The effect of combined aerobic and breathing training on rate-pressure (double) product, exercise capacity and fatigue in women with mitral valve prolapse: A randomized clinical trial

Ashtaee, Sara; Zarneshan, Azam; Zanjani, Babak

doi:10.61882/JBUMS.33.109

Volume 33 - Supplement (Cardiometabolic) J Transl Med Res. 2026, 33 - Supplement (Cardiometabolic): 109-121 | Back to browse issues page

‎ 10.61882/JBUMS.33.109

Research code: طرح پژوهشی نمی باشد.

Ethics code: IR.AZARUNIV.REC.1403.005

Clinical trials code: IRCT Id=IRCT20160523028028N4

Mendeley

Zotero

RefWorks

Ashtaee S, Zarneshan A, Zanjani B. The effect of combined aerobic and breathing training on rate-pressure (double) product, exercise capacity and fatigue in women with mitral valve prolapse: A randomized clinical trial. J Transl Med Res. 2026; 33 :109-121
URL: http://journal.bums.ac.ir/article-1-3572-en.html

The effect of combined aerobic and breathing training on rate-pressure (double) product, exercise capacity and fatigue in women with mitral valve prolapse: A randomized clinical trial

Sara Ashtaee¹, Azam Zarneshan ^*², Babak Zanjani³

1- Department of Sports Psychology, Faculty of Educational Sciences and Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran
2- Department of Sports Psychology, Faculty of Educational Sciences and Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran , zarneshan@azaruniv.ac.ir
3- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract: (81 Views)

Background and Aims: Mitral valve prolapse (MVP) is a leading cause of primary mitral regurgitation and is associated with hemodynamic changes, reduced exercise capacity, increased fatigue, and lower quality of life. This study aimed to examine the effects of combined aerobic and breathing training on rate-pressure product (RPP), exercise capacity (VO2peak), quality of life, and multidimensional fatigue (MF) in women with MVP.
Materials and Methods: In this randomized clinical trial, 30 young women with mild to moderate mitral valve regurgitation were randomly assigned, using a web-based random sequence generator, to two groups: exercise (n = 15) and control (n = 15). The exercise group completed a 12-week aerobic and breathing exercise program, three sessions per week, with each session lasting 45–70 minutes at an intensity of RPE of 11–14 and 20–30 beats per minute above resting heart rate, monitored using a wrist-worn heart rate monitor. The control group continued their usual activities. The variables were assessed at two time points: pre-intervention and post-intervention.
Results: The exercise group showed an increase in VO2peak (P = 0.008) and quality of life (P = 0.001) compared to the control group, as well as a decrease in diastolic blood pressure (P = 0.009), resting heart rate (P = 0.043), and MF (P = 0.004). RPP and systolic blood pressure did not show significant changes
Conclusion: Combining aerobic and breathing exercises as a healthy lifestyle intervention can improve quality of life, reduce fatigue, and enhance aerobic capacity in patients with MVP. However, further studies are needed to examine the RPP and changes in systolic blood pressure both at rest and during exercise tests.

Keywords: Breathing exercises, Fatigue, Mitral valve prolapse, Quality of life, Rate-pressure product

Type of Study: Original Article | Subject: Sports Medicine
Received: 2025/12/12 | Accepted: 2026/04/26 | ePublished: 2026/03/30

References

1. Sonaglioni A, Nicolosi GL, Muti-Schünemann GEU, Lombardo M, Muti P. The Prevalence, Pathophysiological Role and Determinants of Mitral Annular Disjunction Among Patients with Mitral Valve Prolapse: A Systematic Review. JCM. 2025;14(5):1423. DOI: https://10.3390/jcm14051423. [DOI:10.3390/jcm14051423] [PMID] [PMCID]

