best format of exercise training for containing cardiovascular risk factors is still to be defined. It is necessary to establish a dose–effect response in different age groups and in both genders, and to identify the best dose of exercise necessary to contain multiple risk factors at the same time. Moreover, to increase the adherence to exercise training programs, it is worth studying the effectiveness of short daily sessions of exercise, that are easily deliverable and do not limit the daily routines of patients. Studies exploring potential synergic or antagonistic effects of exercise and drugs (especially those more recently introduced) on risk factors are lacking. Women, elderly, and frail patients are under-represented in trials assessing the effects of exercise on cardiovascular risk factors.

This Special Issue aims to collect original articles, reviews, and meta-analyses reporting the latest findings on the topic of exercise effects on cardiovascular risk factors.

Prof. Dr. Giuseppe Caminiti
Guest Editor

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Keywords

exercise training
cardiovascular risk factors
physical activity
personalized exercise protocols
aging and cardiovascular health

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Published Papers (9 papers)

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Research

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14 pages, 713 KB

Open AccessArticle

Normobaric Hypoxic Cardiac Rehabilitation: Comparative Effects of Training at 2000 m and 3000 m Simulated Altitude in Post-Myocardial Infarction Patients

by Agata Nowak-Lis, Tomasz Gabryś, Zbigniew Nowak, Anna Konarska-Rawluk, Dominika Grzybowska-Ganszczyk and Radosław Chruściński

J. Funct. Morphol. Kinesiol. 2025, 10(4), 444; https://doi.org/10.3390/jfmk10040444 - 18 Nov 2025

Cited by 1 | Viewed by 1122

Abstract

Background: Coronary artery disease remains the leading cause of morbidity and mortality in developed countries. Despite advances in treatment and standard rehabilitation, conventional programs may be monotonous and insufficiently engaging. Normobaric hypoxia, simulating high-altitude conditions, has emerged as a potential method to enhance cardiovascular adaptations in post-myocardial infarction (MI) patients. Objective: This study aimed to compare the efficacy and safety of exercise-based cardiac rehabilitation performed under normobaric hypoxia corresponding to altitudes of 2000 m and 3000 m above sea level in patients after MI treated with percutaneous coronary intervention (PCI). Methods: A total of 61 male post-MI patients (mean age 60.4 ± 8.9 years) were randomized into two groups: training under simulated altitudes of 2000 m (n = 35) or 3000 m (n = 26). The 22-day program consisted of interval ergometer sessions. Pre- and post-intervention assessments included cardiopulmonary exercise testing (CPET), echocardiography, and tissue Doppler imaging (TDI). Results: Both groups demonstrated significant improvements in exercise tolerance. Training at 2000 m significantly increased test duration (r = 0.735) and peak heart rate (r = 0.467). At 3000 m, additional benefits were observed, including improvements in metabolic equivalent (r = 0.861), peak oxygen consumption (d = 0.81), and reduction in respiratory exchange ratio (r = 0.682). Intergroup analysis revealed moderate differences favoring the 3000 m group in MET, breathing frequency, and RER. Echocardiography showed beneficial remodeling in both groups, with improvements in LV dimensions, ejection fraction, and MAPSE. Notably, training at 2000 m resulted in more consistent echocardiographic benefits compared to 3000 m. Conclusions: Cardiac rehabilitation under normobaric hypoxia is effective and safe in stable post-MI patients. Training at 3000 m provides greater improvements in exercise tolerance, while 2000 m confers more favorable effects on cardiac structure and function. These findings suggest that moderate hypoxic exposure (2000 m) may represent an optimal balance between efficacy and safety in post-MI rehabilitation. Full article

(This article belongs to the Special Issue Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention)

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10 pages, 661 KB

Open AccessArticle

Daily Movement Matters: Post-Exercise Hypotension in Peripheral Arterial Disease—A Quasi-Experimental Pilot Study

by Saúl Peñín-Grandes, Susana López-Ortiz, Montserrat de la Fuente Gómez, Mª Lourdes del Río-Solá, Sergio Maroto-Izquierdo, Alejandro Santos-Lozano, Juan Martín-Hernández and José Pinto-Fraga

