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Nearly four decades ago, the World Health Organization stated that functional capacity explorations best reflected the impact of a chronic disease on quality of life. Today, cardio-pulmonary exercise test (CPET) is recommended in the follow-up of patients with congenital heart diseases (CHDs). Indeed, the maximum oxygen uptake (VO 2max ) and the ventilatory efficiency (VE/VCO 2 slope) correlate with both the prognosis and the quality of life in this population. Atrial septal defects (ASDs) represent the second most frequent CHD and are usually considered as simple CHDs. However, the exercise capacity of ASD patients may be impaired. Therefore, the CPET provides important information in assessment and follow-up of patients with ASDs, for both children and adults. Exercise capacity of patients with unrepaired ASDs depends on the importance of the shunt, the right ventricular (RV) function and volume overload, the level of pulmonary arterial pressure, and the occurrence of arrhythmias. For repaired ASDs, exercise capacity also depends on the delay before closure and the type of procedure (catheter or surgery). In most cases, the exercise capacity is nearly normal and CPET contributes to promote sports participation. In addition, a regular CPET follow-up is necessary to evaluate the occurrence, severity and physiological mechanisms of comorbidities, i.e., heart failure, pulmonary hypertension and arrhythmia. Furthermore, CPET follow-up in patients with ASDs may detect early onset of muscular deconditioning, for which cardiac rehabilitation may be considered., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background: It has been documented that aerobic exercise may increase pulmonary functions and aerobic capacity, but limited data has evaluated a child's satisfaction and pediatric quality of life (PQoL) with exercise training., Objectives: This study aimed to investigate the effects of moderate-intensity exercise training on asthmatic school-aged children., Subjects and Methods: This study included 38 school-aged children with asthma (23 males and 15 females) aged between 8-12 years. They were randomly assigned to two groups, aerobic exercise (AE) and conventional treatment (Con ttt) groups. The AE group received a program of moderate-intensity aerobic exercise for 10 weeks with asthma medications and the Con ttt group received only asthma medications without exercise intervention. A home respiratory exercise was recommended for the two groups. Aerobic capacity was investigated using maximal oxygen uptake (VO 2max ), 6-minute walk test (6MWT), and fatigue index. PQoL was evaluated using Pediatric Quality of Life Questionnaire (PQoLQ). Also, pulmonary function tests were performed, and the results recorded., Results: The findings of this study showed significant improvements in pulmonary functions and VO 2max in the two groups; however, this improvement was significantly higher in the AE group than in the Con ttt group ( p <0.05). The 6MWT and fatigue index improved in the AE group ( p <0.05) but not in the Con ttt group ( p >0.05). All dimensions of PQoL significantly improved in the AE group ( p <0.05), but there was no significant improvement in the Con ttt group after the 10-week intervention period ( p >0.05)., Conclusion: Ten weeks of physical exercise had beneficial effects on pulmonary functions, aerobic capacity, and PQoL in school-aged children with asthma. Effort and awareness should be dedicated to encouraging the active lifestyle among different populations, especially asthmatic children., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Carbohydrate (CHO) availability during endurance exercise seems to attenuate exercise-induced perturbations of cellular homeostasis and might consequently diminish the stimulus for training adaptation. Therefore, a negative effect of CHO intake on endurance training efficacy seems plausible. This study aimed to test the influence of carbohydrate intake on the efficacy of an endurance training program on previously untrained healthy adults. A randomized cross-over trial (8-week wash-out period) was conducted in 23 men and women with two 8-week training periods (with vs. without intake of 50g glucose before each training bout). Training intervention consisted of 4x45 min running/walking sessions/week at 70% of heart rate reserve. Exhaustive, ramp-shaped exercise tests with gas exchange measurements were conducted before and after each training period. Outcome measures were maximum oxygen uptake (VO 2max ) and ventilatory anaerobic threshold (VT). VO 2max and VT increased after training regardless of CHO intake (VO 2max : Non-CHO 2.6 ± 3.0 ml*min -1 *kg -1 p = 0.004; CHO 1.4 ± 2.5 ml*min -1 *kg -1 p = 0.049; VT: Non-CHO 4.2 ± 4.2 ml*min -1 *kg -1 p < 0.001; CHO 3.0 ± 4.2 ml*min -1 *kg -1 p = 0.003). The 95% confidence interval (CI) for the difference between conditions was between +0.1 and +2.1 ml*min -1 *kg -1 for VO 2max and between -1.2 and +3.1 for VT. It is concluded that carbohydrate intake could potentially impair the efficacy of an endurance training program.

