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PubMedDate not supplied

Development of an unsupported arm exercise test in patients with chronic obstructive pulmonary disease.

BACKGROUND: Unsupported arm exercise tests have been used to evaluate the effects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), but the reliability and validity of these tests are not established. OBJECTIVE: We evaluated the test-retest reliability and validity of a 6-minute pegboard and ring test (PBRT) in 27 outpatients with COPD and 30 age-matched controls. METHODS: We evaluated a 6-minute PBRT, subject demographics, pulmonary function and disease-specific quality of life questionnaire, and the Pulmonary Functional Status Dyspnea Questionnaire-Modified version in 27 patients with COPD. RESULTS: Highly significant correlation coefficients (r = .91, P < .001) were found between test and retest of PBRT scores. Statistically significant correlation coefficients were found between PBRT scores and pulmonary function tests such as FEV1% pred and FVC% pred, and activity domain and subdomain of Pulmonary Functional Status Dyspnea Questionnaire-Modified (P <or= .045). In addition, PBRT scores of healthy subjects were significantly higher than those of COPD subjects (P < .001), and were inversely related to age (P = .031). The FEV1% predicted and gender together accounted for 50% of the variance in the PBRT scores of patients with COPD. CONCLUSION: PBRT is a reliable and valid method to assess unsupported arm exercise endurance in patients with COPD.

Aged↗
PubMed1996

Analysis of high frequency QRS potential during exercise testing in patients with coronary artery disease and in healthy subjects.

High resolution ECG waveforms from leads V3, V4, V5, and V6 were analyzed in two groups of male subjects before, during, and following treadmill exercise testing. Group A included 32 coronary artery disease (CAD) patients, with arteriographically proven > 75% obstruction of at least two main coronary arteries, and group B included 30 healthy subjects, without history or symptoms of CAD. Signal averaging and filtering techniques were used in order to enhance the signal-to-noise ratio of the recorded ECG. The averaged QRS waveforms were filtered between 150 and 250 Hz. QRS complexes of the four leads were combined to form a "precordial average complex" (PAC). The PAC signals were examined for each subject at different stages of the exercise test and two parameters were computed: the root mean square (RMS) voltage; and the peak amplitude. The values of RMS and peak amplitudes measured at each stage of the exercise test were normalized to the values at rest. Normalized RMS (NRMS) values at peak exercise, immediately after peak exercise, and during the recovery phase were found to be higher for the healthy subjects than for the CAD group (1.17 +/- 0.31 vs 0.94 +/- 0.26, P < 0.008 at peak exercise, 1.13 +/- 0.24 vs 0.84 +/- 0.19, P < 0.001 after peak exercise, 1.08 +/- 0.22 vs 0.94 +/- 0.17, P < 0.007 during recovery). Cut-off NRMS value of one had a sensitivity of 81.3% and a specificity of 70.0% in differentiating CAD patients from healthy subjects in the examined groups. Normalized peak amplitude (NAMP) values exhibited similar behavior, with higher values for the healthy subjects than for the CAD group (1.23 +/- 0.48 vs 0.94 +/- 0.36, P < 0.03 at peak exercise, 1.20 +/- 0.34 vs 0.83 +/- 0.28, P < 0.001 after peak exercise, 1.10 +/- 0.29 vs 0.94 +/- 0.23, P < 0.02 during recovery). Specificity of 73.3% and sensitivity of 71.8% were found using a postpeak NAMP cut-off value of 1. In conclusion, the present study shows that using high frequency ECG may contribute to identifying patients with CAD. Further studies in larger groups of patients are required to better define the true predictive value of the method described for the diagnosis of CAD.

Adult↗
PubMed1990

[Ergometric exercise tests in the diagnosis of juvenile hypertension].

We analysed 186 exercise stress-tests in children and adolescents with juvenile hypertension. 40 per cent of our patients showed an exaggerated rise of blood pressure during ergometric testing. There were no severe complications during exercise-tests. We recommended an antihypertensive drug therapy in cases of hypertensive resting blood pressure and hypertensive exercise-test. The ergometric investigation can control the effectiveness of drug therapy. Our data documented that 53.5 per cent showed a spontaneous remission of their elevated blood pressure after 3-5 years. There was no statistical dependence on the exaggerated rise of blood pressure during dynamic exercise-test.

