Garyfallia Pepera

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• Doctor of Cardiac Rehabilitation
• Professor (Associate) at University of Thessaly

Background: Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers women, and women’s greatest barriers according to enrollment status. Method...

Abstract: Exercise-based cardiac rehabilitation is a highly recommended intervention towards the advancement of the cardiovascular disease (CVD) patients’ health profile; though with low participation rates. Although home-based cardiac rehabilitation (HBCR) with the use of wearable sensors is proposed as a feasible alternative rehabilitation model,...

Background Participation in exercise-based cardiac rehabilitation programs (exCR) for cancer survivors remains limited, with observed benefits often diminishing after the initial rehabilitation period. Home-based exercise has emerged as a promising approach to enhance engagement in cardiac rehabilitation, showing feasibility, safety, and effectiven...

BACKGROUND: The aim of this study was to investigate the correlation between cardiorespiratory fitness (CRF) with cardiometabolic profile and sedentary behavior and develop predictive equations for assessing CRF in adolescent populations. METHODS: A total of 104 adolescent basketball athletes (36.54% girls) aged 12 to 17 years, (13.95±1.49 years),...

Balneotherapy is based on immersing individuals in thermal water. Water immersion elicits various physiological responses in the human body depending on the physical parameters of the water. These physiological changes may pose certain risks to users of thermal springs of different population groups. The Delphi method is widely used to gather exper...

Background Mobile health (mHealth) is increasingly being used in contemporary health care provision owing to its portability, accessibility, ability to facilitate communication, improved interprofessional collaboration, and benefits for health outcomes. However, there is limited discourse on patient safety in real-world mHealth implementation, espe...

(1) Background: Dynamic knee valgus (DKV) is a common biomechanical risk factor for knee injuries, particularly in sports involving high-intensity movements, such as basketball. While neuromuscular control and structural alignment contribute to DKV, recent evidence indicates that lower limb muscle power (LLMP) and cardiorespiratory fitness (CRF) ma...

Purpose This systematic review aims to evaluate the feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer. The primary research question is: Are home-based exercise interventions safe and feasible for people diagnosed with cancer? Methods A comprehensive search of databases including PubMed, EMBASE...

BACKGROUND Mobile health (mHealth) is increasingly being used in contemporary healthcare provision owning to its portability, accessibility, facilitation of communication, improved inter-professional collaboration, and benefit health outcomes. However, there is limited discourse on patient safety in real-world mHealth implementation, especially as...

Background Telerehabilitation is a practical option for individuals with multiple sclerosis (MS) to engage in sustained physical activity without visiting a rehabilitation facility. The aim of this systematic review was to evaluate the feasibility, effectiveness, safety, and adherence of exercise-based telerehabilitation as compared with usual care...

Background Participation in cardio-oncological rehabilitation is low, and the effects incline to decrease after the initial rehabilitation term. Home-based exercise has the potential to enhance involvement in cardio-oncology rehabilitation and was demonstrated to be feasible, safe, and helpful in increasing short-term cardiorespiratory fitness. The...

BACKGROUND: The anthropometric characteristics of adolescent basketball athletes can determine their ability to produce muscle power. Lack of physical activity (PA) level or an increased sedentary life seem to be associated with the overall health status and the occurrence of knee injuries. The aim of this paper was to identify possible correlation...

Purpose Exercise-based cancer rehabilitation via digital technologies can provide a promising alternative to centre-based exercise training, but data for cancer patients and survivors are limited. We conducted a meta-analysis examining the effect of telehealth exercise-based cancer rehabilitation in cancer survivors on cardiorespiratory fitness, ph...

In the evolving landscape of cardiac rehabilitation (CR), adopting digital technologies , including synchronous/real-time digital interventions and smart applications , has emerged as a transformative approach. These technologies offer real-time health data access, continuous vital sign monitoring, and personalized educational enhanced patient self...

Objective To systematically review the safety and the long-term mortality and morbidity risk-rates of the remotely-delivered cardiac rehabilitation (RDCR) interventions in coronary heart disease (CHD) patients. Methods The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023455471). Five databases (Pubm...

