https://hdl.handle.net/11000/5026 2026-09-22T20:15:05Z https://hdl.handle.net/11000/40745 Título : Detection of exercise intensity thresholds in patients with chronic heart failure based on correlation properties of heart rate variability Autor : Sempere-Ruiz, Noemí; Manresa-Rocamora, Agustín; Fuertes-Kenneally, Laura; Sanz-Rocher, Ana; Baladzhaeva, Sabina; Climent-Payá, Vicente; Moya-Ramón, Manuel; Sarabia, José Manuel Resumen : Purpose This study aimed to assess the agreement between ventilatory thresholds (VT1 and VT2), and heart rate variability (HRV) thresholds (HRVT1 and HRVT2) based on the alpha 1 index of detrended fluctuation analysis (DFA a1) in patients with chronic heart failure (CHF). Validating HRV-based thresholds could provide a cost-effective alternative for individualised exercise intensity prescription, improving safety and efficacy in exercise-based cardiac rehabilitation (CR) programmes. Methods Twenty CHF patients (13 males, 7 females) performed a cardiopulmonary exercise test (CPET) on a cycle ergometer. Ventilatory thresholds were identified using a mixed method, while HRV thresholds were determined at DFA a1 values of 0.75 (HRVT1) and 0.5 (HRVT2). Threshold values for oxygen consumption ( VO2), heart rate (HR), and power output (PO) were compared with paired t test or Wilcoxon test. Agreement was assessed using correlation coefficients (Pearson’s r and Spearman’s rho), intraclass correlation coefficient (ICC), and Bland–Altman analysis. Results HRVT2 showed moderate-to-strong associations with VT2 for VO2 (rho = 0.88, ICC = 0.86), for HR (r = 0.88, ICC = 0.81) and for PO (r = 0.82, ICC = 0.85). Mean biases were small and limits of agreement (LoA) narrow. HRVT1 correlated only modestly with VT1 for VO2 (rho = 0.67, ICC = 0.43) and weakly for HR (r = 0.43, ICC = 0.37) and PO (r = 0.49, ICC = 0.35), with wide LoA. Conclusion In CHF patients, HRVT2 appears to be a valid, practical surrogate for VT2 and may facilitate personalised intensity prescription where full CPET is unavailable. HRVT1 showed insufficient agreement with VT1 and should be used with caution. Larger cohorts and protocol refinements are warranted to confirm these observations and to explore strategies for improving HRVT1 accuracy. 2026-09-22T18:51:14Z https://hdl.handle.net/11000/40744 Título : Response to the letter to the editor on: “Detection of exercise intensity thresholds in patients with chronic heart failure based on correlation properties of heart rate variability” Autor : Sarabia, José Manuel; Sempere-Ruiz, Noemí; Fuertes-Kenneally, Laura; Moya-Ramón, Manuel; Manresa-Rocamora, Agustín 2026-09-22T18:24:53Z https://hdl.handle.net/11000/40743 Título : Effects of Physical Exercise on Substance Use Disorder: A Comprehensive Review Autor : Montón-Martínez, Roberto; Castellano-Galvañ, Ismael; Roldán, Alba; Javaloyes, Alejandro; Peña-González, Iván; Sarabia, José Manuel; Pastor, Diego; Moya-Ramón, Manuel Resumen : Physical exercise has emerged as a promising complementary intervention for individuals with substance use disorders (SUD). This comprehensive review examines the neurobiological, psychological, and social benefits of exercise in improving quality of life (QOL), mental health, sleep quality, craving, physical fitness, and cognitive function among individuals with SUD. Aerobic exercises, particularly those of moderate intensity, demonstrate a consistent efficacy in reducing anxiety, depression, and cravings, while also enhancing cardiovascular health and psychosocial well-being. Strength training and concurrent programs provide additional benefits for muscular and cognitive function, although their effects on mental health are less consistent. Mind–body disciplines like yoga and Tai Chi offer accessible entry points for individuals with low baseline fitness but exhibit variable outcomes, especially in sleep and craving management. High-intensity interval training (HIIT) shows potential for craving reduction and cardiovascular improvements but may pose challenges for individuals with low initial fitness. This review underscores the importance of tailored, well-structured programs that align with participants’ needs and capabilities. Future research should prioritize standardizing protocols, incorporating technological tools, and exploring hybrid intervention models to maximize adherence and therapeutic impact. Physical exercise remains a vital, multifaceted tool in comprehensive SUD rehabilitation strategies. 