{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T20:38:33Z","timestamp":1783024713750,"version":"3.54.6"},"reference-count":60,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Introduction: Balancing the well-documented benefits of regular exercise, particularly its positive impact on cardiovascular risk factors like hypertension, with the potential risks for patients with aortic aneurysms presents a significant challenge. This narrative review aims to summarize the current evidence and guidelines to assist clinicians in making informed exercise and sports recommendations for patients with aortic aneurysms or post-aortic repair. Methods: Nine clinical trials on the effect of exercise on abdominal aortic aneurysms (AAAs) were identified, including one study on cardiopulmonary exercise testing (CPET) in AAA patients. As no clinical trials on exercise in thoracic aortic aneurysms (TAAs) were found, we extrapolated data from other studies on exercise in aortic diseases, including data from patients who have had an aortic dissection, as well as three studies on cardiac rehabilitation (CR) and one study on CPET after proximal aortic repair. Review articles and guidelines were also incorporated to ensure a comprehensive overview of the topic. Results: Currently, no clear correlation exists between intense sports activities and the development of aortic aneurysms or dissections. Conclusions: Light to moderate physical activity appears safe and beneficial for patients with aortic aneurysms and post-aortic repair. Given the lack of evidence linking athletic activity to aortic complications, caution is warranted in restricting such activities for athletes, underscoring the importance of shared decision-making. Regular follow-up and optimal management of cardiovascular risk factors are essential.<\/jats:p>","DOI":"10.3390\/jcdd11120379","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T07:18:42Z","timestamp":1732691922000},"page":"379","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Exercise, Sports, and Cardiac Rehabilitation Recommendations in Patients with Aortic Aneurysms and Post-Aortic Repair: A Review of the Literature"],"prefix":"10.3390","volume":"11","author":[{"given":"Michael","family":"Stiefel","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0268-6567","authenticated-orcid":false,"given":"Hadassa","family":"Brito da Silva","sequence":"additional","affiliation":[{"name":"Hochgebirgsklinik Davos, Medicine Campus Davos, 7265 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Marc","family":"Schmied","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland"},{"name":"Herzgefaesszentrum im Park, Hirslanden Klinik im Park, 8027 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3089-1222","authenticated-orcid":false,"given":"David","family":"Niederseer","sequence":"additional","affiliation":[{"name":"Hochgebirgsklinik Davos, Medicine Campus Davos, 7265 Davos, Switzerland"},{"name":"Christine K\u00fchne-Center for Allergy Research and Education, 7265 Davos, Switzerland"},{"name":"Center of Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/S0140-6736(12)60954-4","article-title":"Stressing harms of physical inactivity to promote exercise","volume":"380","author":"Wen","year":"2012","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1253\/circrep.CR-19-0095","article-title":"Comprehensive Cardiac Rehabilitation as a Therapeutic Strategy for Abdominal Aortic Aneurysm","volume":"1","author":"Nakayama","year":"2019","journal-title":"Circ. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1053\/j.semtcvs.2021.02.029","article-title":"Incidence and Prevalence of Thoracic Aortic Aneurysms: A Systematic Review and Meta-analysis of Population-Based Studies","volume":"34","author":"Melo","year":"2022","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/HCR.0000000000000521","article-title":"Aortic Aneurysm","volume":"40","author":"Ehrman","year":"2020","journal-title":"J. Cardiopulm. Rehabilit. Prev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1097\/SLA.0000000000005716","article-title":"The Global and Regional Prevalence of Abdominal Aortic Aneurysms: A Systematic Review and Modeling Analysis","volume":"277","author":"Song","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1001\/archinte.160.10.1425","article-title":"The Aneurysm Detection and Management Study Screening Program","volume":"160","author":"Lederle","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2398","DOI":"10.1016\/j.jacc.2015.09.039","article-title":"Eligibility and Disqualification Recommendations for Competitive