This study conducted pairwise and network meta-analysis to evaluate the effectiveness of three mind-body exercise interventions (Tai Chi, Qigong, and yoga) on physical capacity, psychological well-being, and quality of life in stroke patients. The research encompassed 30 studies involving 2107 participants and utilized the Risk of Bias 2.0 tool for...

Introduction: The six-minute walk test (6MWT) is a well-established tool for assessing submaximal functional capacity for cardiac patients, but space limitations challenge its implementation. Treadmill-based (TR) 6MWT is a promising alternative, but it requires patients to complete a familiarization test to adapt treadmill speed regulation. With th...

Objective Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Telehealth rehabilitation may offer new opportunities in patient therapy. This systematic review aimed to evaluate the effects of internet-mediated telerehabilitation and compare them with the outcomes of conventional pulmonary rehabilitation in...

Obesity in adolescents combined with the increased exposure time to electronic devices, enhances a sedentary lifestyle and is linked to the risk of developing musculoskeletal injuries. The aim of this study was to identify possible correlations between anthropometric characteristics, body composition, exposure time to electronic devices or screen t...

Obesity in adolescents combined with the increased exposure time to electronic devices, enhances a sedentary lifestyle and is linked to the risk of developing musculoskeletal injuries. The aim of this study was to identify possible correlations between anthropometric characteristics, body composition, exposure time to electronic devices or screen t...

Background: Exercise has indisputable advantages for people with chronic conditions. Engaging in physical activity within natural environments, known as green exercise, contributes to both physical and mental well-being. The aim of this study was to investigate the perceptions of people with chronic conditions and health professionals and the perce...

INTRODUCTION Positive expiratory pressure (PEP) is commonly applied to people who have undergone thoracic surgery; however, PEP devices are not always available. This experimental study investigated if a simple drinking straw could be used as an alternative PEP device in thoracic surgery patients. It was therefore considered necessary to define the...

Background: Exercise-based interventions prevent or delay symptoms and complications of type 2 diabetes (T2D) and are highly recommended for T2D patients; though with very low participation rates. Τelerehabilitation (TR) could act as an alternative to overcome the barriers preventing the promotion of T2D patients' well-being. Aim: Determine the...

Purpose: Cardiovascular disease is a competing mortality cause in hematological cancer survivors due to toxic oncological treatment, accumulation of risk factors, and decline of cardiorespiratory fitness. Cardio-oncology rehabilitation (CORE) is an emerging treatment model to optimize the prognosis of hematological cancer patients and survivors; h...

Cardiac Rehabilitation (CR) is a secondary prevention intervention proven to improve quality of life, yet with low participation. The Cardiac Rehabilitation Barriers Scale (CRBS) was developed to assess multi-level barriers to participation. This study aimed at the translation, and cross-cultural adaptation of the CRBS into the Greek language (CRBS...

A tele-assessed 6MWT (TL 6MWT) could be an alternative method of evaluating functional capacity in patients with diabetes mellitus type 2 (DM2). This study aimed to assess the validity and reliability of a TL 6MWT. The functional capacity of 28 patients with DM2 (75% men) aged 61 ± 13 years was evaluated twice via an indoor, center-based 6MWT (CB 6...

Introduction: Alternatives such as remotely delivered therapy in the home environment or telehealth represent an opportunity to increase overall cardiac rehabilitation (CR) utilization. Implementing alternatives into regular practice is the next step in development; however, the cost aspect is essential for policymakers. Limited economic budgets l...

Objective The aim of this study was to assess the effectiveness of a multidimensional exercise intervention on improving fall risk deterrent factors, such as overall strength and flexibility in nursing home residents. Methods A multi-centre, randomized controlled trial was finally utilized in 40 older adults (>65 years) who were randomly allocated...

Introduction Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients’ adherence. This study will investigate the efficacy, efficiency, safe...

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): This research was funded by the Ministry of Health, Czech Republic; conceptual development of research organization (FNBr, 65269705). Background Cardiovascular diseases are usually a partial cause of mortality in patients after cancer treatment. The incre...