Adolescent↗
PubMed1980

Exercise testing early after myocardial infarction: predictive value for subsequent unstable angina and death.

Recently, modified treadmill exercise testing before hospital discharge has been reported to be safe in patients after uncomplicated myocardial infarction. Accordingly, the frequency of treadmill exercise-induced abnormalities and their prognostic value were evaluated in 130 patients with uncomplicated myocardial infarction. Seventy-eight patients (60 percent) had one or more treadmill exercise-induced abnormalities; 42 had S-T segment depression, 35 had angina and 17 had an inadequate blood pressure response. During the mean follow-up period of 11 months, 27 patients experienced unstable angina, 12 had a recurrent myocardial infarction and 10 died of cardiac causes. Compared with patients with no exercise-induced abnormality, patients with S-T segment depression, angina pectoris or an inadequate blood pressure response had a significantly greater (p < 0.001) incidence of all cardiac events during the follow-up period. Furthermore, unstable angina pectoris was significantly more frequent (p < 0.005) in patients with S-T segment depression or angina pectoris. Finally, when the patients with ischemic treadmill abnormalities were combined with the patients exhibiting an inadequate blood pressure response, they had a statistically greater (p < 0.005) incidence of cardiac death than that of patients with no treadmill abnormalities. Therefore, these three abnormalities during modified treadmill exercise testing before hospital discharge identify patients with uncomplicated myocardial infarction who are at risk for a future cardiac event.

Adult↗
PubMed1989

Evaluation of coronary artery disease in the patient unable to exercise: alternatives to exercise stress testing.

Exercise stress testing is a well-established method for the diagnostic, prognostic, and functional assessment of patients with known or suspected CAD. A variety of alternative tests have been described in patients unable to perform leg exercise. Atrial pacing and dipyridamole imaging have been evaluated most extensively, and results compare favorably with those of exercise testing for diagnosing the presence of CAD. Both tests may be used to assess prognosis after myocardial infarction, and dipyridamole imaging may be useful in patients undergoing preoperative evaluation. The use of the cold pressor test and isometric handgrip exercise have also been described. However, the value of both tests is limited by a relatively low sensitivity for detecting the presence of CAD. Other testing modalities--arm ergometry, intravenous infusion of beta-adrenergic agonists, and transthoracic pacing--show promise but require further assessment to confirm their value.

Adrenergic beta-Agonists↗
PubMed1980

Exercise testing with special reference to children with diabetes mellitus.

The purpose of exercise testing in diabetes mellitus is to examine physical fitness and to motivate the patient to perform physical activity as a valuable part of the treatment. Different types of tests and ergometry are presented. The stepwise increase of workload at submaximal levels is recommended for diabetics as an annual test. Maximal exercise is of value in determining the maximal oxygen uptake (VO2 max) = the aerobic capacity, maximal heart rate and systolic blood pressure.

Child↗
PubMed2000

[Diagnostic accuracy of exercise testing for diagnosis of coronary artery disease: the need for a critical review].

In this review the meaning of exercise electrocardiographic changes and interpretative pitfalls in particular clinical conditions are critically reassessed. Existing studies have been carried out on different populations and with different gold standards, nevertheless exercise testing if correctly analyzed and interpreted, can provide invaluable information for diagnosis of coronary artery disease. Given its feasibility, diffusion and low risk, it remains indeed the first choice test in the diagnostic algorithm of ischemic heart disease. The use of more sophisticated and expensive tests have to be limited to selected groups of patients in whom exercise testing, correctly interpreted, remains really doubtful or prematurely interrupted.

Coronary Disease↗
PubMed1988

Comparison of ST segment depression in upright treadmill and supine bicycle exercise testing.

