Practical guidelines for exercise prescription in different clinical populations Klara Komici, Antonio Bianco, Alessandra Cuomo, Roberto Bianco, Maddalena Illario, Germano Guerra, Antonio Paoli, Federico Schena, Guido Iaccarino Frontiers in Sports and Active Living, 2026 Exercise training represents a cornerstone therapeutic intervention for managing chronic health conditions, yet its practical implementation in clinical settings remains suboptimal due to challenges in individualization and safety considerations across diverse patient populations. This narrative review provides practical guidelines for exercise prescription in outpatients with chronic conditions, grounded in recent international recommendations and current scientific evidence. Practical considerations for exercise prescription are addressed across various chronic conditions including cardiovascular disease, heart failure, diabetes, and cancer, with particular emphasis on pre-exercise evaluation in patients with hypertension-related organ damage, decompensated heart failure, and frailty. Exercise prescription should be personalized and adapted to individual health status through gradual and progressive incremental physical activity programs designed to optimize health outcomes while minimizing risks. Social, psychological, environmental factors, and technology integration represent important determinants of adherence that warrant systematic consideration. The successful translation of exercise prescriptions into effective training programs requires dedicated clinical facilities staffed by specialized professionals who can bridge the gap between prescription and implementation.
Exploring motivational readiness for adapted physical activity in older adults with chronic illness: patterns of self-care behaviors, engagement, and psychological distress Daniela Lemmo, Fabrizio Mezza, Alessandra Cuomo, Antonio Bianco, Antonella Di Donato, Vincenzo De Luca, Michele Virgolesi, Antonio Picone, Angela Palomba, Carlo Ruosi, Maddalena Illario, Guido Iaccarino, Maria Francesca Freda Frontiers in Psychology, 2026 Introduction In clinical settings, adapted physical activity (APA) is increasingly prescribed to older adults with chronic conditions, yet adherence remains low and motivational readiness varies widely at the time of prescription. While the Transtheoretical Model (TTM) describes stages of change for health behaviors, less is known about how motivational stage relates to broader psychological dimensions relevant to healthy aging, such as self-care behaviors, engagement in healthy aging promotion, and psychological distress. Methods A cross-sectional study within the Age.it Project was conducted with 74 older adults (mean age ≈ 70.82 years) attending outpatient clinics at the University Hospital Federico II and prescribed APA. Motivational stage was assessed through the MAC2-R AF. Self-care behaviors were measured with the Self-Care Inventory; Engagement in healthy aging promotion with the EHAP-S; Psychological distress with the K10. Group differences across motivational stages were tested using Kruskal–Wallis analyses with Dunn–Bonferroni post-hoc comparisons and epsilon squared effect sizes. Results Most participants were classified in Contemplation (59.5%), followed by Determination (23%) and Precontemplation (17.6%). No participants were in Action or Maintenance stages. Motivational stage was significantly associated with self-care monitoring, engagement, and distress, with large effects. Contemplation showed higher self-care monitoring and higher distress, alongside lower engagement. Engagement was higher in Precontemplation and Determination compared to Contemplation, whereas distress increased progressively from Precontemplation to Determination. Discussion Findings suggest distinct, non-linear psychological configurations within the motivational stages at the time of APA prescription. Contemplation emerges as a vulnerable phase characterized by symptom surveillance and emotional burden without engagement in healthy aging promotion; Determination combines higher engagement with heightened distress; Precontemplation may reflect stable self-care routines and low distress but potential resistance to integrating exercise into self-care identity. Integrating motivational stage assessment with psychological–clinical indicators may support more personalized, motivated, and sustainable APA prescriptions for older adults.