Background Cardiac rehabilitation is an evidence-based intervention that aims to improve health outcomes in cardiovascular disease patients, but it is largely underutilized. One strategy for improving utilization is home-based cardiac rehabilitation (HBCR). Previous research has shown that HBCR programs are feasible and effective. However, there is...

Background/Aims Low functional capacity has been recognised to be the most important predictor of overall mortality compared to all other cardiovascular risk factors in patients with cardiovascular disease. Walk tests, such as the incremental shuttle walking test and the 6-Minute Walk Test, are used to assess functional capacity in patients, the ef...

Η συμβουλευτική για τη σωματική δραστηριότητα και η εξατομικευμένη και υπό επίβλεψη άσκηση αποτελούν βασικά στοιχεία ενός ολοκληρωμένου προγράμματος καρδιακής αποκατάστασης, καθώς αποτελούν το 30-50% (έως και >70%) όλων των δραστηριοτήτων καρδιακής αποκατάστασης. Αυτό ισχύει για την καρδιακή αποκατάσταση φάσης ΙΙ και φάσης ΙΙΙ των ασθενών που έχουν...

The direct toxicity of cancer treatment threatens patients and survivors with an increased risk of cardiovascular disease or adverse functional changes with subsequent progression of cardiovascular complications. An accumulation of cardiovascular risk factors combined with an unhealthy lifestyle has recently become more common in cancer patients an...

Social Networking Sites (SNSs) use increase tremendously among university students, creating at the same time second thoughts and opportunities for their use. This study explored, for the first time, the impact of Social Networking Sites and eLearning platform (eClass) on the education and academic life of Greek students. An online 35-statement que...

Valvular heart disease (VHD) is a major cause of mortality and morbidity, and its prevalence increases with age. VHD is mainly degenerative in origin, and it is widespread in the developed countries, following rheumatic heart disease. In most cases of mitral valve (MV) disease, surgery is needed to either repair or replace the MV. Cardiac rehabilit...

Background Low cardiorespiratory fitness (CRF) is associated with the development of cardiovascular diseases during childhood, adolescence and older ages. The purpose of the study was to investigate associations between fatness, hemodynamic characteristics and secondary time with CRF in primary school-aged children. Methods Height, weight, body ma...

Background Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from China, the novel coronavirus disease 2019 (COVID-19) has caused more than five milion deaths worldwide. Several studies have elucidated the role of risk factors in the prognosis of cardiovascular disease (CVD) in the progression of COVID-19 pandemic....

Social Networking Sites (SNSs) use increase tremendously among university students, creating at the same time second thoughts and opportunities for their use. This study explored, for the first time, the impact of Social Networking Sites and eLearning platform (eClass) on the education and academic life of Greek students. An online 35-statement que...

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Increased rates of morbidity and mortality have led to the increased need for the implementation of secondary prevention interventions. Exercise-based cardiac rehabilitation (CR) represents a multifactorial intervention, including elements of physical exercise and a...

Cardiovascular rehabilitation (CR) is an effective secondary preventive model of care. However, the use of CR is insufficient, and the reasons for this are not well-characterized in East- Central Europe. This prospective observational study psychometrically validated the recently translated Cardiac Rehabilitation Barriers Scale for the Czech langua...

Telehealth cardiac rehabilitation (CR) is a feasible and effective alternative to conventional outpatient CR. Present evidence is limited on the comparison of exercise intensity adherence in telehealth and outpatient CR. The purpose of the study was to evaluate and compare training intensity adherence through 12-week phase II CR in telehealth and o...

Αbstract Objectives To assess hemodynamic and physical function responses during a two-month multicomponent group exercise program (MCEP) in residents of long-term care facilities. Methods 40 older long-term care residents were randomly allocated equally to an intervention (IG; n = 20; 80 ± 7 years) and control group (CG; n = 20; 79 ± 7 years); t...

Background: Age-related adaption in physical function, cognitive capacity, and cardiovascular function are the most typical changes remarked in older adults. A few findings have demonstrated that different types of exercise can positively affect hemodynamic parameters in older adults, however, some bias of these exercise training models limit thei...

