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Chronotropic incompetence (CI) is an inability to adequately raise heart rate during physiological stress. We established CI prevalence and exercise capacity in heart failure versus healthy age-matched controls. We conducted a systematic search (1966–July 1, 2020) and meta-analysis of studies reporting peak VO2 in people with heart failure with reduced (HFrEF) and preserved (HFpEF) left ventricular ejection fraction and controls. Seventeen studies of 4410 participants were included, 4167 with heart failure and 243 age-matched controls. In both heart failure phenotypes, CI was more prevalent in HFrEF (51.7%) and HFpEF (55.8%) than in healthy controls (9%). Mortality was 24% higher in people with HFrEF and CI versus those with HFrEF and without CI; OR −1.24 (95% CI −2.20 to −0.28; p = 0.01). People with heart failure and CI had lower peak VO2 than those without CI (MD) −3.30 ml kg−1 min−1 (95% CI −4.25 to −2.35, p < 0.01), and this was primarily driven by the HFrEF sub-population (MD) −3.86 ml kg−1 min−1 (95% CI −4.83 to −2.89, p < 0.01). Maximum heart rate MD −37.51 beats min−1 (95% CI −41.99 to −33.03, p < 0.01) and maximum-resting heart rate were lower MD −29.44 beats min−1 (95% CI −34.55 to −24.33, p < 0.01) in people with heart failure with CI vs without CI. People with heart failure and CI demonstrated similar respiratory exchange ratios (RER) to people with heart failure but without CI; (MD) −0.02 (95% CI −0.03 to −0.01), p < 0.01, suggesting that poor effort was unlikely to explain CI. CI is more prevalent in heart failure than in age-matched controls and although it is associated with lower peak VO2 in HFrEF, it is unrelated to the lower peak VO2 in HFpEF. RER values suggest poor effort is unlikely to explain these findings.

Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research.

Chronic kidney disease (CKD) is prevalent, affecting 13% of adult Australians and poses increased risk for cardiovascular morbidity and mortality. This position article provides evidence-based guidelines on the role of exercise training for CKD patients and provides recommendations for prescribing and delivering exercise training. Position stand. Synthesis of published work within the field of exercise training and chronic kidney disease. Exercise training likely to provide benefits to CKD patients, including improvements in cardio-respiratory fitness, quality of life, sympatho-adrenal activity, muscle strength and increased energy intake and possible reduction in inflammatory biomarkers. Existing studies generally report small sample sizes, brief training periods and relatively high attrition rates. Exercise training appears to be safe for CKD patients with no deaths directly related to exercise training in over 30,000 patient-hours, although strict medical exclusion criteria in previous studies resulted in 25% of patients being excluded potentially impacting the generalisability of the findings. Aerobic exercise at an intensity of >60% of maximum capacity is recommended to improve cardio-respiratory fitness. Few data are available on resistance training and it is unclear whether this form of training retards catabolic/inflammatory processes typical of CKD. However, it should be considered important due to its proven beneficial effects on bone density and muscle mass. Due to the high prevalence and incidence of co-morbidities in CKD patients, exercise training programs should be prescribed and delivered by individuals with appropriate qualifications and experience to recognise and accommodate co-morbidities and associated complications.

There exists no examination of what is the minimum anti-hypertensive threshold intensity for isometric exercise training. Twenty two normotensive participants were randomly assigned to training intensities at either 5 % or 10 % of their maximal contraction. Twenty participants completed the study. Clinical meaningful, but not statistically significant, reductions in systolic blood pressure were observed in both 5 % and 10 % groups –4.04 mm Hg (95 % CI –8.67 to +0.59, p=0.08) and –5.62 mm Hg (95 % CI –11.5 to +0.29, p=0.06) respectively after 6 weeks training. No diastolic blood pressure reductions were observed in either 5 % –0.97 mm Hg (95 % CI –2.56 to +0.62, p=0.20) or 10 % MVC +1.8 mm Hg (95 % CI –1.29 to +4.89, p=0.22) groups respectively after training. In those unable to complete isometric exercise at the traditional 30 % intensity, our results suggest there is no difference between 5 and 10 % groups and based on the principle of regression to the mean, this could mean both interventions induce a similar placebo-effect.

