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PubMed2006

The predictive value of exercise testing for survival among 75-year-old men and women.

All 75-year-olds born in 1914 and living in the city of Jyväskylä, central Finland (n=388) were invited to study the predictive value of exercise test for mortality. Subjects who entered the laboratory (n=295) were to have a standard pre-test evaluation and perform a cycle ergometer exercise test. Subjects with complete background, exercise-test status and mortality data (n=282) were divided into three groups according to exercise-test status: a non-exercise test group (n=79), an exercise-test termination group (n=95), and an exercise-test completion group (n=108). Mortality was followed up for 9 years. The multivariate hazard ratio (HR) for death among the non-exercise test group compared with exercise-test completion group was 1.87 (CI 1.19-2.94). The multivariate HR for death among the exercise-test termination group compared with the exercise-test completion group was 0.95 (CI 0.58-1.54). High cycling power (W/kg body weight) in the exercise-test completion group was associated with a decreased risk for death with a multivariate HR 0.14 (CI 0.05-0.38). Performing an exercise test serves information on the risk of death that is incremental to clinical data and traditional risk factors of death in elderly people.

Aged↗
PubMed1987

Patterns of oxygen consumption during exercise testing in peripheral vascular disease.

Exercise testing on a treadmill was performed in 15 patients with peripheral vascular disease to determine the pattern of oxygen consumption during exercise. A plateau in the oxygen consumption over the final 90 s of exercise was used as a criterion for maximal effort and only 4 out of 15 (27%) obtained a plateau of oxygen consumption compared to 20 out of 26 (77%) normal subjects (chi 2 7.9, p less than 0.005). These findings may account for the limited value of exercise testing in detecting coronary artery disease in patients with peripheral vascular disease.

Adult↗
PubMed2003

Central hemodynamic responses during serial exercise tests in heart failure patients using implantable hemodynamic monitors.

INTRODUCTION: Exercise testing is commonly used in patients with congestive heart failure for diagnostic and prognostic purposes. Such testing may be even more valuable if invasive hemodynamics are acquired. However, this will make the test more complex and expensive and only provides information from isolated moments. We studied serial exercise tests in heart failure patients with implanted hemodynamic monitors allowing recording of central hemodynamics. METHODS: Twenty-one NYHA Class II-III heart failure patients underwent maximal exercise tests and submaximal bike or 6-min hall walk tests to quantify their hemodynamic responses and to study the feasibility of conducting exercise tests in patients with such devices. RESULTS: Patients were followed for 2-3 years with serial exercise tests. During maximal tests (n=70), heart rate increased by 52+/-19 bpm while S(v)O(2) decreased by 35+/-10% saturation units. RV systolic and diastolic pressure increased 29+/-11 and 11+/-6 mmHg, respectively, while pulmonary artery diastolic pressure increased 21+/-8 mmHg. Submaximal bike (n=196) and hall walk tests (n=172) resulted in S(v)O(2) changes of 80 and 91% of the maximal tests, while RV pressures ranged from 72 to 79% of maximal responses. CONCLUSIONS: An added potential value of implantable hemodynamic monitors in heart failure patients may be to quantitatively determine the true hemodynamic profile during standard non-invasive clinical exercise tests and to compare that to hemodynamic effects of regular exercise during daily living. It would be of interest to study whether such information could improve the ability to predict changes in a patient's clinical condition and to improve tailoring patient management.

Adult↗
PubMed1991

[Early exercise test after acute myocardial infarction].

PURPOSE: To study the predischarge exercise testing importance in determining prognosis after acute myocardial infarction (AMI). PATIENTS AND METHODS: Treadmill exercise testing was performed in 50 stable and without complications patients with AMI, just before hospital discharge; there were 43 men and 7 women, mean age of 53.6 +/- 9.3 years. It was used the modified Naughton protocol and there were no casualties during the exercise testing. Patients were followed up for a mean period of 22.2 +/- 7.7 months. RESULTS: The test was positive in 32% of the patients, abnormal (inadequate blood pressure, heart rate response or arrhythmia) in 36% and normal in 42%. During the first year of follow-up, eleven patients presented with a serious cardiac event. There was one cardiovascular death, 6 patients with unstable angina, 2 reinfarctions and 7 patients had a coronary bypass revascularization. The cumulative risk for these events at one year after myocardial infarction was 50% in patients with a positive exercise test, and 5% in those with a normal exercise test (p less than 0.005). CONCLUSION: The predischarge exercise testing proved to be a simple and safe method to determine prognosis after acute myocardial infarction, identifying a high risk group early after the acute event.

