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PubMed1985

Cardiovascular drugs: effects on exercise testing and exercise training of the coronary patient.

The exercise test response and exercise capacity of patients with atherosclerotic coronary heart disease may be significantly altered by a number of commonly used cardiovascular drugs, alone or in combination, via complex interactions of hemodynamic and electrophysiologic changes. The clinician must assess the effects of pharmacotherapy when evaluating the results of exercise testing as well as when prescribing a rehabilitative exercise training regimen.

Adrenergic beta-Antagonists↗
PubMed1985

Exercise test as a physiological form of antepartum stress test.

Exercise test (ET) was repeated in 5-7 day intervals between 35 and 43 weeks of gestation in normal and high-risk pregnancies. The obtained FHR patterns were categorized according to their incidence in different clinical situations and correlated with appearance of amniotic fluid at amniocentesis and incidence of fetal distress in subsequent labor. Prospective meaning of ET is drawn for evaluation of utero-placental reserve and degree of umbilical cord pathology. Consistency and dynamics of FHR pattern is stressed out. Advantage of ET to OCT is discussed.

Exercise Test↗
PubMed1980

Adjusted single load exercise test. A new exercise test for improved diagnosis of coronary heart disease.

A new adjusted single load exercise test (ASLET) is presented. The test is aimed to improve diagnosis of coronary heart disease and should not be used in patients with a well-established diagnosis. 60--120 min after a multistage near-maximal ergometric test with a negative electrocardiographic outcome ASLET is performed. The single load used in ASLET is based on the last load reached at the multistage procedure. If for example a heart rate of 150 beats/min (end point parameter of the multistage test for the age group above 40 years) is reached at 100 W (after performing 25, 75, and 100 W) the ASLET will be a sudden load of 100 W. This procedure has proved to increase the sensitivity of our exercise test. In about one third of false negative results at the multistage procedure the ASLET test was positive in symptomatic patients.

Adult↗
PubMed1983

Sudden death after myocardial infarction and T-wave changes in connection with exercise testing.

Exercise testing-induced T-wave changes in lead CH6 were analysed after acute myocardial infarction. In 21 patients with subsequent sudden death the mean +/- SD T-wave amplitude at supine rest 5 minutes after exercise was -2.74 +/- 2.37, in 26 patients with non-sudden death -1.08 +/- 2.67, and in 23 patients who survived +0.44 +/- 2.26 mm. Differences between groups were statistically significant. Within the sudden death group and in patients who survived the T-wave was lower (p less than 0.05) after exercise than before exercise. In the non-sudden death group, however, the T wave depth was about the same before and after exercise. The pattern of T-wave changes in the sudden death group was similar to the primary, "vasoregulatory" T-wave changes in young men and, accordingly, enhanced sympathoadrenal activity could be involved.

Death, Sudden↗
PubMed1980

Functional evaluation of aortocoronary bypass surgery by exercise testing.

Exercise stress test was performed prior to and after aortocoronary bypass surgery in 91 male patients in an attempt to quantitate the change of physical capacity after operation and to correlate this to clinical improvement and late shunt angiography. The mean maximal work load was significantly higher after than prior to surgery in all groups. In average the maximal work load increased 65%. No difference was found between patients who were operated on for stable angina pectoris and those with unstable angina or impending myocardial infarction. Patients, who subjectively were without symptoms or much better after surgery, had a higher maximal work load after operation than those who were subjectively less improved or worse. In a sub-group of patients the maximal oxygen consumption was calculated in per cent of normal values for the age. The mean maximal oxygen consumption increased from 59% prior to surgery to 76% of normal values after surgery.

Angina Pectoris↗
PubMed1986

Functional translation of exercise responses from graded exercise testing to exercise training.

This study attempts to develop a quantitative approach to the prescription of absolute exercise intensity during level ground ambulation (min/mile) or cycle ergometry (kpm) from responses observed during GXT. A total of 345 subjects performed GXT and exercise training sessions with either the Bruce treadmill protocol and level ground ambulation (N = 154) or cycle ergometry (N = 191). Responses from 90% of each group were used to generate equations for predicting training pace (or power output) from the time (or power output) during the GXT when target HR was achieved. FAI was also included in the prediction of training pace (or power output). The remaining 10% of subjects in each group were used to cross-validate the prediction equations. The correlation between the time (or power output) during GXT when the training HR was observed and the pace of ambulation (or power output) was 0.70 for treadmill walking and 0.88 for cycle-cycle. Correlations were increased by the addition of FAI to the prediction equation. The results of this investigation suggest that the absolute intensity of exercise for training can be predicted accurately from GXT results.

Cardiac Rehabilitation↗
PubMed1997

Exercise testing and exercise rehabilitation for patients with peripheral arterial disease: status in 1997.