Background: * The use of Positive Expiratory Pressure (PEP) devices is considered beneficial for patients undergone abdominal and thoracic surgery. The access to the classic PEP devices is not always available. The use of alternative PEP devices is popular in physiotherapy. Water bottles, gloves or oxygen tubes are some of them. A possible alternat...

Background: * Exercise is well recognized as a tool for assessment, prevention and management of cardiovascular disease. Cardiac patients are encouraged to join in supervised exercise cardiac rehabilitation programmes after cardiac risk stratification based on their functional capacity test performance. However, there was no information in the lite...

Purpose: * The purpose of this study was to investigate the association of cardiorespiratory fitness and muscle strength, with obesity and time of sedentary exposure to electronic devices in primary schoolchildren. Methods: * The sample of the study consisted of 105 Greek primary schoolchildren with a mean age of 10.52 ± 1.94 years of which 88 wer...

Objective: To critically present and discuss the influences of turning on incremental shuttle walking test (ISWT) performance in clinically stable patients with cardiovascular disease (CVD). Methods: We searched the literature in the most widely used health care electronic databases, including PubMed, MEDLINE, Elsevier, and Google Scholar, publishe...

Background: Exercise performance depend on the ability of the cardiovascular system to respond to a wide range of metabolic demands and physical exertion. Objectives: To investigate the habitual smoking effects in heart rate response and heart rate recovery after step test in athletes.Methods: Seventy-eight physically healthy active athletes (45 no...

Abstract Background: In most of the European Union countries, students may choose between general and vocational high school programs after finishing their primary education1. Similarly, in Greece there are General (GHS) and Technical (THS) high schools. The curriculum of GHS includes mainly general courses (e.g. mathematics, biology etc.), althoug...

BACKGROUND The use of social and eLearning media as a teaching and learning tool has been only minimally examined especially in health science education1. Therefore, the main purpose of this study was to identify, for the first time, the impact of Social Networking sites (SNSs) and eLearning platform (eClass) on the education and academic life of G...

High quality cardiopulmonary resuscitation (CPR) is crucial for influencing survival from cardiac arrest. Healthcare professionals are expected to know how to perform CPR as they may encounter emergency situations during their work. Physiotherapists, who use exercise as a therapeutic approach, should have good knowledge and skills in CPR not only t...

Relevance: Panhellenic Physiotherapists’ Association (PSF) is the official organisation for physiotherapy in Greece. The successful development of a new section within the PSF is a case study that could serve as an example of planning organisational developments. Purpose: To create a cardiorespiratory scientific group/section within the PSF. This g...

Background The six-minute walking test (6-MWT) is the most common exercise test, used to evaluate functional capacity and effects of therapeutic interventions on heart failure (HF) patients enrolled in cardiac rehabilitation (CR) programmes. Purpose The purpose of this study was to establish a reference equation to predict 6-MWT performance i...

The incremental shuttle walk test (ISWT) is used to assess functional capacity of patients entering cardiac rehabilitation. Factors such as age and sex account for a proportion of the variance in test performance in healthy individuals but there are no reference values for patients with cardiovascular disease. The aim of this study was to produce r...

Introduction: The six-minute walk test (6-MWT) is a simple, inexpensive measure used to evaluate functional capacity in heart failure (HF). The purpose of this study was to identify routinely made predictors of 6-MWT performance and develop a prediction equation in the HF population. Methods: Seventy-one patients with HF (82% males and 18% females;...

Background: The Incremental Shuttle-Walk Test (ISWT) is used in cardiac rehabilitation to predict cardiorespiratory fitness and functional capacity. However, Vo2peak accounts for only 63% of the variance in test performance and non-clinical variables (age, height) may account for ~20% of variance in performance. The aim of this study was to identif...

Objective: The incremental shuttle walking test (ISWT) is used to estimate cardiorespiratory fitness, but data from healthy individuals suggest that demographic and anthropometric measures account for much of the variance in test performance. The aim of this study was to determine whether anthropometric, demographic and selected gait measures also...

