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PubMed2001

The role of exercise testing in the evaluation of the patient with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a genetic disease of the sarcomeric contractile proteins that is characterized by left ventricular hypertrophy and myocyte disarray. The majority of patients are limited in terms of functional capacity and a minority die suddenly. The main aims of management are symptom alleviation and prevention of sudden cardiac death. In patients with HCM, cardiopulmonary exercise testing provides a more accurate index of functional capacity than New York Heart Association classification status and is useful in assessing symptoms following various therapeutic interventions. Cardiopulmonary exercise testing plays an important role in differentiating HCM from other conditions associated with left ventricular hypertrophy. Cardiopulmonary exercise testing is also valuable in identifying individuals at high risk of sudden cardiac death and is an integral part of the algorithm in risk stratification and delivery of prophylactic therapy. Over the past few years, cardiopulmonary exercise testing has provided insight into the determinants and mechanisms of exercise limitation. This understanding helps in targeting therapy and the development of new treatment modalities.

Cardiomyopathy, Hypertrophic↗
PubMed1978

Heart rate during a defined exercise test in horses with heart and lung diseases.

During a gradually increasing exercise test heart rates were determined in healthy animals and in 2 groups of sick horse. These included 31 animals with a chronic pulmonary disorder and 5 with chronic heart disease. The alteration in heart rate was correlated with the clinical signs exhibited. In the horses with lung disease there was a close correlation between the stage of the diseases and the heart rate during the exercise test. In 3 animals with heart valve disease there was no apparent difference in heart rate compared with healthy horses. On the other hand the exercising heart rate of horses with atrial fibrillation showed a significant increase. The recovery rate of pulse and respiration after a 20 min trot did not show any correlation with the stage of disease or the pulse and respiration after a 20 min trot did not show any correlation with the stage of disease or the results of gradually stepping up the exercise in horses with lung disease.

Animals↗
PubMed1992

Diagnosis of familial hypokalemic periodic paralysis: role of the potassium exercise test.

Familial hypokalemic periodic paralysis (FHOPP) is a rare, dominantly inherited disease, the diagnosis of which may require the induction of paralysis. We studied whether the increase in plasma potassium concentration during exercise can be used in the diagnosis of FHOPP. Potassium concentration increased 0.3 +/- 0.1 mEq/l in patients with FHOPP and 0.6 +/- 0.1 mEq/l in healthy controls (p < 0.001) during a 10-minute bicycle exercise test, and 0.3 +/- 0.1 mEq/l in patients with FHOPP and 0.8 +/- 0.2 mEq/l in healthy controls (p < 0.001) during a 30-minute bicycle exercise test. We conclude that the potassium exercise test may be useful in the diagnosis of FHOPP.

Adolescent↗
PubMed1982

[Principles of ergometry. - Part II: criteria for assessment of the exercise test. Criteria for interpretation (author's transl)].

Because exercise testing is of value not only for "qualitative" but even more for "quantitative" diagnostic purposes, the exercise ECG is often of minor importance in relation to the other exercise responses. 1. Exercise capacity. Maximal aerobic power or aerobic capacity as a measure of physical and cardiovascular performance can not be calculated from measurements during submaximal exercise (with the exception of young healthy persons), but correlates well with the maximal workload attained in a (symptom-limited) maximal test when sex, age and the state of health as well as of physical training are taken into account. Therefore, exercise capacity as measured in such a test is of diagnostic and prognostic significance. 2. Heart rate. Changes in heart rate at a given submaximal workload correlate well with qualitative changes of exercise capacity in the individual. The peak heart rate that is attained in a (symptom-limited) maximal exercise test (HR max) varies greatly interindividually. It declines with age and because heart rate is one of the major determinants of myocardial oxygen uptake it is a measure of "coronary reserve" in the patient with coronary heart disease. Limits for professional activities or other physical exercise may be expressed as a certain percentage of HR max (% HR max). 3. Blood pressure. An inadequate rise of systolic blood pressure or a fall despite increasing workloads indicate inadequacy of cardiac output. In coronary heart disease, it is often a sign of acute left ventricular dysfunction due to reversible ischemia and is of therapeutic and prognostic consequence. 4. ECG. Electrocardiographic changes should always be related to other exercise responses. Sensitivity and specificity of the ST-segment changes depend on sex, age, resting ECG, type of exercise, lead system and medical treatment. In coronary heart disease, "Bayes' theorem" should be regarded. The predictive value of a test result should be calculated, based on the prevalence and the pretest likelihood of the disease. Other than ST-segment changes are or relatively minor significance or need further evaluation.

