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PubMed2004

Effect of nutritional composition of meals on exercise tests in patients with ischaemic heart disease.

BACKGROUND: Patients with ischaemic heart disease have to perform exercise tests repeatedly. It is not clear if a small meal eaten before the test might influence it and if the meal's composition is important. DESIGN AND METHOD: We performed a double blind, randomised, crossover study on 20 volunteers with documented ischaemic heart disease known to have positive exercise tests. Each had three symptom limited exercise tests done one hour after a 200 ml meal, rich in either fat, carbohydrate or protein. Each postprandial test was compared to a fasting exercise test performed just before the meal. RESULTS: Postprandial blood pressure, time to angina and to peak exercise and double product at onset of ST-depression were not significantly altered by any of the meals. Heart rate was slightly increased only after the fat meal. CONCLUSIONS: The nutritional composition of a small meal eaten an hour before an exercise test has no clinically important impact on the results of the test in patients with stable angina pectoris.

Aged↗
PubMed1997

[Is the predischarge exercise test valid in patients younger than 40 years old after myocardial infarct for determination of multivascular disease?].

BACKGROUND AND OBJECTIVES: Conventional exercise testing before hospital discharge is the most useful procedure in order to estimate postinfarction prognosis and in detecting multivessel coronary disease which is associated with a poor long-term prognosis. There are no bibliographic reports about it in younger myocardial infarction survivors. The aim of the study was to evaluate sensitivity, specificity and predictive value of symptoms limited maximal exercise testing for multivessel disease diagnosis in young patients after myocardial infarction. METHODS: Myocardial infarction survivors until the age of 40 performed symptoms limited maximal exercise testing and had a coronary arteriography before hospital discharge. RESULTS: A total of 100 consecutive patients were included, although in only 83 of them exercise tests and coronariographic studies were done. In this group, multivessel disease was confirmed in 27 patients (15 with positive tests and 12 with normal exercise testing). In the remaining 56 young adults without multivessel involvement, positive tests were only observed in 15 patients and normal tests in 45. Thus, a sensitivity of 56%, specificity of 73%, positive predictive value of 50% and negative predictive value of 77% were found. When patients showed high risk exercise test criteria, the exercise test positive predictive value increased to 80%. CONCLUSIONS: Due to the lower sensitivity of this test in young myocardial infarction survivors for detecting multivessel artery disease, we remark on the need for predischarge complementary tests such as isotopic, stress echocardiography or coronariography testing.

Adult↗
PubMed1993

Peroxide plasma level in patients with coronary heart disease as a possible indicator of ischemia during exercise test.

BACKGROUND: This study evaluated the possible changes in production of free oxygen species during myocardial ischemia in the course of exercise testing of ischemic coronary disease. METHODS: Exercise testing was performed on 58 patients with suspected ischemic coronary disease. Plasma hydrogen peroxide (H2O2) level was assayed according to Frew et al. (Anal Chim Acta 1983, 155:139-150) in venous blood samples obtained before the test, at submaximal and maximal work loads, and after 30 minutes of rest. RESULTS: Hydrogen peroxide plasma level significantly increased (P < 0.001) at maximal work load in patients with positive exercise test results. Patients with negative exercise test results initially manifested a higher H2O2 level that dropped during maximal work load. CONCLUSIONS: The rise in plasma H2O2 level during myocardial ischemia indicates that intensification of oxygen free radical production occurs. This may be the result of hypoxanthine conversion by xanthine oxidase, catecholamine auto-oxidation, polymorphonuclear neutrophil activation, and/or derangement within mitochondrial electron transfer. The noticed difference between patients with a positive exercise test and those diagnosed as without ischemia may be of clinical relevance.

Adult↗
PubMed1994

Guidelines for exercise testing in the pediatric age group. From the Committee on Atherosclerosis and Hypertension in Children, Council on Cardiovascular Disease in the Young, the American Heart Association.

Exercise testing of children differs from adult exercise testing in many ways beyond the technical issues related to test performance that are addressed in this report. Disease processes that produce myocardial ischemia are relatively rare in children compared with adults. Exercise testing may be useful in these cases, but the use of testing to assess functional capacity or cardiac rhythms will be encountered more often. Although the precise role of exercise testing in patient evaluation or long-term management of the cardiac patient will vary somewhat from center to center, exercise testing is often essential to diagnose and to direct treatment in a wide variety of clinical problems. An understanding of the role of exercise testing for children with known or suspected heart abnormalities is an essential part of the training of pediatric cardiologists. The staff of the pediatric exercise laboratory should be available to discuss with the clinician when a test might be of value in a specific case in addition to providing advice about the specifics of the performance of the test and offering age- and size-appropriate normal data from the laboratory with test interpretation.

