[Guidelines for exercise tests, by the Working Group on "Exercise Tests and Rehabilitation" of the French Society of Cardiology].
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Cardiovascular Agents↗
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Diagnostic utility of a modified forearm ischemic exercise test and technical issues relevant to exercise testing.
The sensitivity and specificity of a modified forearm ischemic test (FIT) are described in the diagnosis of glycogen storage disease, myoadenylate deaminase deficiency, and mitochondrial disease. FIT and muscle biopsy results were reviewed from 99 patients (glycogen storage disease [GSD], myoadenylate deaminase deficiency [AMPD], mitochondrial disease [MITO], miscellaneous neuromuscular disorders, and controls). The influence of catheter placement and an antecedent sugar bolus were also assessed in healthy young men. The FIT had a sensitivity of 1.00 and a specificity of 1.00 for a diagnosis of GSD, whereas the corresponding values were 1.00 and 0.37 for AMPD deficiency. A baseline lactate of >2.5 mmol/L provided the highest sensitivity (0.62) and specificity (1.00) for MITO disease. A baseline and +1 min sample provided optimal sensitivity and specificity for GSD and AMPD deficiency. Catheter placement in any vein other than the ipsilateral antecubital resulted in attenuated lactate responses (P < 0.0001). A pre-FIT sugar bolus did not alter the postexercise lactate or ammonia response. Thus, a modified FIT was helpful in the diagnosis of GSD and excluding AMPD deficiency, but not in the diagnosis of MITO disease. Catheter placement is critical to the interpretation of a FIT, whereas pretesting diet is less important.
Adult↗
Using the exercise test to develop the exercise prescription in health and disease.
The objective of an exercise program for persons with or without disease should be the development or maintenance of cardiorespiratory fitness, strength and muscular endurance, and flexibility. The basic principles of prescribing exercise--frequency, intensity, and duration of training--and the mode of activity as recommended by the ACSM for healthy adults are also appropriate for persons with disease. The difference in the exercise prescription for persons with disease is the manner in which these principles are applied. Usually, the more fragile the patient, the lower the intensity of exercise and the slower the progression of training. The role of cardiopulmonary exercise testing is to determine a safe and effective level of exercise for healthy persons as well as those with disease. GXT is useful in identifying individuals with disease and in providing information regarding the level of supervision needed during exercise training. In addition, exercise testing can be used to clear a person for participation in a resistance training program. Resistance training should be integrated as part of a well-rounded program, because of the importance of maintaining strength, muscle mass, and bone mineral density. Generally, the starting intensity for persons with disease is lower, the frequency and duration higher, and the progression of exercise slower to allow a more gradual adaptation to exercise training.
Exercise↗
Exercise testing for sports and the exercise prescription.
The uses of the exercise test continue to grow and diversify. Familiarity with the mechanics, logistics, and interpretation of these tests leads to their optimal use. The application of exercise testing for competitive or recreational sports, cardiovascular fitness exercise training, and cardiac rehabilitation is the focus of this review. Many test protocols are available, but treadmill testing is the most widely used. The inclusion of thallium scintigraphy in the exercise protocol requires additional time and expense and is best reserved for those in whom the exercise electrocardiographic response cannot be adequately interpreted. Exercise testing is a relatively safe procedure, providing that adequate screening of individuals for unstable cardiac or medical conditions has been performed. The test must be administered by experienced personnel in a setting where the necessary emergency resuscitative equipment is available. Adequate interpretation of the exercise test requires knowledge of the individual being tested and of the reason the test is being performed. Complete analysis of the exercise test includes electrocardiographic response (ST segment changes and rhythm disturbances), hemodynamic response (heart rate and blood pressure before, during, and after exercise), and functional capacity (exercise duration, symptoms, conversion to MET's). When exercise tests are employed to establish a diagnosis of coronary artery disease, an assessment of the pretest likelihood (prevalence) of disease is essential in deriving a reasonable assessment of the probability of disease after the test has been performed and reviewed. This information is particularly important when screening asymptomatic subjects for underlying coronary disease before they engage in an exercise program. Exercise testing of individuals with known cardiac disease prior to engaging in competitive or recreational sports can yield much useful information. In addition to a knowledge of the underlying cardiac condition, the type and intensity of the sport being performed must be taken into account when exercise testing is performed for athletic screening. Individuals with congenital or acquired valvular heart disease, coronary artery disease, and rhythm disturbances should undergo an exercise test as part of the pretraining evaluation. Patients with ischemic heart disease, especially those who have had a recent myocardial infarction or have undergone coronary artery bypass surgery, require counseling regarding their ability to perform certain activities of daily living and to return to work. Exercise testing can be a useful tool in establishing activity guidelines for these individuals.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Relationship between arterial blood gas values, pulmonary function tests and treadmill exercise testing parameters in patients with COPD.