Blood Pressure↗
PubMed1983

Effects of early postmyocardial infarction exercise testing on self-perception and subsequent physical activity.

The effects of exercise testing 3 weeks after clinically uncomplicated myocardial infarction (MI) on subsequent physical activity were evaluated in 40 consecutive men with a mean age of 52 +/- 9 years. Patients' confidence in their ability to perform various physical activities was evaluated with self-efficacy scales which patients completed before and after a symptom-limited treadmill exercise test. Increases in confidence (self-efficacy) for activities similar to treadmill exercise (walking, stair climbing, and running) were greatest after treadmill exercise, whereas increases for dissimilar activities (sexual intercourse and lifting) were greatest after test results were explained by a physician and nurse. The intensity and duration of subsequent physical activity at home were more highly correlated with self-efficacy after treadmill exercise than with peak treadmill heart rate. Of the 8 patients whose treadmill tests were limited by angina pectoris, 7 had self-efficacy scores which remained low after treadmill testing or which decreased from initially high values after treadmill testing. These patients had lower peak heart rates and work loads than patients whose self-efficacy increased or remained high after treadmill testing. After MI, patients' perception of their capacity for physical activity and their actual patterns of subsequent physical activity are influenced by early treadmill testing in a manner which is congruent with these patients' treadmill performance.

Adult↗
PubMed1987

A single treadmill exercise test does not accurately quantitate claudication.

The diagnosis of vascular occlusive disease is confirmed by documenting a fall in the ankle-brachial pressure index following a treadmill exercise test. The authors hypothesize that this test does not provide a reproducible quantitative assessment of the patient's disability due to the disease. In 25 patients a series of five treadmill exercise tests were performed on the same day. There was a significant (p less than 0.05) increase in the time to the occurrence of claudication when tests 3, 4 and 5 were compared with test 1. There was also a significant (p less than 0.05) rise in the maximum time walked comparing test 3 with test 1. There was no difference in the fall in ankle-brachial pressure index with each test. The majority of patients had achieved their maximum walking distance by test no. 3. It is concluded that a single treadmill exercise test will not accurately assess disability due to intermittent claudication and it is recommended that three tests be performed for a reproducible evaluation.

Blood Pressure↗
PubMed1994

The superiority of exercise testing over spirometry in the evaluation of postoperative lung function for patients with pulmonary disease.

Thoracic surgeons have often been embarrassed by the discrepancy between an improvement in symptoms and the unchanged or even worse results of spirometry in postoperative patients with either bullae or inflammatory lung disease. Forty-four patients with lung diseases, who underwent a total of 47 operations, were categorized as follows: 12 cases of empyema, 16 cases of giant bulla (undergoing surgery a total of 19 times), 4 cases of bronchiectasis, and 12 cases of other miscellaneous diseases. All patients were tested preoperatively and again 4-6 months after surgery on both the spirometer and treadmill exercise tests. The forced vital capacity (FVC) and forced expiratory volume (FEV1.0) results were as follows: the empyema group 1.82 +/- 0.52 liters preoperatively to 1.93 +/- 0.69 liters postoperatively and 1.47 +/- 0.44 liters to 1.56 +/- 0.53 liters, respectively; and the giant bulla group, 3.49 +/- 0.96 liters to 3.35 +/- 0.77 liters and 2.35 +/- 0.96 liters to 2.48 +/- 0.69 liters, respectively. However, the exercise time was prolonged in the empyema group from 6.00 +/- 3.77 min to 8.33 +/- 3.80 min (P < 0.01) and in the giant bulla group from 11.83 +/- 3.71 min to 12.92 +/- 2.84 min (P < 0.05). It was thus concluded that exercise testing should be chosen for the postoperative evaluation of patients with inflammatory pulmonary disease and giant bullae, especially if any discrepancies are seen between spirometry and performance status, because on the basis of our results, it appears that the benefits obtained by surgery are best measured by the dynamic values of exercise testing and not by the static values of spirometry at rest.

