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Wearing a cloth face mask has been shown to impair exercise performance; it is essential to understand the impact wearing a cloth face mask may have on cognitive performance. Participants completed two maximal cardiopulmonary exercise tests on a cycle ergometer (with and without a cloth face mask) with a concurrent cognitive task. Blood pressure, heart rate, oxygen saturation, perceived exertion, shortness of breath, accuracy, and reaction time were measured at rest, during each exercise stage, and following a 4-minute recovery period. The final sample included 35 adults (age = 26.1 ± 5.8 years; 12 female/23 male). Wearing a cloth face mask was associated with significant decreases in exercise duration (−2:00 ± 3:40 min, P = 0.003), peak measures of maximal oxygen uptake (−818.9 ± 473.3 mL/min, −19.0 ± 48 mL·min(-1)·kg(-1), P

A 23-year-old male competitive athlete performed a maximal cardiopulmonary exercise test on a cycle ergometer with a concurrent cognitive test on an iPad 6 days before and 19 weeks after a nonhospitalized COVID-19 illness. Results indicated reductions in time to exhaustion (−3.25 min), peak oxygen consumption (–1.68 mL/kg/min), and accuracy (–8%) during peak exertion despite his return to prior levels of activity. Reductions in functional or cognitive performance in competitive athletes may elicit noticeable differences in athletic performance; therefore, fitness specialists should consider the assessment of both cognitive function as well as aerobic capacity in athletes following COVID-19, regardless of severity, to facilitate safe and effective return to activity.

Following a traumatic coronary artery dissection and subsequent myocardial infarction from a nonpenetrating strike to the chest by an airborne metal pipe, a 33-year-old male police officer completed 12 weeks of high-intensity, symptom-limited cardiac rehabilitation in order to return to active duty. Physiological and perceptual responses to exercise were used to progress the patient through high-intensity activities that challenged the musculoskeletal and cardiorespiratory systems while simulating real work activities. In addition to substantial improvements in functional capacity (8.6 to 10.3 METS) and left ventricular ejection fraction (20% to 45%), the patient was able to fully return to work as an active-duty police officer.

A 29-year-old woman with a left ventricular assist device (LVAD) completed a progressive, symptom-limited cardiac rehabilitation program consisting of boxing, weight-lifting, and aerobic exercise, where she improved her exercise capacity by 2.7 metabolic equivalents (P

ObjectivesTo (1) determine if wearing a cloth face mask significantly affected exercise performance and associated physiological responses, and (2) describe perceptual measures of effort and participants’ experiences while wearing a face mask during a maximal treadmill test.MethodsRandomised controlled trial of healthy adults aged 18–29 years. Participants completed two (with and without a cloth face mask) maximal cardiopulmonary exercise tests (CPETs) on a treadmill following the Bruce protocol. Blood pressure, heart rate, oxygen saturation, exertion and shortness of breath were measured. Descriptive data and physical activity history were collected pretrial; perceptions of wearing face masks and experiential data were gathered immediately following the masked trial.ResultsThe final sample included 31 adults (age=23.2±3.1 years; 14 women/17 men). Data indicated that wearing a cloth face mask led to a significant reduction in exercise time (−01:39±01:19 min/sec, p2max) (−818±552 mL/min, p2 and rating of perceived exertion existed between the different stages of the CPET as participant’s exercise intensity increased. No significant differences were found between conditions after the 7-minute recovery period.ConclusionCloth face masks led to a 14% reduction in exercise time and 29% decrease in VO2max, attributed to perceived discomfort associated with mask-wearing. Compared with no mask, participants reported feeling increasingly short of breath and claustrophobic at higher exercise intensities while wearing a cloth face mask. Coaches, trainers and athletes should consider modifying the frequency, intensity, time and type of exercise when wearing a cloth face mask.

Research Objectives To describe the clinical implications of wearing a mask among special populations in inpatient rehabilitation. Design Narrative Review. Setting Inpatient rehabilitation. Participants Patients undergoing acute inpatient rehabilitation. Interventions Mask wearing. Main Outcome Measures Effect of mask wearing on exercise outcomes, including perceived exertion, shortness of breath, and patient perception; clinical implications for the interdisciplinary team. Results Five trials which observed exercise outcomes after mask wearing were identified and summarized. Findings for the effect of face masks on exercise and vital signs varied due to heterogeneity of exercise protocols and outcome measures. Relevant findings show that patients who wore masks had higher ratings of perceived exertion, increased shortness of breath, and feelings of claustrophobia while wearing a face mask during exercise. Wearing masks affected physical and mental outcomes despite exercise intensity (low, moderate, or high). Conclusions Moderate-to-high intensity exercise is needed for neuroplasticity. This type of exercise may not be possible in neurological populations, who do not have normal oxygen consumption at rest or with exercise, and may be further affected by wearing masks. Clinicians should their patients' mask wearing into consideration, and change the frequency, intensity, timing and types of exercises when patients are wearing a face mask. Frequent measurement of vital signs and fatigue symptoms are critical to maintain patient safety, and adjustments should be made as necessary. Other neurological challenges to monitor include impaired cognitive function, limited communication, reduced mood, and interactions with medications. These can affect the patients' ability to accurately determine and state their perceived effort or may hinder physiological and autonomic responses. Lastly, interdisciplinary teams should communicate patient findings related to mask wearing at team conferences, huddles and include discussion for ways to increase patients' participation and how to optimize health outcomes. Author(s) Disclosures None.