2. Huang M-H, Tuan S-H, Tsai Y-J, Huang W-C, Huang T-C, Chang S-T, et al. Comparison of the Results of Cardiopulmonary Exercise Testing between Healthy Peers and Pediatric Patients with Different Echocardiographic Severity of Mitral Valve Prolapse. Life. 2023;13(2):302. DOI: https://10.3390/life13020302 [DOI:10.3390/life13020302] [PMID] [PMCID]

3. Drory Y, Fisman EZ, Fines A, Kellermann JJ. Exercise response in young women with mitral valve prolapse. Chest. 1989;96(5):1076-80. DOI: https://10.378/chest.96.5. [DOI:10.1378/chest.96.5.1076] [PMID]

4. Chung J-H, Tsai Y-J, Lin K-L, Weng K-P, Huang M-H, Chen G-B, et al. Comparison of cardiorespiratory fitness between patients with mitral valve prolapse and healthy peers: Findings from serial cardiopulmonary exercise testing. JCDD. 2023;10(4):167. DOI:https://10.3390/jcdd10040167. [DOI:10.3390/jcdd10040167] [PMID] [PMCID]

5. Jiang Z-H, Aierken A, Wu T-T, Zheng Y-Y, Ma Y-T, Xie X. Rate pressure product as a novel predictor of long-term adverse outcomes in patients after percutaneous coronary intervention: a retrospective cohort study. J BMJ open. 2023;13(4):e067951. DOI: https://10.1136/bmjopen-2022-. [DOI:10.1136/bmjopen-2022-067951] [PMID] [PMCID]

6. Staniute M, Bunevicius A, Brozaitiene J, Bunevicius R. Relationship of health-related quality of life with fatigue and exercise capacity in patients with coronary artery disease. EJCN. 2014;13(4):338-44. DOI: https://10.1177/1474515113496942. [DOI:10.1177/1474515113496942] [PMID]

7. Nascimento DM, Machado KC, Bock PM, Saffi MAL, Goldraich LA, Silveira AD, et al. Functional training improves peak oxygen consumption and quality of life of individuals with heart failure: a randomized clinical trial. BMC Cardiovasc Disord. 2023;23(1):381. DOI: https://10.1186/s12872-023-03404-7. [DOI:10.1186/s12872-023-03404-7] [PMID] [PMCID]

8. Garg P, Mendiratta A, Banga A, Bucharles A, Piccoli MVF, Kamaraj B, et al. Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis. Int J Cardiol Cardiovasc Risk Prev. 2024;20:200232. DOI: https://10.1016/j.ijcrp.2023. [DOI:10.1016/j.ijcrp.2023.200232] [PMID] [PMCID]

9. Tosun MI, Demirkan E, Kaplan A, Ari Yilmaz Y, Eker Arici I, Favre M, et al. Respiratory muscle training improves aerobic capacity and respiratory muscle strength in youth wrestlers. Front Physiol. 2025;16:1492446. DOI: https://10.3389/fphys.2025.. . [DOI:10.3389/fphys.2025.1492446] [PMID] [PMCID]

10. Ubolnuar N, Tantisuwat A, Thaveeratitham P, Lertmaharit S, Kruapanich C, Mathiyakom W. Effects of breathing exercises in patients with chronic obstructive pulmonary disease: systematic review and meta-analysis. Ann Rehabil Med. 2019;43(4):509-23. DOI: https://10.5535/arm.2019.43.4.509. [DOI:10.5535/arm.2019.43.4.509] [PMID] [PMCID]

11. Ghanbari A, Shirmohamadi N, Paryad E, Bazghale M, Mohammadpourhodki R, Discovery. Effect of breathing exercises on fatigue dimensions in patients with COPD. Medical Science. 2018;5(4):174-9. DOI: https://doi.org/10.36472/msd.v5i4.232 [DOI:10.36472/msd.v5i4.232.]

