AUCTORES
Globalize your Research
Chat with us
Research Article | DOI: https://doi.org/10.31579/2641-0419/324
1 Human Performance Laboratory, Department of Kinesiology, East Carolina University.
2 School of Kinesiology & Recreation, Illinois State University, Normal, IL.
3 Department of Obstetrics and Gynecology, East Carolina University.
4 Department of Pediatrics, East Carolina University.
5 Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV.
6 Department of Public Health, East Carolina University.
*Corresponding Author: Linda E. May, PhD, Human Performance Laboratory Ward Sports Medicine Bldg., 3rd floor East Carolina University.
Citation: Alex Claiborne, Samantha Mcdonald, Filip Jevtovic, Diana Strickland, Edward Newton, et all (2023), Maternal Exercise Type and Fetal Echocardiographic Measures. J. Clinical Cardiology and Cardiovascular Interventions, 6(5); DOI:10.31579/2641-0419/324
Copyright: © 2023 Aubin Sandio, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 14 March 2023 | Accepted: 07 April 2023 | Published: 24 April 2023
Keywords: fetus, pregnancy; echocardiography; exercise; cardiac output; ventricle; stroke volume
Background/Aims: While aerobic exercise during pregnancy has been specifically shown to benefit fetal heart dimensions and outflow, the exercise type-specific effects of resistance and combination (resistance and aerobic) exercise have not been explored. The study was performed to independently assess the effects of resistance, aerobic and combination exercise on fetal heart measures in late pregnancy.
Materials and Methods: This study utilized 3 exercise intervention groups (aerobic AE n=61, combination AERE n=40, or resistance RE n=33) in comparison to a non-exercise control group (n = 50). At 35-36 weeks of gestation, fetal echocardiographs were obtained via ultrasonography and analyzed for heart rate, cardiac chamber size, and cardiac outflow diameters. Between-group mean differences in fetal measures were assessed by one-way ANOVA for continuous (fetal heart rate, ventricle diameter, stroke volume, cardiac output, vascular diameter) variables.
Results: Prenatal exercise altered left ventricular stroke volume and aortic diameter in AE and RE groups, respectively. Maternal exercise dose was significantly (p < .05) and negatively correlated with most measures, including fetal heart rate. Further, fetal heart rate was predicted by maternal fitness level, while fetal right and left ventricular measures were dependent on maternal exercise attendance.
Conclusion: These data suggest that different prenatal exercise types are safe for fetal heart development, and that compliance with the recommended prenatal exercise dose contributes to beneficial outcomes.
Evidence for the programming of fetal cardiovascular health during the prenatal period has emerged through the past two decades [1–6]. Prenatal exercise can reduce risk factors for cardiovascular disease in both mother [5, 7–10] and infant [2, 3, 5, 6, 9, 11–14]. Cardiovascular disease risk factors are present in early childhood (15), and it is therefore of interest to assess cardiac adaptations in the developing fetus in response to prenatal exercise. Fetal echocardiography (echo) is the most direct mode of assessing size and function in the developing heart [16–22]. The current study will focus on whether prenatal exercise type influences fetal cardiac chamber and vascular size as well as functional measures, such as cardiac output [23, 24]. Studies consistently show that aerobic exercise training in adults for >6 weeks leads to increased [25, 26] resting stroke volume and cardiac output [27, 28], with specific increases of end-diastolic diameter and left ventricular stroke volume [29]. These adaptations provide a greater capacity for oxygen delivery to exercising skeletal muscle and myocardium [26, 28, 30]. It has been shown that maternal physical activity [1] and aerobic exercise [2, 3] alter fetal heart outcomes and could influence healthy cardiovascular function throughout the lifespan. Resistance exercise training has been shown to induce similar volumetric responses during acute exercise [44] and is recommended alongside aerobic exercise for cardiovascular health (45. In contrast, resistance exercise has not been thought to induce plasma volume expansion to the same extent, as evidenced by lack of stroke volume changes with prolonged training [45, 46]. Thus, there is no reason to expect changes in this outcome within the fetus. However, while there is evidence to the suggest that combination exercise benefits left ventricular diastolic volume and mass [47], relatively few studies prescribe combination exercise [48].
In hypothesizing how prenatal exercise might influence fetal heart characteristics, we entertained the idea that some exercise type-specific changes to chamber structure occur in utero. This is supported by evidence of altered fetal HR and heart rate variability (HRV) [1, 2, 6], and positive associations [13] and causation [6] relationships seen between prenatal exercise and heart function in the fetus and child. As a complement to these observations, it is the aim of this study to determine if any exercise type influences fetal cardiac adaptations.