OBJECTIVE: There have been controversial reports regarding the relationship between exercise tolerance and resting pulmonary function in patients with COPD. The aim of this study was to examine the relationship between resting pulmonary function tests (rPFT) and cardiopulmonary exercise testing parameters (CETP) and their value in estimating exercise tolerance of patients. METHODOLOGY: In total, 45 patients with COPD (nine females, 36 males; mean age 61.2 +/- 11.2) and 21 healthy subjects (four females, 17 males; mean age 60.3 +/- 9.7) as a control group were studied. COPD patients (group I) were divided into three subgroups according to their FEV(1) (mild/group II: FEV(1) 60-79% of predicted; moderate/group III: FEV(1) 40-59%; severe/group IV: FEV(1) < 40%). In controls FEV(1) was >/= 80%. RESULTS: There were significant correlations between FEV(1) and CETP in group III (maximal O(2) consumption (mVO(2)), r= 0.35, P < 0.005; total treadmill time (TTT), r= 0.31, P < 0.01; total metabolic equivalent values (TMET), r= 0.29, P < 0.01)) and in group IV (mVO(2), r= 0.49, P < 0.001; TTT, r= 0.45, P < 0.005; TMET, r= 0.31, P < 0.01; peak heart rate (pHR), r= 0.29, P < 0.02; frequency of ventricular extrasystole (fVES), r=-0.27, P < 0.05). Additionally, in group IV there were significant correlations between PaO(2) and CETP (mVO(2), r= 0.41, P < 0.02; TTT, r= 0.38, P < 0.03; TMET, r= 0.31, P < 0.05; pHR, r= 0.29, P < 0.05; fVES, r=-0.28, P < 0.05). CONCLUSION: There are significant correlations of resting FEV(1)% predicted and PaO(2) values with CETP in patients with moderate and severe COPD and these parameters may also have a role as indicators of exercise tolerance in these COPD patients.
Aged↗
Incidence of coronary artery disease in asymptomatic uncomplicated essential hypertensive patients--evaluation by treadmill exercise test.
Treadmill exercise test was performed in 100 patients, 50 were hypertensive who were not having any clinical or electrocardiographic manifestation of coronary artery disease and 50 were controls. The test was positive in 28% of hypertensive patients as compared to 6% in controls. This study therefore suggests that hypertension is frequently associated with asymptomatic coronary artery disease as compared to normotension and it is concluded that exercise electrocardiography test is a definite diagnostic tool in diagnosis of coronary artery disease not only in symptomatic but also in asymptomatic patients with one or more risk factors.
Blood Pressure↗
[Comparison of the informative value of the dipyridamole test, transesophageal electrostimulation and exercise tests in the diagnosis of coronary heart disease].
The informative value of dipyridamole test, transesophageal cardiac pacing, bicycle ergometer and treadmill exercise tests were compared in 65 patients suspected for coronary heart disease and Functional Classes I-III angina pectoris. The sensitivity, specificity, positive and negative predictive values of the techniques alone and in various combinations were evaluated. The incoincidence of results from exercise tests was ascertained to be 40-48%. The significance of diagnosis increased with combined functional examination and reached the maximum when all the four tests were performed. The use of the sensitivity, specificity, and predictive value of the techniques in assessing the individual test results allows the optimal scope of studies to be determined on an individual basis in order to make or exclude the diagnosis of coronary heart disease.
Adult↗
Pulmonary exercise testing.
Pulmonary exercise testing can help define the specific cause of exercise-related symptoms. A knowledge of basic respiratory physiology and static pulmonary function studies is necessary to understand and interpret these tests.
Exercise Test↗
[An analysis of S/N ratio of the phonocardiogram exercise test].
Phonocardiogram exercise testing (PCGET) is a method through applying a phonocardiograph to evaluate cardiac contractility and the cardiac reserve. In order to test the certainty of PCGET method, a study on its S/N ratio was performed. Thirty volunteers performed PCGET. The average value of baseline amplitudes after exercise with respect to the average value of baseline amplitudes before exercise is 1.150; The average value of number of time of the S1 amplitude after exercise with respect to the S1 amplitudes before exercise is 10.57. The results suggest that PCGET has increased S/N ratio; introcardiac noise, noise from transmission of heart/thorax acoustic system, respiratory noise, muscle noise and ambient noise could not interfere in the application of PCGET. PCGET might be a noninvasive, convenient, and inexpensive technique to quantitatively evaluate cardiac reserve for abnormal or normal persons.
