Multi-site lactate kinetics during moderate intensity resistance and endurance exercise in definitive and probable arrhythmogenic cardiomyopathy

Q: What are the key findings of this study?

Moderate-intensity resistance and endurance exercise safely increased radial artery lactate from 0.93 mmol/L at rest to a peak of 2.25 mmol/L at 20-min cycling (p<0.001) in ACM patients.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Arrhythmogenic cardiomyopathy (ACM) (n=20). Intervention: Moderate-intensity resistance (isometric handgrip, dynamic bicep curl) and endurance cycling exercise vs. Supine rest and comparisons across vascular sampling sites (radial artery, pulmonary artery, femoral vein). Primary outcome: Radial artery lactate concentration (mmol/L) at peak (20 min cycling) versus supine rest (p=<0.001).

Q: What does this research mean for the field?

Moderate-intensity resistance and endurance exercise safely increase circulating lactate while maintaining predominantly aerobic metabolism without provoking malignant arrhythmias in patients with arrhythmogenic cardiomyopathy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate multi-site vascular lactate kinetics and metabolic responses during moderate-intensity resistance and endurance exercise in patients with definitive and borderline arrhythmogenic cardiomyopathy (ACM).

Simon Wernhart; Marwin Shir; David Federle; Karl Ludwig Laugwitz; Martin Halle; Manuel Rattka; Mark J Haykowsky

doi:10.1016/j.ijcha.2026.101913

March 27, 2026IJC Heart & VasculatureOpen Access

Multi-site lactate kinetics during moderate intensity resistance and endurance exercise in definitive and probable arrhythmogenic cardiomyopathy

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Key result

Moderate-intensity exercise safely increases radial artery lactate ~2.4-fold at peak cycling in ACM patients.

P<0.001
n=20

Figures

Graphical abstract published by IJC Heart & Vasculature — Graphical abstract · Published by IJC Heart & Vasculature · CC BY-NC

Why the study?

Does moderate-intensity isometric and dynamic resistance exercise and continuous moderate-intensity endurance exercise alter multi-site lactate concentrations and arrhythmic safety in patients with definitive and borderline arrhythmogenic cardiomyopathy?

Key Points

To evaluate multi-site vascular lactate kinetics and metabolic responses during moderate-intensity resistance and endurance exercise in patients with definitive and borderline arrhythmogenic cardiomyopathy (ACM).
Assessed lactate concentrations across three vascular extraction sites: radial artery (RA), pulmonary artery (PA), and femoral vein (FV).
Evaluated responses at rest, after 1-minute isometric handgrip (HG), dynamic bicep curl (BC) at 70% 1RM, and during 20 and 40 minutes of continuous cycling at the first ventilatory threshold.
Included patients with definitive (n=13) and borderline ACM, evaluating hemodynamic parameters, cardiac strain, and arrhythmic events during exercise.
Lactate concentrations differed across exercise modes at all sites (all p < 0.001), peaking at 20 minutes of cycling (RA: 2.25 ± 1.08 mmol/L; PA: 2.20 ± 1.02 mmol/L; FV: 2.21 ± 1.27 mmol/L; p = 0.829 across sites).
Radial artery lactate was higher during resistance tasks compared to PA and FV (HG: RA 1.58 ± 0.58 mmol/L vs. PA 1.19 ± 0.47 mmol/L, FV 1.30 ± 0.39 mmol/L, p < 0.001; BC: RA 2.09 ± 0.56 mmol/L vs. PA 1.69 ± 0.46 mmol/L, FV 1.56 ± 0.47 mmol/L, p < 0.001).
No malignant arrhythmias occurred, although definitive ACM patients exhibited more premature ventricular beats during exercise than borderline patients (p < 0.001), with all exercise modes maintaining predominantly aerobic metabolism.

Study Design

Type

Observational (n=20)

Blinding

Open-label

Multicenter

No

Structured PICO

Does moderate-intensity isometric and dynamic resistance exercise and continuous moderate-intensity endurance exercise alter multi-site lactate concentrations and arrhythmic safety in patients with definitive and borderline arrhythmogenic cardiomyopathy?