Background : Patients suffering from exercise-induced laryngeal obstruction (EILO) are subjected to several exhausting tests. We aimed to assess the feasibility of using a single test to obtain diagnostic measurements for maximum oxygen uptake (VO 2 max) and exercise-induced laryngeal obstruction (EILO). Methods : Patients referred to the outpatient respiratory clinic at the University Hospital of Bispebjerg, Copenhagen with exercise-induced dyspnoea were evaluated for inclusion over 13 months. Eligible patients were aged 18-43 years, had a known EILO diagnosis (moderate or severe) and were inactive (self-reported activity) with less than 3 hours activity per week. In randomised order, all participants ( n  = 11) underwent three tests: a VO 2 max test with and without concurrent laryngoscopy. VO 2 max and EILO values from the two testing methods were compared. Findings : There was no difference in VO 2 max measured by ergospirometry with and without simultaneous continuous laryngoscopy during exercise (CLE) testing (mean difference -22 ml O 2 ･min -1 ; 95% CI -125 to 81 ml O 2 ･min -1 ; P  = 0.647). EILO scores obtained during the CLE testing on the treadmill versus CLE testing on the ergometer bike revealed identical supraglottic scores in nine of the 11 participants (82%) with substantial agreement between the two types of test ( x  = 0.71). Glottic scores were identical in six of the 11 (55%), showing moderate agreement between test types ( x  = 0.38). Conclusions : Based on our findings in inactive individuals, ergospirometry with laryngoscopy is feasible and well tolerated, yielding measurements for maximal oxygen uptake comparable to those of standard bike ergospirometry. Likewise, measurements of supraglottic EILO are comparable to those of the standard treadmill CLE test., Competing Interests: No potential conflict of interest was reported by the authors.

Endurance exercise improves cardiac performance and affords protection against cardiovascular diseases but the signalling events that mediate these benefits are largely unexplored. Phosphorylation is a widely studied post-translational modification involved in intracellular signalling, and to discover novel phosphorylation events associated with exercise we have profiled the cardiac phosphoproteome response to a standardised exercise test to peak oxygen uptake (VO2peak). Male Wistar rats (346±18g) were assigned to 3 independent groups (n=6, in each) that were familiarised with running on a motorised treadmill within a metabolic chamber. Animals performed a graded exercise test and were killed either immediately (0h) after or 3h after terminating the test at a standardised physiological end point (i.e. peak oxygen uptake; VO2peak). Control rats were killed at a similar time of day to the exercised animals, to minimise possible circadian effects. Cardiac proteins were digested with trypsin and phosphopeptides were enriched by selective binding to titanium dioxide (TiO2). Phosphopeptides were analysed by liquid chromatography and high-resolution tandem mass spectrometry, and phosphopeptides were quantified by MS1 intensities and identified against the UniProt knowledgebase using MaxQuant (data are available via ProteomeXchange, ID PXD006646). The VO2peak of rats in the 0h and 3h groups was 66±5mlkg -1 min -1 and 69.8±5mlkg -1 min -1 , respectively. Proteome profiling detected 1169 phosphopeptides and one-way ANOVA found 141 significant (P<0.05 with a false discovery rate of 10%) differences. Almost all (97%) of the phosphosites that were responsive to exercise are annotated in the PhosphoSitePlus database but, importantly, the majority of these have not previously been associated with the cardiac response to exercise. More than two-thirds of the exercise-responsive phosphosites were different from those identified in previous phosphoproteome profiling of the cardiac response to β 1 -adrenergic receptor stimulation. Moreover, we report entirely new phosphorylation sites on 4 cardiac proteins, including S81 of muscle LIM protein, and identified 7 exercise-responsive kinases, including myofibrillar protein kinases such as obscurin, titin and the striated-muscle-specific serine/threonine kinase (SPEG) that may be worthwhile targets for future investigation., (Copyright © 2017. Published by Elsevier Ltd.)