ObjectivesWe aimed to explore sex-specific differences in resting blood pressure (BP) reduction and associated cardiovascular adaptations following isometric exercise training (IET).Methods100 sedentary adults with normal to high-normal systolic BP volunteered for the study. Participants either performed home-based lower-body IET in the form of a wall squat three times a week for 4 weeks (each session comprised 4×2 min bouts) or were allocated to the control group. Cardiovascular variables, including BP, cardiac output, total peripheral resistance, stroke volume and heart rate variability (HRV), were measured at rest preintervention and postintervention.ResultsFollowing 4 weeks of IET, there were no significant differences in resting systolic BP and diastolic BP between females (122.1±6.9 and 80.0±8.3 mm Hg) and males (119.6±7.2 and 77.4±8.6 mm Hg). However, female participants had a greater cardiac autonomic response following training, evidenced by a lower low-frequency to high-frequency HRV ratio (F: 1.38±1.27 and M: 2.1±1.5, p=0.004) and decreased and elevated low-frequency normalised units (F: 50.3%±16.2% and M: 60.9%±16.9%, p=0.015) and high-frequency normalised units (F: 49.7%±16.2% and M: 39.1%±16.9%, p=0.015), respectively.ConclusionsWhile resting BP reductions were comparable between female and male participants, there was a greater autonomic response and a higher incidence of clinically important BP reductions in females, which could indicate a greater cardioprotective effect following IET. These findings highlight the importance of considering sex differences in the prescription and evaluation of exercise interventions for hypertension management.

We used tele-monitoring to attempt to improve exercise adherence (number of hours of exercise completed), peak VO2, HbA1c% and quality of life in an unsupervised, home based exercise program in people with type II diabetes, a cost analysis was also conducted. Thirty-nine patients with type II diabetes were randomized to tele-monitoring (TELE) or control (CON) groups. All patients were asked to complete 6 months exercise training and complete an exercise activity diary. The TELE group was instructed to record their exercise heart rates using a monitor and received weekly telephone calls from an exercise physiologist. Six TELE patients and seven CON patients did not complete the 6 month testing. TELE patients completed a mean weekly volume of 138 minutes, moderate intensity exercise, while CON patients completed 58 minutes weekly (p < 0.02). Neither group achieved the American Heart Association statement guideline for weekly exercise volume of 150 minutes. TELE patients improved peak VO2 (5.5 %), but neither group improved HbA1c% or quality of life. The CON group showed a 4.9% reduction in peak VO2. While tele-monitored patients completed more hours of exercise and demonstrated improved peak VO2 compared to controls, the exercise volume completed was insufficient to improve glycemic control. There is the potential via tele-monitoring to enable people with diabetes to meet exercise training guidelines. Weekly telephone calls from a health professional providing encouragement, increases the amount of exercise completed by people with diabetesWeekly telephone calls will result in improved fitnessAt least 150 minutes weekly exercise is required to improve diabetes controlThe cost of home exercise with telephone monitoring is cheaper (and more convenient for the patient) than delivering an exercise program at the hospitalLonger term research is needed to examine whether telephone supervised exercise will prevent serious events such as heart attack, strokes and death.

Diastolic dysfunction contributes to the development and progression of heart failure. Conventional echocardiography and tissue Doppler imaging are widely utilised in clinical research providing a number of indices of diastolic function valuable in the diagnosis and prognosis of heart failure patients. The aim of this meta-analysis was to quantify the effect of exercise training on diastolic function in patients with heart failure. Exercise training studies that investigate different indices of diastolic function in patients with heart failure have reported that exercise training improves diastolic function in these patients. We sought to add to the current literature by quantifying, where possible, the effect of exercise training on diastolic function. We conducted database searches (PubMed, EBSCO, EMBASE, and Cochrane Trials Register to 31 July 2016) for exercise based rehabilitation trials in heart failure, using the search terms ‘exercise training, diastolic function and diastolic dysfunction’. Data from six studies, with a total of 266 heart failure with reduced ejection fraction (HFrEF) participants, 144 in intervention groups and 122 in control groups, indicated a significant reduction in the ratio of early diastolic transmitral velocity (E) to early diastolic tissue velocity (E′) (E/E′ ratio) with exercise training, exercise vs. control mean difference (MD) of −2.85 (95% CI −3.66 to −2.04, p  < 0.00001). Data from five studies in heart failure with preserved ejection fraction (HFpEF) patients, with a total of 204 participants, 115 in intervention groups and 89 in control groups, also demonstrated a significant improvement in E/E′ in exercise vs. control MD of −2.38 (95% CI −3.47 to −1.28, p  < 0.0001).