This investigation was completed as a study on the effects of prenatal exercise types on mother and infant health outcomes [5]. Our hypothesis was that exercise would alter fetal echocardiographic characteristics in a type-specific manner. We expected that 1) prenatal aerobic exercise would increase cardiac dimensions and outflow, 2) that concurrent aerobic and resistance exercise would have a less pronounced effect than aerobic exercise on cardiac dimensions and outflow, and 3) there would be little effect of resistance training on cardiac dimensions and outflow.
Study Participants
The current report is a secondary analysis of the data from a single blinded, prospective, randomized control trial (RCT) investigating the influence of different exercise types throughout pregnancy on fetal and infant outcomes. The primary focus for this analysis was to determine the influence of distinct types of prenatal exercise on fetal heart outcomes (i.e., cardiac output, stroke volume, etc.). All protocols were approved by the East Carolina University Institutional Review Board. Women enrolled in the study met the following criteria: clearance from a health care provider to participate in physical activity; between 18 and 40 years of age; pre-pregnancy body mass index (BMI; kg▪m-2) between 18.5-39.9 kg▪m-2; singleton pregnancy; ≤16 weeks gestation; no current alcohol, tobacco, or medication use. Criteria for exclusion included smoking, pre-existing diabetes mellitus, hypertension, cardiovascular disease, and comorbidities and/or medications known to affect fetal growth and well-being such as systemic lupus erythematosus.
Ethics Statement
This study used ultrasound echocardiographs collected from participants enrolled in the ENHANCED (Enhanced Neonatal Health and Neonatal Cardiac Effect Developmentally) Study (IRB#: 12-002524, ClinicalTrials.gov Identifier: NCT03517293). Approval for this study was obtained from the East Carolina University Institutional Review Board and written informed consent was obtained from each participant upon enrollment. All experimental procedures were conducted at East Carolina University.
Pre-Intervention Exercise Testing & Randomization
Following study enrollment, participants completed a submaximal exercise treadmill test to determine individual aerobic capacity and calculate specific target HR (THR) ranges for moderate-intensity exercise training. Peak oxygen consumption (VO2peak) was estimated via the modified Balke protocol previously validated for pregnant women [49]. To minimize exposure and potential risk associated with exercise testing after the start of the COVID-19 pandemic, women recruited following March 2020 did not complete the treadmill protocol, and THR zones for aerobic exercise were determined based on their pre-pregnancy physical activity level and age, using published guidelines [49]. THR zones for the aerobic exercise components corresponded to maternal HR at 60 to 80% of maximal oxygen consumption, reflecting moderate intensity. After completing this test, participants were randomized via computerized sequencing (GraphPad software) to aerobic, resistance, combination (aerobic and resistance), or a stretching/breathing comparison group.
Exercise Intervention
All participants were supervised by trained exercise instructors in the university facilities and followed a standard protocol. All sessions started at 16 weeks’ gestation and were performed three times weekly until delivery [7]. All participants’ sessions began with a 5-minute warm-up, 50 minutes of their randomized group activity, and ended with a 5-minute cool-down. Women were supervised to maintain THR corresponding to moderate intensity (60%-80% maximal oxygen consumption, 40–59% VO2peak, and 12-15 rated perceived exertion) throughout the exercise session regardless of training mode. HR monitoring (Polar FS2C) ensured appropriate target HR ranges were maintained; target HR zones validated for pregnant women were utilized [49].
The aerobic exercise (AE) group completed moderate intensity training on treadmills, ellipticals, recumbent bicycles, rowing and/or stair-stepping equipment. To maintain the appropriate HR zone, speed and grade were adjusted on the treadmill, and resistance and speed levels were adjusted on the elliptical and recumbent bike. The resistance exercise (RE) group completed sessions of two to three sets of 15 repetitions of each exercise at ~ 60% of 1 repetition maximum (1-RM) [5]. Lifts were performed in circuit with minimal rest using seated machines (Cybex) (leg extension, leg curl, shoulder press, chest press, triceps extension, latissimus dorsi pull down), dumbbells (biceps curls, lateral shoulder raises, front shoulder raises), resistance bands/dumbbells, exercise balls, benches, and/or mats. The combination exercise (AE+RE) group performed half of the aerobic protocol and half of the resistance protocol exercises in five circuits, with minimal rest lasting 4.5-5 minutes each. Resistance exercises were performed at 15 repetitions (same exercises and equipment as RE group), while the aerobic exercises were performed on the same equipment as the AE group. Moderate intensity was monitored the same way as the aerobic group.
