Role Of Exercise Testing Research Articles

Can Self-Reported Tolerance of Exercise Intensity Play a Role in Exercise Testing?

To examine the relationship between self-reported tolerance of exercise intensity, measured by the Preference for and Tolerance of Exercise Intensity Questionnaire, and the amount of time individuals persevered during incremental treadmill tests to volitional fatigue beyond the point at which they had reached their ventilatory threshold. The participants in study 1 were college age and physically active (14 women, 16 men). The participants in study 2 were 24 middle-aged women who were healthy but sedentary. Tolerance was related to the duration after the ventilatory threshold, and this relationship remained after age, body mass index, and self-reported frequency and duration of habitual physical activity (study 1) or after age, body mass index, and maximal aerobic capacity (study 2) had been taken into account. Self-reports of exercise intensity tolerance might account for variability in the extent to which individuals persevere during exercise tests. Identifying individuals predisposed to under- or overexertion could be of value in exercise testing and prescription.

The Role of Exercise Testing in the Management of Pulmonary Arterial Hypertension

The assessment of exercise capacity is of critical importance in the evaluation and management of patients with moderate to severe pulmonary arterial hypertension (PAH). The practicing clinician uses various exercise modalities in evaluating and managing patients with PAH. These include the 6-minute walk test (6MW), cardiopulmonary exercise testing, and exercise echocardiography. The change in exercise capacity appears to parallel other clinical indicators of disease severity, such as survival, hemodynamics, and time to clinical worsening. Exercise testing can aid the clinician in outlining the nature of a patient's exercise limitation, noninvasively assessing disease severity, establishing prognosis, and evaluating the response to therapy. Additional work must be done to validate the utility of measuring exercise capacity in patients with less severe PAH.

Preoperative Evaluation of Patients Submitted to Pneumonectomy for Lung Carcinoma: Role of Exercise Testing

The aim of the present investigation was to evaluate which parameters of preoperative spirometry, arterial blood gas, radionuclide lung scanning and cardiopulmonary exercise test are the best predictor of postoperative morbidity and mortality in patients submitted to pneumonectomy. The study was conducted in 150 patients (mean age, 57.1). Forty-four patients (29.3%) had postoperative complications. Four patients (2.7%) died within one month of the pneumonectomy. Patients with complications had significantly lower ppoFEV1 as percentage of predicted and lower VO2 max, and those who died also had a significant decrease in PaO2 during exercise. Moreover, among patients with obstructive pulmonary disease (FEV1<70% of predicted), we found a significantly higher percentage predicted residual volume and a significantly lower VO2 max in complicated patients. The present data support the suggestion that exercise testing could be a useful adjunct in the evaluation of postoperative risk for pneumonectomy, especially in patients with obstructive pulmonary disease. In particular, patients with VO2 max <50% of predicted should be considered at high risk of morbidity from cardiopulmonary causes.

Coronary artery stent thrombosis associated with exercise testing

Chest pain following coronary artery stenting is common, yet finding the cause can be difficult. Exercise testing has long been used in the assessment of chest pain, but its usefulness in patients who have recently undergone coronary artery stenting is in doubt. A case of exercise testing appearing to precipitate acute stent thrombosis in a patient several weeks post-coronary artery stenting is reported and compared to a similar case in the literature. The role of exercise testing in the assessment of chest pain early after coronary artery stenting is then reviewed.

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.

Role of Exercise Testing in the Functional Assessment of Cerebral Palsy Children After Botulinum A Toxin Injection

The purpose of this clinical prospective study was to assess the effect of intramuscular injections of botulinum toxin A on energy cost of movement and walking endurance in 15 children with cerebral palsy, aged 4 to 13 years, by using incremental walking treadmill protocol to voluntary exhaustion. Oxygen-uptake response to exercise stress and endurance time were analyzed before and 2 and 6 months after botulinum toxin A injection. Endurance time was significantly improved 2 months after botulinum toxin A injection in 13 patients, and a residual improvement was still present 6 months after injection in some of them. The effect of botulinum toxin A on energy cost of movement was very variable. This study provides clinical evidence of the efficacy of botulinum toxin A in reducing the energy cost of movement and in improving the endurance of spastic muscles in children with cerebral palsy.

Determinants of exercise-induced ST-segment displacement in the aVL lead in patients with known or suspected coronary artery disease.