Significant differences in the hemodynamic response to upright and supine exercise have been reported in patients with coronary artery disease. The purpose of the present study was to compare the degree of myocardial ischemia as assessed by ST segment depression during upright treadmill and supine bicycle exercise in 98 patients with coronary artery disease and in 34 patients with normal coronary arteries. The amount of ST segment depression at maximal exercise in patients with coronary artery disease was 0.90 +/- 0.80 mm for treadmill and 1.34 +/- 1.09 mm for supine bicycle (p less than 0.001). The amount of ST segment depression during treadmill and supine bicycle exercise tests was also compared at highest similar heart rates (0.68 +/- 0.77 versus 1.17 +/- 1.01, p less than 0.001), at highest similar rate-pressure products (0.71 +/- 0.77 versus 1.08 +/- 1.04, p less than 0.001), at highest similar metabolic equivalents of oxygen consumption (MET) levels (0.69 +/- 0.75 versus 1.20 +/- 1.05 mm, p less than 0.001) and at the onset of angina (0.84 +/- 0.73 versus 1.18 +/- 0.88 mm, p less than 0.001). The rate-pressure product achieved at maximal exercise was similar in both tests (18.74 +/- 5.80 x 10(3) versus 18.81 +/- 5.17 x 10(3), p = NS). The occurrence of angina during treadmill and supine bicycle exercise tests was similar (47 of 98 versus 48 of 98, respectively, p = NS). For the detection of coronary artery disease, the sensitivity was 50.0% for treadmill and 63.3% for supine bicycle (p less than 0.05) and the specificity was 73.5 versus 70.6%, respectively (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Cardiopulmonary exercise tests and lung cancer surgical outcome.

STUDY OBJECTIVES: Surgical resection remains the treatment of choice for anatomically resectable non-small cell lung cancer. However, the presence of associated comorbid conditions increases the risk of death and surgical complications. Several studies have evaluated the usefulness of preoperative exercise testing for predicting postoperative morbidity and mortality. The aim of this study was to establish whether exercise testing could predict poor surgical outcome in lung cancer surgery and whether the absolute value or percentage of predicted value is the better predictor of the surgical outcome. DESIGN: The study was designed as a prospective study. PATIENTS AND SETTING: One hundred thirty patients with potentially operable lung cancer at Papworth Hospital over 2 years were recruited; of these, 101 underwent curative surgery. INTERVENTIONS: Spirometry and cardiopulmonary exercise tests were performed for every patient (n = 99), except for two patients with back problems. We also recorded the outcome of surgery, in particular, complications and mortality. MEASUREMENTS AND RESULTS: Mean maximum oxygen transport at peak exercise (Vo(2)peak) was 18.3 mL/kg/min (SD, 4.7 mL/kg/min), and mean percentage of predicted Vo(2)peak value was 84.4% (SD, 30%). Poor surgical outcome was significantly related to Vo(2)peak percentage of predicted (p < 0.01) but not to the actual oxygen uptake value. CONCLUSIONS: The use of the percentage of predicted Vo(2)peak value would be a better indicator of surgical outcome, since it predicts the surgical outcome better, and corrects for normal physiologic ranges. The threshold of Vo(2)peak for surgical intervention could be set between 50% and 60% of predicted without excess surgical mortality.

Adult↗
PubMed1991

[Prediction of late restenosis using early treadmill exercise testing after PTCA].

The purpose of this study was to evaluate the capability of treadmill exercise testing early after percutaneous transluminal coronary angioplasty (PTCA) for prediction of restenosis during the follow-up period. Subjects were comprised of 30 patients with single vessel disease, in whom angiographic success immediately after PTCA was obtained. Follow-up coronary angiography at a mean of 3.5 months after initial PTCA demonstrated restenosis in 15 patients. Treadmill exercise testing was conducted before PTCA (pre-EX), at a mean of 11 days after PTCA (early-EX), and at a mean of 3.2 months after PTCA (late-EX). The degree of residual stenosis immediately after PTCA measured using videodensitometry was similar in both the groups with and without restenosis. In the non-restenosis group, Functional aerobic impairment (FAI), myocardial aerobic impairment (MAI), and heart rate impairment (HRI) measured in the early-EX period improved significantly compared to that in the pre-EX period (p less than 0.05, p less than 0.01, and p less than 0.05, respectively). There were no significant changes in the restenosis group. Using exercise parameters before and soon after PTCA, a discriminant analysis was made between these groups. The formula was defined as follows; Z = 0.0178 x (FAI of pre-EX) +0.0543x (FAI of early-EX) +0.0513x (MAI of pre-EX) -0.1056x (MAI of early-EX) -0.3135. Under this formula, 14 of the 17 patients with Z less than 0 had restenosis during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1978

The significance of hypotension developing during treadmill exercise testing.