Adult↗
PubMed2003

Effects of trimetazidine on submaximal exercise test in patients with acute myocardial infarction.

BACKGROUND: It was demonstrated that the novel metabolic agent, trimetazidine, could lessen the incidence and severity of angina, whether used in monotherapy or combination. Although the animal studies demonstrated that trimetazidine reduces myocardial infarct size anf improves recovery of mechanic function after ischemia, little is known on the potential benefits of trimetazidine in patients with myocardial infarction (AMI). The aim of this study was to evaluate the efficacy of trimetazidine on AMI by sub-maximal exercise test. METHODS: A double-blind crossover trimetazidine versus placebo trial was carried out in 44 patients with AMI. Patients with randomly allotted into trimetazidine (23 patients) or placebo (21 patients) for 5 days and underwent an initial sub-maximal exercise test. Exercise tests according to the modified Bruce protocol were performed. Exercise end points included completion of stage II or 75% of maximum predicted heart rate whichever came first. An average 12-lead ECG was obtained at rest, every minute during exercise, at the onset of anginal symptoms, at the onset of 1-mm ST segment depression, at peak exercise and every 2-minute during recovery. After the initial exercise tests, study groups resumed the drugs in the opposite order for 4 to 5 days and underwent a second sub-maximal exercise test. RESULTS: Exercise induced ST segment depression was noted in 17 patients (38.6%) receiving placebo. However, exercise induced ST-segment depression was observed in 8 patients (18.1%) taking TMZ. Positive exercise test results were significantly higher on placebo group than TMZ group (p=0.018). Additionally, trimetazidine prolonged the time to 1-mm ST-segment depression (6.1 +/-0.5 vs 4.9 +/-0.4, P< 0.031) and exercise duration (7.2+/-0.9 vs 5.8 +/-0.9, p<0.025). CONCLUSION: Trimetazidine therapy improves the exercise capacity and reduces evidence ischemia derived from sub-maximal post-infarction exercise testing.

Cross-Over Studies↗
PubMed1999

Effect of test exercises and mask donning on measured respirator fit.

Quantitative respirator fit test protocols are typically defined by a series of fit test exercises. A rationale for the protocols that have been developed is generally not available. There also is little information available that describes the effect or effectiveness of the fit test exercises currently specified in respiratory protection standards. This study was designed to assess the relative impact of fit test exercises and mask donning on respirator fit as measured by a controlled negative pressure and an ambient aerosol fit test system. Multiple donnings of two different sizes of identical respirator models by each of 14 test subjects showed that donning affects respirator fit to a greater degree than fit test exercises. Currently specified fit test protocols emphasize test exercises, and the determination of fit is based on a single mask donning. A rationale for a modified fit test protocol based on fewer, more targeted test exercises and multiple mask donnings is presented. The modified protocol identified inadequately fitting respirators as effectively as the currently specified Occupational Safety and Health Administration (OSHA) quantitative fit test protocol. The controlled negative pressure system measured significantly (p < 0.0001) more respirator leakage than the ambient aerosol fit test system. The bend over fit test exercise was found to be predictive of poor respirator fit by both fit test systems. For the better fitting respirators, only the talking exercise generated aerosol fit factors that were significantly lower (p < 0.0001) than corresponding donning fit factors.

Equipment Design↗
PubMed1988

Use of the cardiopulmonary exercise test to evaluate the patient with chronic heart failure.

Isotonic exercise testing imposes a physiological stress on the cardiopulmonary unit. Accordingly, monitoring of oxygen, carbon dioxide and air flow during an exercise test (i.e. a cardiopulmonary exercise test) can be used to assess heart function in patients with chronic heart failure. Specifically, an incremental treadmill cardiopulmonary exercise test represents a non-invasive means to determine aerobic capacity, or maximal oxygen uptake (VO2max ml min-1 kg-1), and anaerobic threshold (AT, ml min-1 kg-1). These objective measures of cardiopulmonary function are then used to grade the severity of failure and the functional capacity of the patient. In addition, they may be used to predict the cardiac reserve, or maximal cardiac index (CImax, l min-1 m-2) during exercise. That is, the severity is considered to be mild (class A) when AT greater than 14 or VO2max greater than 20, mild to moderate (class B) when AT falls between 11 and 14 or VO2max between 16 and 20, moderate to severe (class C) when AT ranges between 8 and 11 or VO2max between 10 and 16, and severe (class D) when AT less than 8 or VO2max less than 10. The predicted CImax for classes A, B, C and D are greater than 8, 6-8, 4-6 and less than 4, respectively. Finally, a major objective of medical therapy in patients with heart failure is to improve cardiac output and oxygen delivery to working skeletal muscle and thereby enhance effort tolerance. This therapeutic endpoint can be gauged by cardiopulmonary exercise testing from the response in AT and VO2max.

