Objective: Sleeve gastrectomy (SG) effectively reduces food intake and enhances health and longevity, although weight loss often involves reductions in body fat and skeletal muscle. Hence, we examined how changes in skeletal muscle density relate to muscle strength and physical activity before and after SG. Methods: This pilot observational study included 173 patients (mean age: 46 ± 11 years) who attended the hospital before and 1 year after undergoing SG between December 2018 and July 2022. Muscle cross-sectional area (cm²), skeletal muscle density, and fat cross-sectional area (cm²) at the 3rd lumbar vertebra were measured on computed tomography (CT) images. The psoas muscle index (PMI) was calculated as the cross-sectional area of both psoas muscles (cm²) divided by height squared (m²), and CT values for skeletal muscle density of the psoas and multifidus muscles, visceral fat area (VFA), and subcutaneous fat area (SFA) were obtained. Relative and absolute muscle strengths, sitting time, and total physical activity from the International Physical Activity Questionnaire were also assessed. Results: Although VFA, SFA, PMI, and absolute muscle strength decreased significantly after SG compared to those before SG (p <0.001), skeletal muscle density, relative muscle strength, and total physical activity increased significantly after SG, with a significant reduction in sitting time (p <0.001). There were significant positive correlations between changes in skeletal muscle density and changes in relative muscle strength and total physical activity. Conclusions: Improving skeletal muscle density with SG may be associated with increased relative muscle strength and improved physical activity.

Objectives: This study aimed to clarify the impact of cachexia on physical function recovery during hospitalization among patients with heart failure using the new Asian Working Group for Cachexia criteria and to identify the characteristics of heart failure patients with cachexia.

Methods: Cachexia at discharge was defined by low body mass index combined with one or more of the following: low handgrip strength, elevated C-reactive protein, or anorexia. Physical function was assessed at admission and discharge. Two-way analysis of variance (ANOVA) was performed to examine the interaction and main effects of the presence of cachexia and duration factors (admission and discharge) on physical function. Hierarchical logistic regression analysis was performed to explore factors associated with the presence of cachexia.

Results: Of the 96 patients analyzed, 26 were heart failure patients with cachexia, and 70 were heart failure patients without cachexia. The results of the 2-way ANOVA indicated that heart failure patients without cachexia exhibited improved physical function at discharge compared to that at admission. In contrast, heart failure patients with cachexia showed no improvement in physical function during hospitalization. Hierarchical logistic regression analysis revealed that a low geriatric nutritional risk index (GNRI) and low muscle power were associated with the presence of cachexia in patients with heart failure.

Conclusions: Our results suggest that heart failure patients with cachexia experience poor recovery of physical function during hospitalization, and that reduced muscle power and deterioration in nutritional status, as indicated by a low GNRI, were associated with the presence of cachexia.

Objectives: Anaerobic threshold (AT) assessment using cardiopulmonary exercise testing (CPX) during hospitalization is considered ideal for prescribing exercise regimens in patients with acute myocardial infarction (AMI). However, practical limitations often hinder its implementation. This study evaluated strategies for prescribing exercise based on resting heart rate (RHR). Methods: A total of 194 consecutive male patients with AMI who underwent CPX within 13 days of hospitalization were enrolled. Bland–Altman analysis was performed to assess the agreement between the heart rate (HR) at AT (ATHR) and RHR +20, +25, and +30 beats. Multiple regression analysis was conducted to identify factors influencing ΔHR (ATHR−RHR). Decision-tree analysis was used to establish thresholds for appropriate exercise prescriptions based on RHR. Results: Regardless of β-blocker use, the RHR + 25 formula most closely approximated the ATHR in patients who underwent early CPX after AMI. Multivariate analysis identified RHR and hemoglobin (Hb) as significant predictors of ΔHR. Decision-tree analysis indicated that RHR + 25 was appropriate when RHR <91 bpm and Hb ≥12.0 g/dL. Conclusions: RHR + 25 is a practical alternative for determining the target HR in post-AMI rehabilitation among male patients, particularly in those with RHR <91 bpm and Hb ≥12.0 g/dL, when CPX is not feasible.

