Treadmill Test In Patients Research Articles

Laparoscopic hernia repair enhances early return of physical work capacity.

Several researchers have documented less postoperative pain and a quicker return to daily activities after laparoscopic herniorrhaphy. However, little objective data that validates this hypothesis exists. This study compares the rate of postoperative physical work capacity with return to preoperative levels, which is measured by a standard treadmill test in patients who underwent laparoscopic and conventional open hernia repair. Patients completed a 6-minute walking test preoperatively and 1 week postoperatively using a nonmotorized treadmill. The distance walked was recorded. If the distance that a patient achieved at 1 week was not within 0.02 miles of the preoperative values of the patient, the patient was asked to return at 1 month for repeat testing. Patients were enrolled prospectively in this study from October 1997 to February 1999. Sixty-six patients participated in the study (27 laparoscopic herniorrhaphies and 39 open herniorrhaphies were performed). There was no significant difference in age, body mass index, or preoperative distance achieved among the two groups. At 1 week, patients who underwent laparoscopic repair demonstrated a mean increase of 18 meters from preoperative distance (P = 0.07). In the open group, patients demonstrated a mean decrease of 90 meters at 1 week (P = 0.001). The change in distance at 1 week between the laparoscopic and the open groups was statistically significant (P = 0.001). However, at 1 month, there was no significant difference among the two groups. Measured using treadmill walking, laparoscopic hernia repair seems to offer an early advantage to open repair in return-to-physical-work capacity.

Meta-analysis of efficacy and safety of second- generation dihydropyridine calcium channel blockers in heart failure

Second-generation dihydropyridine calcium channel blockers slightly increase cardiac index, left ventricular ejection fraction, and exercise treadmill tests in patients with chronic heart failure, and do not increase norepinephrine levels; these drugs seem to be safe and beneficial in this category of patients. A 6% reduction in mortality was found, which, although not significantly different from 0%, does indicate that these drugs do not increase mortality in this category of patients.

Laparoscopic Hernia Repair Enhances Early Return of Physical Work Capacity

Several researchers have documented less postoperative pain and a quicker return to daily activities after laparoscopic herniorrhaphy. However, little objective data that validates this hypothesis exists. This study compares the rate of postoperative physical work capacity with return to preoperative levels, which is measured by a standard treadmill test in patients who underwent laparoscopic and conventional open hernia repair. Patients completed a 6-minute walking test preoperatively and 1 week postoperatively using a nonmotorized treadmill. The distance walked was recorded. If the distance that a patient achieved at 1 week was not within 0.02 miles of the preoperative values of the patient, the patient was asked to return at 1 month for repeat testing. Patients were enrolled prospectively in this study from October 1997 to February 1999. Sixty-six patients participated in the study (27 laparoscopic herniorrhaphies and 39 open herniorrhaphies were performed). There was no significant difference in age, body mass index, or preoperative distance achieved among the two groups. At 1 week, patients who underwent laparoscopic repair demonstrated a mean increase of 18 meters from preoperative distance (P = 0.07). In the open group, patients demonstrated a mean decrease of 90 meters at 1 week (P = 0.001). The change in distance at 1 week between the laparoscopic and the open groups was statistically significant (P = 0.001). However, at 1 month, there was no significant difference among the two groups. Measured using treadmill walking, laparoscopic hernia repair seems to offer an early advantage to open repair in return-to-physical-work capacity.

Test-Retest Reproducibility of the Exercise Treadmill Examination in Lumbar Spinal Stenosis

To provide further validation of the treadmill test by assessing its "test-retest" reproducibility. In this prospective study, 28 patients with severe lumbar spinal stenosis underwent exercise treadmill testing, first at a walking speed of 1.2 mph and then at the patient's preferred walking speed. All patients had a second treadmill examination or "retest." No treatment intervention was performed between the initial test and the retest. Time to first symptoms (TFS) and total ambulation time (TAT) were measured. Differences between the baseline examination and the retest examination were assessed by using the concordance correlation coefficient (CCC) as well as graphically. There was good reproducibility between baseline test and retest results for all 4 end points: 1.2 mph, TFS (CCC = 0.90); 1.2 mph, TAT (CCC = 0.89); preferred walking speed, TFS (CCC = 0.98); and preferred walking speed, TAT (CCC = 0.96). The median difference between trials was not significantly different from zero for any of the 4 outcomes. Exercise treadmill testing has good test-retest reproducibility. There was no learning phenomenon associated with the test procedure. The study further validates the clinical utility of exercise treadmill testing in patients with lumbar spinal stenosis and neurogenic claudication.