Understanding self-care behaviors in older adults with chronic diseases: The influence of personal views on aging and illness perceptions Fabrizio Mezza, Daniela Lemmo, Antonio Bianco, Alessandra Cuomo, Maria Francesca Freda Geriatric Nursing, 2025 The global rise in Non-Communicable Diseases (NCDs) due to population aging poses significant challenges for healthcare systems. Self-care is crucial for managing NCDs, yet older adults often struggle to engage in these behaviors. Psychological factors like personal Views on Aging (VoA) and Illness Perceptions (IP) influence health behaviors, but how these factors correlate with each other and their relevance to Self-Care Maintenance (SCM) in older adults with NCDs remain underexplored. This cross-sectional study examined the associations among Awareness of Age-Related Changes (AARC-Gains; AARC-Losses; indicators of personal views on aging), IP and SCM in a sample of older patients with NCDs recruited in primary care settings. Findings revealed that negative IP were associated with higher AARC-Losses and lower SCM. Higher AARC-Gains were associated with higher SCM, whereas the negative association between AARC-Losses and SCM approached significance. Furthermore, AARC-Gains and AARC-Losses emerged as significant cross-sectional predictors of SCM, whereas IP showed no significant effect. Targeting personal VoA may be key to strengthening interventions aimed at promoting self-care among older adults with NCDs, within a person-centered approach.
The activin pathway in chronic thromboembolic pulmonary hypertension: a potential biomarker for residual pulmonary hypertension after endarterectomy Alessandra Cuomo, Corinne Normand, Raphaël Thuillet, Thomas Jaffrezic, Ly Tu, Xavier Jaïs, Mitja Jevnikar, David Montani, Athénaïs Boucly, Olivier Sitbon, Valentina Mercurio, Elie Fadel, Olaf Mercier, Christophe Guignabert, Marc Humbert, Laurent Savale Erj Open Research, 2025 Background Chronic thromboembolic pulmonary hypertension (CTEPH) is characterised by persistent pulmonary vascular obstruction due to unresolved thromboembolic lesions and distal pulmonary vascular remodelling. Despite the recognised role of the activin pathway in pulmonary vascular remodelling, its involvement in CTEPH remains insufficiently explored. This study aimed to investigate the presence of activin pathway components in CTEPH-related microvasculopathy and evaluate their potential as biomarkers. Methods Plasma levels of activin pathway biomarkers and key inflammatory mediators were assessed in controls and operable CTEPH patients pre- and post-surgery. The study enrolled 69 patients (mean age 62±13 years, 51% male), among whom 29 exhibited residual pulmonary hypertension (PH) after surgery, and two died following post-endarterectomy (PEA). Results CTEPH patients demonstrated elevated levels of activin-A, activin-B, FSTL3, C-X-C motif chemokine ligand 9 (CXCL9), β-nerve growth factor, C-reactive protein (CRP) and pro-brain natriuretic peptide (compared to controls). Pre-operative activin-A levels were associated with an increased risk of residual PH or mortality post-surgery (odds ratio 2.469, 95% CI 1.011–5.487; p=0.027), following adjustments for age, mean pulmonary arterial pressure before PEA, and CRP. Histological analysis of lung specimens from CTEPH patients revealed nuclear accumulation of phosphorylated Smad 2 and upregulation of inhibin-βA, inhibin-βB, activin receptor type IIB (ACTRIIB) and FSTL3 in muscularised pulmonary arterioles. Conclusions These findings suggest a potential role for activin-A as a predictive biomarker for residual PH following pulmonary endarterectomy in CTEPH. Further investigation into the activin pathway may uncover therapeutic targets for managing CTEPH-associated vascular remodelling.
TAPSE/sPAP Ratio to Improve Risk Assessment in Pulmonary Arterial Hypertension Roberto Badagliacca, Khodr Tello, Michele D’Alto, Stefano Ghio, Paola Argiento, Natale Daniele Brunetti, Vito Casamassima, Gavino Casu, Nadia Cedrone, Marco Confalonieri, Marco Corda, Michele Correale, Carlo D’Agostino, Lucrezia De Michele, Domenico Filomena, Giuseppe Galgano, Alessandra Greco, Carlo Mario Lombardi, Rosalinda Madonna, Giovanna Manzi, Valentina Mercurio, Alexandra Mihai, Massimiliano Mulè, Giuseppe Paciocco, Silvia Papa, Zvonimir Andelko Rako, Tommaso Recchioni, Manuel Richter, Antonella Romaniello, Emanuele Romeo, Laura Scelsi, Davide Stolfo, Patrizio Vitulo, Athiththan Yogeswaran, Robert Naeije, Raymond L. Benza, Carmine Dario Vizza, Francesca