J. Funct. Morphol. Kinesiol. 2025, 10(4), 426; https://doi.org/10.3390/jfmk10040426 - 3 Nov 2025

Viewed by 1645

Abstract

Background: Aerobic and resistance training have acute effects on blood pressure (BP) in peripheral arterial disease (PAD). However, the combined effect of both exercises in a single session is still unknown. The aim of this study was to analyze the effects of a single exercise session combining walking and circuit-based training on BP in patients with PAD. Methods: Participants with PAD (n = 13; 65.0 ± 10.2 years; 76.9% male) underwent a supervised exercise therapy (SET) intervention (312 sessions, 24 sessions/patient) that included 15–30 min of walking, followed by 15 min circuit-based training. Clinic systolic (SBP) and diastolic (DBP) were recorded 5 min before and after each exercise session. Longitudinal changes were analyzed using repeated-measures analysis of variance (ANOVA) and categorical changes in blood pressure levels were evaluated with chi-square tests. Results: After each exercise session, clinic SBP decreased 4.87 mmHg (p < 0.001) and clinic DBP decreased 2.11 mmHg (p < 0.001). Furthermore, there were no differences between the initial stage of training (1–10 sessions) and late (14–24 sessions) for each time that SBD or DBP were measured. Conclusions: After an acute exercise session, both clinical SBP and DBP decreased in patients with PAD compared to pre-exercise values. However, no additional reductions in clinical BP were observed when comparing early (sessions 1–10) and late (sessions 14–24) stages of the full SET intervention. Full article

(This article belongs to the Special Issue Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention)

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15 pages, 795 KB

Open AccessArticle

Interrelationship Between Cardiopulmonary Exercise Testing Indices and Markers of Subclinical Cardiovascular Dysfunction in Those with Type 2 Diabetes—An Observational Cross-Sectional Analysis

by Grace W. M. Walters, Gaurav S. Gulsin, Joseph Henson, Stavroula Argyridou, Kelly S. Parke, Thomas Yates, Melanie J. Davies, Gerry P. McCann and Emer M. Brady

J. Funct. Morphol. Kinesiol. 2025, 10(4), 371; https://doi.org/10.3390/jfmk10040371 - 26 Sep 2025

Viewed by 1066

Abstract

Purpose: While peak oxygen uptake (

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O_2peak) is the gold standard method for assessing exercise tolerance, there is a tendency for underestimation. Several other cardiopulmonary exercise testing (CPET) variables may provide additive prognostic value beyond

\dot{V}

O [...] Read more.

Purpose: While peak oxygen uptake (

\dot{V}

\dot{V}

O_2peak alone. The aim of this study was to examine if alternative CPET indices of exercise tolerance are (a) impaired in people with T2D and (b) independently associated with measures of cardiovascular structure and function measured via echocardiography and cardiac MRI. Methods: Participants with type 2 diabetes (T2D) and healthy controls underwent cardiac magnetic resonance imaging, transthoracic echocardiography, and a CPET. Multiple linear regression was used to determine the relationship between indices of exercise tolerance and markers of cardiovascular structure and function. Results: A total of 84 people with T2D and 36 healthy volunteers were included in the analysis. All CPET outcomes were worse in those with T2D vs. the controls. Three CPET outcomes were associated with markers of cardiovascular structure and function:

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O₂ recovery with mean aortic distensibility (β = 0.218, p = 0.049); heart rate recovery with early filling velocity on transmitral Doppler/early relaxation velocity (β = −0.270, p = 0.024), left ventricular mass/volume ratio (β = −0.248, p = 0.030) and mean aortic distensibility (β = 0.222, p = 0.029); and

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O₂ at the ventilatory threshold with myocardial perfusion reserve (β = 0.273, p = 0.018). Perspective: These lesser-used CPET indices could be used to identify which people with T2D are at elevated risk of progression to symptomatic heart failure. However, larger longitudinal studies are required to confirm these findings and their potential clinical application. Full article

(This article belongs to the Special Issue Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention)

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13 pages, 262 KB

Open AccessArticle

Effects of a Moderate-Intensity Interval Training Protocol on University Students’ Body Composition: A Pilot Study

by Bastian Parada-Flores, Luis Valenzuela-Contreras, Cristian Martínez-Salazar, Pablo Luna-Villouta, Daniela Lara-Aravena, Constanza Pino-Bárcena, Sofía Saavedra-Godoy, Álvaro Levín-Catrilao and Rodrigo Vargas-Vitoria

