{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:34:59Z","timestamp":1788824099013,"version":"build-2803163510"},"reference-count":37,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,2,11]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate whether aligning exercise timing with chronotype enhances cardiometabolic and sleep-related benefits in sedentary adults with cardiovascular risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this 12-week randomised controlled trial conducted in Lahore, Pakistan (January\u2013June 2025), 150 sedentary adults (aged 40\u201360) with at least one cardiovascular risk factor were recruited and categorised as morning-type or evening-type using the Morningness-Eveningness Questionnaire and validated by 48 hour core body temperature monitoring. Participants were randomised into a chronotype-aligned exercise (CAE) group exercising at their preferred time, or a chronotype-misaligned exercise (CME) group exercising at their non-preferred time. Moderate-intensity aerobic training (5 sessions\/week, 40\u2009min\/session) was supervised. Primary outcomes included systolic and diastolic blood pressure (BP) and heart rate variability (RMSSD); secondary outcomes included peak oxygen consumption (VO\u2082 peak), low density lipoprotein (LDL), fasting glucose and sleep quality (PSQI), assessed pre- and post-intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 150 randomised participants, 134 completed the study (CAE: n=64; CME: n=70). CAE led to significantly greater improvements in systolic BP (\u201310.8 vs \u20135.5 mm Hg, p=0.002), diastolic BP, RMSSD, VO\u2082 peak, LDL, fasting glucose and PSQI scores compared with CME. Repeated measures analysis of variance (ANOVA) revealed significant group\u00d7time interactions across all outcomes (eg, systolic BP: \u03b7\u00b2=0.095, p=0.005). The reduction in systolic BP in the CAE group was substantial and significantly greater than in the CME group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Aligning exercise timing with individual chronotype significantly enhances cardiometabolic and sleep-related outcomes in at-risk adults. Chronotype-based exercise prescriptions may offer a cost-effective, personalised approach to improving cardiovascular health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003573","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:05:46Z","timestamp":1776211546000},"page":"e003573","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Chronotype-aligned exercise timing in middle-aged adults at cardiometabolic risk: a randomised controlled trial"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"isrctn14276441","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1606-280X","authenticated-orcid":false,"given":"Arsalan","family":"Tariq","sequence":"first","affiliation":[{"name":"University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6315-7208","authenticated-orcid":false,"given":"Mohammed","family":"Harris Khalid","sequence":"additional","affiliation":[{"name":"Edinburgh Medical school, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Ammar","sequence":"additional","affiliation":[{"name":"Ibadat International University, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"2026041417053898000_13.1.e003573.1","doi-asserted-by":"crossref","DOI":"10.5334\/gh.1278","article-title":"World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update","volume":"19","author":"Laranjo","year":"2024","journal-title":"Glob Heart"},{"key":"2026041417053898000_13.1.e003573.2","article-title":"Chronotype and Social Jetlag: A (Self-) Critical Review","volume":"8","author":"Roenneberg","year":"2019","journal-title":"Biology (Basel)"},{"key":"2026041417053898000_13.1.e003573.3","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1516953113"},{"key":"2026041417053898000_13.1.e003573.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cub.2014.12.036"},{"key":"2026041417053898000_13.1.e003573.5","article-title":"ACSM\u2019s guidelines for exercise testing and prescription 9th Ed. 2014","volume":"58","author":"Ferguson","year":"2014","journal-title":"J Can Chiropr Assoc"},{"key":"2026041417053898000_13.1.e003573.6","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-017-0741-z"},{"key":"2026041417053898000_13.1.e003573.7","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-2923"},{"key":"2026041417053898000_13.1.e003573.8","unstructured":"Baird J . 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