Adult↗
Optimizing the clinical exercise test: a commentary on the exercise protocol.
The exercise test has a high yield of diagnostic, prognostic, and functional information and continues to have an integral place in cardiovascular medicine. Its two most common clinical uses are to estimate the probability of a patient having coronary disease and to estimate the likelihood of future coronary events. Although recent guidelines for exercise testing have recommended that the exercise protocol should be adjusted for each patient, this is often overlooked. This review examines the use of the exercise test and discusses which protocols are most appropriate for which patients. Appropriate attention given to exercise testing methodology, including the choice of the exercise protocol, can help to assure the maximum functional, diagnostic, and prognostic yield of information.
Clinical Protocols↗
Reduced heart rate response to exercise in ischemic heart disease: the fallacy of the target heart rate in exercise testing.
When exercise testing 159 patients with prior myocardial infarction, we identified 39 who were limited by fatigue. This group was all in sinus rhythm; none were taking drugs likely to impair the chronotropic response of the heart; none experienced chest pain or developed ischemic ECG changes. In 18 of this group, maximal heart rate achieved with exercise was 2SD or more below the age predicted value, and their heart rate response to exercise was reduced compared to that of the other 21 whose maximal exercise heart rates were within 2SD of age predicted values. A subgroup of 8 subjects with reduced exercise heart rates was studied before and after vagal blockade. In the 4 subjects whose infarction was inferior, the reduction in heart rate response was more profound and persisted after vagal blockade, suggesting either reduced pacemaker responsivness, due to ischemia or infarction, or autonomic imbalance as possible mechanisms. All 8 showed alinear increases in ventilation at higher power outputs and mean blood lactate postexercise was 7.5 mM/I without vagal blockade. Our findings suggest that a reduced heart rate response to exercise, already shown to imply added coronary risk, may be subdivided aetiologically and possibly prognostically. The use of a "Target Heart Rate" in such patients offers no safety margin, and maximal exercise capacity will be grossly over-estimated if extrapolated from the submaximal heart rate response. A cardiovascular limitation to exercise may be detected by an alinear increase in ventilation.
Adult↗
Prognostic significance of transient type II second degree atrioventricular block induced during exercise testing.
During exercise testing a 70 years old male developed Type II second degree AV block which reverted in recovery period. On follow up 3 months later, he developed symptomatic 2: 1 atrioventricular block and required permanent pacemaker implantation.
Aged↗
[An analysis of precision and accuracy of the phonocardiogram exercise test].
Phonocardiogram exercise testing (PCGET) is a recently developed method to evaluate cardiac contractility and the cardiac reserve of patients with heart disease and of healthy subjects. In order to test the reliability of PCGET method, the present author conducted a study on its precision and accuracy. Thirty volunteers underwent PCGET. When different examiners measured the S1 amplitude in the same cardiac cycle of the same subject, the data obtained by examiner A were: x +/- s = 5.05 +/- 0.0451; the data obtained by examiner B were: x +/- s = 4.95 +/- 0.0346, F = 1.699, P > 0.05. When different examiners measured the same cardiac cycle of the same subject, the data obtained by examiner A were: x +/- s = 0.789 +/- 0.0018; the data obtained by examiner B were: x +/- s = 0.787 +/- 0.0017, F = 1.167, P > 0.05. The results suggest that PCGET is a nonivasive, convenient, and inexpensive technique to quantitatively evaluate cardiac reserve for abnormal or normal persons.
Coronary Circulation↗
[Value and indications of exercise test in pneumology].
Exercise testing is the only integrate exploration technique, i.e., a technique which tests pulmonary, cardiac and muscular function, currently available in pneumology. The first indication for exercise testing in pneumology is to evaluate the exercise capacity of dyspnea patients. This can be done by measuring exercise tolerance and by differentiating each of the elements in the oxygen transport chain which can contribute to the dyspea, from a classical diagnostic standpoint, the exercise test can be used to screen for post-exercise asthma or a right-left shunt, estimate the severity of respiratory disease by demonstrating, for example, exercise-induced hypoxia. The exercise test also plays a fundamental role in preoperative evaluation prior to surgical resection of lung transplantation. It can also serve as a natural follow-up for treatment of respiratory diseases. One final and fundamental indication for exercise.