A 56-year-old man with end-stage heart failure performed a 4-week, symptom-limited, progressive inpatient cardiac prehabilitation program while confined to the cardiovascular intensive care unit awaiting heart transplantation. Mobility was limited by an acute gout flare and multiple central venous access lines. He received a tailored prescription of intermittent boxing, supervised hallway ambulation, stair training, and golfing on a putting green on four consecutive weekdays and was encouraged to mobilize with nursing on the remaining days. The patient progressed and by the last week demonstrated increased activity tolerance. He had a successful transplant after 40 days in the intensive care unit and was discharged with stamina sufficient to participate in outpatient cardiac rehabilitation, demonstrating the value, safety, and feasibility of an individualized inpatient cardiac prehabilitation program for patients with advanced cardiac disease medically confined to the intensive care unit.

A 53-year-old male mountain biker received a total artificial heart and remained in the cardiovascular intensive care unit for 56 days. To reduce functional decline caused by inactivity, he performed a six-session cycle ergometer exercise program in his hospital room. Traditional cardiac responses for exercise prescription were not applicable; therefore, a symptom-limited, monitored progression scheme in conjunction with recommendations for the artificial heart was implemented to modify duration and intensity. Over the six sessions, the patient improved his distance pedaled by 320% and functional capacity by 1 metabolic equivalent. He was subsequently discharged from the hospital and later successfully transplanted without readmission.

The purpose of this study was to investigate the maximum rate-pressure product of cardiac rehabilitation participants after myocardial infarction, percutaneous coronary intervention, or both during high-intensity resistance training (HI-RT) using continuous blood pressure monitoring. Thirty-four individuals exercised on the leg press machine while being monitored with a continuous blood pressure monitor. The maximum rate-pressure product was significantly lower than the established safety threshold of 36,000 (P < 0.001), with a mean of 17,369 and standard deviation of 6634. Only 2% of observations had a value ≥36,000. These results suggest that cardiac rehabilitation patients can perform HI-RT while keeping their rate-pressure products under the safety threshold of 36,000 after myocardial infarction/percutaneous coronary intervention. Performance of HI-RT exercises contributes to return to precardiac event occupations, and continuous blood pressure monitoring may be an effective tool in evaluating the safety of HI-RT in this patient population.

Purpose New donor organ allocation systems can potentially result in longer ischemic times (IT). The purpose of this study was to evaluate the effects of longer donor IT on functional exercise capacity (FEC) after orthotopic heart transplantation (OHT). Methods Thirty OHT recipients (22 males; 180 min) and short IT (≤180 min). Comparisons in CPET performance were made between cohorts using Chi-Square, Fisher's Exact, and Wilcoxon-rank sum, and t-tests. Results 12 patients received a donor heart with long IT. Donor and recipient characteristics were not significantly associated with having a long IT. Recipient and donor characteristics were similar between groups with 73% male, median recipient age of 57.5 years [Q1-Q3: 54.0 - 65.0], and mean donor age of 36.0 years (standard deviation: 13.4) (Table 1). The 10-W ramped protocol was performed by 9/18 (50%) and 4/12 (33%) recipients with a short and long IT, respectively. The duration of CPET testing was significantly reduced in recipients with a long IT (p=0.04) despite similar outcomes in fall risk and FEC [peak oxygen consumption (VO2), metabolic equivalents and anaerobic threshold]. Conclusion In this cohort, there was no significant difference in FEC, however, duration of exercise was significantly reduced in patients with long IT. Additional research is warranted to investigate the impact of testing modality on FEC in OHT recipients as well as the association between increased IT and reduced CPET duration.

Purpose Low functional exercise capacity (FEC) is directly associated with reduced quality of life and poor prognosis after orthotopic heart transplant (OHT). Due to inconsistencies in the literature, the purpose of this study is to investigate several proposed independent risk factors for poor FEC post-OHT. Methods Thirty OHT recipients (22 males; Results 15 patients exhibited high FEC. Characteristics were similar between groups, with the high FEC group having higher cardiac index (CI) and cardiac output (CO), longer ischemic time (IT), less chance of falling (all p Conclusion Lower cardiac output and index as well as higher fall risk were associated with low FEC. Shorter IT was paradoxically associated with low FEC. Higher FEC despite longer IT suggest centers may be willing to travel further for donor hearts, although other perioperative factors may contribute to poor FEC.

Purpose Ischemic time (IT) is an independent risk factor for patients’ functional exercise capacity (FEC) during the months following orthotopic heart transplantation (OHT). The OHT recipient's post-transplant FEC, measured in peak VO2, is directly associated with improved quality of life. There is debate in the literature about the deleterious impact of extended IT on FEC following OHT. Methods 15 OHT recipients (14 males; Results The minimal and maximal IT were 62 and 312 minutes, respectively. The median (IQR) recipient and donor characteristics are presented in Table 1. The Fisher's Exact Test between IT and FEC yielded a p value of 0.62. Conclusion Surprisingly, extended IT was not associated with decreased FEC (

The Cognistat is a widely used screening instrument for assessing cognitive functioning. However, the manualized scoring guidelines for one of the questions in the Judgment subtest appear insensitive to responses when examinees answer in light of current societal attitudes. Penalization of examinees is likely to lead to an underestimation of functional ability and a decrease in test validity. Suggestions for correcting this issue are presented.