Search Results (44)

Background: Anderson–Fabry disease (AFD) is a progressive lysosomal storage disorder characterized by systemic glycosphingolipid accumulation. While cardiac imaging plays a central role in disease monitoring, the relationship between structural myocardial changes and exercise capacity remains incompletely defined. This study aimed to evaluate functional impairment in AFD patients using cardiopulmonary exercise testing (CPET) and to determine whether limitations are primarily cardiac or extracardiac in origin. Methods: Thirty-one patients with genetically confirmed AFD were retrospectively enrolled from two tertiary centers. All underwent baseline clinical assessment, resting transthoracic echocardiography (TTE), spirometry, and symptom-limited CPET using a cycle ergometer and a 10 W/min ramp protocol. Echocardiographic parameters included the LVEF, global longitudinal strain (GLS), E/e′ ratio, TAPSE, and PASP. CPET measurements included the peak VO₂, anaerobic threshold (AT), VE/VCO₂ slope, oxygen pulse (VO₂/HR), and VO₂/watt ratio. Results: The mean age was 48.4 ± 17.6 years, with most patients classified as NYHA I. LVEF was preserved (62.3 ± 8.6%), and diastolic indices were within normal limits (E/e′ 7.1 ± 2.4), but GLS was impaired (11.3 ± 10.5%). CPET showed reduced peak VO₂ (18.6 ± 6.1 mL/kg/min; 71.4% predicted) and early AT (40.8%), with preserved ventilatory efficiency and oxygen pulse. VO₂/watt was mildly reduced, suggesting peripheral limitations despite intact central hemodynamics. Conclusions: Functional impairment is common in AFD patients, even with mild cardiac involvement. CPET reveals early systemic limitations not captured by standard imaging, supporting its role in phenotypic characterization and therapeutic decision-making. Full article

Background: ESC sports classification in 2020, based on cardiac morphological adaptations, may not fully reflect also the variations in functional parameters of athletes. This study aims to characterize CPET-derived physiological parameters in elite athletes according to the ESC classification and evaluate whether this morphological classification also corresponds to a functional categorization. Methods: Elite athletes underwent pre-participation screening before the 2023 European Games and 2024 Olympic Games. Athletes were classified into four categories (skill, power, mixed and endurance). CPET was performed on a cycle ergometer using a ramp protocol, with measurements of VO₂ max, heart rate, power output and ventilatory efficiency. Results: We enrolled 1033 athletes (46.8% females; mean 25.6 ± 5.2 years old) engaged in skill (14.1%), power (33.2%), mixed (33.3%) and endurance (19.4%) disciplines. O₂ pulse showed an incremental significant increase (p < 0.0001) among sport categories (skill 14.9 ± 3.8 mL/beat; power 17.5 ± 4.6 mL/beat, mixed 19 ± 4.3 mL/beat and endurance 22.7 ± 5.8 mL/beat). The lowest ${\dot{\mathrm{V}}\mathrm{O}}_2$max was observed in skill disciplines (36.3 ± 7.9 mL/min/kg) whilst endurance ones showed the highest values (52.4 ± 9.7 mL/min/kg) (p < 0.0001). ${\dot{\mathrm{V}}\mathrm{O}}_2$max was higher in power compared to mixed (42 ± 7.7 mL/min/kg vs. 40.5 ± 5.8 mL/min/kg, p = 0.005) disciplines with an overlapping amount between some mixed and power disciplines. No differences were found for VE max (p = 0.075). Conclusions: Our study provided values of CPET parameters in elite athletes. Significant differences in CPET parameters were observed among different sports disciplines, with endurance athletes showing the highest absolute and relative values in all parameters. An overlap amount was noted between mixed and power categories, especially for relative maximal oxygen consumption. Full article

