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Introduction: Physical techniques used for the prevention of vasovagal syncope have limited evidence for efficacy. We aimed to evaluate multimodal supervised physical training as a treatment approach. Methods: In this 1:1 randomized trial, patients with ≥2 episodes of clinically diagnosed vasovagal syncope were included. On top of standard care, the intervention arm performed supervised tilt training and aerobic exercise in six sessions at a cardiac rehabilitation center (three sessions during the first month, and then at 3-month intervals), plus home tilt training. The control arm received standard care with a similar protocol of home tilt training. The primary outcome was time to first syncopal recurrence during 1 year of follow-up.Results: Fifty participants were randomized (mean age: 34.5 ± 14.8 years; 64% female). The rate of syncopal recurrence was 28% and 64% within the intervention and control arms, respectively, with significantly higher syncope-free survival at 1 year in the intervention arm (Log-rank p = .003). The frequency of recurrent syncopal events was significantly lower with physical training (p = .017). Participants in the intervention arm reported significantly higher adherence to the home tilt training program (80% vs. 52%; p = .037).Conclusion: Among patients with recurrent vasovagal syncope, a supervised program of tilt training and aerobic exercise reduced syncopal recurrence. Future trials are warranted to further investigate multimodal supervised physical techniques as a therapeutic approach in treating vasovagal syncope.

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AIM: To determine the effects of a structured, moderate-intensity, early cardiac rehabilitation (CR) program on physical function and psychological wellbeing in patients following aortic root replacement. MATERIALS AND METHODS: Patients were randomly assigned to either an 8-week (24 sessions) cardiac rehabilitation (CR) program, 4 to 6 weeks after aortic root replacement using the Bentall procedure, or to an age- and sex-matched control group undertaking no structured exercise. Physical function (via exercise treadmill test (ETT)) and psychological wellbeing (assessed via DASS-21 and SF36) were assessed before and following 8-weeks of CR. RESULTS: 30 patients (15 in the control (mean age: 37±10 years) and 15 in the intervention group (mean age: 38±11 years)) completed the 8-week CR programme and no adverse events were reported over the intervention period. In the CR group, all sub-components of the SF-36 and DASS-21 increased (all P <  0.05), showing an overall improvement in psychological wellbeing following the intervention. Distance walked on the ETT (improved significantly following 8-weeks of CR (490±167 m v 659±141 m; Λ improvement = 169 m; P <  0.05). There were no changes in physical function and psychological wellbeing in the controls (P >  0.05). A significant group-by-time interaction effect was evident for physical function and all sub-components of the SF-36 and DASS-21 (all P <  0.05) highlighting significant improvements in outcomes in the CR group compared to controls. CONCLUSIONS: This small sample, aerobic-based, moderate-intensity CR is safe and effective, and can be tolerated only 4–6 weeks after complex aortic root replacement surgery.