Background: The Incremental Shuttle-Walk Test (ISWT) is used in cardiac rehabilitation to predict cardiorespiratory fitness and functional capacity. However, Vo2peak accounts for only 63% of the variance in test performance and non-clinical variables (age, height) may account for ~20% of variance in performance. The aim of this study was to identif...

We conducted a pilot study to evaluate the safety of the shuttle walking test (SWT) and exercise training for cardiac patients in community-based cardiac rehabilitation settings. Overall, 33 cardiac patients were tested (19 males and 14 females, 67 ± 8 years). Eleven cardiac patients (testing group) and 22 cardiac patients (training group) underwen...

To investigate the influence of gait parameters including step length and walking speed during performance of the 6-minute walking test (6MWT) in patients with chronic heart failure (CHF). Observational study. Specialist heart failure clinic. Patients with CHF and aged-matched, apparently healthy controls. Each patient and control performed a 6MWT...

Background Exercise training is a key component of cardiac rehabilitation but there is a discrepancy between the high volume of exercise prescribed in trials comprising the evidence base and the lower volume prescribed to UK patients. Objective To quantify prescribed exercise volume and changes in cardiorespiratory fitness in UK cardiac rehabilitat...

Background: Improving aerobic capacity is an important outcome in phase III, exercise-based cardiac rehabilitation. UK studies evidencing improvements in functional capacity in CR are limited to estimates obtained using field tests like the incremental shuttle walking test (Fowler et al., Physiotherapy 91, 22-27). US data using maximal treadmill te...

Background: Functional capacity testing provides an important prognostic tool. National guidelines recommend the use of functional capacity tests to evaluate improvements resulting from attending cardiac rehabilitation (CR) programmes (Scottish Intercollegiate Guidelines Network 2002: URL http://www.sign.ac.uk/pdf/sign57.pdf. 0.08.200; NICE 2007: N...

Background: Improving aerobic capacity is an important outcome in phase III, exercise-based cardiac rehabilitation. UK studies evidencing improvements in functional capacity in CR are limited to estimates obtained using field tests like the incremental shuttle walking test (Fowler et al., Physiotherapy 91, 22-27). US data using maximal treadmill te...

BASES/PC17 Normative values for functional capacity testing in cardiac patients and the influence of anthropometric measures on performance G. Pepera & G. Sandercock University of Essex, Department of Biological Sciences Background: Functional capacity testing provides an important prognostic tool. National guidelines recommend the use of functional...

Functional capacity is an important predictor of mortality in patients with cardiovascular disease. Exercise walk tests, such as the modified shuttle walking test (MSWT) and the six-minute walking test (6-MWT), are the recommended protocols in the United Kingdom for evaluating functional capacity and the effects of therapeutic interventions on pati...

The incremental shuttle walking test (ISWT) is a valuable tool for assessing changes in patients' functional capacity during cardiac rehabilitation. However, studies have only assessed its test-retest reliability in the short term. The purpose of this study was to examine long-term test-retest reliability of the ISWT in clinically stable cardiac pa...

Background: The Incremental Shuttle-Walk Test (ISWT) is used in cardiac rehabilitation to predict cardiorespiratory fitness and functional capacity. However, Vo2peak accounts for only 63% of the variance in test performance and non-clinical variables (BMI, height) may account for ~20% of variance in performance. The aim of this study was to identif...

Introduction. The six-minute walk test (6-MWT) is a simple and safe measure used to evaluate functional capacity in chronic heart failure (CHF). The purpose of this study was to identify, routinely made clinical measures associated with 6-MWT performance and establish a reference equation to predict 6-MWT performance. Methods. 71 CHF patients (82%...

The BACR recommend the use of Modified Shuttle Walking Test (MSWT) to assess and monitor functional capacity in patients with chronic heart failure and patients who have had undergone cardiovascular surgery or pacemaker insertion (Francis, 2000; Lewis et al. 2001; Sandercock et al. 2007). While the MSWT appears able to assess changes in functional...