Adamo, Carlo Albera, Davide Barbisan, Vincenzo Bellomo, Marta Beretta, Marco Biolo, Federico Biondi, Michela Boromei, Andrea Bonelli, Beatrice Pezzuto, Renato Carignola, Francesco Cassadonte, Maria Alberta Cattabiani, Annalisa Caputo, Vincenzo Antonio Ciconte, Paola Confalonieri, Chiara Cresci, Alessandra Cuomo, Raffaele De Caterina, Elisabetta De Tommasi, Gabriele Di Gesaro, Stefania Farina, Francesco Fedele, Martino Fortunato, Giulia Gagno, Pietro Geri, Daniele Ghiraldin, Daniela Giannazzo, Giorgio Giardina, Hossein-Ardeschir Ghofrani Paolo Golino, Maria Chiara Grimaldi, Ludovico Lanfranchi, Mariangela Lattanzio, Claudio Lunardi, Enrico Maggio, Antonella Mannarini, Lavinia Martino, Pierluigi Merella, Cristina Piccinino, Francesca Rampini, Imma Romanazzi, Francesco Salton, Piermario Scuri, Gianmarco Scoccia, Giorgia Serino, Gianfranco Sinagra, Corrado Tamburino, Lucia Tricarico, Sara Uras Circulation Heart Failure, 2025 BACKGROUND: Right ventricular functional adaptation to afterload is a major determinant of outcome in pulmonary arterial hypertension (PAH). We aimed to investigate if right ventricular-pulmonary artery (PA) coupling evaluated by the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP) improves risk assessment scores for survival prediction. METHODS: A total of 677 consecutive patients with PAH (55% idiopathic) were prospectively enrolled with follow-up clinical, right heart catheterization, and echocardiographic evaluations within 12 months (interquartile range, 180–344 days) after initiation of targeted therapies in 11 Italian centers. European Society of Cardiology/European Respiratory Society guidelines-derived risk scores and REVEAL 2.0 (US Registry to Evaluate Early and Long-Term PAH Disease Management 2.0) risk scores were collected at baseline and follow-up. 254 consecutive patients with PAH retrospectively enrolled in a German reference center served as a validation cohort. RESULTS: A low-risk status at a median of 3.7 years (interquartile range, 1.2–6.8) follow-up was significantly associated with each unit (0.1 mm/mm Hg) increase in TAPSE/sPAP under targeted therapies (European Society of Cardiology/European Respiratory Society score: odds ratio, 1.78; P ≤0.001; REVEAL 2.0 score: odds ratio, 1.43; P ≤0.001). At follow-up, the TAPSE/sPAP ratio increased the prognostic information of each risk stratum of the European Society of Cardiology/European Respiratory Society risk score, except the highest risk stratum, with 0.5 mm/mm Hg, 0.35 mm/mm Hg, and 0.30 mm/mm Hg, from the lowest to the intermediate-high risk score, identified as the best cutoff value. TAPSE/sPAP ratio increased the prognostic information of the REVEAL 2.0 score at follow-up, with 0.35 mm/mm Hg identified as the best cutoff value to discriminate within a score of 5 to 8, with no added value for scores <5 and >8. These results were confirmed in the validation cohort. CONCLUSIONS: Assessment of right ventricular-PA coupling by the TAPSE/sPAP ratio in PAH improves risk assessment scores except in the lowest or most advanced stage of the disease
Nonpharmacological management of pulmonary arterial hypertension Alessandra Cuomo, Valentina Mercurio Ers Monograph, 2025 Besides standard medical care, PAH management should be implemented with supportive therapies, including promotion of physical activity and healthy lifestyle, fluid restriction, nutritional advice, oxygen therapy, consideration of iron supplementation when needed, psychological support and encouraging vaccinations in patients. Given the fragile equilibrium of PAH patients, addressing all the different aspects of this disease, alongside with the administration of targeted PAH therapies, is pivotal not only to enhance clinical outcome but also to improve quality of life. Furthermore, it is essential to address possible cardiovascular comorbidities with the appropriate medical treatment, considering the peculiar and specific characteristics of each PAH patient. Finally, selected patients might benefit from interventional and surgical procedures, such as atrial septostomy, Potts shunts and pulmonary artery denervation, which might reduce symptoms of advanced right heart failure. <bold>Cite as:</bold> Cuomo A, Mercurio V. Nonpharmacological management of pulmonary arterial hypertension. <italic>In:</italic> Boucly A, Kovacs G, Condliffe R, eds. Pulmonary Hypertension (ERS Monograph). Sheffield, European Respiratory Society, 2025; pp. 142–156 [<ext-link>https://doi.org/10.1183/2312508X.10020124</ext-link>].