J. Funct. Morphol. Kinesiol. 2025, 10(3), 340; https://doi.org/10.3390/jfmk10030340 - 5 Sep 2025

Viewed by 2363

Abstract

Background: Unhealthy lifestyles have been reported among university students, characterized by excess body weight and physical inactivity, which affects body composition and increases the risk of non-communicable diseases. Physical exercise (PE) is an effective strategy for body reshaping; however, its demands and difficulties make its practice complex. Therefore, there was an interest in investigating the effects of a low-volume, moderate-intensity interval training (MIIT) protocol. Methods: A 5-week quasi-experimental study was conducted. Twelve university students (ten women and two men), aged 22 ± 3.4 years, engaged in low-level physical activity. The intervention group (n = 6) performed a MIIT protocol of 1′ × 1′ × 7′ (seven series of 1 min of moderate-intensity exercise interleaved with a recovery period of 1 min) three times a week, while the control group (n = 6) continued with its regular activities. Results: Significant improvements were reported in body fat percentage (%BF) (p = 0.04; d = 0.9), fat mass (FM) (p = 0.00; d = 0.7) and recovery heart rate (RHR) (p = 0.001); d = 1) in the MIIT group compared with the pre-test and control group values. Furthermore, the body weight (p = 0.04) and body mass index (BMI) (p = 0.04) values also improved in the MIIT group, compared to the pre-test values. Conclusions: MIIT is an effective strategy for short-term improvement in body composition, as well as in anthropometric measures and fitness parameters, in university students with a low PAL. Its ease of applicability—based on low exercise volume and intensity—is notable, making it feasible of incorporation into student health programs. Full article

(This article belongs to the Special Issue Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention)

17 pages, 538 KB

Open AccessArticle

Effectiveness of a Multidisciplinary Treatment Program for Severe Obesity in Adults Based on the Clinically Significant Weight Loss

by Greice Westphal-Nardo, Angélica Sbrolini Marques Mincache, Paulo César Franzini, Mara Jane Pascoini dos Santos, Gisele Nicchio Rocha, Ieda Carla Candido, Andrea Herrera-Santelices, Felipe Merchan Ferraz Grizzo, Jean-Philippe Chaput and Nelson Nardo Junior

J. Funct. Morphol. Kinesiol. 2025, 10(2), 225; https://doi.org/10.3390/jfmk10020225 - 11 Jun 2025

Viewed by 4043

Abstract

Background: Obesity is a chronic and complex disease; by its nature, it represents an enormous challenge to be solved and managed. For that matter, several guidelines have been published, but there is still a long way to go until concrete scaled results can be presented. Adults with obesity, and especially severe obesity, need to have access to treatment programs, but they are not available for the vast majority of the population. Objective: The aim of this study is to evaluate the effectiveness of a multidisciplinary treatment program for obesity (MTPO) offered to adults (ages 18 to 50 years old) with a BMI over 30 kg/m². Methods: Participants were invited through media ads, resulting in 404 participants for the first phase of that study, from whom the risk profile was assessed. After that, 180 participants (82.8% with severe obesity) concluded the MTPO, which consisted of 48 sessions of exercises and the same number of professional orientations about a healthy lifestyle, including the importance of being physically active, how to improve their eating habits, and how to control their emotions. Results: For the analysis of results, participants were grouped according to their weight loss in terciles, with the first, tercile presenting an average weight loss of 7.6%, which is considered clinically significant. In the same way, the average percental variations were even higher in this group for body fat (12.7%) and the lean mass to fat mass ratio (LM/FM), which increased by 14.3%. The homeostatic model assessment for insulin resistance, HOMA-IR, was around 3 times the variation of body mass, whereas the triglycerides (TG) and the hemoglobin A1C (H1Ac) were around twice that rate. Conclusions: These results made clear the effectiveness of the MTPO, which needs to be tested in public health services. Full article

(This article belongs to the Special Issue Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention)

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22 pages, 3169 KB

Open AccessArticle

Effects of High-Intensity Intermittent Training Combined with Asparagus officinalis Extract Supplementation on Cardiovascular and Pulmonary Function Parameters in Obese and Overweight Individuals: A Randomized Control Trial