Athletes with Cardiovascular Abnormalities: Task Force 7: Aortic Diseases, Including Marfan Syndrome","volume":"66","author":"Braverman","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/HCR.0000000000000446","article-title":"Cardiopulmonary Exercise Testing Following Open Repair for a Proximal Thoracic Aortic Aneurysm or Dissection","volume":"40","author":"Hornsby","year":"2020","journal-title":"J. Cardiopulm. Rehabilit. Prev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1249\/MSS.0b013e3182a088b8","article-title":"A Randomized Trial of Exercise Training in Abdominal Aortic Aneurysm Disease","volume":"46","author":"Myers","year":"2014","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e007959","DOI":"10.1161\/JAHA.117.007959","article-title":"Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm","volume":"7","author":"Nakayama","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1007\/s00380-019-01441-x","article-title":"The potential of cardiac rehabilitation as a method of suppressing abdominal aortic aneurysm expansion: A pilot study","volume":"34","author":"Nakayama","year":"2019","journal-title":"Heart Vessel."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/HCR.0000000000000270","article-title":"Exercise Training Improves Ventilatory Efficiency in Patients with a Small Abdominal Aortic Aneurysm","volume":"38","author":"Lima","year":"2018","journal-title":"J. Cardiopulm. Rehabilit. Prev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.avsg.2013.09.001","article-title":"Supervised Exercise Program Improves Aerobic Fitness in Patients Awaiting Abdominal Aortic Aneurysm Repair","volume":"28","author":"Barakat","year":"2014","journal-title":"Ann. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.amjmed.2020.07.029","article-title":"Effects of Exercise Training on Vascular Markers of Disease Progression in Patients with Small Abdominal Aortic Aneurysms","volume":"134","author":"Niebauer","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.1016\/j.apmr.2012.07.012","article-title":"Endurance Exercise Training in Patients with Small Abdominal Aortic Aneurysm: A Randomized Controlled Pilot Study","volume":"93","author":"Tew","year":"2012","journal-title":"Arch. Phys. Med. Rehabilit."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1093\/bja\/aep205","article-title":"Effect of short-term exercise training on aerobic fitness in patients with abdominal aortic aneurysms: A pilot study","volume":"103","author":"Kothmann","year":"2009","journal-title":"Br. J. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1002\/bjs.10669","article-title":"Randomized feasibility trial of high-intensity interval training before elective abdominal aortic aneurysm repair","volume":"104","author":"Tew","year":"2017","journal-title":"Br. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/1741826710389384","article-title":"Cardiopulmonary exercise testing in small abdominal aortic aneurysm: Profile, safety, and mortality estimates","volume":"18","author":"Myers","year":"2011","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1080\/14017431.2016.1257149","article-title":"Exercise-based cardiac rehabilitation in surgically treated type-A aortic dissection patients","volume":"51","author":"Fuglsang","year":"2017","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zhou, N., Fortin, G., Balice, M., Kovalska, O., Cristofini, P., Ledru, F., Mampuya, W.M., and Iliou, M.-C. (2022). Evolution of Early Postoperative Cardiac Rehabilitation in Patients with Acute Type A Aortic Dissection. J. Clin. Med., 11.","DOI":"10.3390\/jcm11082107"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/HJR.0b013e32831fd6c8","article-title":"Cardiac Rehabilitation working Group of the French Society of Cardiology French registry of cases of type I acute aortic dissection admitted to a cardiac rehabilitation center after surgery","volume":"16","author":"Corone","year":"2009","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ejvs.2014.10.008","article-title":"Beneficial Effects of Pre-operative Exercise Therapy in Patients with an Abdominal Aortic Aneurysm: A Systematic Review","volume":"49","author":"Pouwels","year":"2015","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1161\/CIRCULATIONAHA.109.901074","article-title":"Prevalence and Clinical Significance of Aortic Root Dilation in Highly Trained Competitive Athletes","volume":"122","author":"Pelliccia","year":"2010","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1136\/heartjnl-2018-314288","article-title":"Prevalence and progression of aortic root dilatation