{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T11:25:43Z","timestamp":1766057143761,"version":"3.48.0"},"reference-count":39,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Culture, Sports and Tourism and the Korea Sports Promotion Foundation"},{"name":"Korean government","award":["RS-2024-00336696"],"award-info":[{"award-number":["RS-2024-00336696"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: To examine the safety and clinical applicability of a newly developed outdoor-simulated interactive indoor cycling device as a potential exercise modality for cardiac rehabilitation (CR) in patients with cardiovascular disease (CVD). Methods: Twenty patients with CVD with low-to-moderate cardiovascular exercise risk performed a symptom-limited cardiopulmonary exercise stress test (CPET) using a modified Bruce protocol to obtain peak cardiopulmonary responses. After a 30\u201360 min rest, they rode the outdoor-simulated interactive indoor cycling device for 10 min with continuous gas exchange and electrocardiography monitoring. The treadmill-based CPET results were compared with those from the cycling device, focusing on key cardiopulmonary variables, such as VO2, HR, METs, and Rating of Perceived Exertion (RPE). Results: The 20 male participants had a mean age of 56.1 years. When treadmill peak values were used as reference, the cycling device elicited responses corresponding to moderate-to-vigorous intensity. In subgroup analysis, treadmill-derived peak VO2, peak HR, and peak MET values were significantly lower in patients aged \u226560 years compared with those aged &lt;60 years. However, no significant differences were observed in cycling-derived values between the two groups, suggesting that cycling may represent a relatively higher-intensity exercise compared with treadmill in older patients. No significant adverse cardiac events were observed during cycling. Conclusions: The outdoor-simulated interactive indoor cycling device delivered exercise intensity within the therapeutic range recommended for CR in patients with CVD. Furthermore, it appeared to elicit relatively higher exercise intensity in older patients, supporting its potential as a safe and effective alternative exercise modality for CR.<\/jats:p>","DOI":"10.3390\/jcm14248947","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T11:08:28Z","timestamp":1766056108000},"page":"8947","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility and Safety of an Outdoor-Simulated Interactive Indoor Cycling Device for Cardiac Rehabilitation: A Pilot Validation Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Jin Taek","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7788-7904","authenticated-orcid":false,"given":"Bo Ryun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1933-038X","authenticated-orcid":false,"given":"Sung Bom","family":"Pyun","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Mo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ho Sung","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8848-4112","authenticated-orcid":false,"given":"Jae Seung","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5254-1405","authenticated-orcid":false,"given":"Hee Jung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025, November 15). Cardiovascular Diseases, Available online: https:\/\/www.who.int\/health-topics\/cardiovascular-diseases#tab=tab_1."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2015.10.044","article-title":"Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis","volume":"67","author":"Anderson","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1093\/eurheartj\/ehac747","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease: A meta-analysis","volume":"44","author":"Dibben","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3144","DOI":"10.1161\/CIRCULATIONAHA.109.192520","article-title":"Recommendations for clinical exercise laboratories: A scientific statement from the american heart association","volume":"119","author":"Myers","year":"2009","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Noseworthy, M., Peddie, L., Buckler, E.J., Park, F., Pham, M., Pratt, S., Singh, A., Puterman, E., and Liu-Ambrose, T. (2023). The Effects of Outdoor versus Indoor Exercise on Psychological Health, Physical Health, and Physical Activity Behaviour: A Systematic Review of Longitudinal Trials. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20031669"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1080\/17437199.2024.2383758","article-title":"Acute effects of outdoor versus indoor exercise: A systematic review and meta-analysis","volume":"18","author":"Peddie","year":"2024","journal-title":"Health Psychol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1001\/jamainternmed.2021.3830","article-title":"Cycling for Health","volume":"181","author":"Redberg","year":"2021","journal-title":"JAMA Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/j.1600-0838.2011.01299.x","article-title":"Health benefits of cycling: A systematic review","volume":"21","author":"Oja","year":"2011","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2151458517748742","DOI":"10.1177\/2151458517748742","article-title":"Geriatric Cyclists: Assessing Risks, Safety, and Benefits","volume":"9","author":"Ikpeze","year":"2018","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7994866","DOI":"10.1155\/2022\/7994866","article-title":"Prediction of Severe Injury in Bicycle Rider Accidents: A Multicenter Observational Study","volume":"2022","author":"Wang","year":"2022","journal-title":"Emerg. Med. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1093\/ehjdh\/ztaf070","article-title":"Extended reality in cardiovascular care: A systematic review","volume":"6","author":"Kanschik","year":"2025","journal-title":"Eur. Heart J. Digit. Health"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"J\u00f3\u017awik, S., Cie\u015blik, B., Gajda, R., and Szczepa\u0144ska-Gieracha, J. (2021). Evaluation of the Impact of Virtual Reality-Enhanced Cardiac Rehabilitation on Depressive and Anxiety Symptoms in Patients with Coronary Artery Disease: A Randomised Controlled Trial. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102148"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Micheluzzi, V., Navarese, E.P., Merella, P., Talanas, G., Viola, G., Bandino, S., Idini, C., Burrai, F., and Casu, G. (2024). Clinical application of virtual reality in patients with cardiovascular disease: State of the art. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1356361"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1161\/CIR.0b013e31829b5b44","article-title":"Exercise standards for testing and training: A scientific statement from the American Heart Association","volume":"128","author":"Fletcher","year":"2013","journal-title":"Circulation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s12984-025-01657-1","article-title":"Biomechanical analysis of patients with mild Parkinson\u2019s disease during indoor cycling training","volume":"22","author":"Kang","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1152\/jappl.2000.89.2.465","article-title":"Estimation of skeletal muscle mass by bioelectrical impedance analysis","volume":"89","author":"Janssen","year":"2000","journal-title":"J. Appl. Physiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.4070\/kcj.2000.30.8.1004","article-title":"Development of Korean Activity Scale\/Index (KASI)","volume":"30","author":"Sung","year":"2000","journal-title":"Korean Circ. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: A measure of health status from the EuroQol Group","volume":"33","author":"Rabin","year":"2001","journal-title":"Ann. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"85","DOI":"10.11005\/jbm.2020.27.2.85","article-title":"Measurement and Interpretation of Handgrip Strength for Research on Sarcopenia and Osteoporosis","volume":"27","author":"Lee","year":"2020","journal-title":"J. Bone Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/01.HCR.0000291297.70517.9a","article-title":"Handgrip strength in cardiac rehabilitation: Normative values, interaction with physical function, and response to training","volume":"27","author":"Savage","year":"2007","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS statement: Guidelines for the six-minute walk test. Am. J. Respir. Crit. Care Med., 166, 111\u2013117.","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"ref_23","first-page":"897","article-title":"Six-minute walk test in patients with cardiac dysfunction","volume":"42","author":"Bittner","year":"1997","journal-title":"Cardiologia"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1249\/MSS.0b013e318213fefb","article-title":"American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise","volume":"43","author":"Garber","year":"2011","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Taylor, J.L., Bonikowske, A.R., and Olson, T.P. (2021). Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.734278"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ren, C., Zhu, J., Shen, T., Song, Y., Tao, L., Xu, S., Zhao, W., and Gao, W. (2022). Comparison Between Treadmill and Bicycle Ergometer Exercises in Terms of Safety of Cardiopulmonary Exercise Testing in Patients With Coronary Heart Disease. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.864637"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Gon\u00e7alves, C., Raimundo, A., Abreu, A., and Bravo, J. (2021). Exercise Intensity in Patients with Cardiovascular Diseases: Systematic Review with Meta-Analysis. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18073574"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.pcad.2022.02.001","article-title":"Exercise training in cardiac rehabilitation: Setting the right intensity for optimal benefit","volume":"70","author":"Sabbahi","year":"2022","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e328","DOI":"10.1161\/CIR.0000000000001289","article-title":"Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation","volume":"150","author":"Brown","year":"2024","journal-title":"Circulation"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1093\/eurjpc\/zwab007","article-title":"Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: Why and how: A position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology","volume":"29","author":"Hansen","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"179","DOI":"10.2165\/00007256-200939030-00002","article-title":"Physiological differences between cycling and running: Lessons from triathletes","volume":"39","author":"Millet","year":"2009","journal-title":"Sports Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.gaitpost.2010.11.013","article-title":"Comparison of elliptical training, stationary cycling, treadmill walking and overground walking. Electromyographic patterns","volume":"33","author":"Prosser","year":"2011","journal-title":"Gait Posture"},{"key":"ref_33","first-page":"e45880","article-title":"Comparison of Cardiovascular Response to Lower Body and Whole Body Exercise Among Sedentary Young Adults","volume":"15","author":"Kumari","year":"2023","journal-title":"Cureus"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Cersosimo, A., Longo Elia, R., Condello, F., Colombo, F., Pierucci, N., Arabia, G., Matteucci, A., Metra, M., Adamo, M., and Vizzardi, E. (Minerva Cardiol. Angiol., 2025). Cardiac rehabilitation in patients with atrial fibrillation, Minerva Cardiol. Angiol., ahead of print.","DOI":"10.23736\/S2724-5683.25.06885-1"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.11124\/JBIES-24-00457","article-title":"Effectiveness of alternative exercises in cardiac rehabilitation for program completion and outcomes in women with or at high risk of cardiovascular disease: A systematic review and meta-analysis","volume":"23","author":"Suebkinorn","year":"2025","journal-title":"JBI Evid. Synth."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/j.apmr.2019.10.184","article-title":"Comparison of Treadmill and Cycle Ergometer Exercise During Cardiac Rehabilitation: A Meta-analysis","volume":"101","author":"Gerlach","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Gloc, D., Nowak, Z., Nowak-Lis, A., Gabry\u015b, T., Szmatlan-Gabrys, U., Valach, P., and Pilis, A. (2021). Indoor cycling training in rehabilitation of patients after myocardial infarction. BMC Sports Sci. Med. Rehabil., 13.","DOI":"10.1186\/s13102-021-00379-w"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s40798-017-0086-z","article-title":"The Contribution of Individual Exercise Training Components to Clinical Outcomes in Randomised Controlled Trials of Cardiac Rehabilitation: A Systematic Review and Meta-regression","volume":"3","author":"Abell","year":"2017","journal-title":"Sports Med. Open"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1002\/clc.24130","article-title":"Factors associated with participation in cardiac rehabilitation in patients with acute myocardial infarction: A systematic review and meta-analysis","volume":"46","author":"Wang","year":"2023","journal-title":"Clin. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8947\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T11:19:50Z","timestamp":1766056790000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8947"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":39,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248947"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248947","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,12,18]]}}}