The liver and the lungs: Hepatopulmonary syndrome and portopulmonary hypertension Pulmonary Hypertension and Lung Transplantation, 2025
Advanced pulmonary hypertension: Mechanical support and lung transplantation Pulmonary Hypertension and Lung Transplantation, 2025
ERS Congress 2024: highlights from the Pulmonary Vascular Diseases Assembly Vasile Foris, Aleksandar Bokan, Katarina Zeder, Alessandra Cuomo, Olivier Sitbon, Anton Vonk Noordegraaf, Mona Lichtblau, Athénaïs Boucly Erj Open Research, 2025 Extract Pulmonary vascular diseases remain a major cause of morbidity and mortality, and their complexity continues to drive both clinical and translational research. The 2024 European Respiratory Society (ERS) Congress in Vienna, Austria, offered a unique opportunity to showcase the latest advances in diagnostics, therapeutic approaches and precision medicine strategies in pulmonary vascular diseases. In this article, we provide a concise summary of some of the most impactful presentations from Assembly 13 (Pulmonary Vascular Diseases), with a focus on pulmonary embolism, right heart failure, and emerging insights into precision medicine.
Cardio-Oncology Challenges in Elderly Patients Ester Topa, Eliana De Rosa, Alessandra Cuomo, Francesco Curcio, Marika Rizza, Francesco Elia, Veronica Flocco, Umberto Attanasio, Martina Iengo, Francesco Fiore, Maria Cristina Luise, Grazia Arpino, Roberto Bianco, Chiara Carlomagno, Mario Giuliano, Luigi Formisano, Marco Picardi, Carminia Maria Della Corte, Floriana Morgillo, Giulia Martini, Erika Martinelli, Stefania Napolitano, Teresa Troiani, Giovanni Esposito, Antonio Cittadini, Guido Iaccarino, Giuseppe Rengo, Pasquale Abete, Valentina Mercurio, Carlo Gabriele Tocchetti Journal of Clinical Medicine, 2025 Background and Objectives: Along with the ageing of the population, cancer and cardiovascular (CV) diseases more frequently coexist, complicating patients’ management. Here, we focus on elderly oncologic patients, describing clinical features and comorbidities, discussing therapeutic management CV risk factors and CV complications risen during our CV follow-up, and exploring the different items of the comprehensive geriatric assessment (CGA) and the correlation between cardiac function by means of standard 2D echocardiography and each of the CGA items. Methods: A total of 108 consecutive patients (mean age 73.55 ± 5.43 years old; 40.7% females) referred to our cardio-oncology unit were enrolled, and three different groups were identified: Group 1, patients naïve for oncologic treatments (mean age 73.32 ± 5.40; 33% females); Group 2, patients already on antineoplastic protocols (mean age 73.46 ± 5.09; 44.1% females); and Group 3, patients who had already completed cancer treatments (mean age 74.34 ± 6.23; 55% female). The correlation between CGA, performed in a subgroup of 62 patients (57.4%), and echocardiographic parameters was assessed. Results: Group 2 patients had the highest incidence of CV events (CVEs) (61.8% vs. 14.8% in Group 1, 15% in Group 3; p ≤ 0.001) and withdrawals from oncologic treatments (8.8% vs. none in Group 1; p = 0.035). Group 2 had worse 48-month survival (47.1% vs. 22.2% in Group 1, 20% in Group 3; p = 0.05), which was even more evident when focusing on patients who died during follow-up. When assessing echocardiographic parameters, physical activity showed an inverse correlation with the left ventricular mass index (p = 0.034), while the Frailty index showed a direct correlation with the E/e’ ratio (p = 0.005). Conclusions: A thorough baseline CV assessment is important in elderly oncologic patients eligible for anticancer treatment. In this population, CGA can be a simple, feasible screening tool that might help identify patients at a greater risk of developing CVEs correlating to several pivotal cardiovascular parameters.