Adult↗
PubMed1999

Reliability of submaximal exercise tests in patients with COPD. Chronic obstructive pulmonary disease.

UNLABELLED: Submaximal constant work rate exercise tests are often used to measure the efficacy of an exercise intervention, but the reliability of these tests in patients with chronic obstructive pulmonary disease (COPD) has not been established. PURPOSE: To examine the reproducibility of submaximal exercise responses of COPD patients compared with those of healthy elderly subjects. METHODS: Sixteen COPD patients and 15 healthy subjects performed four weekly submaximal exercise tests against two different constant work rates: 20 W and 50% of the peak work rate (PWR). Spirometry was performed before each exercise test. COPD patients and healthy subjects were: age 69 +/- 5 and 65 +/- 5 yr, body mass index 26.4 +/- 3.9 and 26.7 +/- 3.0 kg x m(-2), respectively. RESULTS: Both groups had no change in minute ventilation (V(E)), oxygen uptake (VO2), breathlessness (RPB), and leg fatigue (RPLF) for either work rate over repeated measures (P > 0.05). At 50% PWR test-retest reliability coefficients for V(E) and VO2 ranged from r = 0.88 to r = 0.96 for COPD patients and from r = 0.72 to r = 0.97 for healthy subjects; for RPB and RPLF test-retest reliability ranged from r = 0.76 to r = 0.89 for COPD patients and from r = 0.70 to r = 0.91 for healthy subjects. Intrasubject mean absolute differences for repeated measures of V(E), VO2, RPB, or RPLF were low and there were no group differences (P > 0.05). Percent error for V(E) and VO2 ranged from 6 +/- 3 to 9 +/- 7%, and for RPB and RPLF ranged from 19 +/- 18 to 68 +/- 65% for both groups at each work rate. CONCLUSIONS: Submaximal exercise responses were reliable over a 1-month period, and measures of the physiological and psychophysical responses of COPD patients were as reliable as those of healthy subjects.

Aged↗
PubMed1994

The ventilation, lactate and electromyographic thresholds during incremental exercise tests in normoxia, hypoxia and hyperoxia.

These experiments examined the effect of hypoxia and hyperoxia on ventilation, lactate concentration and electromyographic activity during an incremental exercise test in order to determine if coincident chances in ventilation and electromyographic activity occur during an incremental exercise test, despite an enhancement or reduction of peripheral chemoreceptor activity. In addition, these experiments were completed to determine if electromyographic activity and ventilation are enhanced or reduced in response to the inspiration of oxygen-depleted and oxygen-enriched air, respectively. Seven subjects performed three incremental exercise tests, until volitional exhaustion was achieved, while inspiring air with a fractional concentration of oxygen of either 66%, 21% or 17%. In addition, another single subject completed two tests while inspiring air with a fractional concentration of either 17% or 21%. During the tests, ventilation, mixed expired oxygen and carbon dioxide, arterialized venous blood and the electromyographic activity from the vastus lateralis were sampled. From these values ventilation, electromyographic and lactate thresholds were detected during normoxia, hypoxia and hyperoxia. The results showed that although ventilation and lactate concentration were significantly less during hyperoxia as compared to normoxia or hypoxia, the carbon dioxide production values were not significantly different between the normoxic, hypoxic and hyperoxic conditions. For a particular condition, the time, carbon dioxide production and oxygen consumption values that corresponded to the ventilation and electromyographic thresholds were not significantly different, but the values corresponding to the lactate threshold were significantly less than those for the electromyographic and ventilation thresholds. Comparisons between the three conditions showed that the time, carbon dioxide production and oxygen consumption values corresponding to each of these thresholds were not significantly difficult.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Directional ST-segment deviation in graded exercise tests correlated with motion of the individual segments of the left ventricular wall.