2026-09-22T18:13:47Z https://hdl.handle.net/11000/40742 Título : Effect of Exercise Training with Consideration of Potential Moderating Variables in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis Autor : Manresa-Rocamora, Agustín; Fuertes-Kenneally, Laura; Sempere-Ruiz, Noemí; Blasco-Peris, Carles; Ibáñez-Criado, Alicia; Climent-Payá, Vicente; Sarabia, José Manuel Resumen : Background Exercise-based cardiac rehabilitation (CR) shows promise as an adjunctive treatment for patients with atrial fibrillation (AF). Previous evidence has highlighted its beneficial impact in this population. However, studies exhibit significant heterogeneity and often fail to differentiate between AF types. Furthermore, the specific influence of training variables such as exercise modality or intensity on the exercise-induced effects remains unclear. Therefore, the aim of our review was to assess the effect of exercise training (i.e., aerobic, resistance, and combined exercise), on exercise capacity, quality of life (QoL), resting heart rate (HR), AF burden, and symptoms in AF. Methods Electronic searches were conducted in PubMed, Embase, and Web of Science up to May 2025. Standardised mean difference (SMD) or mean difference (MD) were estimated in controlled and multi-intervention studies. Effect size indices were pooled using a random-effects model when at least three studies reported a specific outcome. Additionally, subgroup analyses were carried out based on AF type. Results Most of the studies used moderate intensity exercise (MIE). Across included studies, peak oxygen uptake (VO2 peak) (n = 5, N = 1,519), 6-min walk test (6MWT) (n = 5, N = 1,344), QoL (n = 9, N = 1,596), resting HR (n = 6, N = 490), AF burden (n = 5, N = 412), and AF symptoms (n = 4, N = 428) were reported. The results showed that aerobic exercise improves VO2 peak to a greater extent than usual care, regardless of AF type (MD+ = 4.24 [95%CI = 0.87; 7.45] ml/ kg/min). Compared to usual care, aerobic exercise only diminished resting HR in non-permanent AF (MD+ = − 12.79 [95%CI = − 15.90: − 9.67] bpm). No differences were found for improving QoL and 6MWT (p > .050). The effect of exercise on AF burden and symptoms has been poorly studied. No pooled analyses were performed by including multi-intervention studies. The findings showed no influence of the aerobic intensity or modality. Conclusion Aerobic exercise improves VO2 peak in patients with permanent and non-permanent AF. MIE reduces resting HR in patients with permanent AF, while no differences were found in non-permanent AF. In contrast, the limited and heterogeneous RCT evidence available is insufficient to demonstrate superior improvements in the 6MWT or QoL compared to usual care. Further research is needed to determine the impact of CR on AF burden and symptoms, and to elucidate how exercise modality and intensity influence outcomes. 2026-09-22T17:46:34Z https://hdl.handle.net/11000/40741 Título : Impact of heart rate variabilitybased exercise prescription: self-guided by technology and trainer-guided exercise in sedentary adults Autor : Casanova-Lizón, Antonio; Manresa-Rocamora, Agustín; Sarabia, José Manuel; Pastor, Diego; Javaloyes, Alejandro; Peña-González, Iván; Moya-Ramón, Manuel Resumen : Introduction: Exercising at home is an accessible alternative to the gym, although it presents challenges such as low adherence, poor quality and difficulties in reaching set goals. Wearable technologies and the use of heart rate variability (HRV) make it possible to personalise workouts, optimise fitness and improve adherence. However, specific exercise recommendations based on these metrics are still lacking. This study evaluated the impact of HRVbased training using the Selftraining UMH app in an autonomous format versus a Personal Trainer-led approach. Methods: Seventy sedentary adults were divided into three groups: Autonomous (n = 18), Personal Trainer (n = 23), and Control (n = 29). After a two-week baseline HRV assessment, participants underwent an 11-week intervention, with pre- and post-tests on peak oxygen uptake, aerobic power, total test time, strength, and HRV. Results: Both intervention groups completed similar session numbers (23.3 vs. 24.5) and high-intensity workouts (13.7 vs. 14.6). Both groups improved significantly (p < 0.05) across all fitness metrics, except aerobic power in the Autonomous group. Effect sizes ranged from small to large (0.21–1.12 Autonomous; 0.23–1.63 Personal Trainer). Strength improvements were greater in the Personal Trainer group, and both outperformed the Control group (p < 0.05) on all variables except aerobic power in the Autonomous group. Conclusions: The findings demonstrate that HRV-based training effectively enhances fitness in sedentary adults, with both delivery methods showing similar adherence and benefits. The Selftraining UMH app offers an accessible alternative for autonomous exercise, particularly in settings without professional supervision, promoting improved population health outcomes. 2026-09-22T16:48:17Z https://hdl.handle.net/11000/40725 Título : Exergaming System for Exercise-Based Cardiac Rehabilitation in Patients With Heart Failure: Development and Usability Assessment Study of a Device Prototype Autor : Blasco-Peris, Carles; Alcocea Garrido, Juan Pedro; Seguí, Bárbara; Zaragoza, Rocío; Climent-Paya, Vicente; Fuertes-Kenneally, Laura; Manresa-Rocamora, Agustín; Sanz-Rocher, Ana; Baladzhaeva, Sabina; Sarabia, José Manuel Resumen : Background: Heart failure (HF) is a growing global health concern, and adherence to early cardiac rehabilitation (CR) remains suboptimal. Exergaming is a promising alternative to conventional exercise programs for patients with HF. However, existing research has limitations, and the integration of exergaming into clinical practice remains challenging. Most notably, current studies often rely on commercially available systems that are not tailored to needs specific to patients with HF, lack long-term adherence strategies, and have limited evaluation in the initial phases of cardiac rehabilitation. Objective: This study aimed to design, develop, and assess the usability of a novel exergaming prototype (ie, HEFMOB), integrating immersive virtual reality (VR), real-time biometric monitoring, and autonomous session management to support early-phase, exercise-based CR in patients with HF. Methods: A multidisciplinary team developed HEFMOB through iterative prototyping. The final system included a pedalbased VR cycling game and an upper-limb mobilization minigame, with real-time monitoring of heart rate, blood pressure, and peripheral capillary oxygen saturation. Usability was assessed in two phases: (1) an expert evaluation and refinement phase and (2) a single-session usability phase involving 10 patients with HF (4 female). The sessions were recorded and individually evaluated by 2 researchers using the Serious Game Usability Evaluator tool. After each session, the participants completed the System Usability Scale (SUS) and a subscale of Intrinsic Motivation Inventory (IMI) to rate the usability of the exergaming prototype and enjoyment, respectively. Descriptive statistics were reported. Results: The participants had a mean age of 64.8 (SD 8.4) years, BMI of 26.7 (SD 4.6) kg/m2, and left ventricular ejection fraction of 40.5% (SD 7.4%). All participants completed the session without adverse events. The SUS score averaged 71.5, SD 17.8 (indicating good usability) and IMI scores indicated very high enjoyment (mean 25.1, SD 3.5). A total of 136 gameplay-related events were recorded: negative (n=76, mostly confusion), neutral (n=49), and positive (n=11). Interface-related issues (n=61) were most common, followed by design (n=52) and hardware (n=23). Conclusions: HEFMOB appears to be a promising, engaging, and well-tolerated tool for delivering tailored exergaming interventions in patients with HF. High usability and enjoyment ratings support its acceptability, while structured user experience analysis provided valuable insights for system refinement. This study marks a critical step toward integrating personalized, gamified exercise in inpatient settings, especially where early mobilization is lacking. Building on these findings, future research will assess long-term usability and clinical impact through a multicenter randomized controlled trial. 