Arteriosclerosis↗
PubMed2006

[Cardiopulmonary exercise testing].

The resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity. Cardiopulmonary exercise testing (CPET) provides to assessment of the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems. Thus, CPET has gained increasing popularity for the evaluation of undiagnosed exercise intolerance and exercise related symptoms, and to reveal functional capacity and impairment.

Cardiovascular Diseases↗
PubMed1996

Computerized ECG recording in horses during a standardized exercise test.

In the horse, it is important to make a reliable ECG recording during exercise as cardiac arrhythmia is one of the possible causes of poor performance. The purpose of the present study was to obtain a satisfactory, standardized method for ECG recording by computer during a standardized treadmill exercise test and to evaluate the procedure both in healthy and in diseased horses. Ten experienced healthy research horses were used to develop and adapt the original method (for humans) of computerized ECG recording with the Cardio Perfect software program and to obtain reference values for heart rate and blood variables. Further, three diseased horses (patients) were examined to evaluate whether the test procedures were also usable for horses without extensive experience in treadmill and other experimental procedures. During a standardized exercise test on a treadmill at walk (1.7 m/s), trot (4.0 m/s), and canter (7.0 m/s at 0% and 4% treadmill inclination), the ECG was recorded using two bipolar leads (from xiphoid to manubrium respectively to the left withers) and one unipolar lead (on the left ventral thorax). The quality of the exercise ECGs was satisfactory. The heart rate was detectable and arrhythmias were identifiable. Most research horses did not show arrhythmias during exercise, except a single atrial premature complex (APC). The reference values for the mean heart rate for the different stages of the exercise test differed from 84 + or - 7 to 176 + or - 21 beats per minute (bpm). The exercise test provoked in healthy horses a plasma lactate concentration around the anaerobic threshold. Most patients were also able to finish the test. In conclusion, the developed method to obtain an exercise ECG during a standardized exercise test proved to be reliable and applicable both in research horses and in patients, thus extending the possibilities to diagnose arrhythmias.

Animals↗
PubMed2004

Five-year cardiovascular and all-cause mortality, and myocardial infarction in all subjects referred for exercise testing in two Danish counties.

OBJECTIVE: To examine the association between exercise test results and the 5-year cardiovascular and all-cause mortality, and myocardial infarction, in patients referred for exercise testing because of known or suspected coronary heart disease. DESIGN: A study of all patients (N = 2763) who in 1996 had an exercise test in two Danish counties (900000 inhabitants). Data and follow-up were based on medical records and general administrative healthcare and population registries. RESULTS: Abnormal tests, compared with normal ones, were associated with an increased adjusted cardiovascular mortality ratio of 1.77 (95% confidence interval (CI): 1.19-2.63), all-cause mortality ratio of 1.46 (95% CI: 1.11-1.93), and myocardial infarction ratio of 1.71 (95% CI: 1.28-2.28). Inconclusive tests, compared with normal ones, were associated with an increased adjusted all-cause mortality ratio of 1.52 (95% CI: 1.05-2.20) and myocardial infarction ratio of 1.67 (95% CI: 1.12-2.56). A history of myocardial infarction increased the cardiovascular death ratio by 1.51 (95% CI: 1.05-2.16) and the myocardial infarction ratio by 2.39 (95% CI: 1.84-3.10). CONCLUSION: Over a 5-year period, the result of the bicycle exercise test was clearly associated with both mortality and risk of myocardial infarction. An inconclusive test may deserve special attention.

Aged↗
PubMed1994

[Exercise tests in spirometry].

Actual situation: There is a great variety of exercise programs (formerly called protocols) used in daily routine and general practice. Exercise programs vary with increments, step-duration, speed and grade, although standard recommendations have been published recently. In the USA, the Bruce program is widely accepted, although some criticism has been published. Comparing different exercise programs it is obvious, that maximal values (VO2, heart rate etc.) are only moderately affected by the program, but submaximal values are strongly influenced by the methodological procedure. Advantages and disadvantages of the different exercise testing procedures will be presented. As we need some standardized exercise programs to avoid "free-style ergometry", recommendations may be based on the following assumptions: Exercise testing should not be too short nor too long (10-12 min total test time), work rate increments should be intermediate (adapted to physical fitness), work rate steps should be about 2 min or an individualized ramp test should be used. Exercise test programs have to be selected according to the patient's fitness, to the disease or function to be studied, and to the laboratory setting. Standardization is strongly recommended.