An exercise test may be characterized as positive because of the production of either electrocardiographic ST-segment depression or elevation. The relationship of exercise-induced ST-segment deviation to the specific motion abnormalities of the individual segments of the left ventricular wall was investigated. The first 280 subjects to enter the Program of Surgical Control of Hyperlipidemia were studied by treadmill exercise testing and left ventriculography. The results showed that exercise-induced ST-segment elevation could occur without evidence in the resting subject of either dyskinesia or aneurysm of the left ventricle, that the area of left ventricular damage was much greater in subjects with exercise-induced ST-segment elevation than in those with ST-segment depression, and that wall motion abnormalities were concentrated in the inferoposterior area in the group with ST-segment elevation, but were generally scattered throughout the left ventricular wall in the group with ST-segment depression.

Adult↗
PubMed1989

Prognostic significance of exercise testing three weeks after myocardial infarction.

Treadmill exercise test was performed in 50 patients aged 35-60 years, 3 weeks after myocardial infarction. Thirty-two had anterior and 18 had inferior wall transmural myocardial infarction. Cardiac events like angina, reinfarction and sudden death were more common in patients with positive stress test. Thus treadmill testing in the early postinfarction period is of great prognostic value.

Adult↗
PubMed1983

Value of isometric exercise testing during cardiac catheterization in mitral stenosis.

To examine the value of preoperative isometric exercise testing during cardiac catheterization in patients with mitral stenosis, the isometric handgrip exercise test was performed on 28 patients during preoperative diagnostic catheterization. Eighteen patients who subsequently underwent mitral valve surgery were recatheterized and reevaluated clinically 12 months after operation. Preoperatively, the patients were divided into 2 groups: 16 whose mean mitral valve pressure gradient increased greater than 4 mm Hg during isometric exercise (group A) and 12 whose pressure gradient decreased or increased less than 4 mm Hg (group B). The ejection fraction remained unchanged and the peak systolic pressure/end-systolic volume ratio increased during isometric exercise in group A (p less than 0.001). In group B, the ejection fraction decreased (p less than 0.001) and the peak systolic pressure/end-systolic volume ratio remained unchanged. In the total group, a positive correlation existed between the change in mean mitral valve pressure gradient during isometric exercise and the changes in measures of left ventricular function during exercise. The patients in group A had a significant improvement in both symptoms and in exercise tolerance as determined by symptom-limited bicycle ergometry after surgery. The patients in group B showed minimal or no symptomatic improvement and their exercise tolerance did not improve. The change in mitral valve pressure gradient during isometric exercise appears to reflect the left ventricular response to exercise.

Adult↗
PubMed1999

Plasma catecholamine responses to four resistance exercise tests in men and women.

The plasma adrenaline ([A]) and noradrenaline ([NA]) concentration responses of nine men and eight women were investigated in four resistance exercise tests (E80, E60, E40 and E20), in which the subjects had to perform a maximal number of bilateral knee extension-flexion movements at a given cycle pace of 0.5 Hz, but at different load levels (80%, 60%, 40% and 20% of 1 repetition maximum, respectively). The four test sessions were separated by a minimal interval of 3 rest days. The number of repetitions (Repmax), the total work (Wtot) done normalized for the lean body mass and the heart rate (HR) responses were similar in the two groups in each test. In addition, no differences were found between the two groups in [A] and [NA] either before or after the exercise tests. The postexercise [NA], both in the men [10.8 (SD 7.0) nmol x l(-1)] and in the women [11.7 (SD 7.4) nmol x l(-1)], was clearly the highest in E20, where also the Repmax, WtOt, the total amount of integrated electromyograph activity in the agonist muscles and the peak postexercise blood lactate concentration [men 8.3 (SD 1.6) vs women 7.3 (SD 0.9) mmol x l(-1), ns] were significantly higher than in the other tests. Although the postexercise [A] in E20 both in the men [7.1 (SD 6.0) nmol x l(-1)] and in the women [5.2 (SD 2.0) nmol x l(-1)] were higher than in E80 [men 3.1 (SD 4.2), women 2.1 (SD 2.0) nmol x l(-l)] (P < 0.05), they were not significantly different from E60 [men 3.6 (SD 1.9), women 4.0 (SD 3.3) nmol x l(-1)] and E40 [men 3.8 (SD 4.1), women 5.8 (SD 4.0) nmol x l(-1)] in either group. The present study did not indicate any sex differences in performance and in plasma catecholamine responses in different exhausting resistance exercise tests performed with the knee extensor muscles. In both groups the plasma [NA] response was clearly the largest in the longest exercise with the greatest amount of muscle activity and work done, and with the largest blood lactate response. The differences in the plasma [A] responses between the exercises tended to be somewhat smaller.