Visible Light Communication (VLC) has the potential to advance Intelligent Transportation Systems (ITS). This study explores the current advancements of VLC in ITS applications that may enhance traffic flow, road safety, and vehicular communication performance. The potential, benefits, and current research trends of VLC in ITS applications are discussed first. Then, the state-of-the-art VLC technologies including overall concept, IEEE communication protocols, hybrid VLC systems, and software-defined adaptive MIMO VLC systems, are discussed. We investigated different potential applications of VLC in ITS, such as signalized intersection and ramp metering control, collision warning and avoidance, vehicle localization and detection, and vehicle platooning using vehicle–vehicle (V2V), infrastructure–vehicle (I2V), and vehicle–everything (V2X) communications. Besides, VLC faces several challenges in ITS applications, and these concerns, e.g., environmental issues, communication range issues, standards and infrastructure integration issues, light conditions and integration issues are discussed. Finally, this paper discusses various advanced techniques to enhance VLC performance in ITS applications, such as machine learning-based channel estimation, adaptive beamforming, robust modulation schemes, and hybrid VLC integration. With this review, the authors aim to inform academics, engineers, and policymakers about the status and challenges of VLC in ITS. It is expected that, by applying VLC in ITS, mobility will be safer, more efficient, and sustainable. Full article

AIM: Higher exercise blood pressure in adults correlates with many cardiometabolic markers. The aim of this study was to investigate the main determinants of longitudinal variations in exercise blood pressure in young athletes. METHODS: A longitudinal retrospective study was conducted on adolescent athletes who underwent at least two sport-related pre-participation screening visits, including exercise testing with a standardized incremental ramp protocol on treadmill. Blood pressure was assessed at rest (SBP_rest), at the 3rd minute of exercise (SBP_3min), and at peak exercise (SBP_peak). Predictors of blood pressure response (i.e., respective changes vs. baseline (Δ)) were determined by multivariate regression models after adjustment for age, sex, follow-up duration, related baseline SBP values, characteristics of sport, and ΔBMI. RESULTS: A total of 351 young athletes (mean age at baseline 13 ± 2 years, 54% boys, average follow-up duration 3.4 ± 2.2 years) were enrolled. BMI increased by 1.5 ± 1.8 kg/m² (p < 0.001) during follow-up. At baseline, mean SBP_rest was 103 ± 14 mmHg, mean SBP_3min 124 ± 18 mmHg, and mean SBPpeak 154 ± 23 mmHg. A significant between-visit increase in SBP_rest (ΔSBP_rest 7.0 ± 17.4 mmHg; p < 0.001), ΔSBP_3min (4.8 ± 11 mmHg, p < 0.001), and ΔSBP_peak (11.7 ± 24 mmHg, p < 0.001) was observed. ΔSBP_3min was significantly predicted by male sex (p < 0.01), baseline BMI (p < 0.01), ΔBMI (p < 0.01), and number of practiced sports (p < 0.05), whereas ΔSBP_peak was positively predicted by male gender (p < 0.01), baseline BMI (p < 0.05), and ΔBMI (p < 0.01) and negatively by baseline resting heart rate (p < 0.01). In a logistic regression model, ΔBMI was the only independent determinant of passing from a lower to an upper quartile of SBP_3min (p < 0.001), while ΔBMI and male sex were independent determinants of moving to a higher quartile of SBP_peak (p < 0.001). CONCLUSIONS: Increase in BMI during development and male sex are independent determinants of the increase in exercise blood pressure, both at light and maximal intensity, in a population of adolescent athletes. Full article

The maximal rate of fat oxidation (MFO, in g∙min⁻¹) and the relative exercise intensity at which it occurs (FAT_max, as %V̇O_2max) are indexes of metabolic flexibility. The time-consuming, graded exercise protocol required for MFO/FAT_max determination hinders the extensive use of these indexes for individualized exercise prescription and monitoring. Purpose: validate ramp testing for MFO and FAT_max measures in postmenopausal women. Methods: Seventeen healthy women (age: 54 ± 4 years, BMI 22 ± 3 kg·m⁻², and V̇O_2max 36.4 ± 5.3 mL·min⁻¹), who were 4 ± 3 years from menopause, performed on a cycle-ergometer, a ramp, and a graded incremental test. Based on V̇O₂ and respiratory exchange ratio from the ramp and graded protocol (i.e., the 5th minute of each step), MFO and FAT_max were determined. Data from the two protocols were compared using paired t-tests, linear regression, and Bland–Altman analysis. Results: The MFO measured with a ramp protocol was not different from (0.24 ± 0.09 vs. 0.20 ± 0.08 g·min⁻¹, p = 0.10), and moderately associated with, that of the graded protocol (r² = 0.46). FAT_max occurred at similar exercise intensity for both protocols (47.8 ± 5.1 vs. 47.5 ± 4.3 %V̇O_2max, p = 0.91, r² = 0.52). The comparison of MFO and FAT_max across the protocols yields a non-significant bias but a relatively large limit of agreement (respectively, 0.05 g·min⁻¹, LOA = −0.08, and 0.19 g·min⁻¹; 0.3 %V̇O_2max, LOA = −7.8, and 10.6 %V̇O_2max). Conclusions: In postmenopausal women, ramp testing offers a valid alternative to the graded protocol for identifying MFO and FAT_max. The availability of a time- and cost-efficient approach, which can be incorporated into standard ramp incremental testing, can facilitate using these indexes of metabolic flexibility in research and medicine. Full article