Determinants of a positive exercise test in patients admitted with acute non-infarct chest pain

Background and objectives. Some patients with suspected unstable angina show ischemia at the exercise treadmill test despite having been medically stabilized. The objective of this study was to determine clinical characteristics predicting a positive exercise treadmill test in patients with suspected unstable angina after medical stabilization. Methods. In 885 hospitalized patients with medically stabilized unstable angina, the relationship between the result of the pre-discharge exercise treadmill test and clinical characteristics was studied. Results. Mean age was 62±9 years and 668 (75%) were male. Exercise test was positive (chest pain and/or ST depression ≥1 mm) in 288 patients (33%). Univariate analysis showed the following associated with ischemia at the exercise test: male gender (56% vs. 20%, P<0.001), diabetes mellitus (41% vs. 31%, P=0.009), previous unstable angina (41% vs. 24%, P=0.001), previous stable angina (44% vs. 30%, P<0.001), previous coronary artery bypass grafting (43% vs. 31%, P=0.043), peripheral artery disease (45% vs. 31%) and progressive angina (55% vs. 31%, P<0.001). Multivariate analysis showed the following as independent predictors of ischemia: male gender (OR=2.25), diabetes (OR=4.12), previous unstable angina (OR=3.89), previous stable angina (OR=3.74) and progressive angina (OR=4.05). Conclusions. In patients with suspected unstable angina, after medical stabilization: (1) the exercise treadmill test is positive in one-third of cases; (2) male gender, diabetes, previous angina (unstable and stable) and progressive angina are independent predictors of ischemia.

The effect of naftidrofuryl on transcutaneous oxygen tension during a treadmill test in patients with peripheral arterial occlusive disease

The effect of naftidrofuryl on transcutaneous oxygen tension during a treadmill test in patients with peripheral arterial occlusive disease

The stresst'er ergometer as an alternative to treadmill testing in patients with claudication

To compare a new pedal ergometer (the Stresst'er) with conventional treadmill examination in patients with leg pain on exercise. Patients presenting with claudication were assessed by standard treadmill test and by the new device in two District General Hospitals. Ninety-four subjects were studied. Symptoms induced by both types of exercise were compared. Distance walked on the treadmill was compared to the number of pumps using the Stresst'er. The percentage change in ankle systolic pressure produced by the two tests was compared. Subjective symptoms induced by the tests were similar. Distance walked did correlate with pumps on the ergometer, as did change in systolic pressure. Analysis of a subgroup of 41 cases with receiver operator curve (ROC) tests showed that the new device is sensitive and specific. This new device is comparable with treadmill testing, but being easier to use, may have a place in the vascular clinic.

Asymptomatic cardiac ischemia pilot (ACIP) study: Impact of anti-ischemia therapy on 12-week rest electrocardiogram and exercise test outcomes

This report from the Asymptomatic Cardiac Ischemia Pilot (ACIP) study examines differences in the magnitude of reduction of myocardial ischemia as determined by exercise treadmill testing in patients randomized to three different treatment strategies: angina-guided medical therapy, ischemia-guided medical therapy and coronary revascularization. No prospective randomized clinical trials in patients with exercise electrocardiographic (ECG) abnormalities and asymptomatic cardiac ischemia on ambulatory ECG monitoring have compared the impact of different treatment strategies, including coronary revascularization, in terms of reducing myocardial ischemia. The ACIP exercise protocol was used. Exercise variables measured included final exercise stage; presence of exercise-induced angina or ischemia; time to angina; time to 1-mm ST segment depression; number of exercise ECG leads with abnormalities; maximal depth of ST segment depression in any lead; sum of ST segment depression; ST/HR index; and rate-pressure product at time to angina, at time to 1-mm ST segment depression and at peak exertion. Peak exercise time was increased by 0.5, 0.7 and 1.6 min in patients assigned to the angina-guided, ischemia-guided and coronary revascularization strategies, respectively, from the qualifying visit to the 12-week visit (p < 0.001). At the qualifying visit, the sum of exercise-induced ST segment depression was 9.4 +/- 5.0 (mean +/- SD), 9.6 +/- 4.7 and 9.9 +/- 5.5 mm (p = NS) in the three treatment strategies, respectively. At the 12-week visit, the sum of exercise-induced ST segment depression was 7.4 +/- 5.7, 6.8 +/- 5.3 and 5.6 +/- 5.6 mm (p = 0.02) in the three treatment strategies, respectively. Each treatment strategy resulted in a significant reduction in all exercise-induced variables of myocardial ischemia measured at 12 weeks. Coronary revascularization significantly reduced the extent and frequency of exercise-induced myocardial ischemia compared with either medical strategy. The prognostic impact of these observations should be evaluated in a large-scale multicenter clinical trial.

Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation

The purpose of this study was to investigate the relationship between performance on the shuttle walking test and maximal oxygen uptake (VO2max) during a conventional treadmill test in patients with chronic airflow limitation. Two different techniques were used to measure oxygen consumption, i.e. conventional Douglas bag techniques (treadmill test) and a portable oxygen consumption meter (shuttle test). Initially, 19 patients performed a shuttle walking test (after one practice walk) and a maximal treadmill walking test, in a randomized, balanced design. Subsequently, 10 patients, (after one practice) completed an unencumbered shuttle walking test and one supporting the portable oxygen consumption meter, in random order. The results of the first experiment revealed a strong relationship between performance during the shuttle walking test and VO2max during the treadmill walking test (r = 0.88). The results of the second experiment consistently demonstrated an incremental increase in oxygen consumption and ventilation in response to the increasing intensity of the shuttle walking test. Again, a strong relationship between VO2max and performance on the shuttle test was demonstrated (r = 0.81). We concluded that the shuttle walking test is a valid field exercise test of functional capacity. Performance on the test relates strongly to VO2max, the traditional indicator of cardiorespiratory capacity.

Time course of oxygen uptake and heart rate during Bruce treadmill test in patients following surgery for tetralogy of Fallot.

Exercise performance was examined in 14 patients with a prior history of surgical repair for tetralogy of Fallot. Using a Bruce protocol, we evaluated the time course of oxygen uptake and heart rate in these patients and compared them with a standard curve obtained from 63 sex- and age-matched healthy children. Five of the 14 patients had unusual findings. The heart rate increased rapidly in four of them, while the oxygen uptake increased gradually (95% confidence lower limit). It is hypothesized that a reduction in stroke volume during exercise was responsible for these abnormal findings. The remaining unusual finding was in a patient who was known to have myocardial fibrosis and vacuolization. In this particular case, the time course of oxygen uptake and heart rate were both below the 95% coefficient of variation from the beginning to the end of exercise. In patients who have undergone surgical repair for tetralogy of Fallot, the analysis of oxygen uptake time course and the heart rate may provide valuable information for the long-term follow-up.

無症候性糖尿病患者におけるトレッドミル負荷時のＳＴ下降の頻度とその予後的意義

臨床的に明らかな心血管系症状のない成人発症型の糖尿病患者における運動負荷時のST下降の頻度とその予後的意義を検討する目的で, 176例の40歳以上の成人発症型の糖尿病患者 (男113例, 女63例, 平均年齢59歳) にトレッドミル負荷試験を行ない, 172例にて6～36ヵ月 (平均23ヵ月) 経過観察を行なった.運動負荷陽性は29例 (16.5%) にみられ, 負荷陰性例に比べて有意に高年齢であったが, 糖尿病罹病歴, 治療内容, 腎症・網膜症・高血圧症の合併頻度には両群間で差はみられなかった.経過観察中, 4例の心筋梗塞と1例の突然死発生をみたが, いずれも負荷陽性例であった.負荷陽性例のうちで, 心事故発生例と非発生例の比較では, 運動時間, 最大ST下降度には差がなく, 負荷後のST下降時間が前者で有意に長かった.糖尿病患者の予後予測の上で, 運動負荷試験は有用であり, 陽性例には慎重な管理が必要と結論された.