Objectives: This study aimed to systematically review exercise-based cardiac rehabilitation (CR) programs implemented in South Korea since their inclusion in the National Health Insurance System in 2017. Methods: A systematic literature search was conducted using international and Korean databases for studies published after January 2017. The inclusion criterion was exercise-based CR intervention in patients with cardiac disease in South Korea. The methodological quality of each study was assessed using the Physiotherapy Evidence Database scale. Results: A total of 11 studies met our inclusion criteria. Most CR programs are hospital-based, whereas some incorporate home-based, aquatic, or forest environments. The exercise prescriptions followed the FITT (frequency, intensity, time, and type) principle and often included aerobic and high-intensity interval training. The reported outcomes included improvements in cardiopulmonary fitness, physical activity, and psychological well-being. Despite their clinical effectiveness, participation in CR programs remains low in Korea owing to accessibility and institutional limitations. Conclusions: Exercise-based CR programs in Korea demonstrated clinical benefits and diversified delivery models. Further efforts are required to enhance accessibility and promote wider adoption through policy and infrastructure development.

Objectives: Inpatient cardiac rehabilitation (CR) and pharmacotherapy are important for better in-hospital outcomes in elderly heart failure (HF) patients. We aimed to examine whether conventional CR combined with Waon therapy (Waon-CR) improves exercise capacity compared to CR alone in elderly HF patients. Methods: Decompensated and hospitalized HF patients who could not walk independently over 200 m were recruited. Patients admitted from May 2020 to March 2021 and from April 2021 to March 2024 were included in the CR and Waon-CR groups, respectively. Participants underwent a 5-session program during hospitalization. The main outcome measure was a 6-minute walk distance (6MWD) at the completion of the program. We also investigated exercise-related adverse events. Results: A total of 34 patients (mean age 79.5 years, 13 males) were enrolled, including 18 patients in the CR group and 16 patients in the Waon-CR group. The 6MWD after the 5-session program was longer in the Waon-CR group than in the CR group (362.2 ± 103.7 vs. 286.3 ± 100.6 m, p = 0.038). Significant improvement of the 6MWD was demonstrated in the Waon-CR group after adjusting for confounding factors (adjusted B, 147.0 m; 95% confidence interval, 41.3–252.8 m, p = 0.012). There were no adverse events during the hospital stay. Conclusions: Inpatient Waon-CR was feasible and led to improved 6MWD in elderly HF patients at the completion of the 5-session program.

Objectives: This study aimed to investigate the effect of the number of days from surgery to ambulation on activities of daily living (ADL) at discharge in postoperative patients with type A aortic dissection (TAAD). Methods: It included patients with a diagnosis of TAAD who were independent in ADL before the onset of symptoms. ADL was assessed using the Katz Index (KI), with a KI score of 6 points at discharge defining independence and less than 6 points classified as dependence. Patients were divided into 2 groups based on independence in ADL at discharge. Logistic regression analysis was performed with independence in ADL at discharge as the object variable and the number of days from surgery to ambulation as the explanatory variable. A receiver operating characteristic curve was constructed to calculate the cutoff value. Results: A total of 100 patients were included in the analysis. There was a significant difference in the number of days to ambulation between the 2 groups. Multiple logistic regression analysis revealed that the probability of being independent in ADL at discharge was significantly lower with more days to ambulation (odds ratio: 0.93, 95% confidence interval: 0.86–0.99, P < 0.035). The cutoff value for the number of days from surgery to ambulation for independence in ADL at discharge was 8 days (area under the curve: 0.64). Conclusions: In postoperative patients with TAAD, the longer the postoperative days to start ambulation, the more difficult ADL recovery may be, but the cutoff values need further validation.

Objectives: The 6-minute walk test (6MWT) is generally used to evaluate endurance in interstitial lung disease (ILD). In ILD, treatment efficacy differs between patients with idiopathic pulmonary fibrosis (IPF) and those with non-idiopathic pulmonary fibrosis (non-IPF), and the clinical profile varies according to disease severity. This study compared 6MWT parameters by severity of illness in patients with IPF and non-IPF. Methods: The participants were hospitalized patients with ILD and either IPF (n = 20) or non-IPF (n = 25). To compare IPF and non-IPF by severity, patients were classified using the gender–age–physiology (GAP) index as having GAP stage I (i.e., mild) or GAP stage II/III (i.e., moderate to severe). The evaluation parameters were the 6-minute walk distance (6MWD), minimum percutaneous oxygen saturation (SpO₂), heart rate recovery at 1 minute (HRR1) after the 6MWT, and modified Borg scale rating of perceived exertion. Results: The minimum SpO₂ value during exertion was significantly lower in the IPF group than in the non-IPF group (p < 0.05). Furthermore, when comparing by severity, patients with IPF and GAP stage I had a significantly lower 6MWD, HRR1, and SpO₂ value. In patients with GAP stage II/III, there were no significant differences in 6MWD, SpO₂ values, or dyspnea. Conclusions: Patients with mild IPF were more prone to hypoxemia, while in moderate-to-severe cases, we observed no significant hypoxemia- or endurance-related differences between IPF and non-IPF patients. This study highlights the importance of severity-based evaluation, particularly in guiding individualized rehabilitation and risk management for patients with IPF.

