Role Of Exercise Testing Research Articles

Perioperative Exercise Testing in Pregnant and Non-Pregnant Women of Reproductive Age: A Systematic Review.

Women have classically been excluded from the development of normal data and reference ranges, with pregnant women experiencing further neglect. The incidence of Caesarean section in pregnant women, and of general operative management in young women (both pregnant and non-pregnant), necessitates the formal development of healthy baseline data in these cohorts to optimise their perioperative management. This systematic review assesses the representation of young women in existing reference ranges for several functional exercise tests in common use to facilitate functional assessment in this cohort. Existing reference range data for the exercise tests the Six Minute Walk Test (6MWT), the Incremental Shuttle Walk Test (ISWT) and Cardiopulmonary Exercise Testing (CPET) in young women of reproductive age were assessed using the MEDLINE (Ovid) database, last searched December 2023. Results were comparatively tabulated but not statistically analysed given underlying variances in data. The role of exercise testing in the perioperative period as an assessment tool, as well as its safety during pregnancy, was evaluated using 65 studies which met inclusion criteria. There is a significant lack of baseline data regarding these tests in this population, especially amongst the pregnant cohort, which limits the application of exercise testing clinically.

The Role of Pulmonary Function Testing in the Diagnosis and Management of COPD.

Pulmonary function testing (PFT) has a long and rich history in the definition, diagnosis, and management of COPD. For decades, spirometry has been regarded as the standard for diagnosing COPD; however, numerous studies have shown that COPD symptoms, pathology, and associated poor outcomes can occur, despite normal spirometry. Diffusing capacity and imaging studies have called into question the need for spirometry to put the "O" (obstruction) in COPD. The role of exercise testing and the ability of PFTs to phenotype COPD are reviewed. Although PFTs play an important role in diagnosis, treatment decisions are primarily determined by symptom intensity and exacerbation history. Although a seminal study positioned FEV1 as the primary predictor of survival, numerous studies have shown that tests other than spirometry are superior predictors of mortality. In years past, using spirometry to screen for COPD was promulgated; however, this only seems appropriate for individuals who are symptomatic and at risk for developing COPD.

PH Roundtable: Tailoring CTEPH Imaging for Evaluation and Postintervention Assessment—What Works and What’s New?

PH Roundtable: Tailoring CTEPH Imaging for Evaluation and Postintervention Assessment—What Works and What’s New?

Role of Exercise Testing and Speckle Tracking Echocardiography in Paradoxical Severe Aortic Stenosis.

IntroductionThe clinical behavior and prognosis of patients with asymptomatic paradoxical low-gradient aortic stenosis (PLGAS) still remain controversial. Some authors consider PLGAS as an echocardiographically poorly quantified moderate AS (MAS). We aimed to investigate the clinical behavior of PLGAS by comparing it with that of asymptomatic high-gradient aortic stenosis (HG-AS) and MAS using transthoracic echocardiography (TTE) with speckle tracking imaging (STI) and cardiopulmonary exercise testing (CPET). The hypothesis of our study is, unlike that described by other authors, to demonstrate the existence of clinical and echocardiographic differences between PLGAS and MAS.MethodsA cohort of 113 patients was included and categorized into three groups according to AS type: MAS (n=63), HG-AS (n=29), and PLGAS (n=21). Patients’ clinical data were obtained. Patients underwent 2D TTE with STI and CPET.ResultsThere were no significant differences in the clinical variables between the three AS groups. In the multivariate multinomial logistic regression analysis, with PLGAS being the reference category, the most powerful variable for establishing a difference with HG-AS was the left ventricular mass (LVM) indexed by body-surface area (odds ratio [OR]=1.04, confidence interval (CI)=1.01-1.06, p<0.05). The MAS group showed less abnormal CPET (OR=0.198, CI=0.06-0.69, p<0.05), and higher left ventricle global longitudinal strain rate (GLSR) (OR=0.003, CI=0.00-0.35, p<0.05) than the PLGAS group.ConclusionsTTE with STI and CPET established the clear differences between patients with asymptomatic PLGAS and those with asymptomatic MAS, as well as the similarities between patients with PLGAS and those with HG-AS. Our data identify PLGAS as a completely different entity from MAS.