Exercise Test↗
PubMed2000

Maximal exercise test as a predictor of risk for mortality from coronary heart disease in asymptomatic men.

Exercise testing in asymptomatic persons has been criticized for failing to accurately predict those at risk for coronary heart disease (CHD). Previous studies on asymptomatic subjects, however, may not have been large enough or long enough to provide reliable outcome measures. This study examines the ability of a maximal exercise test to predict death from CHD and death from any cause in a population of asymptomatic men. This is a prospective longitudinal study performed between 1970 and 1989, with an average follow-up of 8.4 years. The subjects are 25,927 healthy men, 20 to 82 years of age at baseline (mean 42.9 years) who were free of cardiovascular disease and who were evaluated in a preventive medicine clinic. The main outcome measures are CHD mortality and all-cause mortality. During follow-up there were 612 deaths from all causes and 158 deaths from CHD. The sensitivity of an abnormal exercise test to predict coronary death was 61%. The age-adjusted relative risk of an abnormal exercise test for CHD death was 21 (6.9 to 63.3) in those with no risk factors, 27 (10.7 to 68.8) in those with 1 risk factor, 54 (21.5 to 133.7) in those with 2 risk factors, and 80 (30.0 to 212. 5) in those with >/=3 factors. A maximal exercise test performed in asymptomatic men free of cardiovascular disease does appear to be a worthwhile tool in predicting future risk of CHD death. An abnormal exercise test is a more powerful predictor of risk in those with than without conventional risk factors.

Adult↗
PubMed1990

Effects of exercise testing, training and beta blockade on serum potassium in normal subjects.

To evaluate the effects of exercise testing, training and beta blockade on serum potassium, 40 normal subjects (24 men, 16 women, mean age 33 years) had 4 maximal exercise tests with venipuncture for serum potassium before and less than or equal to 40 seconds after each test. After initial exercise testing, they were randomized to atenolol 50 mg daily, atenolol 100 mg daily, propranolol 80 mg twice daily or placebo. All began a 9-week dynamic exercise program for 8 weeks followed by a 1-week drug-free washout period. Tests were done after weeks 1, 8 and 9. A significant mean increase (p less than 0.05) in serum potassium occurred with maximal exercise in the atenolol 50 mg and propranolol groups after 1 week of treatment (mean +/- standard deviation, 4.78 +/- 0.29 to 5.09 +/- 0.43 mEq/liter and 4.81 +/- 0.55 to 5.30 +/- 0.33 mEq/liter). By week 8 after training, all beta blockade groups showed an increase in postmaximal exercise test serum potassium (atenolol 50 mg, 4.78 +/- 0.29 to 5.11 +/- 0.26 mEq/liter; atenolol 100 mg, 4.95 +/- 0.41 to 5.16 +/- 0.36 mEq/liter; propranolol, 4.81 +/- 0.55 to 5.05 +/- 0.29 mEq/liter). After washout, only the placebo group showed an increase in postmaximal test serum potassium (4.99 +/- 0.46 to 5.35 +/- 0.27 mEq/liter). Data indicate that hyperkalemia with maximal exercise testing increases after training with atenolol and propranolol compared to placebo and that this effect resolves once treatment is discontinued.

Adult↗
PubMed1987

Usefulness of Holter monitoring to improve the sensitivity of exercise testing in determining the degree of myocardial revascularization after coronary artery bypass grafting for stable angina pectoris.

To assess whether Holter monitoring improves the sensitivity of exercise testing in identifying incomplete myocardial revascularization, both tests were performed in 45 patients from 3 to 5 months after elective coronary artery bypass grafting (CABG) for stable angina pectoris. Coronary angiography revealed incomplete revascularization in 26 patients. Six of these 26 had 52 episodes of ST-segment depression during Holter monitoring and myocardial ischemia during exercise testing. Their exercise capacity was significantly lower than that of 10 other patients in whom the results of exercise testing only were positive (heart rate at 0.1 mV ST-segment depression 112 +/- 9 vs 123 +/- 15 beats/min, p less than 0.001). In the other 10 patients with incomplete myocardial revascularization the results of both investigations were negative. The graft patency rate was lower in patients with a positive response to exercise testing than in those with a negative response (52% vs 71%, p less than 0.005). Myocardial revascularization was angiographically complete in 19 patients. In 18 of these 19 patients the findings of both investigations were negative; in 1 patient Holter monitoring revealed episodes of ST-segment elevation suggestive of variant angina. Thus, after CABG for stable angina pectoris the results of Holter monitoring do not improve the sensitivity of exercise testing in identifying patients with angiographically incomplete myocardial revascularization because findings are positive only in patients with low exercise capacity. Both tests fail to show evidence of myocardial ischemia in most patients with angiographically complete myocardial revascularization.