The maximum oxygen uptake (V̇O 2 max), determined from graded maximal or submaximal exercise tests, is used to classify the cardiorespiratory fitness level of individuals. The purpose of this study was to examine the validity and reliability of the YMCA submaximal exercise test protocol performed on a newly-designed rectilinear stepping ergometer (RSE) that used up and down reciprocating vertical motion in place of conventional circular motion and giving precise measurement of workload, to determine V̇O 2 max in young healthy male adults. Thirty-two young healthy male adults (32 males; age range: 20-35 years; height: 1.75 ± 0.05 m; weight: 67.5 ± 8.6 kg) firstly participated in a maximal-effort graded exercise test using a cycle ergometer (CE) to directly obtain measured V̇O 2 max. Subjects then completed the progressive multistage test on the RSE beginning at 50W and including additional stages of 70, 90, 110, 130, and 150W, and the RSE YMCA submaximal test consisting of a workload increase every 3 minutes until the termination criterion was reached. A metabolic equation was derived from the RSE multistage exercise test to predict oxygen consumption (V̇O 2 ) from power output (W) during the submaximal exercise test (V̇O 2 (mL·min -1 )=12.4 ×W(watts)+3.5 mL·kg -1 ·min -1 ×M+160mL·min -1 , R 2 = 0.91, standard error of the estimate (SEE) = 134.8mL·min -1 ). A high correlation was observed between the RSE YMCA estimated V̇O 2 max and the CE measured V̇O 2 max (r=0.87). The mean difference between estimated and measured V̇O 2 max was 2.5 mL·kg -1 ·min -1 , with an SEE of 3.55 mL·kg -1 ·min -1 . The data suggest that the RSE YMCA submaximal exercise test is valid for predicting V̇O 2 max in young healthy male adults. The findings show that the rectilinear stepping exercise is an effective submaximal exercise for predicting V̇O 2 max. The newly-designed RSE may be potentially further developed as an alternative ergometer for assessing cardiorespiratory fitness and the promotion of personalized health interventions for health care professionals.

This study aimed to describe the acute changes of both standard physiological-perceptual markers and circulating microRNAs in response to tennis match-play in a detailed case report. Two elite male baseliners with comparable tennis experience were tested for anthropometric and fitness related variables and played 2 h of match-play on a red-clay court. The changes of standard physiological-perceptual markers including the heart rate, lactate concertation, creatine kinase activity, urea concentration and rating of perceived exertion as well as circulating microRNA-133a, -486 and -126 expression rates were examined at 10 different time-points (i.e., pre, during and up to 24 h post match-play). Player 2 had lower fitness related variables, but a higher heart rate, lactate concentration, creatine kinase activity and rating of perceived exertion during play than player 1. Player 2 showed an increase in all microRNAs (≤3.83-fold), most evident post match-play, whereas player 1 demonstrated a decrease (≤0.41-fold). The time-course in the changes of all standard physiological-perceptual markers was similar in both players, whereas this of the microRNAs was different. It was concluded that the relative changes of the circulating microRNA-133a, -486 and 126 expression rates of both players differed in response to tennis match-play with respect to the experienced physiological-perceptual stress and the underlying fitness level. Therefore, circulating microRNAs can serve as additional biomarkers for tennis exercise physiology and may be assessed together with standard markers to conclude whether key cellular regulatory processes were induced in response to match-play.

Purpose: The purpose of this study was to evaluate the use of a treadmill walk-jog-run exercise test previously validated in adults and physical activity questionnaire data to estimate maximum oxygen consumption (VO2max) in boys (n = 62) and girls (n = 66) aged 12 to 17 years old., Methods: Data were collected from Physical Activity Rating (PA-R) and Perceived Functional Ability (PFA) questionnaires, a walk-jog-run submaximal treadmill exercise test, and a maximal graded exercise test., Results: Regression analysis resulted in the development of 2 models to predict VO2max. Submaximal exercise test data were used to build the following model (R2 = .73; SEE = 4.59 mL + kg(- 1) + min(- 1)): VO2max (mL + kg(- 1) + min(- 1)) = 26.890+(5.877 × Gender; 0 = female; 1 = male) - (0.782 × Body Mass Index [BMI])+(0.438 × PFA Score) +(2.712 × Treadmill Speed; mph) +(0.746 × Age) +(0.449 × PA-R Score). Maximal exercise test data were used to build the following model (R2 = .83; SEE = 3.63 mL + kg(- 1) + min(- 1)): VO2max (mL + kg(- 1) + min(- 1)) = 10.716+(1.334 × Maximal Treadmill Grade) +(5.203 × Treadmill Speed; mph) +(3.494 × Gender; 0 = female; 1 = male) - (0.413 × BMI) +(0.249 × PFA)., Conclusions: The results of this study demonstrate, for the first time, that regression equations that use both exercise data and physical activity questionnaire data can accurately predict VO2max in youth. The submaximal and maximal exercise tests that use self-selected treadmill speeds can be used to assess cardiorespiratory fitness of youth with a wide range of fitness levels.

