Jenna L. Taylor

Aims: Programme accreditation and certification are key mechanisms for standardising, assuring, and continuously improving the quality of cardiac rehabilitation. Comparative evidence on existing accreditation and certification schemes remains limited. This review compared these schemes to identify key characteristics, standards, convergences, divergences, implementation, and gaps to inform future quality improvement directions. Methods: A scoping review following PRISMA-ScR guidelines was conducted searching four databases, grey literature and accreditation bodies’ websites (August–September 2025). Cardiac rehabilitation certification schemes with publicly accessible descriptive or evaluative documentation were included. Extracted data were analysed narratively. Results: Eleven peer-reviewed studies and 38 organisational documents met the inclusion criteria. Four schemes from USA, United Kingdom, Europe, and the International Council of Cardiovascular Prevention and Rehabilitation were included in the comparative analysis because sufficient public documentation was available. Certification standards were mapped across schemes, consolidated into 18 and classified according to Donabedian domains. Thirteen standards were universal (endorsed by all four schemes) or near-universal (endorsed by three) including multidisciplinary care, assessments, exercise, education, and counselling; however, their operationalisation varies. Certification uptake was concentrated in high-income settings. Reported barriers were related to resources, cost, and infrastructure. Evidence of certification impact was limited. Conclusion: Shared standards suggest broad consensus on the core components of high-quality cardiac rehabilitation. Resource, cost, and infrastructure barriers may influence certification accessibility and adoption. Leveraging shared standards while allowing flexible implementation pathways may support broader uptake of quality-assured cardiac rehabilitation. Further rigorous evaluation is needed to determine whether certification translates into sustained improvements in service quality and meaningful health gains.

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Background: Cardiac rehabilitation (CR) leads to increased exercise capacity (VO ₂ peak) and risk reduction of major adverse cardiovascular events (MACEs). Women exhibit blunted VO ₂ peak improvements following CR. The purpose was to examine sex differences in the clinical predictors of VO ₂ peak improvement and odds of MACEs following CR. Methods: From 1999 to 2017, all consecutive patients undergoing cardiopulmonary exercise testing before and after CR were included. Sex differences in peak exercise metrics in response to CR were compared. Multiple logistic regression models were fit to assess clinical predictors of VO ₂ peak improvement (defined as >0% from pre‐CR) and MACEs following CR for men and women. Results: A total of 513 men and 158 women were included. Men had greater increases in VO ₂ peak than women following CR ( P =0.001). For men, independent predictors of VO ₂ peak improvement following CR included higher CR session attendance (odds ratio [OR], 1.04 [95% CI, 1.02–1.06]), peripheral artery disease (OR, 0.47 [95% CI, 0.25–0.86]), and pre‐CR VO ₂ peak (OR, 0.98 [95% CI, 0.97–0.99]) (all, P 2 peak (OR, 0.98 [95% CI, 0.97–0.99]), surgical CR indication (OR, 0.34 [95% CI, 0.18–0.68]), and no history of peripheral artery disease (OR, 2.94 [95% CI, 1.60–5.38]) (all, P 2 peak improvement or odds of MACEs (except for diabetes) following CR. Conclusions: These findings suggest that clinical predictors of VO ₂ peak improvement and odds of MACEs following CR are sex specific.

Aim: We investigated whether a commercial bi‐level positive airway pressure (BPAP) device, would improve peripheral oxygen saturation (SpO₂) during recreational aviation up to 12,500 feet without supplemental oxygen. Ten adults with recreational flight experience (age:47 ± 14; female = 5) completed a standardized flight profile in an unpressurised aircraft, involving randomized crossover design at 8,000 feet and 12,500 feet with BPAP or control. SpO₂, middle cerebral artery velocity (MCAv), heart rate (HR), respiratory rate (RR), and relative tidal volume (TV) index were measured continuously. Psychomotor vigilance test (3‐min) assessed reaction time halfway through taxi and altitude stages. Altitude significantly (p < 0.05) decreased mean SpO₂, MCAv, and RR, and increased TV index and HR. There was no effect of altitude (p > 0.05) on reaction time. BPAP increased mean SpO₂ at 8,000 feet [Control: 92 ± 1%; BPAP: 94 ± 2%; mean difference (MD) = 2 ± 2%; p = 0.002] and 12,500 feet [Control: 86 ± 4%; BPAP: 89 ± 4%; MD = 2 ± 3%; p = 0.013]. BPAP lowered MCAv at 8,000 feet [Control: 53 ± 10 cm/s; BPAP: 50 ± 9 cm/s; MD = ‐3 ± 2 cm/s; p = 0.001] and 12,500 feet [Control: 52 ± 10 cm/s; BPAP: 50 ± 8 cm/s; MD = ‐2 ± 3 cm/s; p = 0.041]. BPAP increased TV index at 8,000 feet (Control: 6.6 ± 1.3; BPAP:8.1 ± 1.8; MD = 1.9 ± 0.8; p < 0.001) but not 12,500 feet, without effect on RR or reaction time. This study provides preliminary results that BPAP may improve mean SpO₂ for recreational aviators up to 12,500 feet without supplemental oxygen.

Menopause marks a major milestone in female reproductive ageing. It is characterized by the cessation of ovarian function and a concomitant decline in hormones such as oestradiol. Subsequently, females undergoing menopausal transition experience a progressive increase in cardiovascular and cerebrovascular disease risk. During menopause, reductions in nitric oxide (NO) bioavailability, endothelial dysfunction, increases in systemic inflammation, oxidative stress, and impaired vascular remodelling may contribute towards an accelerated decline in the function of cerebral and peripheral vascular systems. Historically, hormone therapy (HT) has been used as a means of managing vascular disease risk and reducing menopause‐associated vasomotor symptoms such as hot flushes, though some studies suggest regular exercise has the potential to be a promising alternative. Regular aerobic exercise during early postmenopause may slow vascular decline by improving NO and oestradiol bioavailability, promoting positive vascular remodelling and lowering systemic inflammation. However, exercise‐mediated improvements in markers of vascular function are not consistently observed in oestradiol‐deficient postmenopausal women. Emerging evidence suggests that due to the greater oestradiol bioavailability during early postmenopause, vascular adaptations to exercise may be enhanced during this stage, as opposed to late postmenopause. Subsequently it may be important to begin regular exercise in the years preceding and immediately following the final menstrual period to slow the progression of vascular disease risk during perimenopause and beyond. The present review will provide a summary of our current understanding of how vascular function is affected during menopause and the role of regular aerobic and resistance exercise training in managing vascular disease risk.

Considerable and convincing global data from cohorts across the health spectrum (i.e. apparently healthy to known disease) indicate that cardiorespiratory fitness (CRF) is a major predictor of overall and cardiovascular disease (CVD)-survival, seemingly with greater prognostic resolution compared to other traditional CVD risk factors. Therefore, the assessment of CRF in research and clinical settings is of major importance. In this manuscript, we review the technology of measuring CRF assessed by the 'gold standard,' cardiopulmonary exercise testing (CPET), as well as with various other methods (e.g. estimated metabolic equivalents, 6-minute walk tests, shuttle tests, and non-exercise equations that estimate CRF), all of which provide significant prognostic information for CVD- and all-cause survival. The literature through May 2024 has been cited. The promotion of physical activity in efforts to improve levels of CRF is needed throughout the world to improve lifespan and, more importantly, healthspan. The routine assessment of CRF should be considered a vital sign that is routinely assessed in clinical practice.