The control group performed stretching, breathing, and flexibility exercises for the duration of the session. Stretches targeted major muscle groups; breathing exercises combined stretches and breathing; flexibility exercises consisted of stretches with controlled breathing. Low intensity was confirmed during sessions using HR (<40>80%.
Fetal Measurements
At 34-36 weeks gestation, an obstetric ultrasound scan and fetal echocardiogram were performed with a Logiq P5 ultrasound system (General Electric [GE] Healthcare, New York City, NY) between 12:00 and 1:00 PM at the University-affiliated outpatient clinic by a certified sonographer who was blinded to group assignment. One sonographer obtained all images for study participants. These procedures were validated previously and found reliable in healthy, normal pregnancies producing accurate measurements of the fetal cardiac chamber dimensions and physiologic measures of cardiac function.[50–53] Fetal echocardiograms were used to assess fetal morphometric and anatomic cardiac structures that included estimated fetal weight (grams), body length (centimeters), pulmonary valve diameter and aortic valve diameter, respectively. Body length was calculated based on a standard formula of 6.18 + 0.59 ▪ femur length (millimeters) [54]. The pulmonary and aortic outflow tract diameters were used to calculate outflow tract area (0.785 ▪ diameter2). The fetal echocardiogram was used to assess HR (beats∙min-1), stroke volume (mL ∙ beat-1), cardiac output (L ∙ min-1), and pulmonary and aortic peak velocities (cm∙sec-1). Cardiac output was calculated as the product of stroke volume and HR. Stroke volume and cardiac output were additionally adjusted for body size via body surface area (BSA) using the Mosteller formula: 
(55). The BSA was then used to calculate stroke volume index (mL ∙ (m2)-1) and cardiac index (L ∙ (m2)-1), respectively. Fetal activity state was determined by visual inspection of the HR pattern as described previously [56].
Statistical Analysis
Based on our preliminary fetal HR data, with at least 80% power, analysis justified a sample size of 34 participants per group to detect a statistically significant difference of 6 beats/minute at a two-tailed alpha level of .05. Participants with complete fetal echocardiogram data were eligible for analyses. Analysis of covariance (ANCOVA) models were performed for both intention-to-treat (exercise dose as received) and per-protocol (participants attending ≥80% of exercise sessions) analysis. To determine the effects of prenatal exercise on fetal cardiac function, ANCOVA regression models were performed while controlling for fetal activity state during the echocardiogram (active vs quiet), maternal peak aerobic capacity (VO2 peak), and additional covariates via stepwise regression analysis. To assess the relationship between prior aerobic fitness and fetal heart outcomes, bivariate Pearson correlation coefficients were used to examine the association between VO2peak (relative ml▪kg-1▪min-1; absolute L▪min-1) and all fetal echocardiograph outcomes. All statistical analyses were performed using SAS (version 9.4, SAS Institute Inc., Cary, NC) & SPSS software (version 28.0.1.1, SPSS Inc. IBM Corp., Chicago, IL) software.
Maternal Covariates
Maternal age, parity, gravida, pre-pregnancy weight and height, were collected from pre-screening eligibility questionnaires. Pre-pregnancy BMI (healthy BMI 18.0-19,49; Overweight 19.5-29.99, Obese >30) was calculated using height (m), measured by stadiometer, and weight (kg) collected from the pre-screening eligibility questionnaire. Maternal pre-pregnancy BMI was calculated via the following established equation: [weight (kg)] / [height (m)]2.
Maternal Descriptive Statistics
Responses were obtained for 373 pregnant women interested in the study. Eighty-seven participants were excluded due to not meeting inclusion criteria, 44 for not accepting the proposed exercise regimen, 12 for not obtaining a physician clearance letter, and two who were confirmed to have a multifetal pregnancy. Our final analysis included 184 participants (control n=50, aerobic n=61, combination n=40, or resistance n=33). For the intention-to-treat analysis,
participants were similar in age, gravida, race/ethnicity, and pre-pregnancy BMI between groups (Table 1). We had a diverse population with 21% participants self-reporting as a black or indigenous people of color (Table 1). For the per-protocol analysis, of the exercising women, a total of 87 women met ≥80
The aim of this study was to determine the influence of prenatal exercise type on fetal cardiac measures [5]. Our hypothesis was that prenatal aerobic exercise would increase cardiac dimensions and outflow, with a less pronounced increase in combination, and little difference in resistance from control. The fetal heart showed little differences between groups in per-protocol analysis; however, there are significant associations with measures of maternal exercise, as well as maternal fitness and fetal heart measures. While maternal exercise attendance, regardless of type, predicts all fetal heart measures, maternal fitness predicted fetal heart rate and resistance exercise and attendance predicted outflow size. Importantly, it was encouraging that prenatal resistance and aerobic exercise, either alone or in combination, are safe to the developing fetal cardiovascular system. Thus, current exercise recommendations during pregnancy appear to be appropriate [7, 57, 58].