Characteristics of Second-Line Investigations of Middle-Aged Athletes Who Failed Preparticipation Examinations.

The role of exercise testing during preparticipation examinations (PPEs) of middle-aged athletes is uncertain. This study examined the characteristics of disqualifications after an initial PPE that includes an exercise test in competitive athletes older than 30 years. We investigated disqualification rates and reasons, second-line investigations performed, and final decisions regarding competitive sports participation. Chart review. Sports medicine clinic. Athletes aged >30 years that performed an exercise test as part of their annual PPE at our sports medicine clinic (n = 866). Age, sex, height, weight, sport type, cardiovascular risk factors, and abnormal PPE findings. Additional investigations performed, approval/disqualification regarding competitive sports participation. The initial disqualification rate of athletes was 9.8%. Three (3.6%) athletes were disqualified following questionnaire and physical examination, 19 (22.4%) because of resting electrocardiogram findings, and 65 (76.5%) following the exercise test. After additional work-up, only 5 athletes (0.4%) were ultimately found ineligible for competitive sports. From those, only 2 athletes (0.2%) were disqualified because of exercise test findings, which were episodes of supraventricular tachycardia and not ischemia-related. The addition of an exercise test to the PPE of middle-aged athletes is of limited value. If exercise testing of older athletes is performed, arrhythmias are probably of higher significance than ST-T changes.

Evaluating poor exercise tolerance in children and adolescents and the role of exercise testing

Evaluating poor exercise tolerance in children and adolescents and the role of exercise testing

Exercising caution: is there a role for exercise testing in the hypertrophic cardiomyopathy population?

Exercising caution: is there a role for exercise testing in the hypertrophic cardiomyopathy population?

Practice Variations in Exercise Training Programs in Dutch Cardiac Rehabilitation Centers: Prospective, Observational Study.

A recent survey among Dutch cardiac rehabilitation centers demonstrated considerable between-center variations in the contents of exercise training programs. For patients entering cardiac rehabilitation, current guidelines recommend tailored exercise training programs based on patient characteristics and rehabilitation goals. This study was to analyze to what extent these patient characteristics are determinants of variations in training programs. This was a prospective, observational study with cross-sectional measurements among 10 cardiac rehabilitation centers. The following data were obtained about patients entering cardiac rehabilitation: referral diagnosis, rehabilitation goals, and exercise training variables. Primary outcomes were variations in total aerobic training time, intensity, and volume before and after case-mix correction for population differences between centers. Secondary outcomes were variations in other training characteristics and the role of exercise testing in the determination of training intensity. Also, the roles of diagnosis and training goals in determining aerobic training time and intensity were studied. Data from 700 participants were analyzed. There were significant variations between centers in all aerobic and most resistance training characteristics. For aerobic training intensity, time, and volume, great variations remained after case-mix correction. An exercise test was performed for 656 participants (93.7%) but was used to determine training intensity in only 344 (52.4%) of these participants. In most centers, referral diagnosis and rehabilitation goals were unrelated to aerobic training time or intensity. Some form of selection bias cannot be excluded because the competing centers represented a minority of Dutch exercise-based cardiac rehabilitation centers. This study showed that the contents of training programs varied considerably between cardiac rehabilitation centers, independent of population differences. Furthermore, aerobic training time and intensity were mostly unrelated to rehabilitation goals and referral diagnosis.

The role of exercise testing in predicting successful ambulation with a lower extremity prosthesis: a systematic literature review and clinical practice guideline