Evaluation of exercise capacity by means of cardiopulmonary exercise testing (CPET) in older adult cancer patients undergoing antineoplastic treatments Antonio Carannante, Umberto Attanasio, Alessandra Cuomo, Paolo Parrella, Giacomo Campi, Martina Iengo, Francesco Fiore, Lidia Cicia, Ester Topa, Remo Poto, Giancarlo Marone, Luigi Formisano, Roberto Bianco, Chiara Carlomagno, Marco Picardi, Carminia Maria Della Corte, Morena Fasano, Erika Martinelli, Stefania Napolitano, Teresa Troiani, Nicola Ferrara, Pasquale Abete, Valentina Mercurio, Carlo Gabriele Tocchetti Journal of Gerontology and Geriatrics, 2023
Mildly Elevated Pulmonary Hypertension: Gray Zone or Already a Disease? Alberto M. Marra, Umberto Attanasio, Alessandra Cuomo, Carmen Rainone, Anna D’Agostino, Antonio Carannante, Andrea Salzano, Eduardo Bossone, Antonio Cittadini, Carlo Gabriele Tocchetti, Valentina Mercurio Heart Failure Clinics, 2023
The broad spectrum of cardiotoxicities from immunotherapies Martina Iengo, Ester Topa, Alessandra Cuomo, Giancarlo Marone, Remo Poto, Gilda Varricchi, Leonardo Cristinziano, Maria Rosaria Galdiero, Anne Lise Ferrara, Stefania Loffredo, Luigi Formisano, Teresa Troiani, Valentina Mercurio, Carlo Gabriele Tocchetti Frontiers in Cardiovascular Medicine, 2023
Predictors of sacubitril/valsartan high dose tolerability in a real world population with HFrEF Valeria Visco, Ilaria Radano, Alfonso Campanile, Amelia Ravera, Angelo Silverio, Daniele Masarone, Giuseppe Pacileo, Michele Correale, Pietro Mazzeo, Giuseppe Dattilo, Francesco Giallauria, Alessandra Cuomo, Valentina Mercurio, Carlo Gabriele Tocchetti, Paola Di Pietro, Albino Carrizzo, Rodolfo Citro, Gennaro Galasso, Carmine Vecchione, Michele Ciccarelli Esc Heart Failure, 2022
Impact of a cardio-oncology unit on prevention of cardiovascular events in cancer patients Alessandra Cuomo, Valentina Mercurio, Gilda Varricchi, Maria Rosaria Galdiero, Francesca Wanda Rossi, Antonio Carannante, Grazia Arpino, Luigi Formisano, Roberto Bianco, Chiara Carlomagno, Carmine De Angelis, Mario Giuliano, Elide Matano, Marco Picardi, Domenico Salvatore, Ferdinando De Vita, Erika Martinelli, Carminia Maria Della Corte, Floriana Morgillo, Michele Orditura, Stefania Napolitano, Teresa Troiani, Carlo G. Tocchetti Esc Heart Failure, 2022
Causes and outcomes of ICU hospitalisations in patients with pulmonary arterial hypertension Mario Naranjo, Valentina Mercurio, Hussein Hassan, Noura Alturaif, Alessandra Cuomo, Umberto Attanasio, Nermin Diab, Sarina K. Sahetya, Monica Mukherjee, Steven Hsu, Aparna Balasubramanian, Catherine E. Simpson, Rachel Damico, Todd M. Kolb, Stephen C. Mathai, Paul M. Hassoun Erj Open Research, 2022
How can we manage the cardiac toxicity of immune checkpoint inhibitors? Remo Poto, Giancarlo Marone, Flora Pirozzi, Maria Rosaria Galdiero, Alessandra Cuomo, Luigi Formisano, Roberto Bianco, Carminia Maria Della Corte, Floriana Morgillo, Stefania Napolitano, Teresa Troiani, Carlo G Tocchetti, Valentina Mercurio, Gilda Varricchi Expert Opinion on Drug Safety, 2021
What Is the Cardiac Impact of Chemotherapy and Subsequent Radiotherapy in Lymphoma Patients? Valentina Mercurio, Alessandra Cuomo, Roberta Della Pepa, Deasy Ciervo, Laura Cella, Flora Pirozzi, Paolo Parrella, Giacomo Campi, Riccardo Franco, Gilda Varricchi, Pasquale Abete, Gianni Marone, Mario Petretta, Domenico Bonaduce, Roberto Pacelli, Marco Picardi, Carlo Gabriele Tocchetti Antioxidants and Redox Signaling, 2019