12. Alemayehu A, Teferi G. Effectiveness of Aerobic, Resistance, and Combined Training for Hypertensive Patients: A Randomized Controlled Trial. Ethiop J Health Sci. 2023;33(6):1063-74. DOI: https://10.4314/ejhs.v33i6.17. [DOI:10.4314/ejhs.v33i6.17] [PMID] [PMCID]

13. Deka P, Pozehl BJ, Pathak D, Williams M, Norman JF, Alonso WW, et al. Predicting maximal oxygen uptake from the 6 min walk test in patients with heart failure. ESC Heart Fail. 2021;8(1):47-54. DOI: https://10.1002/ehf2.13167. [DOI:10.1002/ehf2.13167] [PMID] [PMCID]

14. Higa H, Lennie TA, Chung ML, Tsuchihashi-Makaya M. Associations of multidimensional fatigue with the physical, psychological, and situational factors in outpatients with heart failure: a cross-sectional study. Eur J Cardiovasc Nurs. 2023;22(6):647-54. DOI: https://doi.org/10.1093/eurjcn/zvac117 [DOI:10.1093/eurjcn/zvac117.] [PMID]

15. Hafezi S, Zare H, Mehri SN, Mahmoodi H, editors. The Multidimensional Fatigue Inventory validation and fatigue assessment in Iranian distance education students. 2010 4th International Conference on Distance Learning and Education; 2010: IEEE. DOI: https://10.1109/ICDLE.2010.5606006. [DOI:10.1109/ICDLE.2010.5606006]

16. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Qual Life Res. 2005;14:875-82. DOI: https://10.1007/s11136-004-1014-5. [DOI:10.1007/s11136-004-1014-5] [PMID]

17. Bayles MPea. ACSM's exercise testing and prescription. Bayles, Madeline Paternostro. Ed. by Madeline Paternostro Bayles, Stephanie L. Cooper, and Garrett G. Kellar. Second edition. Philadelphia, PA: Wolters Kluwer, 2023. DOI: https://catalog.nlm.nih.gov/permalink/01NLM_INST/1o1phhn/alma99184876815066762023. .

18. Mytinger M, Nelson RK, Zuhl M, Disease. Exercise prescription guidelines for cardiovascular disease patients in the absence of a baseline stress test. J Cardiovasc Dev Dis. 2020;7(2):15. DOI: https://0.3390/jcdd7020015. [DOI:10.3390/jcdd7020015] [PMID] [PMCID]

19. Zarneshan A, Safaie N, Esmealy L, Esmealy B. Effect of Stretching Combined With a Slow Deep Breathing Exercise on Patients' Anxiety after Coronary Artery Bypass Grafting: A Randomized Clinical Trial. J Res Dev Nurs Midw. 2022;19(2):22-6. DOI: https://10.61186/jgbfnm.19.2.22. [DOI:10.61186/jgbfnm.19.2.22]

20. Hejazi K, Iraj ZA, Saeidi A, Hackney AC, Laziri F, Suzuki K, et al. Differential effects of exercise training protocols on blood pressures and lipid profiles in older adults patients with hypertension: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2025;131:105737. DOI: https://10.1016/j.archger.2024. [DOI:10.1016/j.archger.2024.105737] [PMID]

21. Masroor S, Bhati P, Verma S, Khan M, Hussain ME. Heart rate variability following combined aerobic and resistance training in sedentary hypertensive women: a randomised control trial. Indian Heart J. 2018;70:S28-S35. DOI: https://10.1016/j.ihj.2018.03.005. [DOI:10.1016/j.ihj.2018.03.005] [PMID] [PMCID]

22. Almutawa AM, Al-Shelash AA, Al-Gazlan BM, Al-Sallali RM, Al-Marzougi RA, Al-Sowayan NS. The effects of different quality of exercise on blood pressure and heart rate in healthy female. Health Promot Perspect. 2020;12(4):425-35. DOI: https://10.4236/health.2020.124034 [DOI:10.4236/health.2020.124034]

23. Xin X, Guo Y, Wang M, Hu Z, Chen J, Xie J. Optimal Exercise Modalities and Dosages for Blood Pressure Reduction in Adults With Prehypertension and Established Hypertension: A Network Meta‐Analysis and Dose-Response Relationship Study. J Am Heart Assoc. 2026;15(10):e044003. DOI: https://10.1161/JAHA.125. [DOI:10.1161/JAHA.125.044003] [PMID] [PMCID]