Anaerobic Threshold↗
PubMed1989

Ischemia in the ambulatory setting--the total ischemic burden: relation to exercise testing and investigative and therapeutic implications.

To establish the relation between treadmill exercise testing and ambulatory St segment monitoring in the detection of ischemia in patients with coronary artery disease, and to assess whether standard medical therapy affects any such relation, 277 patients with stable angina and angiographically documented coronary artery disease were studied with treadmill exercise testing and 48 h ambulatory ST segment monitoring. One hundred forty-six patients (52%) were studied while receiving no routine antianginal therapy, and 131 (48%) while receiving standard medical therapy. In 187 patients (67%) the exercise test was positive for ischemia. During 11,964 h of ambulatory monitoring, 881 episodes of ischemia (645 [73%] silent) were recorded, of which 809 (92%) occurred in patients with a positive exercise test. The mean heart rate at the onset of ischemic episodes during ambulatory monitoring was significantly less than that at the onset of 1 mm ST segment depression during exercise testing (94.5 versus 105.9 beats/min, p less than 0.0001). However, the frequency of ambulatory ischemic episodes was strongly related to a positive exercise test (p less than 0.001), and this relation was similar for both silent and painful ischemia (p less than 0.0001 for both) and in patients who were and were not receiving therapy (p less than 0.0001 for both). The total duration of ischemia was similarly related to a positive exercise test (p less than 0.0001). Only one patient with a negative exercise test had frequent (greater than 5/day) episodes of ischemia on ambulatory monitoring and had documented coronary artery spasm. Thus, exercise testing identifies the majority of patients likely to have significant ischemia during their daily activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The evolving role of exercise testing prior to lung resection.

Exercise testing prior to lung resection has long and honored tradition. It began as a test of tolerance using simple techniques such as stair climbing. This was followed by aggressive and invasive protocols using right cardiac catheterization in the search for pulmonary hypertension. More recently, measurement of VO2 with exercise has been reported to predict both postoperative mortality and survivable morbidity. Exercise testing holds promise as a noninvasive test to predict the physiologic outcome from lung resection. Significant questions remain concerning the pathophysiologic mechanisms responsible for an abnormal result and who should be denied thoracotomy based on these results.

Exercise Test↗
PubMed1976

Effects of training on resting and postexercise ECG in standardbred horses, using a standardized exercise test.

Five healthy, mature, previously trained Standardbred horses were given no exercise (left in a stall) for 4 months, then jogged (slow exercise) for 3 weeks, and placed in a 6-week training period. Cardiac variables were measured at the beginning of training and after 14, 20, 35, and 42 days of training before and at 10, 15, 20, 25, and 30 minutes after a 1.8-km (in 3:12 +/- 2 seconds) standard, submaximal exercise test on a deep 0.53-km track. There was no significant change during the 6-week conditioning period in the following variables at rest or at any of the times observed during recovery from test exercise: heart rate, PQ-interval, QRS-duration, QT-interval, and ratio of electrical systole to diastole. It appeared that measuring heart rate by electrocardiogram at rest and during recovery from execise is not of significance in evaluating the fitness in the previously trained adult horse.

Animals↗
PubMed1994

A new "complex exercise test" for children with cardiac diseases.

In view of the characteristics of children's play or exercise activity, we designed a new method of exercise testing for children, called the "Complex Exercise Test" (CET), which includes three kinds of exercise test: (1) a graded exercise test on the treadmill, (2) a simple bending and stretching test to evaluate momentary exercise tolerance and (3) a swimming test with the ECG in the water. The CET was applied to a total of 25 cases which included 10 cases of postoperative tetralogy of Fallot and 15 cases with ventricular premature contraction (VPC). A two-way exercise test, which included the treadmill test and the simple bending and stretching test, was also applied to 36 postoperative cases (21 cyanotic and 15 non-cyanotic), 20 VPC cases and 16 control children without any organic cardiac disorders, for a total of 72 cases. The treadmill test was useful to evaluate the maximal exercise tolerance. The simple bending and stretching test, on the other hand, seemed useful for observation of VPC changes by exercise (including postoperative VPC), since the heart rate immediately after bending and stretching exceeded that observed at the time VPC disappeared during the treadmill test, thus proving VPC disappearance by this testing. With ECG during diving, it is possible to detect VPC associated with possible risks which could not be identified by the above two methods of testing. Since each one of the three different types of exercise tests has different characteristics, it seems desirable to control children's exercise after performing the CET.