Intermittent claudication is a common manifestation of peripheral arterial occlusive disease (PAOD). Patients with claudication are limited in terms of work, housework and leisure activities so that functional status is very impaired. Therefore, the goals for treatment should focus on improving the functional impairment as well as on modifying risk factors. Evaluation of the functional status is of critical importance before beginning any therapy so that any resultant changes can be assessed. A validated graded treadmill protocol and validated questionnaires are used for this purpose. Three questionnaires that are currently used include the Walking Impairment Questionnaire, the PAOD Physical Activity Recall and the Medical Outcomes Study SF-36. Exercise rehabilitation is a method that has been particularly efficacious for treating the functional impairment associated with intermittent claudication. Exercise rehabilitation has been shown to improve pain-free treadmill walking distance by 44% to 300% and absolute walking distance by 25% to 442%. In addition, improvements have also been reported (using questionnaire data) in the ability to walk distances and speeds, in amount of habitual physical activity and in physical functioning. Thus, exercise rehabilitation has caused improvements not only in exercise capacity but also in community-based functional status. Because of the benefits of this treatment, in addition to the low associated morbidity, exercise therapy is recommended as an important treatment option for people with intermittent claudication due to PAOD.

Animals↗
PubMed1986

The false positive exercise test: usefulness of sublingual nitroglycerin exercise test and cardiac scintigraphy for differentiating from patients with coronary artery disease.

Exercise tests with sublingual nitroglycerin were performed on 7 patients with true positive and 8 patients with false positive exercise test results. Four of 7 patients with true positive changes and 8 patients with false positive changes underwent exercise cardiac scintigraphy. Scintigrams showed perfusion defects in 4 patients with true positive outcomes, and no perfusion defect in 8 patients with false positive outcomes. Exercise tests with sublingual nitroglycerin were performed with the same load as that without nitroglycerin. In all 7 patients with true positive exercise test results, ST segment depression observed in the control exercise test was not observed in the nitroglycerin exercise test. In the false positive patients, ST segment depression observed in the control exercise test remained unchanged in 7 of 8 patients receiving nitroglycerin. Exercise tests with sublingual nitroglycerin as well as exercise cardiac scintigraphy are valuable tods in differentiating false positive from true positive patients. Furthermore, these data suggest that ST segment depression in the false positive patients may not be related to myocardial ischemia.

Administration, Oral↗
PubMed1997

Comparison of dobutamine ECG stress test with predischarge exercise test after acute myocardial infarction.

Exercise testing after acute myocardial infarction is commonly used, but in recent years alternative methods have been proposed. Standard exercise testing was compared with dobutamine electrocardiographic (ECG) stress testing in 100 patients after an acute initial myocardial infarction. Dobutamine ECG stress testing was performed in a standard manner at 5 +/- 1 days after the infarction and exercise testing was performed a mean of 10 +/- 2 days following the event. Agreement between both tests was observed in 91 cases (91%), P < .001, Fisher test kappa value, 0.79). The dobutamine test predicted the result of the exercise test with a sensitivity of 100% (95% confidence interval, 87-100) and a specificity of 88% (95% confidence interval 77-93) for a positive predictive value of 75% (95% confidence interval, 62-97) and a negative predictive value of 100% (95% confidence interval, 91-100). Dobutamine ECG stress testing is concluded to be an objective and reliable procedure, which accurately predicts the results of standard exercise testing. It is inexpensive, easy to perform, and although not yet confirmed, could be particularly useful in patients who cannot perform exercise.

Aged↗
PubMed1996

Cardiovascular and respiratory adjustments in normal volunteers during modified exercise tests in comparison to standard exercise tests.

Sixteen normal, non-smoking first year medical students underwent four standard exercise tests, while cardiovascular (heart rate and blood pressure) and pulmonary (respiratory rate, tidal volume and oxygen consumption) adjustments were being monitored. Maximal exercise level for all tests were defined following the Jones scale. No variation was noted in respiratory rate among the four exercise tests. The cycle ergometry (CE), hand ergometry (HE), and treadmill (TM) exercise tests produced progressive increases of the various parameters as expected, although target maximal heart rates were not reached in most cases secondary to muscle fatigue. The step test (ST) approximated the physiological parameter changes noted in these three tests during the early stages of exercise, but levelled off after 3 minutes, probably due to lack of incremental load. The ST took the longest time to reach maximal level of exercise parameters, and recorded the lowest tidal volume increase. The same subjects underwent a modified step test (MST1) by adding 1 kg sandbags every 3 min to backpacks worn by the subjects, to provide incremental load. This modification provided a slight increase in the parameters measured, but still plateaued after 3 min. Another set of 18 normal, non-smoking medical students underwent bicycle ergometry and two other modified exercise tests. The modified step test two (MST2) was similar to our initial MST1, except that the sandbags added every 3 min were not fixed at 1 kg but were also incremental (1, 2, 3 and 4 kg). The other test (Ramp test or RT) required the subjects to walk up and down a ramp, which entailed not only the addition of incremental weights of sandbags every 3 min, but also increasing the elevation of the ramp at each stage. Data analysis showed that these two tests showed almost similar changes in cardiovascular and respiratory adjustments in the subjects, compared to the standard bicycle ergometry. These pilot studies showed that low-cost modified step tests may be utilized to approximate the expensive standard treadmill and bicycle exercise tests. More studies on larger populations have to be done to validate these results.

Adaptation, Physiological↗