Adult↗
PubMed2004

Relationship between insulin resistance assessed by HOMA-IR and exercise test variables in asymptomatic middle-aged patients with type 2 diabetes.

UNLABELLED: We investigated the relationship between index of insulin resistance (IR) and exercise test variables in middle-aged asymptomatic patients with Type 2 diabetes. METHODS: 90 patients (48 men, 42 women; age: 49 +/- 6 yr) were included in the study. We used homeostasis model assessment for IR (HOMA-IR) index as index of IR. All patients were subjected to treadmill exercise test. Four subjects were tested positive (4.4%). Study patients were separated into three groups: group I (no.=26) HOMA-IR index <2.24; group II (no.=26) index 2.24-3.59; group III (no.=38) index >3.59. RESULTS: group I had less frequency of cardiovascular risk factors than group II and III (p=0.001). Systolic blood pressure baseline as well as peak exercise values, were higher in group III than in group I and II (p=0.048 vs p=0.01, respectively). Higher total exercise time and peak workload were found in group I than group II and III (p=0.04). The recovery of heart rate (delta HR(pr)) was similar among the study groups. We found significant negative correlations between HOMA-IR and total exercise time and peak workload. In addition we found significant negative correlations between age vs chronotrophic index (CI), delta HR(pr), and peak workload. There were also similar negative correlations between duration of diabetes vs CI and delta HR(pr). CONCLUSIONS: IR is associated with a variety of cardiovascular risk factors. Some exercise test variables point out changes of autonomic tone during exercise in elevated IR group. Negative correlation between HOMA-IR and peak exercise capacity (METs) may well confirm increased mortality in hyperinsulinemia.

Adult↗
PubMed1980

Angiocardiography and exercise testing at one month after a first myocardial infarction.

The results of exercise testing (77 patients), left ventriculography and coronary arteriography (78 patients) are presented for men under the age of 60, one month after a first myocardial infarct. Cineangiocardiography revealed that patients with anterior infarction (n = 25) had both poorer left ventricular function and more totally occluded vessels than those with either inferior (n = 33) or subendocardial infarction (n = 20). In contrast, patients with inferior and subendocardial infarction had a greater proportion of myocardium supplied by sub-total lesions likely to be haemodynamically significant (75%-99% cross sectional area loss). Subendocardial infarction was also characterised by the best left ventricular function and the fewest number of total coronary occlusions. Stress testing showed that the combination of ischaemic ST segment changes and angina during exercise was 91% predictive of severe coronary disease (equivalent to triple vessel disease) while no angina in the presence of a negative test was 81% predictive of mild or moderate disease. Stenoses of 75%-99% cross sectional area loss were more common when angina occurred during exercise testing, and both angina and ischaemic ST segment changes occurred within ten minutes in all four patients with haemodynamically significant left main coronary artery lesions. Our data supports the usefulness of exercise testing after a first myocardial infarct and may provide valuable baseline information in the analysis of long term prognosis.

Angiocardiography↗
PubMed1994

[Evaluation of the exercise capacity recovery process after lung cancer surgery by exercise test and expire gas analysis].

This study was conducted to evaluate the numerical changes and the recovery process in exercise capacity over time, and to establish new criteria that will objectively evaluate the recovery in exercise capacity after lung surgery using an expired gas analysis incorporating an exercise test. The subjects consisted of 47 patients that underwent curative resection (only lobectomy) for lung cancer in the four years from 1989 to 1992 that were able to undergo expired gas analysis incorporating an exercise test before and after surgery. The expired gas analysis were performed within one week prior to surgery and over a period from 14 to 449 days after surgery, maximum oxygen consumption (VO2max) and anaerobic threshold (AT) measured, and the VO2max/m2 and AT/m2 were calculated as an index by dividing by the body surface area (m2). In addition, in order to examine the changes in exercise capacity after surgery, the presurgical values were used as 100, and the rate of change after surgery found. These rate were divided into the following measuring times, and the postsurgical changes over time analyzed. The postsurgical measuring times were divided into five groups from 14-30 days (n = 11), from 31-90 days (n = 25), from 91-180 days (n = 8), from 181-270 days (n = 19), and greater than 271 days (n = 8) after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1998

[Diagnostic use of oxygen consumption and gas exchange in exercise testing].