Contrary to previous reports from our group [3, 6, 13, 14, 59], prenatal aerobic exercise did not yield any significant changes in fetal heart outcomes, whether specific to the right or left ventricle. We did not observe an increase in fetal RV measures as we have in previous prenatal aerobic exercise groups [6], In the per-protocol analysis, no between-group differences in fetal RV cardiac variables were observed. This could reflect methodological discrepancies between studies. Fetal pulmonary valve velocities and diameter were similar between groups, though May et al. showed significant increases of velocity-time integral and diameter in prenatal aerobic exercisers [6], Potentially this is due to a limitation in estimating hemodynamics from echocardiography in feti, due to the fetus in the control group also receiving cardiovascular benefits [60], and/or due to the normal weight participants diluting the effect which is typically stronger in overweight and obese women and their feti [61]. When further controlling for fetal activity status, no significant between-group differences were found in fetal echo outcomes, possibly due to smaller sample sizes. Previous findings of increased active fetal state in prenatal exercisers [6] was also present in the current study. While the total number of participants was similar across control and exercise groups, fetal echocardiograms obtained on prenatal exercisers were more frequently obtained in an active fetal state than the control group. Although there were no detectable differences for fetal heart measures based on type of prenatal exercise, this further supports that all exercise types during pregnancy are safe for the fetus and do not alter normal cardiac development.
Interestingly, maternal exercise attendance, regardless of type, was found to predict all fetal heart measures, while pre-pregnancy fitness predicted fetal heart rate, and resistance exercise and attendance predicted outflow size. Differences in fetal HRV, an indicator of cardiac autonomic nervous development, in resistance exercisers has been seen in other studies with self-reported exercise [3].
To the best of our knowledge, this is the first randomized controlled trial of this size, with a supervised exercise program, at recommended levels, performed in a cohort of pregnant women across a range of BMIs. In addition, the three exercise groups studied are more externally valid, as women often perform combination and resistance training during pregnancy. In addition to strengths, there are potential limitations. For example, a limitation of our study design is the estimation of fetal cardiac measures with ultrasound echocardiography. While the current study employed certified and experienced sonographer, fetal echocardiographs are difficult to standardize the orientation for accurate fetal measures. It has been previously reported that the smallness of the heart, and relatively accelerated HR contribute to difficulties in obtaining accurate, standardized measurements [66]. In addition, while the velocity time integral has been suggested to assess the fetal heart more accurately [67]. it was not performed in the current study. Importantly, previous research finds stronger associations in offspring of overweight/obese women; however, we were not able to stratify based on BMI due to sample size.
The responses of the fetal heart to prenatal resistance and aerobic exercise are within normal ranges, as exercise of any type had similar fetal echocardiogram outcomes. Similar measures were found in fetal cardiac responses to prenatal resistance, aerobic, or combination exercise. Importantly, maternal exercise attendance, regardless of type, predicts fetal heart measures. Further, an interesting relationship of fetal HR to maternal fitness warrants continuing research. A larger sample is needed to evaluate the influence of exercise types on cardiac function in offspring of overweight-obese women. Importantly, all exercise types during pregnancy are safe for fetal cardiac function.
Alex Claiborne: Formal analysis, Visualization, Writing – original draft, Writing – review & editing; Samantha McDonald: Formal analysis, Writing – review & editing; Filip Jevtovic: Writing – review & editing; Diana Strickland: Methodology, Investigation, Resources, Writing – review & editing; Edward Newton: Project administration, Writing – review & editing; Christy Isler: Project administration, Writing – review & editing; R. Dennis Steed: Project administration, Writing – review & editing; Lauren Sarno: Project administration, Writing – review & editing; George Kelley: Project administration, Writing – review & editing; Devon Kuehn: Project administration, Writing – review & editing; Xiangming Fang: Formal analysis, Writing – review & editing; Linda May: Conceptualization, Methodology, Data curation, Formal analysis, Funding acquisition, Investigation, Project administration, Resources, Software, Supervision, Validation, Writing – review & editing.
We thank the women who participated in this study and who gave their time and effort.
The authors report no conflict of interest.
American Heart Association # 18IPA34150006. Curation of funds only. Funding source was not involved in study design or the collection, analysis, and interpretation of data.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