Exercise Test↗
[The studies of hemodynamic changes and liver uptake in a combination of ATP stress test and low workload exercise test on myocardial scintigraphy].
A pharmacological adenosine-tri-phosphoric acid (ATP) stress test has been used in patients who can not perform an enough exercise stress test. However, falling blood pressure during the stress test and increased liver uptake of the tracer are often found in patients undergoing the ATP test. To prevent these phenomena, a combination of ATP stress test and low workload exercise test (ATP & EX) is proposed. The usefulness of this newly developed stress test was elucidated from two viewpoints. Firstly, the changes of hemodynamic parameters were measured in 34 patients: 17 undergoing ATP alone and 17 undergoing ATP & EX. Systolic blood pressure fell from 150 +/- 20 mmHg to 126 +/- 16 mmHg (p < 0.05) for ATP alone. However, it changed from 141 +/- 19 mmHg to 149 +/- 31 mmHg (ns) for ATP & EX. There was a significant fall in systolic blood pressure (> 30 mmHg) in 58.8% for ATP alone and 5.9% for ATP & EX (p < 0.01). Secondly, the ROI count in the liver and heart on an anterior projection image were measured in 38 patients: 11 undergoing ATP alone, 13 undergoing ATP & EX, and 14 undergoing an ergometer exercise test (EX). The ROI count in the liver at 60 minutes after tracer injection were 29.0 +/- 10.7 count/pixel, 21.4 +/- 5.2 count/pixel, 18.3 +/- 4.5 count/pixel for ATP alone, ATP & EX and EX, respectively. The activities for ATP & EX and EX were lower than that for ATP alone (p < 0.05 and p < 0.01). Thus, ATP & EX decreased the rates of the fall of systolic blood pressure and decreased liver uptake of the tracer compared with ATP alone. In conclusion, ATP & EX is a useful stress method for myocardial perfusion scintigraphy in patients who can not perform the enough exercise stress test.
Adenosine Triphosphate↗
[The exercise test in pulmonology].
Pulmonary exercise testing is intended to evaluate the functional capacity of a patient and to identify the limiting factors. Its indications cover the whole spectrum of the diseases associated with dyspnea. Many clinical situations can easily be resolved during a non-invasive test merely by measuring ventilation, heart rate and systemic blood pressure. For the determination of pulmonary gas exchange, samples of arterial blood and expiratory O2 and CO2 fractions are necessary. In comparison with other pulmonary function tests, exercise testing is the only technique which provides overall information on the many adaptive mechanisms triggered by exercise. Consequently, it is of special value in distinguishing between pathophysiological states.
Adolescent↗
[Angina pectoris: 1st-line electrocardiographic exercise test and 2nd-line isotopic and echocardiographic exercise test].
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Angina Pectoris↗
Evaluation of pretest and exercise test scores to assess all-cause mortality in unselected patients presenting for exercise testing with symptoms of suspected coronary artery disease.
OBJECTIVES: To determine how well recently developed multivariables scores assess for all-cause mortality in patients with suspected coronary disease presenting for exercise electrocardiography (ExECG). BACKGROUND: Recently revised American College of Cardiology/American Heart Association guidelines for ExECG have suggested that ExECG scores be used to assist in management decisions in patients with suspected coronary artery disease. Recently developed scores accurately stratify patients according to angiographic disease severity. METHODS: To determine how well these scores assess for all-cause mortality, we utilized 4,640 patients without known coronary disease who underwent ExECG to evaluate symptoms of suspected coronary disease between 1995 and 2001. Previously validated pretest and exercise test scores as well as the Duke treadmill score were applied to each patient. All-cause mortality was our end point. RESULTS: Overall mortality was 3.0% with 2.8 +/- 1.6 years of follow-up. All three scores stratified patients into low-, intermediate-, and high-risk groups (p < 0.00001). No differences were seen when patients were evaluated as subgroups according to gender, diabetes, beta-blockers, or inpatient status. Low-risk patients defined by the Duke treadmill score had consistently higher mortality and absolute number of deaths compared with low-risk patients using other scores. In addition, the Duke treadmill score had less incremental stratifying value than the new exercise score. CONCLUSIONS: Simple pretest and exercise scores risk-stratified patients with suspected coronary disease in accordance with published guidelines and better than the Duke treadmill score. These results extend to diabetics, inpatients, women, and patients on beta-blockers.
Adrenergic beta-Antagonists↗