Clinical Markers of Exercise Intensity as a Surrogate for Blood Lactate Levels Only During Low-Intensity Exercise in Patients With Coronary Artery Disease

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

Next steps to advance general physical activity recommendations towards physical exercise prescription: a narrative review

Physical inactivity is a major health concern, associated with the development of several non-communicable diseases and with an increased mortality rate. Therefore, promoting active lifestyles has become a crucial public health necessity for enhancing overall health and quality of life. The WHO guidelines for physical activity (PA) present valuable contributions in this respect; however, we believe that greater specificity should be added or complemented towards physical exercise (PE) testing, prescription and programming in future recommendations. In this review article, we suggest simple and practical tools accessible to the entire population to improve the specificity of this approach, highlighting aspects of PE programming used by trained subjects. By adopting these suggestions, exercise professionals, clinicians and physical trainers can optimise the current general PA recommendations towards PE prescription to improve fitness status and encourage PE adherence in the general population.

There are no differences in brachial artery endothelial shear stress and blood flow patterns between males and females during exercise

Premenopausal females have a lower cardiovascular risk than males. Sex differences on exercise-induced endothelial shear stress (ESS) and blood flow patterns may explain part of this risk reduction. The purpose of this cross-sectional study was to determine the differences in brachial artery exercise-induced ESS and blood flow patterns between males and females. Thirty subjects (13 females) were recruited to perform a three-workload steady-state exercise test based on blood lactate levels (i.e. <2.0, 2.0-4.0, >4.0 mmol/l). ESS and blood flow patterns were estimated at rest and during each workload using Womersley's approximation and Reynolds number, respectively. Both males and females showed an exercise intensity-dependent increase in antegrade and retrograde ESS. There was no significant sex effect or interaction for antegrade ESS (F_{(1, 30)}  = 0.715, p = 0.405 and F_{(1·672, 60)}  = 1.511, p = 0.232, respectively) or retrograde ESS (F_{(1, 30)}  = 0.794, p = 0.380 and F_{(1·810, 60)}  = 1.022, p = 0.361, respectively). Additionally, antegrade blood flow was turbulent during all bouts of exercise while retrograde blood flow became disturbed at moderate and high exercise intensities in both groups. There are no differences in exercise-induced ESS and blood flow patterns between males and females when the exercise load is equivalent. This suggests that the vascular benefits of exercise training are similar in both sexes from a haemodynamic standpoint.