Although the aVL lead in exercise electrocardiography is reported to be helpful in identifying a significant narrowing of the left anterior descending coronary artery (LAD), its role in exercise testing has not been fully evaluated. Accordingly, 821 patients who underwent both standard exercise testing and coronary angiography were evaluated. In patients with aVL lead ST elevation, the incidence of a significant narrowing of the LAD (124/165 vs 348/656; p<0.001) was higher than in those without. Multiple logistic regression analysis revealed that the 2 most important variables that correlated with aVL lead ST elevation were a greater number of leads with ST depression in the inferior leads and a smaller amplitude of R wave in the aVL lead. In contrast, variables correlating with aVL lead ST depression in the majority of cases were a greater number of leads with ST depression in all leads and the presence of inferior lead ST elevation. The results of this study indicate that although aVL lead ST elevation could be a marker for LAD narrowing, more important factors such as inferior lead ST-segment depression and the R-wave amplitude of the aVL lead should be taken into consideration. In contrast, ST depression in the aVL lead mostly represents exercise-induced myocardial ischemia of greater extent and severity.

The Role of Exercise Testing in Interstitial Lung Disease

The Role of Exercise Testing in Interstitial Lung Disease

The Role of Exercise Testing in Heart Failure

The Role of Exercise Testing in Heart Failure

Determination of agreement between cardiopulmonary and standard ECG stress testing in coronary artery disease

The agreement between the results of standard ECG (CX) and cardiopulmonary (CPX) exercise stress tests performed in randomized sequence was evaluated in 40 patients with known coronary artery disease but who were not taking cardioactive therapy. Systolic blood pressure and heart rate were significantly higher during CPX only at low workload (less than 100 W). Exercise time and rate-pressure product at both peak exercise and ischaemic threshold were not significantly different between the two tests, even though their variability exceeded the value of 20%, which is generally accepted as the cut-off point for defining CX parameters as reproducible. However, the metabolic response to exercise, assessed by means of blood lactate kinetics analysis, was highly reproducible between the two tests. We conclude that the provocative role of exercise testing is not altered by the gas exchange analysis technique used in CAD patients. However, the common indexes of myocardial as well as of global physical performance may be influenced, thus requiring caution in comparing data with those derived from CX or from reference values.

The Role of Exercise Testing in Heart Failure

The objectives of exercise testing in congestive heart failure (CHF) may be summarized as follows: (a) detect impaired cardiac performance, (b) grade severity of cardiac failure and classify functional capability, and (c) assess effects of interventions. Several different methods are available to make these assessments, and we have to ask ourselves how well exercise testing achieves these objectives. It has to be kept in mind that the power generated by the exercising muscles is dependent on the oxygen delivery to the skeletal muscles. Oxygen uptake is the result of an integrated performance of the lungs, heart, and peripheral circulation. In patients, as well as in normal subjects, oxygen uptake is related to hemodynamic indices such as cardiac output, stroke volume, or exercise duration when a stepwise regulated maximal exercise protocol is used. However, there are major differences in the concept of a true maximum in normal subjects versus heart failure patients. Fit-normal subjects will achieve a real maximal oxygen uptake, whereas patients may stop testing before a maximum is reached because of symptoms such as dyspnea or leg fatigue. Therefore, it is better if the actual oxygen uptake can be measured. "Peak" rather than true maximal oxygen uptake has been suggested for the classification of the severity of heart failure. Peripheral factors modify the cardiac output through such factors as vascular resistance, organ function, and hormonal release. Maximal exercise will stress the cardiovascular system to a point where the weakest chain will impose a limiting effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of patients for coronary artery bypass surgery: The role of exercise testing

Evaluation of patients for coronary artery bypass surgery: The role of exercise testing

Exercise in congenital heart disease

SummaryExercise is of both physical and psychological benefit in children with congenital heart disease, leading to improved cardiovascular fitness and better quality of life. In such children, however, capacity for exercise is often impaired, and there is a risk of exercise-induced mortality or morbidity. We have reviewed the abnormal cardiovascular response to exercise in children with congenital heart defects and postoperative residua, and the role of exercise testing and training in their diagnosis and treatment. Some patients should be excluded absolutely from all but mild regular exercise because of known high risk; for example, those with severe aortic or subaortic stenosis. Other patients should be encouraged to participate in sports without any limitation; for example, those with small left-to-right shunts or mild valvar regurgitation. In many patients strict recommendations cannot be made, and one must consider the individual, the lesion and its hemodynamic implications, and the type and level of exercise contemplated. Children with congenital heart disease should be encouraged to participate in exercise and recreational sport within the limits provided by their cardiovascular defect. Understanding the pathophysiology of these defects, and knowledge of the risk of exercise in certain conditions, will allow the physician to make sensible recommendations for participation in exercise by individual patients.