Angina and ST-Segment Depression During Treadmill and Arm Ergometer Testing in Patients with Coronary Artery Disease

The clinical use of exercise rehabilitation programs has increased for patients with coronary artery disease. Exercise testing in these programs typically is conducted on a treadmill or cycle ergometer, although many patients' vocations require upper extremity activities and some patients cannot perform lower extremity exercises. To compare the hemodynamic responses and the incidence of angina and ST-segment depression during upper and lower extremity exercise in patients with coronary artery disease, we administered symptom-limited arm ergometer and submaximal or maximal symptom-limited treadmill tests to 95 cardiac rehabilitation patients who had completed an eight-week exercise training program. Treadmill testing resulted in significantly higher heart rates, systolic blood pressures, and double products than arm ergometer testing. The incidence of ST-segment depression was significantly greater with treadmill testing than with arm ergometer testing, but the incidence of angina was not different between tests. Ten patients had ST-segment depression during both arm ergometer and treadmill testing, and the double products at the onset of ST-segment depression were not different. Our data suggest that arm ergometer testing is less likely to result in ST-segment depression than treadmill testing in patients with coronary artery disease, possibly because of the lower hemodynamic responses during arm ergometer testing.

New nitrate delivery systems: Buccal nitroglycerin

BN, a new nitrate formulation, has recently been made available. The main advantages of this medication is the combination of prompt onset of action, comparable to that of sublingual NTG, and sustained activity that persists for many hours. The tablet remains pharmacologically effective as long as it remains in the buccal pouch. A variety of studies indicate that BN is well tolerated by patients, acts promptly to provide protection against anginal pain, and has sustained efficacy that persists for 2 to 6 hours. Clinical investigations using serial treadmill testing in patients with angina demonstrate clinical effectiveness and bioactivity of BN beginning within minutes and lasting over 4 hours. The potential advantages of this preparation are discussed, and the formulation is compared to other available longacting nitrates. BN is an effective new addition to the nitrate armamentarium.

Diagnostic Value of Treadmill Test in Patients with Angina Pectoris

Diagnostic Value of Treadmill Test in Patients with Angina Pectoris

Use of the treadmill test in the diagnosis of coronary artery disease in patients with chest pain.

For the best clinical use of the treadmill exercise test, and to have rational expectations of it as a reliable diagnostic tool, sound understanding of the information provided by the test is needed. The electrocardiographic response to cardiopulmonary stress; blood pressure response; and workload, heart rate, and blood pressure achieved at peak exercise all are important indicators of exercise performance and must be considered when interpreting test results. Test results indicating the presence or absence and extent of coronary artery disease must be interpreted in the light of particular clinical factors, as diagnostic accuracy differs with patient populations. Diagnostic use of the treadmill test in patients with chest pain syndromes is reviewed, and issues that must be considered by the clinician in doing the test and evaluating its results are emphasized.

Treadmill exercise testing in the presence of digitals therapy or nonspecific ST-T changes: correlation with coronary angiography.

Treadmill exercise test results were studied in 93 patients with chest pain who had received digitalis therapy or had nonspecific ST-T changes in the resting electrocardiogram. Results of the treadmill test were correlated with the findings of coronary angiography. A positive treadmill result was defined as horizontal or down-sloping ST segment depression greater than or equal to 1.0 mm. Of the 40 patients with no or insignificant coronary artery disease, 15 had taken digitalis; 4 of the 15 demonstrated a positive response on the treadmill test. Of the 53 patients with coronary artery disease, 21 had taken digitalis; 15 of the 21 displayed a positive response. Among the remaining 32 not on digitalis, 20 had a positive response. The specificity of the treadmill exercise test was 96% in patients with coronary artery disease not on digitalis and whose resting electrocardiogram showed nonspecific ST changes. The specificity of the treadmill test in patients who had received digitalis was 73%. Sensitivity was 63% and 71%, respectively. By utilizing more stringent criteria in the interpretation of the treadmill exercise test (greater than or equal to 1.5 mm ST depression), among the patients on digitalis only 6.7% (1/15) with normal coronary arteries and 48% (10/21) with coronary artery disease had a positive response. With the use of the latter criterion the test was specific in 93% (14/15) of the patients and is usually indicative of coronary artery disease.