The interpretation of cardio-pulmonary exercise testing is usually performed on successive decisional organigrams which are based on the normality of two initial main branchpoints i.e., Vo2max and ventilatory threshold (VThr). This didactic approach leads however to a simplistic approach of exercise pathophysiology because the answer to the two original branchpoints (Vo2max and VThr) is mainly binary whereas the physiological meaning of these two parameters is multifactorial. Thus, we propose a methodic analytical approach which allows to integrate step by step the various informations concerning aerobic capacity, ventilatory and cardiocirculatory responses, and acidobasic status. After a purely descriptive analysis of data , a first synthesis describes the physiopathological behaviour during exercise and states the specificity of these informations excluding usual confounding factors. The comparison between the functional data and the clinical informations allows to propose some physiopathological hypothesis by confronting several complementary approaches: physiological, physiopathological and clinical ones. This method seems to be more adapted to the clinical diagnostic use of such a physiological investigation because it is sensitive, reproducible but not specific.

Data Interpretation, Statistical↗
PubMed1998

Oxygen uptake does not increase linearly at high power outputs during incremental exercise test in humans.

A group of 12 healthy non-smoking men [mean age 22.3 (SD 1.1) years], performed an incremental exercise test. The test started at 30 W, followed by increases in power output (P) of 30 W every 3 min, until exhaustion. Blood samples were taken from an antecubital vein for determination of plasma concentration lactate [La-]pl and acid-base balance variables. Below the lactate threshold (LT) defined in this study as the highest P above which a sustained increase in [La-]pl was observed (at least 0.5 mmol x l[-1] within 3 min), the pulmonary oxygen uptake (VO2) measured breath-by-breath, showed a linear relationship with P. However, at P above LT [in this study 135 (SD 30) W] there was an additional accumulating increase in VO2 above that expected from the increase in P alone. The magnitude of this effect was illustrated by the difference in the final P observed at maximal oxygen uptake (VO2max) during the incremental exercise test (Pmax,obs at VO2max) and the expected power output at VO2max(Pmax,exp at VO2max) predicted from the linear VO2-P relationship derived from the data collected below LT. The Pmax,obs at VO2max amounting to 270 (SD 19) W was 65.1 (SD 35) W (19%) lower (P < 0.01) than the Pmax,exp at VO2max. The mean value of VO2max reached at Pmax,obs amounted to 3555 (SD 226) ml x min(-1) which was 572 (SD 269) ml x min(-1) higher (P < 0.01) than the VO2 expected at this P, calculated from the linear relationship between VO2 and P derived from the data collected below LT. This fall in locomotory efficiency expressed by the additional increase in VO2, amounting to 572 (SD 269) ml O2 x min(-1), was accompanied by a significant increase in [La-]pl amounting to 7.04 (SD 2.2) mmol x l(-1), a significant increase in blood hydrogen ion concentration ([H+]b) to 7.4 (SD 3) nmol x l(-1) and a significant fall in blood bicarbonate concentration to 5.78 (SD 1.7) mmol x l(-1), in relation to the values measured at the P of the LT. We also correlated the individual values of the additional VO2 with the increases (delta) in variables [La-]pl and delta[H+]b. The delta values for [La-]pl and delta[H+]b were expressed as the differences between values reached at the Pmax,obs at VO2max and the values at LT. No significant correlations between the additional VO2 and delta[La-]pl on [H+]b were found. In conclusion, when performing an incremental exercise test, exceeding P corresponding to LT was accompanied by a significant additional increase in VO2 above that expected from the linear relationship between VO2 and P occurring at lower P. However, the magnitude of the additional increase in VO2 did not correlate with the magnitude of the increases in [La-]pl and [H+]b reached in the final stages of the incremental test.

Acid-Base Equilibrium↗