The assessment of the various skills of athletes is carried out in terms of their ability to perform sport-specific tasks. The cognitive abilities of the players have significance for their effectiveness. In volleyball, a player’s ability to react quickly appears to be crucial in responding to an opponent’s dynamic play. The aim of the study was to evaluate the changes in reaction time to light signals following warm-up and physical exercise. Eighteen volleyball players (15.58 ± 2.01 years) participated in the study. Four FITLIGHT Trainer^TM discs were placed on the wall facing the participant to conduct the reaction time test. The participant’s task was to react as quickly as possible to the illuminated disc by touching it with the palm of their hand. The procedure was repeated five times: before the warm-up, after the warm-up, and after each of the three agility tests. Friedman’s ANOVA showed statistically significant differences in reaction time between the tests (Chi² ANOVA = 61.23; p < 0.001). All tests performed after the warm-up according to the RAMP protocol showed statistically significantly better results than those before the warm-up (p ≤ 0.05). At the same time, no differences were observed between the tests performed after successive agility tests. The results indicated that a well-chosen warm-up plays an important role in shortening the time of visual-motor reaction to a light stimulus (RT). Subsequent studies should be expanded to include other research groups and assess other parameters. Full article

Background: This study assessed the effects of two distinct RAMP (Raise, Activate, Mobilize, Potentiate) protocols, mobility-focused and reactiveness-focused, on change of direction speed in police students (i.e., tactical athletes). Methods: A longitudinal design with two experimental and one control group was employed. The study sample consisted of 39 police students (aged 19.2 ± 0.2 yrs) who were randomly allocated into three equal groups of 13 participants (7 females and 6 males). Experimental groups were labeled as the mobility group or reactiveness group based on the type of RAMP protocol they performed. During the tactical physical education classes, the mobility group performed four complex mobility exercises, while the reactiveness group performed four exercises for trunk reactiveness. After the specific warm-up, both groups continued with syllabus activities. The control group performed only regular activities based on the study syllabus. All participants performed the Illinois Agility test unloaded (IAT) and loaded (10 kg vest [IATL]) and Functional Movement Screening (FMS) before and after 8 weeks of the applied protocols. Results: In general, improvements were observed across all participants in the IAT (p < 0.001), IATL (p < 0.001), and FMS (p < 0.001). The mobility protocol had a more substantial impact compared to the reactiveness protocol on the IAT (d = 0.55 vs. d = 0.40), IATL (d = 0.44 vs. d = 0.38), and FMS (d = 0.88 vs. d = −0.42). Additionally, the control group, which did not follow either RAMP protocol, did not show significant improvements. Conclusions: These results underscore the importance of incorporating targeted mobility training in the limited time available for strength and conditioning programs, as it improves occupationally relevant movement qualities such as change of direction speed ability. Prioritizing mobility training in young tactical athletes may offer broader benefits compared to reactiveness training. Full article