P

Population

20 adults (mean age 42.6 years, 60% female) with definitive or borderline arrhythmogenic cardiomyopathy and largely preserved ejection fraction evaluated during acute multi-mode exercise testing.

I

Intervention

Moderate-intensity exercise protocol during supine exercise right heart catheterization (exRHC): isometric handgrip (HG) and dynamic bicep curl (BC) at 70% maximal voluntary contraction (MVC) for 1 minute each, and continuous supine bicycle exercise at the first ventilatory threshold (VT1, 50-60% VO2 max) for 20 and 40 minutes, with a 5-minute break between each exercise test

C

Comparator

Supine resting state, as well as comparisons across vascular sampling sites (radial artery, pulmonary artery, femoral vein) and between definitive (n=13) vs. borderline (n=7) ACM groups

O

Outcome

Lactate concentrations sampled simultaneously at rest and at the end of each exercise test from the radial artery (RA), pulmonary artery (PA), and common femoral vein (FV)surrogate

Main Result

Absolute Event Rate: 2.25% vs 0.93%

p-value: p=<0.001

Acute moderate-intensity resistance and endurance exercises maintain predominantly aerobic metabolism without inducing malignant arrhythmias in patients with arrhythmogenic cardiomyopathy, though vascular site-specific differences in lactate kinetics exist during upper-body resistance exercise.

Limitations

Most patients (n=14) harbored PKP-2 mutations, limiting generalizability to other genotypes (such as desmoplakin) or gene-elusive patients.
Resting ejection fraction was largely preserved with no clinical heart failure, so findings may not apply to advanced heart failure phenotypes.
The study was not powered to demonstrate differences in lactate concentrations across sites and exercise modes and is hypothesis-generating.
Only acute metabolic and arrhythmic responses were assessed, preventing conclusions on long-term adverse event reduction.
Right ventricular mechanical stress and strain during exercise were not assessed.
Most patients (n = 14) harbored PKP-2 mutations, so data cannot be transferred to other mutations (such as desmoplakin) or gene-elusive patients.
Resting ejection fraction was largely preserved and no patient displayed clinical signs of heart failure, limiting applicability to advanced heart failure phenotypes.
The study was not powered to demonstrate differences in lactate concentrations across sites and exercise modes and must be considered hypothesis-generating.
The study only provides information on acute metabolic and arrhythmic responses and cannot claim that moderate exercise will reduce long-term adverse events.
Right ventricular mechanical stress and acute/chronic right ventricular strain during exercise were not assessed.

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Implication

Moderate exercise appears safe in ACM without malignant arrhythmias; hypothesis-generating and requires randomized trials before guiding prescriptions.

Abstract

Distribution of lactate concentration across vascular sites and exercise. Comparison of rest and moderate intensity resistance and aerobic exercise: Lactate concentration differs across vascular sites. Handgrip (HG), bicep curl (BC), 20 (20min) and 40 (40min) of aerobic cycling. A: Radial artery (RA). B: Pulmonary artery (PA). C: Femoral vein (FV).

Discussion

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Cite This Study

Wernhart et al. (2026) conducted an observational in Arrhythmogenic cardiomyopathy (ACM) (n=20). Moderate-intensity resistance (isometric handgrip, dynamic bicep curl) and endurance cycling exercise vs. Supine rest and comparisons across vascular sampling sites (radial artery, pulmonary artery, femoral vein) was evaluated on Radial artery lactate concentration (mmol/L) at peak (20 min cycling) versus supine rest (p=<0.001). Moderate-intensity resistance and endurance exercise safely increased radial artery lactate from 0.93 mmol/L at rest to a peak of 2.25 mmol/L at 20-min cycling (p<0.001) in ACM patients.

synapsesocial.com/papers/69ca1280883daed6ee09501c https://doi.org/10.1016/j.ijcha.2026.101913

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Multi-site lactate kinetics during moderate intensity resistance and endurance exercise in definitive and probable arrhythmogenic cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Multi-site lactate kinetics during moderate intensity resistance and endurance exercise in definitive and probable arrhythmogenic cardiomyopathy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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