Adolescent↗
PubMed1986

Significance of the walk-through angina phenomenon during exercise testing.

Out of 3,900 patients who performed an exercise test at our clinic, 3 patients demonstrated a walk-through phenomenon (WTP), defined as the occurrence of mild angina during the first stages of exercise with disappearance of chest pain at higher workloads despite a greater pressure-rate product. 2 patients had variant angina, one with normal coronary arteries and the other with single vessel disease, while the third patient had stable exertional angina and a severe coronary artery disease with occlusion of two major vessels retrogradely filled by collateral channels. Repeat exercise tests failed to reproduce constantly the WTP in the 2 patients with variant angina, while in the third patient the phenomenon was repeatedly induced by exercise testing. Thus the WTP, although rarely found during exercise testing, can be observed in two subsets of patients. In variant angina the WTP is not reproducible and is probably due to coronary spasm, spontaneously subsiding during exercise. In patients with exertional angina and severe coronary artery disease, the WTP can be repeatedly observed during exercise and is likely to be secondary to a delayed vasodilation of collateral vessels. The clinical characteristics of the patients and the response to repeat exercise tests may be useful in identifying the different pathogenetic mechanisms.

Adult↗
PubMed1994

Exercise testing in the evaluation of impairment and disability.

Integrative cardiopulmonary exercise testing has evolved from a specialized research laboratory tool into a valuable clinical test that is especially useful for assessment of symptoms of exertional dyspnea and exercise intolerance. There is increasingly convincing evidence that evaluation and quantitation of impairment are enhanced by use of exercise testing. In particular, exercise testing has the advantages of objective determination of abnormal exercise tolerance, increased sensitivity for subtle pulmonary gas exchange abnormalities, the ability in many instances to identify unsuspected or unanticipated non-pulmonary causes of impairment, and a useful quantitation of impairment. Although exercise testing is especially valuable in those with mild-to-moderate lung disease in whom questions about the presence of occupational disease and its contribution to impairment are raised, other important questions can be addressed with these methods (Table 10). Therefore there is a high likelihood that the logic of assessing work capacity while the subject performs work will become increasingly clear.

Disability Evaluation↗
PubMed1984

The pacing stress test: thallium-201 myocardial imaging after atrial pacing. Diagnostic value in detecting coronary artery disease compared with exercise testing.

Many patients suspected of having coronary artery disease are unable to undergo adequate exercise testing. An alternate stress, pacing tachycardia, has been shown to produce electrocardiographic changes that are as sensitive and specific as those observed during exercise testing. To compare thallium-201 imaging after atrial pacing stress with thallium imaging after exercise stress, 22 patients undergoing cardiac catheterization were studied with both standard exercise thallium imaging and pacing thallium imaging. Positive ischemic electrocardiographic changes (greater than 1 mm ST segment depression) were noted in 11 of 16 patients with coronary artery disease during exercise, and in 15 of the 16 patients during atrial pacing. One of six patients with normal or trivial coronary artery disease had a positive electrocardiogram with each test. Exercise thallium imaging was positive in 13 of 16 patients with coronary artery disease compared with 15 of 16 patients during atrial pacing. Three of six patients without coronary artery disease had a positive scan with exercise testing, and two of these same patients developed a positive scan with atrial pacing. Of those patients with coronary artery disease and an abnormal scan, 85% showed redistribution with exercise testing compared with 87% during atrial pacing. Segment by segment comparison of thallium imaging after either atrial pacing or exercise showed that there was a good correlation of the location and severity of the thallium defects (r = 0.83, p = 0.0001, Spearman rank correlation). It is concluded that the location and presence of both fixed and transient thallium defects after atrial pacing are closely correlated with the findings after exercise testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

Significant sex differences in the correlation of electrocardiographic exercise testing and coronary arteriograms.