The significance of hypotension developing during treadmill exercise testing was evaluated and correlated with the findings at cardiac catheterization in two groups of patients. Twenty-five patients (Group I) had a fall in systolic pressure during exercise and were compared to 50 consecutive unselected patients (Group II) with a normal blood pressure response. Clinical characteristics were similar in both groups. Females comprised 48 per cent of the patients in Group I and only 30 per cent in Group II. The incidence of significant coronary artery disease was not different when the two groups were compared as a whole, 56 per cent in Group I and 36 per cent in Group II (P = NS). When males and females were considered separately, it was noted that the incidence of coronary artery disease was higher in hypotensive males (77 per cent) when compared to control males (40 per cent) (p less than 0.01). Females in both groups had a lower but comparable incidence of coronary artery disease (25 per cent and 27 per cent, respectively). Resting hemodynamics and angiographic characteristics, such as contraction abnormalities, and the number and distribution of diseased coronary vessels, were similar in both groups of patients. These findings suggest that hypotension in females does not necessarily connote coronary artery disease. Males with hypotension have a higher incidence of coronary artery disease, but the extent and distribution of their disease is no different from that of patients with a normal blood pressure response to exercise.

Adult↗
PubMed1985

[Prediction of the presence and severity of coronary arteriopathy and left ventricular dysfunction by discriminant multivariate analysis of the exercise test].

266 male p., with chest pain and without previous myocardial infarction were studied by exercise test and coronary arteriography. 17 had no coronary disease (group C-0), 22 had less than or equal to 50% coronary stenosis (C-1), 65 had severe 1 vessel disease (C-2), 73 had 2 vessel disease (C-3), 89 had 3 vessel disease (C-4). 95 had normal ventricular function (group V-0), 111 had hypokinetic ventricular segments (V-1) and 60 had akinetic ventricular segments (V-2). 11 exercise test variables were stepwise selected to discriminate the C-groups and the V-groups. For C-groups significant variables were: test result, heart rate increment, number of leads, work load, rate-pressure product, systolic pressure increment. By 4 discriminant functions, 41% p. were correctly classified. For V-groups significant variables were: hear rate increment, test result, effort angina, rate-pressure product, number of leads, ST depression, ST configuration, age. By 2 discriminant functions 53% p. were correctly classified.

Adult↗
PubMed1994

Utility and safety of immediate exercise testing of low-risk patients admitted to the hospital for suspected acute myocardial infarction.

More than 2 million patients are admitted to U.S. hospitals annually for clinical suspicion of acute myocardial infarction (AMI), and > 70% are found not to have had a cardiac event. This study evaluates the safety and efficacy of immediate exercise testing for patients admitted to the hospital for suspected AMI. Ninety-three nonconsecutive low-risk patients admitted to the hospital from the emergency department to rule out AMI underwent exercise treadmill testing using a modified Bruce protocol immediately on admission to the hospital (median time < 1 hour). Twelve patients had positive exercise electrocardiograms, 6 of whom had significant coronary narrowing by angiography. An uncomplicated non-Q-wave AMI was diagnosed in 1 patient. Fifty-nine patients had negative and 22 patients had nondiagnostic exercise electrocardiograms. Of these 81 patients, 44 were discharged immediately after exercise testing, 17 were discharged within 24 hours, and 20 were discharged after 24 hours of observation. There were no complications from exercise testing. There were 2 late noncardiac deaths and 1 late AMI. Thus, immediate exercise testing of low-risk patients with chest pain who are at sufficient risk to be designated for hospital admission is effective in further stratifying this group into those who can be safely discharged immediately and those who require hospitalization.