When Edmund Hillary and Tenzing Norgay reached the summit of Mt. Everest in 1953, it was the culmination of many attempts beginning in 1921. Alexander Kellas had actually predicted as early as 1920 that the mountain could be climbed, but the extreme altitude of 8848 m with the consequent oxygen deprivation had foiled previous attempts. One reason for the success of the 1953 expedition was the work done by the British physiologist Griffith Pugh in 1952 when he studied many of the physiological factors at high altitude including the oxygen requirements. Seven years later, Pugh and Hillary teamed up again for the Silver Hut Expedition in 1960-1961 that elucidated many of the problems of very high altitude. A group of physiologists spent several months at an altitude of 5800 m in a prefabricated hut and studied many aspects of exercise, pulmonary gas exchange, control of ventilation, and blood changes. Maximal exercise was measured as high as 7440 m and raised anew the question of whether Everest could ever be climbed without supplementary oxygen. The answer was shown to be yes in 1978 by Messner and Habeler, and 3 years later the American Medical Research Expedition to Everest clarified the physiological adaptations that allow humans to reach the highest point on earth. Five people reached the summit, the barometric pressure there was measured for the first time, and alveolar gas samples from the summit showed the critical importance of the extreme hyperventilation. However, the maximal oxygen consumption for the summit inspired PO2 of 43 mmHg was shown to be only about 1 l min(-1). In other words, the highest point on earth is very close to the limit of human tolerance to oxygen deprivation. As we celebrate the anniversary of Charles Darwin, it would be nice to have an evolutionary explanation for this, but in fact it is a cosmic coincidence.

Aim/hypothesis: Little is known about the relative roles of physical activity energy expenditure (PAEE) and cardiorespiratory fitness (CRF) as determinants of glucose regulation. The aim of this study was to examine the associations of PAEE and CRF with markers of glucose metabolism, and to test the hypothesis that CRF modifies the association between PAEE and glucose metabolism., Methods: We analysed cross-sectional data from 755 adults from the Danish ADDITION-PRO study. On the basis of OGTT results, participants without known diabetes were classified as having normal glucose tolerance, isolated impaired fasting glycaemia (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG + IGT or screen-detected diabetes mellitus. Markers of insulin sensitivity and beta cell function were determined. PAEE was measured using a combined heart rate and movement sensor. CRF (maximal oxygen uptake) was estimated using a submaximal 8 min step test. The associations were examined by linear regression analysis. Results were adjusted for relevant confounders., Results: PAEE and CRF were reduced in individuals with i-IGT, combined IFG + IGT and screen-detected diabetes mellitus, but were not significantly different in individuals with i-IFG compared with those with normal glucose tolerance. When adjusting CRF for PAEE and vice versa, PAEE and CRF were both associated with lower fasting and 2 h insulin and higher peripheral insulin sensitivity. CRF was additionally associated with lower fasting and 2 h glucose and higher insulin sensitivity and beta cell function. There was no interaction between CRF and PAEE for any markers of glucose metabolism., Conclusions/interpretation: Only CRF, not PAEE, appears to be independently associated with plasma glucose levels and beta cell function, suggesting that CRF may be particularly important for glycaemic control.