BackgroundGrowing discontent with the k-level system for functional classification of patients with limb loss and movement of healthcare toward evidence-based practice has resulted in the need for alternative forms of functional classification and development of clinical practice guidelines to improve access to quality prosthetic interventions. The purpose of this project was to develop and present a clinical practice recommendation for exercise testing in prosthetic patient care based on the results and synthesis of a systematic literature review.MethodsDatabase searches of PubMed, Google Scholar, Web of Science, and Cochrane were conducted and articles reviewed. Of the potential 1386 articles 10 met the criteria for inclusion. These articles were assessed using the critical appraisal tool of the United Kingdom National Service Framework for Long-Term Conditions. Of the 10 included articles eight were of high, one of medium, and one of low, quality. Data from these articles were synthesized into 6 empirical evidence statements, all qualifying for research grade A. These statements were used to develop the proposed clinical practice guideline.ResultsWhile the results of this systematic review were not able to support the direct connection between cardiorespiratory performance and K-levels, the literature did support the ability of exercise testing results to predict successful prosthetic ambulation in some demographics. Both continuous maximum-intensity single lower extremity ergometer propelled by a sound limb and intermittent submaximal upper extremity ergometer protocols were found to be viable evaluation tools of cardiorespiratory fitness and function in the target population.ConclusionThe ability to sustain an exercise intensity of ≥50% of a predicted VO2max value in single leg cycle ergometry testing and achievement of a sustained workload of 30 W in upper extremity ergometry testing were found to be the strongest correlates to successful ambulation with a prosthesis. VO2 values were found to increase in amputee subjects following a 6-week exercise program. These synthesized results of the systematic literature review regarding exercise testing in patients with loss of a lower extremity were used to develop and a present a clinical treatment pathway.

P169 Rates Of Recovery Of Oxygen Consumption And Heart Rate After Cardiopulmonary Exercise Testing Predict Survival In Patients With Precapillary Pulmonary Hypertension

Introduction Several cardiopulmonary exercise testing (CPET) variables have been shown to predict prognosis in pulmonary hypertension (PH). 1 Recently published data suggests that novel variables such as oxygen uptake efficiency slope (OUES), i.e. the relationship between VO 2 and log-transformed ventilation 2 and heart rate recovery (HRR), the rate of decline of heart rate at one minute after an incremental CPET, have been shown to predict survival in a cohort of PH patients. We aimed to study the prognostic significance of the rate of recovery of VO 2 after incremental CPET alongside HRR and OUES in a large cohort of patients with precapillary PH. We hypothesised that a slower VO 2 recovery would be associated with poorer survival and that we could confirm that lower HRR and OUES are significantly associated with a worse outcome. Method Retrospective analysis was undertaken of data from108 incident patients who underwent CPET at the time of diagnosis of Group I or IV PH. Univariate Cox proportional hazard analyses were undertaken to assess the prognostic significance of the variables considered and the results are shown in Table 1. Results [Table 1] Conclusions The degree of VO 2 recovery at 120 seconds after incremental CPET is predictive of survival in this relatively large group of patients with precapillary PH. We have also confirmed the findings seen in another centre of a significant influence of heart rate recovery and OUES on survival. Further work should focus on whether these variables provide additional prognostic information over their more traditionally studied counterparts. References Johnson MJ, Thomson SD. The role of exercise testing in the modern management of pulmonary arterial hypertension Diseases 2014;2(2):120–47 Ramos, et al . Exercise oxygen uptake efficiency slope independently predicts poor outcome in pulmonary arterial hypertension. Eur Respir J 2014;43(5):1510–12

Role of Self-Reported Individual Differences in Preference for and Tolerance of Exercise Intensity in Fitness Testing Performance

Performance in fitness tests could depend on factors beyond the bioenergetic and skeletomuscular systems, such as individual differences in preference for and tolerance of different levels of exercise-induced somatosensory stimulation. Although such individual-difference variables could play a role in exercise testing and prescription, they have been understudied. The purpose of these studies was to examine the relationships of self-reported preference for and tolerance of exercise intensity with performance in fitness tests. Participants in study I were 516 men and women volunteers from a campus community, and participants in study II were 42 men recruit firefighters undergoing a 6-week training program. Both the Preference and Tolerance scores exhibited significant relationships with performance in several fitness tests and with body composition and physical activity participation. Preference and Tolerance did not change after the training program in study II, despite improvements in objective and perceived fitness, supporting their conceptualization as dispositional traits. Preference and Tolerance scores could be useful not only in ameliorating the current understanding of the determinants of physical performance, but also in personalizing exercise prescriptions and, thus, delivering exercise experiences that are more pleasant, tolerable, and sustainable.