Background: The incremental exercise test is commonly used to measure maximal oxygen uptake (VO₂max), but an additional verification test is often recommended as the “gold standard” to confirm the true VO₂max. Therefore, the aim of this study was to compare the peak oxygen uptake (VO₂peak) obtained in the ramp incremental exercise test and that in the verification test performed on different days at submaximal intensity. Additionally, we examined the roles of anaerobic performance and respiratory muscle strength. Methods: Sixteen physically active men participated in the study, with an average age of 22.7 ± 2.4 (years), height of 178.0 ± 7.4 (cm), and weight of 77.4 ± 7.3 (kg). They performed the three following tests on a cycle ergometer: the Wingate Anaerobic Test (WAnT), the ramp incremental exercise test (IET_RAMP), and the verification test performed at an intensity of 85% (VER₈₅) maximal power, which was obtained during the IET_RAMP. Results: No significant difference was observed in the peak oxygen uptake between the IET_RAMP and VER₈₅ (p = 0.51). The coefficient of variation was 3.1% and the Bland–Altman analysis showed a high agreement. We found significant correlations between the total work performed in the IET_RAMP, the anaerobic peak power (r = 0.52, p ≤ 0.05), and the total work obtained in the WAnT (r = 0.67, p ≤ 0.01). There were no significant differences in post-exercise changes in the strength of the inspiratory and expiratory muscles after the IET_RAMP and the VER₈₅. Conclusions: The submaximal intensity verification test performed on different days provided reliable values that confirmed the real VO₂max, which was not limited by respiratory muscle fatigue. This verification test may be suggested for participants with a lower anaerobic mechanical performance. Full article

Endurance athletes often aim to improve their aerobic metabolism. The aim of this pilot study was to examine if malic acid and L-citrulline supplementation can improve aerobic metabolism and lactate elimination. Nine young (23.9 ± 1.9 years) recreational male athletes participated in this study. Following a standardised breakfast and a body composition analysis (InBody720), 6000 mg of citrulline and 3000 mg of malic acid or a placebo of 300 mL of water were consumed on three separate days in a cross-over design using a double-blind method. Sixty minutes after the supplementation, participants completed a ramp bicycle spiroergometer protocol (35 W/3 min) until reaching a respiratory exchange ratio (RER) of 1.1, followed by a 9 min active recovery. Cadence, heart rate (HR), rate of perceived exertion (RPE), respiratory parameters and lactate levels were registered. The RPExHR value was calculated to accurately characterise exhaustion. During the exercise protocol, citrulline supplementation induced significantly lower RER values at 70-105-140 W compared to malic acid and the placebo, respectively. There was no difference in lactate levels neither during rest nor at RER 1.1. RPExHR rate values were significantly lower after malic acid supplementation compared to placebo at 175 and 210 W. Power at RER 1.1 was higher after malic acid (+4 W) and citrulline (+5 W) supplementation. Although the supplementation failed to decrease lactate levels, lower RER and RPE values may indicate a performance-enhancing benefit. Full article

Trail runners (TRs) must carry an extra load of equipment, food (bars and gels) and liquids, to delay the anticipation of fatigue and dehydration during their competitions. Therefore, we aimed to evaluate how an extra load can influence the metabolic level. Thirteen well-trained trail runners performed a randomized crossover study (total n = 39), completing three treadmill running sessions with a weighted vest of 0%, 5% and 10% of their body mass during a combined test (rectangular test + ramp test). In addition, biomarkers of oxygen metabolism, acid–base and electrolyte status pre-, during and post-test, as well as the rectangular from capillary blood of the finger and time to exhaustion, were analyzed. Repeated-measures ANOVA showed no significant difference between conditions for any of the analyzed biomarkers of blood gas. However, one-way ANOVA showed a significant difference in trial duration between conditions (p ≤ 0.001). Tukey’s post hoc analysis observed a significant decrease in time to exhaustion in the weighted vest of 10% compared to 0% (p ≤ 0.001) and 5% (p ≤ 0.01) and 5% compared to 0% (p = 0.030). In addition, repeated-measures ANOVA detected a significant difference in pH in the group x time interaction (p = 0.035). Our results show that increasing the weighted vest (5% and 10%) anticipates fatigue in runners trained in TR. In addition, increasing the load decreased pH by a smaller magnitude at 10% compared to 0% and 5% at the end of the exercise protocol. Full article