Two hundred fifty-one patients (195 male and 56 females) referred for evaluation of chest pain were studied by multistage submaximal stress testing and selective coronary arteriography. In men with positive exercise tests the incidence rate of true positive exercise test results--that is, positive tests associated with 75 percent of greater coronary stenosis--was 89 percent in contrast to a 33 percent incidence rate of true positive exercise test results in women. The incidence rate of false positive excercise test results--that is, positive tests associated with no coronary stenosis or less than 50 percent stenosis--was 8 percent in men in contrast to 67 percent in women. Conversely, the incidence rate of false negative exercise test results (that is, negative exercise tests associated with 75 percent or greater coronary stenosis) was higher in men (37 percent) than in women (12 percent). It is concluded that in men a positive multistage stress test is useful in predicting the presence of significant coronary artery disease although a negative stress test cannot be relied upon to rule out the presence of significant disease. In women, a positive exercise test is of little value in predicting the presence of significant coronary artery disease, whereas a negative test is quite useful in ruling out the presence of significant disease. New criteria should be developed for stress testing of women.

Adult↗
PubMed1990

Optimizing the exercise test for pharmacological investigations.

Exercise trials in cardiology are often hindered by inconsistent approaches to exercise testing. These inconsistencies include the choice of exercise protocol, exercise end points, points of analysis, and absence or misuse of gas exchange data. Gas exchange techniques greatly enhance the accuracy with which cardiopulmonary function is assessed by exercise. Commonly used protocols are not always appropriate for all patients or all studies. Both cardiovascular disease and the exercise protocol can have an important impact on the relation between changes in work rate and oxygen uptake. Ramp protocols appear to offer the greatest promise for assessing cardiopulmonary function. Analyzing hemodynamic and gas exchange responses at several points submaximally, in addition to those at peak exercise, can add important information concerning the efficacy of a drug. A great deal of confusion continues to hinder the application of the gas exchange anaerobic threshold, and many of the commonly used testing end points are not reliable.

Anaerobic Threshold↗
PubMed1986

Prediction of perioperative cardiac complications by electrocardiographic monitoring during treadmill exercise testing before peripheral vascular surgery.

ECG monitoring during treadmill exercise testing was performed in a prospective series of 105 consecutive patients with intermittent claudication scheduled for peripheral vascular surgery. ECG monitoring during the exercise test was useful in predicting perioperative cardiac complications. In 55 patients with evidence of coronary artery disease by history and ECG obtained at rest, a strong association (p less than 0.001) between an ischemic response to exercise testing and the occurrence of perioperative cardiac events was observed. ECG monitoring during the exercise test also revealed previously unsuspected ischemia or arrhythmias in six of the remaining 50 patients and predicted perioperative cardiac problems in four of these six. An ischemic response to low-level treadmill exercise testing probably indicates advanced coronary artery disease and offers valuable predictive information when a revascularization procedure is considered for the relief of intermittent claudication.

Arteriosclerosis↗
PubMed2001

Validation of a specific activity questionnaire to estimate exercise tolerance in patients referred for exercise testing.

BACKGROUND: Physical activity and symptom questionnaires have been used as surrogates for exercise testing to estimate a patient's functional capacity and to individualize an exercise testing protocol in accordance with exercise testing guidelines. To validate these approaches, they must be compared with measured oxygen uptake (peak VO (2)). METHODS: Before exercise testing was performed, a brief, self-administered questionnaire (Veterans Specific Activity Questionnaire [VSAQ]) was given to 337 patients referred for exercise testing for clinical reasons. The VSAQ was used to estimate exercise tolerance on the basis of symptoms during daily activities to individualize ramp rates on the treadmill so that the test duration would be approximately 10 minutes. Clinical and demographic variables were added to the VSAQ responses in a stepwise regression model to determine their ability to predict both directly measured peak VO (2) and peak metabolic equivalents (METs) predicted from the treadmill workload. RESULTS: The mean exercise time was 9.6 +/- 3 minutes. Responses to the VSAQ and age were the strongest predictors of both measured and predicted exercise capacity. Small but significant contributions to the explanation of variance in both measured and estimated METs were made by resting heart rate, forced expiratory volume in 1 second expressed as a percentage of normal, exercise capacity predicted for age, and body mass index. The multiple R values from the regression equations for measured and estimated METs were 0.58 and 0.72, respectively. CONCLUSIONS: Estimating a patient's symptoms associated with daily activities along with age are the strongest predictors of a patient's exercise tolerance. The VSAQ, combined with pretest clinical data, predicts the estimated MET value from treadmill speed and grade better than directly measured METs do. When used for estimating a patient's symptom limits to individualize ramp rates on a treadmill, this approach yields an appropriate test duration in accordance with recent exercise testing guidelines.

Activities of Daily Living↗