Performance in most sports is determined by the athlete's technical, tactical, physiological and psychological/social characteristics. In the present article, the physical aspect will be evaluated with a focus on what limits performance, and how training can be conducted to improve performance. Specifically how intensified training, i.e., increasing the amount of aerobic high-intensity and speed endurance training, affects physiological adaptations and performance of trained subjects. Periods of speed endurance training do improve performance in events lasting 30 s-4 min, and when combined with aerobic high-intensity sessions, also performance during longer events. Athletes in team sports involving intense exercise actions and endurance aspects, such as soccer and basketball, can also benefit from intensified training. Speed endurance training does reduce energy expenditure and increase expression of muscle Na(+), K(+) pump α subunits, which may preserve muscle cell excitability and delay fatigue development during intense exercise. When various types of training are conducted in the same period (concurrent training), as done in a number of sports, one type of training may blunt the effect of other types of training. It is not, however, clear how various training modalities are affecting each other, and this issue should be addressed in future studies., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Sex and age affect the pulmonary circulation. Whether there may be racial differences in pulmonary vascular function is unknown. Thirty white European Caucasian subjects (15 women) and age and body-size matched 30 black sub-Saharan African subjects (15 women) underwent a cardiopulmonary exercise test and exercise stress echocardiography with measurements of pulmonary artery pressure (PAP) and cardiac output (CO). A pulmonary vascular distensibility coefficient α was mathematically determined from the natural curvilinearity of multipoint mean PAP (mPAP)-CO plots. Maximum oxygen uptake (V̇o2max) and workload were higher in the whites, while maximum respiratory exchange ratio and ventilatory equivalents for CO2 were the same. Pulmonary hemodynamics were not different at rest. Exercise was associated with a higher maximum total pulmonary vascular resistance, steeper mPAP-CO relationships, and lower α-coefficients in the blacks. These differences were entirely driven by higher slopes of mPAP-CO relationships (2.5 ± 0.7 vs. 1.4 ± 0.7 mmHg·l(-1)·min; P < 0.001) and lower α-coefficients (0.85 ± 0.33 vs. 1.35 ± 0.51%/mmHg; P < 0.01) in black men compared with white men. There were no differences in any of the hemodynamic variables between black and white women. In men only, the slopes of mPAP-CO relationships were inversely correlated to V̇o2max (P < 0.01). Thus the pulmonary circulation is intrinsically less distensible in black sub-Saharan African men compared with white Caucasian Europeans men, and this is associated with a lower exercise capacity. This study did not identify racial differences in pulmonary vascular function in women., (Copyright © 2015 the American Physiological Society.)

The main purpose of the present meta-analysis was to examine the criterion-related validity of the 20-m shuttle run test for estimating cardiorespiratory fitness. Relevant studies were searched from twelve electronic databases up to December 2014, as well as from several alternative modes of searching. The Hunter-Schmidt's psychometric meta-analysis approach was conducted to estimate the population criterion-related validity of the 20-m shuttle run test. From 57 studies that were included in the present meta-analysis, a total of 78 correlation values were analyzed. The overall results showed that the performance score of the 20-m shuttle run test had a moderate-to-high criterion-related validity for estimating maximum oxygen uptake (r p = 0.66-0.84), being higher when other variables (e.g. sex, age or body mass) were used (r p = 0.78-0.95). The present meta-analysis also showed that the criterion-related validity of Léger's protocol was statistically higher for adults (r p = 0.94, 0.87-1.00) than for children (r p = 0.78, 0.72-0.85). However, sex and maximum oxygen uptake level do not seem to affect the criterion-related validity values. When an individual's maximum oxygen uptake attained during a laboratory-based test is not feasible, the 20-m shuttle run test seems to be a useful alternative for estimating cardiorespiratory fitness. In adults the performance score only seems to be a strong estimator of cardiorespiratory fitness, in contrast among children the performance score should be combined with other variables. Nevertheless, as in the application of any physical fitness field test, evaluators must be aware that the performance score of the 20-m shuttle run test is simply an estimation and not a direct measure of cardiorespiratory fitness. Key pointsOverall the 20-m shuttle run test has a moderate-to-high mean criterion-related validity for estimating cardiorespiratory fitness.The criterion-related validity of the 20-m shuttle run test is significantly higher for adults than for children. However, when the performance score is combined with other variables, the criterion-related validity value increases considerably among children.Sex and maximum oxygen uptake level of individuals seem not to affect the criterion-related validity of the 20-m shuttle run test.When individuals' maximum oxygen uptake attained during a laboratory-based test is not feasible, the 20-m shuttle run test seems to be a useful alternative for estimating cardiorespiratory fitness.

Aim: To investigate the association between self-reported physical fitness level obtained by a single-item question and objectively measured fitness level in 30- to 49-year-old men and women., Methods: From the Danish 'Check Your Health Preventive Program' 2013-2014 fitness level was assessed in 2316 participants using the Aastrand test. Additionally, participants rated their physical fitness as high, good, average, fair or low. The association of self-reported- with objectively measured fitness level was analyzed by linear regression. Categories of self-reported- and objectively measured fitness level were cross-tabulated and agreement was quantified by Kappa statistics. Gender differences within categories were investigated by Poisson regression., Results: Data from 996 men and 1017 women were analyzed (excluded, n = 303). In both men and women a higher self-reported fitness level was associated with a higher objectively measured fitness level (Rall = 0.42). Kappa agreement was 0.25. Poisson regression revealed that women rated their fitness level significantly lower than men (p < 0.001)., Conclusion: A single-item question is a cost-effective way of measuring physical fitness level, but the method has low association and fair agreement when compared to the Aastrand test. Men tend to overestimate physical fitness more than women, which should be accounted for if using the question in primary care settings.