Background and Objectives: In adults, 150 to 300 min a week of moderate-intensity physical activity is the recommended daily level to maintain or improve fitness. In subjects with chronic obstructive pulmonary disease (COPD), reductions in daily physical activity (DPA) amounts are related to clinically significant outcomes. In this study, we ascertain whether or not COPD patients, when clustered into active (DPA ≥ 30 min a day, 5 days a week) and inactive (DPA < 30 min a day, 5 days a week), may differ in exercise capacity, as assessed by a cardiopulmonary exercise test (CPET). Materials and Methods: A large sample of clinically stable COPD patients was retrospectively recruited and then underwent spirometry and an incremental ramp protocol 5–15 watts/min CPET. DPA was assessed by a questionnaire. Results: A total of 83 (female 25%, age range 41–85 y) active and 131 (female 31%, age range 49–83 y) inactive participants were enrolled. They were similar in age, sex distribution, body mass index (BMI) and in spirometry. The two groups were significantly different in dyspnea on exertion, as assessed by the modified Medical Research Council (mMRC), and in cardio-metabolic parameters, but not in ventilatory ones, as confirmed by the CPET. Conclusions: COPD patients experiencing physical activity of at least 30 min a day, 5 days a week, showed a greater exercise capacity and an improved cardiovascular response to exercise, when compared to inactive ones. Active and inactive participants did not differ in terms of airflow obstruction severity as well as in dynamic hyperinflation and ventilatory inefficiency during exercise. This study further suggests the benefits of regular physical activity in COPD. Full article

Background and Objectives: Cardiovascular diseases (CVDs) are a major global cause of death. Effective secondary prevention is crucial, involving risk factor modification and cardiac rehabilitation. However, mental factors, particularly depression, exert a significant influence on CVD outcomes by increasing cardiovascular risk and impeding treatment adherence. Therefore, the aim of this study is to assess the impact of psychological state on the effectiveness of rehabilitation in cardiac patients. Materials and Methods: Thirty-three patients referred for cardiac rehabilitation participated in a 3-week program, retrospectively categorized into two groups: those with and without depressive symptoms. The functional status of the patients was assessed using the R.A.M.P. protocol exercise test, conducted on a treadmill, during which resting and exercise heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and metabolic equivalent of task (MET) measurements were taken. The Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS-10) were utilized to evaluate the patients’ psychological state. Stepwise regression explored the psychological factors explaining physiological parameter variance. Results: Participants without depressive symptoms exhibited significantly greater improvements in exercise HR (15.58 vs. 1.07; p = 0.02), exercise SBP (7.93 vs. −2.05; p = 0.05), and exercise METs (1.52 vs. 0.50; p = 0.006) compared to those with depressive symptoms. The following predictors were found to be significant: for exercise HR—HADS-D (r² = 12%; p = 0.04); for exercise DBP—PSS-10 (r² = 27%; p = 0.002); and for METs—HADS-D and age (r² = 26%; p = 0.01). Conclusions: In conclusion, cardiac rehabilitation improved psychological and physiological parameters in both groups, with greater effectiveness seen in those without depression. Depressive symptoms predicted exercise HR, SBP, and METs, highlighting their role in worsening cardiac disease. Emphasizing psychological factors, including depression and stress, in cardiac rehabilitation can enhance effectiveness and patient outcomes. Full article