2026-09-21T17:18:49Z https://hdl.handle.net/11000/40724 Título : Reliability and validity of a non-linear index of heart rate variability to determine intensity thresholds Autor : Sempere-Ruiz, Noemí; Sarabia, José Manuel; Baladzhaeva, Sabina; Moya-Ramón, Manuel Resumen : Exercise intensity distribution is crucial for exercise individualization, prescription, and monitoring. As traditional methods to determine intensity thresholds present limitations, heart rate variability (HRV) using DFA a1 has been proposed as a biomarker for exercise intensity distribution. This index has been associated with ventilatory and lactate thresholds in previous literature. This study aims to assess DFA a1’s reliability and validity in determining intensity thresholds during an incremental cycling test in untrained healthy adults. Sixteen volunteers (13 males and 3 females) performed two identical incremental cycling stage tests at least 1 week apart. First and second ventilatory thresholds, lactate thresholds, and HRV thresholds (DFA a1 values of 0.75 and 0.5 for HRVT1 and HRVT2, respectively) were determined in heart rate (HR), relative oxygen uptake (VO2rel), and power output (PO) values for both tests. We used intraclass correlation coefficient (ICC), change in mean, and typical error for the reliability analysis, and paired t-tests, correlation coefficients, ICC, and Bland- Altman analysis to assess the agreement between methods. Regarding reliability, HRV thresholds showed the best ICCs when measured in PO (HRVT1: ICC = .87; HRVT2: ICC = .97), comparable to ventilatory and lactate methods. HRVT1 showed the strongest agreement with LA 2.5 in PO (p = 0.09, r = .93, ICC = .93, bias = 9.9 ± 21.1), while HRVT2 reported it with VT2 in PO (p = 0.367, r = .92, ICC = .92, bias = 5.3 ± 21.9). DFA a1 method using 0.75 and 0.5 values is reliable and valid to determine HRV thresholds in this population, especially in PO values. 2026-09-21T17:18:31Z https://hdl.handle.net/11000/40723 Título : Age does not influence the physical performance of football players with cerebral palsy Autor : Peña-González, Iván; Henríquez, Matías; Sarabia, José Manuel; Moya-Ramón, Manuel Resumen : The aims of this study were to compare the physical performance profile of football players with cerebral palsy (CP), according to their age, consider the sport class (FT1, FT2, and FT3), and analyse the relationship between their age and their physical performance. The physical performance of seventy-five CP football players from the Spanish CP Football National Competition was assessed. A one-way analysis of variance did not reveal physical performance differences between CP football players classified into four age-groups (< 20; 20—29.9; 30—34.9; > 35vyears). The Pearson’s correlation analysis did not show a correlation between players’ physical performance and their age, except for dribbling ability in the overall sample (r = 0.25; P = 0.037). The linear regression analysis showed that the age only predicted the dribbling ability ( = 0.25; P < 0.05) but with low explained variance (R2 = 0.06). The main finding of the present study reveals no systematic differences in physical performance between CP football players according to their age.; Les objectifs de cette étude étaient (1) de comparer le profil de performance phy-sique des joueurs de football porteurs d’une infirmité motrice cérébrale (IMC), en fonction deleur âge, et en considérant la classe sportive (FT1, FT2 et FT3), et (2) d’analyser la relationentre leur âge et leur performance physique. Les performances physiques de soixante-quinzejoueurs de football avec IMC participant à la compétition nationale espagnole de football ontété évaluées. Une analyse unidirectionnelle de la variance n’a pas révélé de différences deperformances physiques entre les joueurs de football IMC classés en quatre catégories d’âge(< 20 ; 20—29,9 ; 30—34,9 ; > 35 ans). L’analyse de corrélation de Pearson n’a pas montré decorrélation entre les performances