Objectives: The effect of the co-occurrence of whole-body muscle wasting and respiratory muscle weakness on the clinical characteristics of patients with chronic obstructive pulmonary disease (COPD) is unclear. We investigated this association in patients with chronic respiratory diseases. Methods: 47 outpatients with mild to very severe COPD were classified into four groups according to their fat-free mass index and respiratory muscle strength: 19 without muscle wasting and respiratory muscle weakness (normal), 6 with muscle wasting only (MW), 11 with respiratory weakness only (RW), and 11 with muscle wasting and respiratory weakness (MW + RW). We measured their body composition, pulmonary function, lower muscle strength, submaximal exercise capacity, physical activity in daily life, nutritional status, frailty status, and health-related quality of life (QOL). Multiple linear regression analyses examined the association of muscle wasting and/or respiratory muscle weakness with participant characteristics, using each participant’s characteristics as an explained variable adjusted for confounding variables (Normal as the reference). Results: The regression analysis revealed that the percentage of vital capacity, lower muscle strength, submaximal exercise capacity, nutritional status, and frailty status were worse in the MW + RW group than in the Normal group. The MR + RW group had the largest number of variables with significant differences compared to the Normal group. Conclusions: These data suggest that the co-occurrence of whole-body muscle wasting and respiratory muscle weakness was significantly associated with deteriorating clinical characteristics in patients with COPD.

Objectives: The need for early postoperative rehabilitation in patients with congenital heart disease (CHD) is increasing. However, rehabilitation settings in the pediatric intensive care unit (PICU) are usually determined subjectively by therapists. To address the lack of objective measurements, we sought to determine the effectiveness of near-infrared spectroscopy (NIRS) in evaluating skeletal muscles during rehabilitation of patients in the PICU. This case series aimed to clarify the characteristics of skeletal muscle oxygenation during exercise in 2 postoperative patients with CHD. Methods: The participants were two 6-month-female infant: one had undergone the Yasui operation (Case 1), and the other had undergone a bidirectional Glenn anastomosis (Case 2). Vital signs and tissue oxygen saturation (StO₂) were measured during each exercise task, and the muscle oxygen extraction ratio (MOER), an index of the intramuscular oxygen extraction rate, was calculated. The results were compared between the two cases. Results: Case 1 showed no significant changes in vital signs, StO₂, or MOER, whereas Case 2 had low oxygen saturation at rest and low StO₂ during the exercise tasks. MOER increased during the exercise tasks. Conclusions: The results showed that sitting did not impose a strong cardiopulmonary load on postoperative patients. However, in children with cyanotic cardiac disease, such as in Case 2, skeletal muscle oxygenation should be considered, and NIRS monitoring may be useful for safely performing rehabilitation.

Objectives: In recent years, the number of elderly heart failure patients with multiorgan failure has been increasing. Furthermore, the combination of heart failure and decreased hepatic reserve can cause severe skeletal muscle impairment and decreased survival rates. This study investigated whether the degree of improvement in the five repetitions of sit-to-stand (5STS) and walking speed (WS) differs depending on hepatic reserve in elderly heart failure patients. Methods: The patients were divided into the following two groups: good hepatic reserve (albumin–bilirubin score [ALBI score] ≤−2.25) and poor hepatic reserve (ALBI score >−2.25). Propensity score matching was performed using the brain natriuretic peptide level. A two-way analysis of variance (ANOVA) was performed to examine the main effects of the hepatic reserve and time points (admission or discharge). Results: After propensity score matching, 28 out of the 33 (84.8%) patients in the good hepatic reserve (age, 83.74 ± 9.25 years and ALBI score, −2.55 ± 0.19 points) and 27 out of 40 (67.5%)patients in the poor hepatic reserve (age, 85.85 ± 7.53 years and ALBI score, −1.93 ± 0.26 points) were analyzed. Two-way ANOVA showed that the 5STS (p = 0.04) and WS (p = 0.01) in poor hepatic reserve tended to be worse than in good hepatic reserve. Furthermore, the 5STS (p = 0.04) and WS tended to improve at discharge in both groups. However, the improvement in WS was not significant (p = 0.15). Conclusions: Our study suggests that the hepatic reserve in elderly heart failure patients may be an important factor in the assessment of physical functions.