24. Wu Y, Johnson BT, Acabchuk RL, Chen S, Lewis HK, Livingston J, et al., editors. Yoga as antihypertensive lifestyle therapy: a systematic review and meta-analysis. Mayo Clin Proc; 2019: Elsevier. [DOI:10.1016/j.mayocp.2018.09.023] [PMID] [PMCID]

25. Pedro M, Lopes M, Bicho M. Heart rate and blood pressure in mitral valve prolapse patients: divergent effects of long-term propranolol therapy. Correlations with catecholamines. J Electrocardiol. 2007;40(4):s20. DOI: https://doi.org/10.1016/j.jelectrocard.2007.03.174 [DOI:10.1016/j.jelectrocard.2007.03.174.]

26. Compagnucci P, Selimi A, Cipolletta L, Volpato G, Gasperetti A, Valeri Y, et al. Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment. Maedica. 2024;13(5):1350. DOI: https://10.3390/jcm13051350. [DOI:10.3390/jcm13051350] [PMID] [PMCID]

27. Madhusudhan U, Pharmacology. Effect of high and low intensities of aerobic training on rate pressure product. NJPPP. 2018;8(4):550-. DOI: https://10.5455/njppp.2018.8.1145702122017.

28. Hui SC, Jackson AS, Wier LT, Sports Si, Exercise. Development of normative values for resting and exercise rate pressure product. Medicine. 2000;32(8):1520-7. DOI: https://10.097/00005768-200008000-00023. [DOI:10.1097/00005768-200008000-00023] [PMID]

29. Karimi N, Roshan VD, Esposito FJZJRMS. Cardiorespiratory fitness and its relationship with health risk factors among university students: A comparison between Iran and Italy. Zahedan J Res Med Sci. 2020;22(3):e91964. DOI: https://doi.org/10.5812/zjrms [DOI:10.5812/zjrms.]

30. Nystoriak MA, Bhatnagar A. Cardiovascular effects and benefits of exercise. Front Cardiovasc Med. 2018;5:135. DOI: https://10.3389/fcvm.2018.00135. [DOI:10.3389/fcvm.2018.00135] [PMID] [PMCID]

31. A Hamed L, Mohamed Abdel Aziz T. Effect of Deep Breathing Exercise Training on Fatigue'Level among Maintenance Hemodialysis Patients: Randomized Quasi-experimental Study. Egypt J Health Care. 2020;11(4):634-44. DOI: https://10.21608/ejhc.2020.169731. [DOI:10.21608/ejhc.2020.169731]

32. Vélez-Santamaría R, Fernández-Solana J, Méndez-López F, Domínguez-García M, González-Bernal JJ, Magallón-Botaya R, et al. Functionality, physical activity, fatigue and quality of life in patients with acute COVID-19 and Long COVID infection. J Scientific Reports. 2023;13(1):19907. ts | (2023) 13: DOI: https://doi.org/10.1038/s41598-023-47218-1 [DOI:10.1038/s41598-023-7218-1.] [PMID] [PMCID]

33. Myers VH, McVay MA, Brashear MM, Johannsen NM, Swift DL, Kramer K, et al. Exercise training and quality of life in individuals with type 2 diabetes: a randomized controlled trial. 2013;36(7):1884-90. DOI: https://10.2337/dc12-1153. [DOI:10.2337/dc12-1153] [PMID] [PMCID]

34. Hung H-F, Kao P-F, Lin Y-S, Chen F-C, Chen F-C, Tsai J-C, et al. Changes of serum β-endorphin by programmed exercise training are correlated with improvement of clinical symptoms and quality of life in female mitral valve prolapse syndrome. Cardiology. 2007;108(4):252-7. DOI: https://10.1159/000096952. [DOI:10.1159/000096952] [PMID]