Adult↗
PubMed1993

Impact of treatment strategy on predischarge exercise test in the Thrombolysis in Myocardial Infarction (TIMI) II Trial.

Predischarge supine bicycle ergometry was used to assess persistent myocardial ischemia in postinfarction patients who received thrombolytic therapy and were randomized to an invasive versus conservative strategy in the Thrombolysis in Myocardial Infarction (TIMI) II trial. The frequency of ischemic responses in both strategies, and the 1-year prognostic importance of the different exercise test outcomes were examined. At 14 days, the percentage of patients with any adverse outcome (including death, presence of exercise-induced ST-segment depression, or inability to perform the exercise test) was 33.7% of 1,681 randomly assigned to the invasive strategy compared with 34.6% of 1,658 randomly assigned to the conservative strategy (p = 0.57). The 1-year mortality was greater in patients who did not perform the predischarge exercise test (7.7%) than in those who did (1.8%) (p < 0.001); the former were older, and a greater proportion were women, had a more frequent history of myocardial infarction, and more extensive coronary artery disease (p < 0.01 for each comparison). The 1-year mortality in patients with exercise-induced ST-segment depression or chest pain was only 1.4% (3 of 22) among those randomly assigned to the conservative strategy where coronary angiography and revascularization were recommended if the test result was abnormal (relative risk compared with those without ST-segment depression or chest pain 0.6; 99% confidence interval 0.1 to 2.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1994

Biochemical changes in relation to a maximal exercise test in patients with fibromyalgia.

Patients with fibromyalgia often complain of fatigue and pain during exercise and of worsening of pain days after exercise. The aim of the study described here was to determine if abnormal changes in potassium or lactate could be observed during an exercise test in fibromyalgia. Whether an abnormal incline in plasma creatine kinase or myoglobin could be observed days after the test was studied also. Fifteen female fibromyalgia patients and 15 age- and sex-matched controls performed a stepwise incremental maximal bicycle-ergometer test. Blood samples were collected from a catheter in a cubital vein. The changes in heart rate, potassium levels, and haematocrit during the exercise test were similar in the two groups. The maximal obtained lactate concentration was 4.2 mmol l-1 (3.5-5.6) in the patients as compared to 4.9 mmol l-1 (3.9-5.9) in the controls (NS). The estimated anaerobic threshold of 2 mmol l-1 was reached at a heart rate of 124 min-1 in the patients with fibromyalgia as compared to 140 min-1 in the controls (P = 0.02). In relation to workload, the patients scored higher on a Borg scale for perceived exertion during exercise, but if the Borg score was related to lactate no significant difference was found. The patients reported 86% and 79% of maximal pain in the thighs on the visual analogue scale 1 and 2 days after the test, but the creatine kinase and myoglobin concentrations were not increased.

Adult↗
PubMed1992

Symptom-limited graded treadmill exercise testing in young adults in the CARDIA study.

Symptom-limited, graded exercise treadmill testing was performed by 4,968 white and black adults, ages 18-30 yr, during the baseline examination for the CARDIA study. The mean estimated maximal exercise capacity by race/gender, expressed as metabolic units (METS), was: white men 13.8, black men 13.0, white women 11.1, and black women 9.4. Exercise test duration was higher in nonsmokers, positively related to physical activity score and pulmonary function (FEV1.ht-2), and inversely related to body mass index. Men had higher mean values than women for both test duration and a measure of submaximal performance, the workload 130 (WL130, the exercise test duration to a heart rate of 130 beats.min-1). Adjusted for age and education, white men had a longer mean test duration than black men (53 s longer, P less than 0.001), but nearly equal mean WL130. White women had higher mean values than black women for both test duration (114 s longer, P less than 0.001) and WL130 (36 s longer, P less than 0.001). Men had higher mean values than women for both outcome measures (P less than 0.001). Thus, in young adults significant gender and ethnic differences exist for exercise test performance, part of which can be explained by personal habits or traits.

Adolescent↗