Objective: The movement of the diaphragm plays an important role in respiration. In this study, we proposed and validated a new method for estimating the volume of a single ventilation (representing the tidal volume [VT]) from the vertical distance of diaphragmatic movement and thoracic circumference. Method: Diaphragm excursion (DE) was measured in healthy adult subjects via ultrasound, and the thoracic cavity volume change was estimated based on DE and thoracic circumference. Moreover, we measured the VT obtained by an expiratory gas analyzer and examined the relationships between DE and thoracic volume change (TVC) and between DE and VT. Results: The results showed that a correlation (ρ = 0.609) existed between DE and VT, and an even higher correlation existed between TVC and VT. TVC correlated better with the product of thoracic circumference squared and DE (ρ = 0.839) than with the product of thoracic circumference and DE as an alternative index (ρ = 0.746). Conclusion: Our findings demonstrate that, taking into account body size in addition to DE, changes in thoracic cavity volume are useful predictors of VT and provide an alternative measure for assessing the respiratory function, which will improve clinical and research practice in respiratory care.

Objective: The objective of this study was to confirm that early mobilization (EM) could reduce pneumonia in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE) for thoracic esophageal squamous cell carcinoma (TESCC). Methods: Postoperative pneumonia was defined as physician-diagnosed pneumonia using the Esophagectomy Complications Consensus Group definition of pneumonia with a Clavien–Dindo classification grade II–V on postoperative day (POD) 3–5. EM was defined as achieving an ICU Mobility Scale (IMS) ≥7 by POD 2. Patients were divided into EM (n = 36) and non-EM (n = 35) groups. Barriers to EM included pain, orthostatic intolerance (OI), and orthostatic hypotension. Results: The overall incidence of postoperative pneumonia was 12.7%, with a significant difference between the EM (2.8%) and non-EM (22.9%) groups (P = 0.014). The odds ratio was 0.098 in the EM group compared to the non-EM group. A significant difference was found between the two groups in terms of the barriers to EM at POD 2 only for OI, with a higher incidence in the non-EM group. Multivariate logistic regression analysis showed that patients with OI were more likely to be unable to achieve EM than those without OI (odds ratio, 7.030; P = 0.006). Conclusion: EM within POD 2 may reduce the incidence of postoperative pneumonia in patients undergoing RAMIE for TESCC. Furthermore, it was suggested that OI can have a negative impact on the EM after RAMIE.

Patient Background: A 75-year-old man had difficulty moving around at home because of loss of appetite and neglect of medication for several days. He was brought to the emergency room and admitted on the same day with a diagnosis of dehydration and diabetic ketoacidosis. He started physical therapy (PT), had frequent fainting and presyncope due to hypotension, and had difficulty leaving bed. The patient was transferred to our hospital to continue PT. Test results on admission were as follows: short physical performance battery (SPPB) [points], 1/12 points; chair stand 5 times (CS5) [sec], not possible; functional independent measure (FIM) [points], 66/126; standing test: blood pressure (BP) [mmHg], 130/60/HR [beats per minute], 76 in supine, 90/56/79 in sitting, 70/–/79 in standing. Process: After transfer, BP continued to fall markedly and he frequently fainted and required assistance with nearly all activities of daily living (ADL). Neuromuscular electrical stimulation (NMES) of the thigh and lower leg was performed five times a week for 30 min. After approximately 3 days of NMES, BP decreased slowly, presyncopic symptoms disappeared, and he could leave bed more frequently and for longer periods. The patient became independent in ADL and was discharged on Day 142. Results at discharge were as follows: SPPB, 11/12; CS5, 13.5; FIM, 114/126. Discussion: Although NMES is not effective for orthostatic hypotension (OH) associated with diabetic autonomic neuropathy (DAN), stabilization of BP early after the introduction of NMES may have been due to its peripheral sympathetic nerve-stimulating effect. Conclusion: The combination of exercise therapy and NMES for OH caused by DAN can alleviate hypotension.