Background: Despite a successful repair of tetralogy of Fallot (rToF) in childhood, residual lesions are common and can contribute to impaired exercise capacity. Although both cycle ergometer and treadmill protocols are often used interchangeably these approaches have not been directly compared. In this study we examined cardiopulmonary exercise test (CPET) measurements in rToF. Methods: Inclusion criteria were clinically stable rToF patients able to perform a cardiac magnetic resonance imaging (CMR) and two CPET studies, one on the treadmill (incremental Bruce protocol) and one on the cycle ergometer (ramped protocol), within 12 months. Demographic, surgical and clinical data; functional class; QRS duration; CMR measures; CPET data and international physical activity questionnaire (IPAQ) scores of patients were collected. Results: Fifty-seven patients were enrolled (53% male, 20.5 ± 7.8 years at CPET). CMR measurements included a right ventricle (RV) end-diastolic volume index of 119 ± 22 mL/m², a RV ejection fraction (EF) of 55 ± 6% and a left ventricular (LV) EF of 56 ± 5%. Peak oxygen consumption (VO₂)/Kg (25.5 ± 5.5 vs. 31.7 ± 6.9; p < 0.0001), VO₂ at anaerobic threshold (AT) (15.3 ± 3.9 vs. 22.0 ± 4.5; p < 0.0001), peak O₂ pulse (10.6 ± 3.0 vs. 12.1± 3.4; p = 0.0061) and oxygen uptake efficiency slope (OUES) (1932.2 ± 623.6 vs. 2292.0 ± 639.4; p < 0.001) were significantly lower on the cycle ergometer compared with the treadmill, differently from ventilatory efficiency (VE/VCO₂) max which was significantly higher on the cycle ergometer (32.2 ± 4.5 vs. 30.4 ± 5.4; p < 0.001). Only the VE/VCO₂ slope at the respiratory compensation point (RCP) was similar between the two methodologies (p = 0.150). Conclusions: The majority of CPET measurements differed according to the modality of testing, with the exception being the VE/VCO₂ slope at RCP. Our data suggest that CPET parameters should be interpreted according to test type; however, these findings should be validated in larger populations and in a variety of institutions. Full article

Driven by the rapid escalation of its utilization, as well as ramping commercialization, Internet of Things (IoT) devices increasingly face security threats. Apart from denial of service, privacy, and safety concerns, compromised devices can be used as enablers for committing a variety of crime and e-crime. Despite ongoing research and study, there remains a significant gap in the thorough analysis of security challenges, feasible solutions, and open secure problems for IoT. To bridge this gap, we provide a comprehensive overview of the state of the art in IoT security with a critical investigation-based approach. This includes a detailed analysis of vulnerabilities in IoT-based systems and potential attacks. We present a holistic review of the security properties required to be adopted by IoT devices, applications, and services to mitigate IoT vulnerabilities and, thus, successful attacks. Moreover, we identify challenges to the design of security protocols for IoT systems in which constituent devices vary markedly in capability (such as storage, computation speed, hardware architecture, and communication interfaces). Next, we review existing research and feasible solutions for IoT security. We highlight a set of open problems not yet addressed among existing security solutions. We provide a set of new perspectives for future research on such issues including secure service discovery, on-device credential security, and network anomaly detection. We also provide directions for designing a forensic investigation framework for IoT infrastructures to inspect relevant criminal cases, execute a cyber forensic process, and determine the facts about a given incident. This framework offers a means to better capture information on successful attacks as part of a feedback mechanism to thwart future vulnerabilities and threats. This systematic holistic review will both inform on current challenges in IoT security and ideally motivate their future resolution. Full article

Cardiac dysfunction induced by premature ventricular complexes (PVCs) is relatively controversial and challenging to detect in the early stage. In this observational study, we retrospectively analyzed the cardiopulmonary exercise test (CPET) data of 94 patients with frequent premature ventricular beats (47 males, 49.83 ± 13.63 years) and 98 participants (55 males, 50.84 ± 9.41 years) whose age and gender were matched with the patient with PVCs. The baseline information and routine echocardiography detection were recorded on admission. PVCs were diagnosed by 24 h Holter monitoring, and cardiorespiratory capacity was assessed using peak oxygen uptake (V’O₂peak), anaerobic threshold (AT), and other CPET parameters with an individualized bicycle ramp protocol according to the predicted workload and exercise situation of each participant. There were no statistically significant differences in most baseline characteristics between the two groups. Indicators that reflect cardiopulmonary capacity, such as V’O₂peak, AT, and ΔO2 pulse/Δwork rate(ΔV’O₂/ΔWR), were all significantly lower in the PVC group (p = 0.031, 0.021, and 0.013, respectively) despite normal and nondiscriminatory left ventricular ejection fractions between the two groups. However, there was no statistically significant difference among subgroups based on the frequency of PVCs, which was <10,000 beats/24 h, 10,000–20,000 beats/24 h, and >20,000 beats/24 h. The cardiorespiratory capacity was lower in patients with frequent PVCs, indicating that CPET could detect early signs of impaired cardiac function induced by PVCs. Full article