by Tadsawiya Padkao and Piyapong Prasertsri

J. Funct. Morphol. Kinesiol. 2025, 10(2), 202; https://doi.org/10.3390/jfmk10020202 - 1 Jun 2025

Cited by 1 | Viewed by 2559

Abstract

Background: High-intensity intermittent training (HIIT) has been proven to improve cardio-metabolic and respiratory health outcomes. In addition, 20-hydroxyecdysone from plant extracts has been studied for its anabolic effects. However, studies examining these two interventions in individuals who are obese or overweight are limited. This study, thus, examined the effects of HIIT combined with Asparagus officinalis (A. officinalis) extract supplementation on cardiovascular and pulmonary function parameters in obese and overweight individuals. Methods: Seventy-two obese and overweight participants were randomized into four groups (n = 18 each): the control (CON) group; HIIT group (HIIT for 3 days/week); AOE (A. officinalis extract) group (supplementation with 20E at 1.71 mg/kg/day); and HIIT + AOE group. Pre- and 12-week post-intervention measures included heart rate (HR), HR variability, endothelial function, blood pressure (BP), BP variability, pulmonary function and volume, respiratory muscle strength, chest expansion, and body composition. Results: The HIIT + AOE group showed better HR variability with higher high-frequency power and a lower low-frequency/high-frequency ratio (both p = 0.038) compared to the CON group. The peak blood flow increased in both the HIIT (p = 0.03) and HIIT + AOE (p = 0.028) groups, but only the HIIT group had a shorter vascular recovery time (p = 0.048). The maximum expiratory pressure was increased in both the HIIT and HIIT + AOE groups compared to the CON group (p = 0.029 and p = 0.041). The ratio of forced expiratory volume in one second to forced vital capacity, the percent-predicted FEV₁/FVC, and chest wall expansion were higher in the HIIT + AOE group than in the CON group (p = 0.047, p = 0.038, and p = 0.001). The waist-to-hip ratio was lower in the HIIT + AOE group than in the CON group (p = 0.043). There were no significant differences in HR, BP, BP variability, or pulmonary volume parameters among groups. Conclusions: The combination of HIIT with A. officinalis extract supplementation markedly improves HR variability. Moreover, it also greatly improves expiratory muscle strength, chest wall expansion, pulmonary function, and body composition parameters in obese and overweight individuals. Full article

(This article belongs to the Special Issue Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention)

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11 pages, 663 KB

Open AccessArticle

Post-Exercise Hypotension Induced by a Short Isometric Exercise Session Versus Combined Exercise in Hypertensive Patients with Ischemic Heart Disease: A Pilot Study

by Matteo Vitarelli, Francesco Laterza, Saúl Peñín-Grandes, Marco Alfonso Perrone, Alejandro Santos-Lozano, Maurizio Volterrani, Giuseppe Marazzi, Vincenzo Manzi, Elvira Padua, Barbara Sposato, Valentina Morsella, Ferdinando Iellamo and Giuseppe Caminiti

J. Funct. Morphol. Kinesiol. 2025, 10(2), 189; https://doi.org/10.3390/jfmk10020189 - 25 May 2025

Cited by 1 | Viewed by 3660

Abstract

Background: Short sessions of isometric exercise have been shown to reduce blood pressure (BP) in normotensive and hypertensive subjects. However, there are few data in hypertensive patients with underlying ischemic heart disease (IHD). In the present study, we compared post-exercise hypotension (PEH) induced by isometric versus combined, aerobic plus dynamic resistance exercise in IHD patients. Methods: Twenty-five stable patients with established IHD and with treated hypertension were enrolled. The study had a cross-over design. All patients performed in a random order and on different days: (1) isometric exercise session (IES) consisting of bilateral knee extension, performed at 20% of maximal voluntary contraction and lasting 20 min; (2) combined exercise session (CES) including moderate-intensity continuous exercise at and dynamic resistance exercise performed at 60% of one repetition maximum, and lasting 60 min and (3) control session (no exercise). BP was measured at rest, immediately after the training and then every 15 min up to 90 min. Results: The repeated measures ANOVA analysis showed that systolic BP significantly decreased after the CES session compared to the control (F = 6.2; p 0.001) and IES (F = 4.4; p 0.004). Systolic BP significantly decreased after IES compared to the control (F = 3.6; p 0.036). Diastolic BP did not show significant changes after CES and IES compared to the control (CES vs. control: F = 2.2; p 0.142; IES vs. control (F = 2.5; p 0.062). There were no significant differences in diastolic BP changes between CES and IES (CES vs. IES: F = 1.8; p 0.156). Conclusions: We observed that CES was more effective than IES in reducing systolic BP; IES was as effective as CES in inducing diastolic PEH in hypertensive patients with underlying IHD. Full article

(This article belongs to the Special Issue Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention)

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Review

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20 pages, 665 KB

Open AccessReview

Effects of Endurance and Resistance Training on Cardiovascular Outcomes and Quality of Life in Patients with Heart Failure with Reduced Ejection Fraction: A Structured Narrative Review

by Michael Stiefel, Jamie O’Driscoll, Hadassa Brito da Silva, Tristan Ramcharan and Michael Papadakis