The Role of Exercise Testing in Screening for Coronary Artery Disease

To predict the effects of using exercise testing to screen healthy persons for coronary artery disease. The publications of the Coronary Artery Surgery Study were the principal sources of data for the cost-effectiveness analysis; we also used data from the Veterans Administration Cooperative Study of stable angina and the publications of the European Coronary Surgery Study Group. We used studies that provided the data that our decision model required--life expectancy and probabilities of outcomes in persons who have or do not have coronary artery disease. We did not use a structured method for abstracting data. We tested the susceptibility of our conclusions to poor quality of data by substituting a wide range of values for a variable in the decision model, and by calculating life expectancy and costs if screening was used routinely or not used. We assumed that persons with an abnormal exercise test would have arteriography and that persons with severe coronary artery disease would have bypass surgery. When there were no suitable published data for the model, we made assumptions that favored screening. The model predicts that screening would increase the life expectancy of 60-year-old men at average risk by at most 12 days. Sixty-year-old men with no risk factors for coronary artery disease would derive less benefit, as would women and younger men. The effect of exercise testing is too small to justify doing this procedure routinely in healthy persons. If coronary bypass surgery is found to prolong life in asymptomatic persons as much as it does in angina pectoris, screening older men with risk factors for coronary artery disease may prove to be worthwhile.

The role of exercise testing in evaluation of arrhythmias

Exercise testing has been widely applied for the evaluation of patients with coronary artery disease. The principles underlying its use for this indication make it a useful adjunctive technique, when combined with ambulatory monitoring, to diagnose arrhythmias and monitor antiarrhythmic drug therapy. During exercise, there is a withdrawal of vagal tone and a marked increase in circulating catecholamines and sympathetic inputs to the heart. These changes may directly cause arrhythmias (e.g., catecholamines can enhance automaticity and delayed afterpotentials and can shorten myocardial conduction time and refractory periods). However, they also augment myocardial oxygen demands by increasing myocardial inotropy, heart rate and blood pressure. Such changes may cause ischemia in patients with heart disease, which is a powerful stimulus for arrhythmia, or lead to dysfunction in left ventricular contraction and increased myocardial wall stress, factors that also may precipitate arrhythmia. In approximately 10% of patients with a history of serious arrhythmia, exercise represents the only means for exposing arrhythmia. Importantly, this technique is useful for evaluating the effect of antiarrhythmic drugs. These agents work by reducing membrane automaticity, slowing impulse conduction through the myocardium and prolonging membrane refractoriness. In contrast, catecholamines, which are secreted in response to exercise, have the opposite effect. Thus, exercise may negate the important effects of the antiarrhythmic drugs. Additionally, exercise testing may expose potentially serious toxic drug reactions that may not be obvious at rest. These include conduction abnormalities, negative inotropic effects, congestive heart failure and aggravation of arrhythmia. Although the presence and frequency of arrhythmia with exercise is highly variable in patients with benign arrhythmia, results are more consistent in patients with a history of serious arrhythmia. If arrhythmia is reproducibly provoked with exercise, this technique can be used to judge drug effect. Thus, exercise testing is an important, reliable and helpful technique for exposing arrhythmia, evaluating drug efficacy and identifying potentially serious toxic drug effects.

Prognostic Value of Bicycle Ergometry in Medically Treated Patients with Three-vessel Coronary Artery Disease