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

A culture of exercise testing is firmly embedded in the management of pulmonary arterial hypertension (PAH) but its clinical relevance and utility have recently been under some debate. The six minute walk test (6MWT) has been used as a primary outcome measure to enable the licensing of many of the medications used for this condition. Recent reviews have questioned the validity of this test as a surrogate of clinical outcomes. At the same time, other questions are emerging where exercise testing may be the solution. With the rise in understanding of genetic markers of idiopathic PAH (IPAH), the screening of an otherwise healthy population for incipient pulmonary hypertension (PH) will be required. The proliferation in treatment choices and identification of populations with PH where PAH treatment is not indicated, such as left heart and lung disease, requires more definitive differentiation from patients with PAH. There is a continuing question about the existence and clinical relevance of exercise induced PAH as a cause of unexplained dyspnoea and fatigue and as a latent phase of resting PH. This review presents a summary and critical analysis of the current role of exercise testing in PAH and speculates on future trends.

Role of exercise testing in assessment of the cardiovascular system function in Zarda users

Background: Zarda is a widely used form of smokeless tobacco in India. Cigarette smoking has extensive effects on cardiovascular functions. Zarda is prepared by the user by mixing tobacco with lime in the palm and gives the user the choice to change the combination. This study aims to determine the effect of Zarda on the cardiovascular system adaptability to exercise. There are conflicting opinions about the degree of adaptability of the cardiovascular system in delivering the physiological needs in case of severe exercise. Role of the normal cardiovascular system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. The effect of Zarda usage on this phenomenon is studied here. Materials and Methods: Cardiovascular functions were assessed after maximal exercise testing by recording parameters such as maximum heart rate (HR), delta HR, recovery HR and maximum oxygen pulse in two groups' viz., Zarda users and non-user controls. Results: On studying the differences in cardiovascular functions in users and controls, there was a significant difference in maximum HR. The other parameters such as delta HR and maximum oxygen pulse were on the higher side in controls while the recovery HR was significantly lower in the control group, which was consistently maintained after exercise testing. Based on these findings it is suggested that there is a higher adaptability of the cardiovascular system to the exercise stimulus in the form of better VO 2 max, faster recovery of the exercise HR and a lesser risk for cardiovascular mortality as suggested by the higher delta HR in non-Zarda users.

Role of exercise testing in assessment of cardiovascular system function in Zarda users

Background: Zarda is a widely used form of smokeless tobacco in India. Cigarette smoking has extensive effects on cardiovascular functions. Zarda is prepared by a user by mixing tobacco with lime in palm and gives the user the choice to change the combination. This study aims to determine the effect of Zarda on cardiovascular system adaptability to exercise. There are conflicting opinions about the degree of adaptability of the cardiovascular system in delivering the physiological needs in case of severe exercise. A role of the normal cardiovascular system in delivering oxygen to meet the demands of various degrees of exercise has been a topic of considerable debate. The effect of Zarda usage on this phenomenon is studied here. Materials and Methods: Cardiovascular functions were assessed after maximal exercise testing by recording parameters like maximum heart rate, delta heart rate, recovery heart rate and maximum oxygen pulse in two groups, namely Zarda users and non-user controls. Results: On studying the differences in cardiovascular functions in users and controls, there was a significant difference found in maximum heart rate. The other parameters like delta heart rate and maximum oxygen pulse were on the higher side in controls while the recovery heart rate was significantly lower in the control group which was consistently maintained after exercise testing. Based on these findings it is suggested that there is a higher adaptability of the cardiovascular system to the exercise stimulus in the form of better VO 2 max, faster recovery of the exercise heart rate, and a lesser risk for cardiovascular mortality as suggested by the higher delta heart rate in non-Zarda users.

OP0227 Features and longitudinal analysis of systemic sclerosis patients with inappropriate exercise-induced increase in pulmonary artery pressure estimated by echocardiography

BackgroundPatients with Systemic Sclerosis (SSc) are at risk of developing pulmonary hypertension (PH). The role of exercise testing in predicting this severe complication is still debated. In SSc, a subset...