in highly trained young athletes","volume":"105","author":"Gati","year":"2019","journal-title":"Heart"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Monda, E., Verrillo, F., Rubino, M., Palmiero, G., Fusco, A., Cirillo, A., Caiazza, M., Guarnaccia, N., Mauriello, A., and Lioncino, M. (2022). Thoracic Aortic Dilation: Implications for Physical Activity and Sport Participation. Diagnostics, 12.","DOI":"10.3390\/diagnostics12061392"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1001\/jamacardio.2020.0054","article-title":"Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes","volume":"5","author":"Churchill","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_27","first-page":"546","article-title":"Cardiovascular and Musculoskeletal Assessment of Elite US Volleyball Players","volume":"25","author":"Davis","year":"2015","journal-title":"Am. J. Ther."},{"key":"ref_28","first-page":"669","article-title":"Aortic dissection and sport: Physiologic and clinical understanding provide an oppor-tunity to save young lives","volume":"51","author":"Mayerick","year":"2010","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1136\/bjsm.2008.047407","article-title":"Effects of sports activity in athletes with bicuspid aortic valve and mild aortic regurgitation","volume":"44","author":"Galanti","year":"2010","journal-title":"Br. J. Sports Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e006852","DOI":"10.1161\/CIRCIMAGING.117.006852","article-title":"Ascending Aortic Dimensions in Former National Football League Athletes","volume":"10","author":"Gentry","year":"2017","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1002\/clc.22418","article-title":"Survivors of Aortic Dissection: Activity, Mental Health, and Sexual Function","volume":"38","author":"Chaddha","year":"2015","journal-title":"Clin. Cardiol."},{"key":"ref_32","first-page":"553","article-title":"Sudden Death Due to Thoracic Aortic Dissection in Young People: A Multicenter Forensic Study","volume":"72","author":"Campillo","year":"2019","journal-title":"Rev. Espanola Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1016\/j.jacc.2016.02.062","article-title":"Etiology of Sudden Death in Sports","volume":"67","author":"Finocchiaro","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","first-page":"747","article-title":"Hemodynamic effects of aerobic vs resistance exercise","volume":"10","author":"Copeland","year":"1996","journal-title":"J. Hum. Hypertens"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1136\/bjsports-2018-099921","article-title":"How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure","volume":"53","author":"Naci","year":"2019","journal-title":"Br. J. Sports Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s11906-015-0600-y","article-title":"Exercise for Hypertension: A Prescription Update Integrating Existing Recommendations with Emerging Research","volume":"17","author":"Pescatello","year":"2015","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_37","first-page":"604","article-title":"Effect of hypertensive response to exercise on aortic diameters","volume":"44","author":"Schmied","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1249\/MSS.0000000000001501","article-title":"Acute Inflammatory Responses to Exercise in Patients with Abdominal Aortic Aneurysm","volume":"50","author":"Windsor","year":"2018","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"H19","DOI":"10.1152\/ajpheart.00344.2017","article-title":"Effects of acute exercise on endothelial function in patients with abdominal aortic aneurysm","volume":"314","author":"Bailey","year":"2018","journal-title":"Am. J. Physiol. Circ. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1161\/01.CIR.88.4.1456","article-title":"Effects of age and aerobic capacity on arterial stiffness in healthy adults","volume":"88","author":"Vaitkevicius","year":"1993","journal-title":"Circulation"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/j.ejvs.2019.02.021","article-title":"Aortic and Systemic Arterial Stiffness Responses to Acute Exercise in Patients with Small Abdominal Aortic Aneurysms","volume":"58","author":"Perissiou","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jvs.2023.09.004","article-title":"A preoperative supervised exercise program potentially improves long-term survival after elective abdominal aortic aneurysm repair","volume":"79","author":"Sethi","year":"2024","journal-title":"J. Vasc. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1093\/bja\/aeu383","article-title":"Cardiopulmonary exercise testing and survival after elective abdominal aortic aneurysm repair","volume":"114","author":"Grant","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"384","DOI":"10.5603\/CJ.a2018.0101","article-title":"Coexistence and management of abdominal aortic aneurysm and coronary artery disease","volume":"27","author":"Iwaszczuk","year":"2020","journal-title":"Cardiol. J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e006438","DOI":"10.1161\/JAHA.117.006438","article-title":"Cardiovascular Benefits of Moderate Exercise Training in Marfan Syndrome: Insights From an Animal Model","volume":"6","author":"Siegert","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1152\/japplphysiol.00132.2017","article-title":"Mild aerobic exercise blocks elastin fiber fragmentation and aortic dilatation in a mouse model of Marfan syndrome associated aortic aneurysm","volume":"123","author":"Gibson","year":"2017","journal-title":"J. Appl. Physiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"ESC Guidelines on the diagnosis and treatment of aortic diseases: Document Covering Acute and Chronic Aortic Diseases of the Thoracic and Abdominal Aorta of the Adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1007\/s40279-013-0057-6","article-title":"Aortic Root Disease in Athletes: Aortic Root Dilation, Anomalous Coronary Artery, Bicuspid Aortic Valve, and Marfan\u2019s Syndrome","volume":"43","author":"Yim","year":"2013","journal-title":"Sports Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.pcad.2012.01.004","article-title":"Aortic Root Dilatation in Athletic Population","volume":"54","author":"Pelliccia","year":"2012","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_51","first-page":"1582","article-title":"Indications and utility of cardiac genetic testing in athletes","volume":"29","author":"Castelletti","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1053\/j.semvascsurg.2022.02.007","article-title":"An assessment of the current medical management of thoracic aortic disease: A patient-centered scoping literature review","volume":"35","author":"Pena","year":"2022","journal-title":"Semin. Vasc. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"znad375","DOI":"10.1093\/bjs\/znad375","article-title":"Influence of cardiometabolic medications on abdominal aortic aneurysm growth in the UK Aneurysm Growth Study: Metformin and angiotensin-converting enzyme inhibitors associated with slower aneurysm growth","volume":"111","author":"Gellatly","year":"2024","journal-title":"Br. J. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jjcc.2012.09.010","article-title":"Heart rate and blood pressure response to ramp exercise and exercise capacity in relation to age, gender, and mode of exercise in a healthy population","volume":"61","author":"Itoh","year":"2013","journal-title":"J. Cardiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1152\/jappl.1985.58.3.785","article-title":"Arterial blood pressure response to heavy resistance exercise","volume":"58","author":"MacDougall","year":"1985","journal-title":"J. Appl. Physiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/MBP.0b013e32835b9e74","article-title":"Assessment of management of cardiovascular risk factors in patients with thoracic aortic disease","volume":"17","author":"Bastien","year":"2012","journal-title":"Blood Press. Monit."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jvn.2013.05.002","article-title":"Patient recruitment and experiences in a randomised trial of supervised exercise training for individuals with abdominal aortic aneurysm","volume":"32","author":"Gunasekera","year":"2014","journal-title":"J. Vasc. Nurs."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1111\/cge.13522","article-title":"Systematic review of quality of life in persons with hereditary thoracic aortic aneurysm and dissection diagnoses","volume":"95","author":"Velvin","year":"2019","journal-title":"Clin. Genet."},{"key":"ref_60","first-page":"171","article-title":"Evidence based guideline for cardiac rehabilitation in German speaking countries of Europe","volume":"146","author":"Schwaab","year":"2021","journal-title":"Dtsch. Med. Wochenschr."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/12\/379\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:40:23Z","timestamp":1760114423000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/12\/379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,27]]},"references-count":60,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcdd11120379"],"URL":"https:\/\/doi.org\/10.3390\/jcdd11120379","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,27]]}}}