“Patients with three-vessel coronary artery disease and stable angina assigned to coronary bypass surgery had an improved survival in the European Coronary Surgery Study. 1 European Coronary Surgery Study Croup Long term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet. 1982; 2: 1173-1180 Google Scholar In the Coronary Artery Surgery Study 2 Passamani E Davies KB Gillespie MJ Killip T CASS Principal Investigators and their Associates Coronary Artery Surgery Study (CASS): a randomized trial of coronary artery bypass surgery: survival of patients with a low ejection fraction. N Engl J Med. 1985; 312: 1665-1671 Crossref PubMed Scopus (499) Google Scholar and in the Veterans Administration Cooperative Study, 3 Takaro T Hultgren HN Detre KM Peduzi P The Veterans Administration Cooperative Study of stable angina: current status. Circulation. 1982; 65: 60-67 Crossref PubMed Google Scholar improved survival in the surgical group was confirmed only in patients with three-vessel disease accompanied by impaired left ventricular function. Exercise testing has had prognostic significance in other studies, and the objective evidence of ischemia during exercise identifies a subgroup of patients with three-vessel disease at increased risk of dying during medical therapy. 4 McNeer JF Margolis JR Lee KL Kisslo JA Peter RH Kong Y et al. The role of the exercise test in the evaluation of patients for ischemic heart disease. Circulation. 1978; 57: 64-70 Crossref PubMed Scopus (383) Google Scholar , 5 Weiner DA Ryan TJ McCabe CH Chaitman BR Sheffield T Fisher LD et al. The role of exercise testing in identifying patients with improved survival after coronary bypass surgery. J Am Coll Cardiol. 1986; 8: 741-748 Abstract Full Text PDF PubMed Scopus (110) Google Scholar , 6 Bonow RO Kent KM Rosing DR Cordon Lan KK Lakatos E Borer JS et al. Exercise-induced ischemia in mildly symptomatic patients with coronary artery disease and preserved left ventricular function. N Engl J Med. 1984; 311: 1339-1345 Crossref PubMed Scopus (175) Google Scholar “Patients with three-vessel coronary artery disease and stable angina assigned to coronary bypass surgery had an improved survival in the European Coronary Surgery Study. 1 European Coronary Surgery Study Croup Long term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet. 1982; 2: 1173-1180 Google Scholar In the Coronary Artery Surgery Study 2 Passamani E Davies KB Gillespie MJ Killip T CASS Principal Investigators and their Associates Coronary Artery Surgery Study (CASS): a randomized trial of coronary artery bypass surgery: survival of patients with a low ejection fraction. N Engl J Med. 1985; 312: 1665-1671 Crossref PubMed Scopus (499) Google Scholar and in the Veterans Administration Cooperative Study, 3 Takaro T Hultgren HN Detre KM Peduzi P The Veterans Administration Cooperative Study of stable angina: current status. Circulation. 1982; 65: 60-67 Crossref PubMed Google Scholar improved survival in the surgical group was confirmed only in patients with three-vessel disease accompanied by impaired left ventricular function. Exercise testing has had prognostic significance in other studies, and the objective evidence of ischemia during exercise identifies a subgroup of patients with three-vessel disease at increased risk of dying during medical therapy. 4 McNeer JF Margolis JR Lee KL Kisslo JA Peter RH Kong Y et al. The role of the exercise test in the evaluation of patients for ischemic heart disease. Circulation. 1978; 57: 64-70 Crossref PubMed Scopus (383) Google Scholar , 5 Weiner DA Ryan TJ McCabe CH Chaitman BR Sheffield T Fisher LD et al. The role of exercise testing in identifying patients with improved survival after coronary bypass surgery. J Am Coll Cardiol. 1986; 8: 741-748 Abstract Full Text PDF PubMed Scopus (110) Google Scholar , 6 Bonow RO Kent KM Rosing DR Cordon Lan KK Lakatos E Borer JS et al. Exercise-induced ischemia in mildly symptomatic patients with coronary artery disease and preserved left ventricular function. N Engl J Med. 1984; 311: 1339-1345 Crossref PubMed Scopus (175) Google Scholar

The role of exercise testing in chronic heart failure.

The role of exercise testing in chronic heart failure.

Arrhythmias in children: the influence of exercise and the role of exercise testing.

Arrhythmias in children: the influence of exercise and the role of exercise testing.

Detection of Anatomically Severe Coronary Artery Disease by the ST/HR Slope

Detection of Anatomically Severe Coronary Artery Disease by the ST/HR Slope

The Role of Exercise Testing in Pulmonary Diagnosis

Exercise stresses the body's functional reserves that allow for the increased metabolic work and gas transport necessary for the efficient production of energy with physical activity or stress. Disease that reduces reserve in the gas transport organs will produce exertional symptoms not present at rest. Exercise testing has been well established in the evaluation of healthy persons and cardiac patients who are limited by cardiac or peripheral muscle function. For patients with lung disease, however, whose exercise performance is limited by reduced ventilatory capacity and disordered gas exchange, principles of exercise testing (and training) are different. In the evaluation of pulmonary patients, exercise testing can be used to measure exercise tolerance, assess the limitation to exercise in patients with unexplained dyspnea, evaluate patients for respiratory disability, assess blood gas changes with exercise, and detect exercise-induced asthma. Nevertheless, our understanding of the role of exercise in pulmonary diagnosis is at an early stage of development and much needs to be learned about the practical applications of exercise testing in the diagnosis, staging, and serial evaluation of pulmonary diseases.