Integration of exercise evaluation into the algorithm for evaluation of patients with suspected heart failure with preserved ejection fraction

Approximately half of all patients with heart failure (HF) have a preserved left ventricular ejection fraction (HFPEF) and the prevalence of this form of HF is increasing. Although dyspnoea on exertion and diminished functional capacity is the key symptom of patients with HFPEF, current diagnostic criteria focus on resting indices of ventricular function. Specifically, current proposed criteria for the diagnosis of HFPEF, include clinical signs of HF; normal left ventricular systolic function; and evidence of abnormal diastolic performance and/or altered natriuretic peptides. By contrast, recent studies demonstrate that the key pathophysiologic features of HFPEF may not be evident at rest, and can only be detected during exertion. This review addresses the potential role of exercise testing using invasive haemodynamic or echocardiographic assessment in patients with suspected HFPEF in which current diagnostic criteria are not met.

The role of exercise testing in the interventional era: a shift of focus

The role of exercise testing has changed in the last decade, due to the development of new interventional treatment options, new cardiac biomarkers, as well as emerging noninterventional imaging techniques. The increasing prevalence of lifestyle-related disease, such as obesity and diabetes mellitus, highlights the role of exercise for primary/secondary prevention and treatment of coronary artery disease. In stable coronary artery disease, the trend of an increasing number of percutaneous coronary interventions, has been questioned, with smaller studies indicating equally good treatment results by aggressive medical treatment and lifestyle changes. Thus, while the role of the exercise test in the evaluation of acute chest pain and early in the setting of an acute coronary syndrome has decreased, it remains an important clinical tool. The exercise test today, has a pivotal and increasing role in tailored exercise prescriptions, with a shift of focus towards giving information on prognosis, functional capac...

The Role of Exercise Testing for Predicting Pregnancy Outcomes in Women with Congenital Heart Disease

The Role of Exercise Testing for Predicting Pregnancy Outcomes in Women with Congenital Heart Disease

Review series: Aspects of interstitial lung disease: Exercise limitation in interstitial lung disease - mechanisms, significance and therapeutic options

Exercise limitation is a cardinal feature of the interstitial lung diseases and is frequently associated with marked dyspnoea on exertion. People with interstitial lung disease exhibit a rapid, shallow breathing pattern during exercise that worsens as disease progresses. Despite this, ventilatory mechanics are not the major limitation to exercise in most patients, with impaired gas exchange and circulatory limitation playing a more important role. Peripheral and respiratory muscle dysfunction may also contribute to impaired exercise tolerance, either due to systemic manifestations of the underlying disease, treatment side-effects or deconditioning. Measures of exercise capacity or desaturation obtained from maximal and submaximal exercise tests are good predictors of survival in patients with idiopathic pulmonary fibrosis. However, to date few pharmaceutical treatments have affected exercise outcomes despite improvements in other important clinical markers. Supplemental oxygen acutely improves exercise capacity in interstitial lung disease and is recommended for hypoxic patients, although quality of life or survival benefits have not yet been demonstrated. Exercise training improves walking capacity and dyspnoea in short-term trials and is useful to maximize functional capacity. The role of exercise testing in the routine management of patients with interstitial lung disease is not clearly defined. However, given the poor prognosis in patients with idiopathic pulmonary fibrosis and the marked variation in clinical course, assessment of exercise capacity may provide useful information for both clinicians and patients when evaluating the risks and benefits of new treatments. The extent of resting or exercise-induced hypoxia in patients with interstitial lung disease may influence the selection of an appropriate exercise test, and oxygen administration should be standardized on repeat testing.

Belastungs–EKG (Ergometrie)

Cardiac imaging plays an increasing role in exercise testing. However, exercise testing with ECG remains a classical and basic approach to analyze cardiac function and to screen for coronary artery disease. Maximal testing, i. e., terminated by exhaustion of the patient, is important to achieve a reliable diagnostic result. New parameters have been introduced such as recovery heart rate, blood pressure and functional capacity. These parameters improve risk stratification, thus, increasing prognostic power of exercise testing. General and specific quality management has still to be improved in exercise testing.