Aged↗
PubMed1991

Preoperative cardiopulmonary exercise testing: determining the limit to exercise and predicting outcome after thoracotomy.

Over the past 15 years evaluation of the patient with exertional complaints has changed from a simple qualitative estimate of overall fitness to a detailed assessment of cardiovascular and pulmonary pathophysiology. By quantifying exercise impairment and identifying the physiological limit to exercise, CPEx can help direct and evaluate the efficacy of medical and surgical interventions. Although no clear consensus has emerged, an objective determination of the etiology of exercise intolerance may also help identify the patient at increased risk for postthoracotomy complications.

Cardiovascular Physiological Phenomena↗
PubMed1994

Exercise testing revisited. The response to exercise in normal and atopic children.

BACKGROUND: Wide differing criteria are used to define the normal airway response to exercise, and as a consequence the estimated incidence of exercise-induced bronchospasm (EIB) in atopic children is wide. The purpose of this study was to establish normal range for changes in spirometry after exercise in children and then to use these normal values to assess the incidence of EIB in atopic children. METHODS: Pulmonary function was assessed before, and 2, 5, and 10 min after 6 min of free running exercise in a group of 48 normal and 96 atopic children (70 asthmatics, 17 with allergic rhinitis, and 9 with atopic dermatitis/food hypersensitivity). RESULTS: The EIB (defined as the normal group mean value -2 SD) occurred with a > 10 percent fall in FEV1, > 17.5 percent fall in peak expiratory flow rate (PEFR), > 26 percent fall in mean forced expiratory flow during the middle half of the forced vital capacity (FEF25-75), and > 40 percent fall in FEF25. Sixty-three of 70 asthmatic patients had EIB by at least one of these definitions, most marked at 5 min postexercise. The combination of FEV1 and FEF25-75 criteria enabled detection of all subjects with EIB. By FEV1 and FEF25-75 criteria, none of the subjects with allergic rhinitis or dermatitis had EIB. The fall in FEV1 after exercise in children with allergic rhinitis was within the range of normal, but with a significantly lower mean value than control subjects. CONCLUSIONS: EIB should be defined by using more than one maximum expiratory flow-volume curve parameter (ie, FEV1 and FEF25-75). The EIB (defined as a fall in FEV1 and FEF25-75) was only seen in asthmatic children and not in other atopic groups.

Adolescent↗
PubMed1983

[Sex and age-dependent differences in the circulatory response to the exercise test].

The testing of normal males and females of different age revealed no intersexual differences in circulatory response to the orthostatic test. During exercise, female subjects showed lower systolic arterial pressure, cardiac and stroke indices, and greater diastolic arterial pressure, heart rate and peripheral resistance to blood flow, irrespective of their age. Parameters of physical efficiency are higher in males as compared to females. Exercise tolerance decreases with age in subjects of both sexes, the decrease, however, being more pronounced in males.

Adolescent↗
PubMed2004

The exercise test as a monitor of disease status in hypokalaemic periodic paralysis.

OBJECTIVE: To evaluate exercise test responses in hypokalaemic periodic paralysis (HPP), to determine its value as a diagnostic tool and the factors that could affect the responses. METHODS: 22 subjects were studied from two families with HPP caused by R528H mutation, four patients with thyrotoxic periodic paralysis, 15 normal controls, and four controls with hyperthyroidism. All family members were submitted to clinical evaluation, electrophysiological exercise testing, and DNA analysis. Patients with thyrotoxic periodic paralysis had exercise tests before and after treatment of their hyperthyroidism. RESULTS: Abnormal responses to the exercise tests were obtained only in subjects with recent attacks of weakness. They were not correlated with genotype, as asymptomatic carriers were unaffected. Patients with thyrotoxic periodic paralysis showed pronounced impairment while they were hyperthyroid, but improved when they were euthyroid. One patient with HPP and chronic KCl use had an increase in amplitude potentials over approximately 20 minutes, possibly related to alteration of potassium homeostasis. CONCLUSIONS: The exercise test is a useful diagnostic test for periodic paralysis, but in the absence of recent weakness negative results must be viewed with caution. It has advantages over the DNA test in being a non-invasive functional test that can provide insights into abnormalities of muscle excitability.

DNA↗