J. Funct. Morphol. Kinesiol. 2025, 10(4), 483; https://doi.org/10.3390/jfmk10040483 - 18 Dec 2025

Viewed by 1805

Abstract

Background: Heart failure with reduced ejection fraction (HFrEF) markedly impairs quality of life (QoL) and life expectancy. The main therapeutic goals are to reduce mortality, improve functional capacity, and enhance QoL. Exercise training is an evidence-based, non-pharmacological component of standard care that improves functional capacity and clinical outcomes in HFrEF. This review examines the effects of endurance and resistance training on peak oxygen uptake (VO₂peak), ventilatory efficiency (VE/VCO₂ slope), health-related QoL, and cardiovascular outcomes in patients with HFrEF. Methods: A structured narrative review was conducted using comprehensive searches of PubMed, EMBASE, and the Cochrane Library for English-language studies published between January 2004 and October 2024. Eligible studies included adult HFrEF populations undergoing aerobic and/or resistance training with reported effects on VO₂peak, ventilatory efficiency, QoL, or clinical outcomes. Given the heterogeneity of interventions, comparators, and outcome metrics, data were synthesized descriptively. Results: Across 18 studies (plus one sub-analysis) including 3401 patients, 17 trials assessed VO₂peak and 16 reported significant improvements, with an average increase of approximately 2 mL·kg⁻¹·min⁻¹. Six studies assessed ventilatory efficiency, and five demonstrated reductions in VE/VCO₂ slope averaging 4.4 units. Eleven studies analyzed QoL, and nine reported significant improvements corresponding to an ≈5-point decrease in the Minnesota Living with Heart Failure Questionnaire (MLHFQ). In the largest trial, exercise training was associated with modest but statistically significant reductions in all-cause mortality or hospitalization (HR 0.89) and cardiovascular mortality or heart-failure hospitalization (HR 0.85) after adjustment for baseline prognostic factors. Conclusions: Structured exercise training improves aerobic capacity, ventilatory efficiency, and QoL in patients with HFrEF, with supportive evidence for reduced morbidity and mortality. These findings underscore the value of structured exercise as a core component of modern HFrEF management. Full article

(This article belongs to the Special Issue Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention)

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14 pages, 414 KB

Open AccessReview

The Role of Artificial Intelligence in Exercise-Based Cardiovascular Health Interventions: A Scoping Review

by Asterios Deligiannis, Panagiota Sotiriou, Pantazis Deligiannis and Evangelia Kouidi

J. Funct. Morphol. Kinesiol. 2025, 10(4), 409; https://doi.org/10.3390/jfmk10040409 - 21 Oct 2025

Cited by 4 | Viewed by 2194

Abstract

Background: As cardiovascular medicine advances rapidly, the integration of artificial intelligence (AI) has garnered increasing attention. Although AI has been widely adopted in diagnostics, risk prediction, and decision support, its application in exercise-based cardiovascular rehabilitation is still limited, representing a new and promising research frontier. Objective: This scoping review aimed to identify and analyze original studies that have applied AI to exercise-based interventions designed to improve cardiovascular outcomes. Methods: Following the PRISMA-ScR guidelines, PubMed, Scopus, Web of Science, Embase, and IEEE Xplore were searched for articles published between January 2015 and August 2025. Eligible studies were peer-reviewed by human research employing AI (machine learning or deep learning) to deliver, adapt, or monitor an exercise intervention with cardiovascular outcomes. Reviews, diagnostic-only studies, protocols without data, and animal studies were excluded. Non-original works (reviews, protocols), animal studies, and purely diagnostic applications were excluded, ensuring a strict focus on AI applied within exercise interventions. Data extraction focused on study design, AI method, exercise modality, outcomes, and findings. Results: From 2183 records, nine studies met the inclusion criteria (two RCTs, feasibility pilots, and validation studies). Designs included feasibility pilots, randomized controlled trials (RCTs), and validation studies. AI applications encompassed adaptive step goals, reinforcement learning for engagement, coaching apps, machine learning–based exercise prescription, and continuous monitoring (e.g., VO₂ estimation). These AI methods, such as machine learning and reinforcement learning, were used to personalize exercise interventions and improve cardiovascular outcomes. Reported outcomes included blood pressure reduction, improved adherence, increased daily steps, improvement in VO₂max, continuous physiological monitoring, and enhanced diagnostic accuracy. Conclusions: Findings demonstrate that AI has the potential to significantly enhance cardiovascular rehabilitation. It can personalize exercise prescriptions, enhance adherence, and facilitate safe monitoring in home settings. However, the evidence base remains preliminary, with very few RCTs and substantial methodological heterogeneity. Future research must prioritize large-scale clinical trials, explainable AI, and equitable implementation strategies to ensure clinical translation. Full article

(This article belongs to the Special Issue Effects of Exercise Training on Cardiovascular Risks Factors in Primary and Secondary Prevention)

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