The purpose of this study was to determine whether an individually designed incremental exercise protocol results in greater rates of oxygen uptake (VO2max) than standardized testing. Fourteen well-trained, male runners performed five incremental protocols in randomized order to measure their VO2max: i) an incremental test (INCS+I) with pre-defined increases in speed (2 min at 8.64 km·h(-1), then a rise of 1.44 km·h(-1) every 30 s up to 14.4 km·h(-1)) and thereafter inclination (0.5° every 30 s); ii) an incremental test (INCI) at constant speed (14.4 km·h(-1)) and increasing inclination (2° every 2 min from the initial 0°); iii) an incremental test (INCS) at constant inclination (0°) and increasing speed (0.5 km·h(-1) every 30 s from the initial 12.0 km·h(-1)); iv) a graded exercise protocol (GXP) at a 1° incline with increasing speed (initially 8.64 km·h(-1) + 1.44 km·h(-1) every 5 min); v) an individual exercise protocol (INDXP) in which the runner chose the inclination and speed. VO2max was lowest (-4.2%) during the GXP (p = 0.01; d = 0.06-0.61) compared to all other tests. The highest rating of perceived exertion, heart rate, ventilation and end-exercise blood lactate concentration were similar between the different protocols (p < 0.05). The time to exhaustion ranged from 7 min 18 sec (INCS) to 25 min 30 sec (GXP) (p = 0.01).The VO2max attained by employing an individual treadmill protocol does not differ from the values derived from various standardized incremental protocols. Key pointsThe mean maximum oxygen uptake during the GXP was lower than for all other tests.Differences in the maximum rate of oxygen uptake between the various protocols exhibited considerable inter-individual variation.From the current findings, it can be concluded that well trained athletes are able to perform an individually designed treadmill running protocol.

Background: Physical exercise capacity has been shown to predict cardiovascular disease incidence and is increasingly measured in epidemiological studies. However, direct measurement of peak oxygen uptake is too time consuming in large-scale studies. We therefore investigated whether a brief 3-minute step-test protocol can be used to estimate peak oxygen uptake in these settings., Design and Methods: A group of 97 subjects performed the YMCA step test and a maximal treadmill test with continuous measurement of oxygen uptake. Correlation and linear regression analyses were used to identify VO2peak predictors obtained from the step test and to develop models for VO2peak estimation., Results: The YMCA model, including the 1-minute heart beat count, predicted VO2peak with R = 0.83. A novel simplified model based on the heart rate at 45 s of recovery performed comparable (R = 0.83). However, models based on heart rate measures were only valid in subjects who completed the test according to protocol, but not in subjects who terminated prematurely. For the applicability in subjects with low exercise capacity, a new model including gas exchange analysis enabled prediction of VO2peak (R = 0.89). All models were validated in an independent sample (r = 0.86-0.91). Exercise time of the step test was less than one-hird of standard ergospirometry (treadmill test: 654 ± 151 s, step test: 180 s, p < 0.001)., Conclusion: In large-scale epidemiological studies with limited time slots for exercise testing and significant proportions of subjects with low exercise capacity a modified version of the YMCA step test may be used to predict VO2peak., (© The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

While life expectancy is greatly improved after a heart transplant, survival is still limited, and compared to the general population, the exercise capacity and health-related quality of life of heart transplant recipients are reduced. Increased exercise capacity is associated with a better prognosis. However, although several studies have documented positive effects of exercise after heart transplantation (HTx), little is known about the type, frequency and intensity of exercise that provides the greatest health benefits. Moreover, the long-term effects of exercise on co-morbidities and survival are also unclear. Exercise restrictions apply to patients with a denervated heart, and for decades, it was believed that the transplanted heart remained denervated. This has since been largely disproved, but despite the new knowledge, the exercise restrictions have largely remained, and up-to-date guidelines on exercise prescription after HTx do not exist. High-intensity, interval based aerobic exercise has repeatedly been documented to have superior positive effects and health benefits compared to moderate exercise. This applies to both healthy subjects as well as in several patient groups, such as patients with metabolic syndrome, coronary artery disease or heart failure. However, whether the effects of this type of exercise are also applicable to heart transplant populations has not yet been fully established. The purpose of this article is to give an overview of the current knowledge about the exercise capacity and effect of exercise among heart transplant recipients and to discuss future exercise strategies.