physiques des joueurs et leur âge, à l’exception de la capa-cité de dribble dans l’échantillon global (r = 0,25 ; p = 0,037). L’analyse de régression linéairea montré que l’âge ne prédisait que la capacité de dribbler ( = 0,25 ; p < 0,05) mais avec unefaible variance expliquée (R2 = 0,06). Le principal message de cette étude est que pour lestranches d’âge considérées, il n’existe aucun effet détectable de l’âge sur les performancesphysiques des joueurs de football IMC. 2026-09-21T17:18:13Z https://hdl.handle.net/11000/40722 Título : Exploring the Impact of Web-Based vs. In-Person Exercise Training on Benefits and Adherence in Substance Use Disorder Interventions: A Pilot Study Autor : Montón-Martínez, Roberto; Ballester-Ferrer, Juan Arturo; Baladzhaeva, Sabina; Sempere-Ruiz, Noemí; Casanova-Lizón, Antonio; Roldan, Alba; Pastor, Diego; Sarabia, José Manuel; Javaloyes, Alejandro; Peña-González, Iván; Moya-Ramón, Manuel Resumen : Background: Substance use disorders pose unique challenges, affecting individuals physiologically and socially. This study addresses the fundamental question of how adherence to exercise programs impacts those with substance use disorders, examining both in-person and online interventions. Methods: A 12-week analysis involving 26 participants assessed physical fitness, strength, and quality of life. Participants were categorized into in-person and online exercise groups, with their adherence tracked through attendance and a dedicated app. Results: The in-person group exhibited higher adherence rates and significant improvements, in contrast to the challenges encountered by the online groups, particularly in substance use disorder cohorts. Statistical analyses highlighted these differences, emphasizing the pivotal role of the exercise program delivery format. Conclusions: This research advocates for hybrid models, blending professional supervision with online flexibility, recognizing the distinct challenges of substance use disorders. Insights from this study will contribute to shaping more effective, personalized interventions in the complex landscape of substance use disorders, offering guidance for advancing treatment strategies. 2026-09-21T17:17:46Z https://hdl.handle.net/11000/40713 Título : Is the Verification Phase a Suitable Criterion for the Determination of Maximum Oxygen Uptake in Patients with Heart Failure and Reduced Ejection Fraction? A Validation Study Autor : Manresa-Rocamora, Agustín; Fuertes-Kenneally, Laura; Blasco-Peris, Carles; Sempere-Ruiz, Noemí; Sarabia-Marín, José Manuel; Climent-Paya, Vicente Resumen : The verification phase (VP) has been proposed as an alternative to the traditional criteria used for the determination of the maximum oxygen uptake (VO2 max) in several populations. Nonetheless, its validity in patients with heart failure with reduced ejection fraction (HFrEF) remains unclear. Therefore, the aim of this study was to analyse whether the VP is a safe and suitable method to determine the VO2 max in patients with HFrEF. Adult male and female patients with HFrEF performed a ramp-incremental phase (IP), followed by a submaximal constant VP (i.e., 95% of the maximal workload during the IP) on a cycle ergometer. A 5-min active recovery period (i.e., 10 W) was performed between the two exercise phases. Group (i.e., median values) and individual comparisons were performed. VO2 max was confirmed when there was a difference of 3% in peak oxygen uptake (VO2 peak) values between the two exercise phases. Twenty-one patients (13 males) were finally included. There were no adverse events during the VP. Group comparisons showed no differences in the absolute and relative VO2 peak values between both exercise phases (p = 0.557 and p = 0.400, respectively). The results did not change when only male or female patients were included. In contrast, individual comparisons showed that the VO2 max was confirmed in 11 patients (52.4%) and not confirmed in 10 (47.6%). The submaximal VP is a safe and suitable method for the determination of the VO2 max in patients with HFrEF. In addition, an individual approach should be used because group comparisons could mask individual differences. 2026-09-17T16:50:15Z