Objective: The aim of this study was to examine the relationship between the frequency and duration of physical therapy (PT) and the development of hospitalization-associated disability (HAD) in hospitalized geriatric patients with heart failure (HF). Methods: This single-center, retrospective, observational study included hospitalized patients with HF aged 65 years or older who had received PT. Data regarding demographics, comorbidities, laboratory findings, medications, rehabilitation, and activities of daily living (ADLs) status were collected from electronic medical records. Based on the average frequency and duration of PT, patients were divided into three groups: Group 1, ≥3 days/week and ≥120 minutes/week; Group 2, ≥3 days/week and <120 minutes/week; and Group 3, <3 days/week and <120 minutes/week. Logistic regression analysis was performed to identify the association between the average frequency and duration of weekly PT and the incidence of HAD. Results: In all, 105 patients (mean age, 84.8 years; proportion of women, 59%) were enrolled in the study, and 43 (41.0%) patients exhibited HAD at discharge. In the multivariate logistic regression analysis, Group 2 (odds ratio [OR], 3.66) and Group 3 (OR, 6.71) had a significantly elevated risk of developing HAD using Group 1 as the reference, even after adjusting for age, ADLs before admission, cognitive function, and severity of HF. Conclusion: This study showed that a lower frequency and shorter duration of PT are associated with developing HAD in hospitalized geriatric patients with HF. However, further prospective studies are required to confirm these findings.

Objective: To investigate skeletal muscle indices influencing the anaerobic threshold (AT) measured by cardiopulmonary exercise testing (CPX). Methods: This study included 125 consecutive men (median age: 66.0 years) diagnosed with acute myocardial infarction who underwent CPX before discharge. Participants were categorized into two groups based on their AT: the AT-lowering and AT-maintaining groups, comprising those with AT <11 and ≥11 ml/min/kg, respectively. Skeletal muscle indices that influenced AT, strengths of such influences, and respective cutoff values were investigated using multiple logistic regression analysis, decision-tree analysis, and the random-forest method. Skeletal muscle indices included grip strength, knee extension strength, lower-limb skeletal muscle index, phase angle (PhA), lower-limb PhA, arm circumference (AC), and calf circumference. Results: Lower-limb PhA, AC, age, and body mass index (BMI) influenced AT (model X² test: p <0.05; Hosmer-Lemeshow test: p = 0.98). Among the skeletal muscle indices, Gini impurity reduction was the highest in the lower-limb PhA. The cutoff values for AT were ≥4.0° for BMI <24 kg/m² and ≥6.4° for BMI ≥24 kg/m². Conclusion: Lower-limb PhA was the most influential skeletal muscle index affecting AT. PhA measured using body composition analyzers is useful to identify exercise-limiting factors and determine the effectiveness of exercise because it can be easily performed shortly.

Objective: There are few analyses of the current status of and responses to acute deteriorations encountered by physiotherapists, occupational therapists, and speech-language pathologists (rehabilitation professions [RPs]). The purpose of this study was to analyze the responses of RPs to acute deterioration in patients using the functional resonance analysis method (FRAM) based on the descriptions in “the Medical Accident Database”. Methods: Subjects were 413 cases with medical incidents reported by RPs to the database from 2012 to 2021. Life-threatening cases with changes in consciousness, circulation, and respiration were selected. Descriptions regarding findings assessed by RPs and support team, and requests for assistance were extracted. We also attempted to construct appropriate respond in RPs by using the FRAM. Results: Thirty-nine cases of acute deterioration were included in the analysis, and descriptions by RPs of consciousness (35 cases), circulation (18 cases), and respiration (36 cases) were identified. Blood pressure and percutaneous oxygen saturation measurement were frequently presented in the assessment by RPs, whereas the support team assessed cardiac arrest and respiratory arrest in high frequency. The FRAM analysis indicated that appropriate and rapid post-response by RPs requires patient information in prior, appropriate assessment and integration/interpretation. Conclusion: We attempted to identify problems analyzing the response by RPs to acute deterioration using the database and construct an appropriate response model. It resulted that RPs need to obtain patient information in advance and integrate/interpret it appropriately based on accurate assessment of conscious, circulation and respiration for rapid response. A model including integration/interpretation for appropriate post-response by RPs was constructed using the FRAM.

Objectives: Previous studies indicated that early ambulation following lung resection can prevent postoperative pulmonary complications (PPCs). However, some patients fail to achieve early ambulation owing to factors such as postoperative nausea, vomiting, or pain, particularly on postoperative day 1. This study aimed to address the critical clinical question: Is ambulation for ≥10 m during initial pulmonary rehabilitation necessary after lung resection surgery? Methods: This retrospective observational cohort study included 407 patients who underwent lung resection surgery for lung cancer between January 2021 and December 2022. Twelve patients with a performance status of ≥2 and 21 patients lacking pulmonary rehabilitation prescriptions were excluded. Patients were categorized into the “early ambulation” group, which included individuals ambulating ≥10 m during rehabilitation on the first postoperative day, and the “delayed ambulation” group. The primary outcome was PPC incidence, with secondary outcomes encompassing pleural drain duration, hospital length of stay, and Δ6-minute walk distance (Δ6MWD: postoperative 6MWD minus preoperative 6MWD). Results: The early and delayed ambulation groups comprised 315 and 59 patients, respectively. Significant disparities were noted in the length of hospital stay (7 [6–9] days vs. 8 [6–11] days, P = 0.01), pleural drainage duration (4 [3–5] days vs. 4 [3–6] days, P = 0.02), and Δ6MWD (−70 m vs. −100 m, P = 0.04). However, no significant difference was observed in PPC incidence (20.6% vs. 32.2%, P = 0.06). Conclusions: Ambulation for ≥10 m during initial pulmonary rehabilitation after lung resection surgery may yield short-term benefits as evidenced by improvements in various outcomes. However, it may not significantly affect the PPC incidence.

Objective: This study aimed to clarify the association between hospital-acquired disability (HAD) and prognosis in older patients who underwent cardiac surgery. Methods: This single-center, retrospective, observational study included 141 patients aged ≥65 years who underwent cardiac surgery at our hospital from November 2016 to August 2021. The primary endpoint of this study was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs) within 2 years of hospital discharge. HAD was defined as a score of ≤5 on any one of the functional independence measure (FIM) subitems at discharge compared to preoperatively. Results: MACCE was observed in 16.3%, and the incidence of MACCE was significantly higher in the HAD group than that in the non-HAD group (12.1 vs. 34.5%, log-rank, p = 0.003). HAD was also significantly associated with the MACCE (hazard ratio [HD]: 2.575, 95% confidence interval [CI]: 1.001–9.655, p = 0.046). The incidence rate of HAD was 20.6%, with age (odds ratio [OR]: 1.260, 95% CI: 1.080–1.470, p = 0.004), preoperative short physical performance battery (SPPB) score (OR: 0.462, 95% CI: 0.301–0.708, p <0.001), and postoperative delirium (OR: 6.660, 95% CI: 1.480–30.000, p = 0.014) identified as significant factors. Conclusion: HAD is an independent predictor of MACCE in older patients who underwent cardiac surgery.

Objective: This study aimed to understand the long-term transition of exercise tolerance in patients on phase III cardiac rehabilitation (CR) and clarify the characteristics of patients with a high risk of declined exercise tolerance during the first emergency declaration. Methods: Patients who participated in phase III outpatient CR before the first emergency declaration and those who performed cardiopulmonary exercise testing were at ≥2-time points: before and at 3 or 12 months post-emergency declaration. Exercise tolerance transition at 3-time points was analyzed, and whether different social background factors affected the peak oxygen uptake (VO₂) transition method remains to be examined. Results: A total of 101 (median age 74.0 years, 69% men), and both peak VO₂ and anaerobic threshold (AT) significantly declined from pre-declaration to 3 months post-declaration but recovered to levels likely similar from pre-declaration at 12 months (peak VO₂: from 17.3 to 16.7 to 18.7 mL/min/kg; AT: from 11.8 to 11.2 to 11.6 mL/min/kg). Further, patients with multiple comorbidities at pre-declaration had a significantly lower peak VO₂ at 3 months (−1.0 mL/min/kg, p = 0.025) and it remained significantly low in those with a slower gait speed at 12 months after lifting the emergency declaration (−2.5 mL/min/kg, p = 0.009). Conclusion: The emergency declaration declined the exercise tolerance in patients on phase III CR but improved to pre-declaration levels over time, but more likely declined in patients with multiple comorbidities during pre-declaration and those with low-gait speeds were less likely to improve their declined exercise tolerance.

Heart failure (HF) is a complex clinical syndrome caused by structural and/or functional abnormalities that results in significant disease burdens not only to the patients and their families but also to the society. Common symptoms/signs of HF include dyspnea, fatigue, and exercise intolerance, which significantly reduce the quality of life of individuals. Since the coronavirus disease 2019 (COVID-19) pandemic in 2019, it has been found that individuals with cardiovascular disease are more vulnerable to COVID-19-related cardiac sequelae including HF. In this article, we review the updated diagnosis, classifications, and interventional guidelines of HF. We also discuss the link between COVID-19 and HF. The latest evidence about physical therapy for patients with HF in both the stable chronic phase and acute cardiac decompensation phase is reviewed. Physical therapy for HF patients with circulatory support devices is also described.