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Viegas JM, Dores H, Freitas A, Cavigli L, D'Ascenzi F. Developments in sports cardiology: The way to a brighter future. Rev Port Cardiol 2024; 43:87-89. [PMID: 37769847 DOI: 10.1016/j.repc.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- José Miguel Viegas
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
| | - Hélder Dores
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal; Human Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal; Department of Pathophysiology, NOVA Medical School, Lisbon, Portugal
| | - António Freitas
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal; Centro de Medicina Desportiva de Lisboa, Lisbon, Portugal
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Magrì D, Piepoli M, Gallo G, Corrà U, Metra M, Paolillo S, Filardi PP, Maruotti A, Salvioni E, Mapelli M, Vignati C, Senni M, Limongelli G, Lagioia R, Scrutinio D, Emdin M, Passino C, Parati G, Sinagra G, Correale M, Badagliacca R, Sciomer S, Di Lenarda A, Agostoni P. Old and new equations for maximal heart rate prediction in patients with heart failure and reduced ejection fraction on beta-blockers treatment: results from the MECKI score data set. Eur J Prev Cardiol 2022; 29:1680-1688. [PMID: 35578814 DOI: 10.1093/eurjpc/zwac099] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022]
Abstract
AIMS Predicting maximal heart rate (MHR) in heart failure with reduced ejection fraction (HFrEF) still remains a major concern. In such a context, the Keteyian equation is the only one derived in a HFrEF cohort on optimized β-blockers treatment. Therefore, using the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) data set, we looked for a possible MHR equation, for an external validation of Keteyien formula and, contextually, for accuracy of the historical MHR formulas and their relationship with the HR measured at the anaerobic threshold (AT). METHODS AND RESULTS Data from 3487 HFrEF outpatients on optimized β-blockers treatment from the MECKI data set were analyzed. Besides excluding all possible confounders, the new equation was derived by using HR data coming from maximal cardiopulmonary exercise test. The simplified derived equation was [109-(0.5*age) + (0.5*HR rest) + (0.2*LVEF)-(5 if haemoglobin <11 g/dL)]. The R2 and the standard error of the estimate were 0.24 and 17.5 beats min-1 with a mean absolute percentage error (MAPE) = 11.9%. The Keteyian equation had a slightly higher MAPE = 12.3%. Conversely, the Fox and Tanaka equations showed extremely higher MAPE values. The range 75-80% of MHR according to the new and the Keteyian equations was the most accurate in identifying the HR at the AT (MAPEs = 11.3-11.6%). CONCLUSION The derived equation to estimate the MHR in HFrEF patients, by accounting also for the systolic dysfunction degree and anaemia, improved slightly the Keteyian formula. Both formulas might be helpful in identifying the true maximal effort during an exercise test and the intensity domain during a rehabilitation programme.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | | | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefania Paolillo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Pasquale Perrone Filardi
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Antonello Maruotti
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne-Libera Università Maria Ss Assunta
- Department of Mathematics, University of Bergen, Bergen, Norway
- School of Computing, University of Portsmouth, Portsmouth, UK
| | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milano, Italy
| | - Carlo Vignati
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Limongelli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Napoli, Italy
| | - Rocco Lagioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Domenico Scrutinio
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Michele Emdin
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.11 Cardiology Division, Santo Spirito Hospital, Roma, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - Claudio Passino
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.11 Cardiology Division, Santo Spirito Hospital, Roma, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | | | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n°1 and University of, Trieste, Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milano, Italy
- Dept. Of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milano, Italy
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D'Ascenzi F, Cavigli L, Pagliaro A, Focardi M, Valente S, Cameli M, Mandoli GE, Mueller S, Dendale P, Piepoli M, Wilhelm M, Halle M, Bonifazi M, Hansen D. Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease. Br J Sports Med 2022; 56:bjsports-2021-105261. [PMID: 35680397 DOI: 10.1136/bjsports-2021-105261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 12/24/2022]
Abstract
Exercise training is highly recommended in current guidelines on primary and secondary prevention of cardiovascular disease (CVD). This is based on the cardiovascular benefits of physical activity and structured exercise, ranging from improving the quality of life to reducing CVD and overall mortality. Therefore, exercise should be treated as a powerful medicine and critical component of the management plan for patients at risk for or diagnosed with CVD. A tailored approach based on the patient's personal and clinical characteristics represents a cornerstone for the benefits of exercise prescription. In this regard, the use of cardiopulmonary exercise testing is well-established for risk stratification, quantification of cardiorespiratory fitness and ventilatory thresholds for a tailored, personalised exercise prescription. The aim of this paper is to provide a practical guidance to clinicians on how to use data from cardiopulmonary exercise testing towards personalised exercise prescriptions for patients at risk of or with CVD.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonio Pagliaro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Stephan Mueller
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
| | | | | | | | - Martin Halle
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
- DZHK (German Center for Cardiovascular Research), Munich, Germany
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
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Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
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Anselmi F, Cavigli L, Pagliaro A, Valente S, Valentini F, Cameli M, Focardi M, Mochi N, Dendale P, Hansen D, Bonifazi M, Halle M, D’Ascenzi F. The importance of ventilatory thresholds to define aerobic exercise intensity in cardiac patients and healthy subjects. Scand J Med Sci Sports 2021; 31:1796-1808. [PMID: 34170582 PMCID: PMC8456830 DOI: 10.1111/sms.14007] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1 ) and second ventilatory thresholds (VT2 ) in cardiac patients, sedentary subjects, and athletes comparing VT1 and VT2 with EI defined by recommendations. METHODS We prospectively enrolled 350 subjects (mean age: 50.7±12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, and 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2 , peak heart rate (HR), and HR reserve were obtained at VT1 and VT2 and compared with the EI definition proposed by the recommendations. RESULTS VO2 at VT1 corresponded to high rather than moderate EI in 67.1% and 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most cardiac patients had VO2 values at VT2 corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory thresholds and recommended EI domains was observed in healthy subjects and athletes (90% and 93.9%, respectively). CONCLUSIONS EI definition based on percentages of peak HR and peak VO2 may misclassify the effective EI, and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable to define an appropriate level of EI.
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Affiliation(s)
- Francesca Anselmi
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Luna Cavigli
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Antonio Pagliaro
- Clinical and Surgical Cardiology UnitCardio‐Thoracic and Vascular DepartmentUniversity Hospital of SienaSienaItaly
| | - Serafina Valente
- Clinical and Surgical Cardiology UnitCardio‐Thoracic and Vascular DepartmentUniversity Hospital of SienaSienaItaly
| | - Francesca Valentini
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Matteo Cameli
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Marta Focardi
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Nicola Mochi
- Sports Medicine UnitUSL Toscana CentroFlorenceItaly
| | - Paul Dendale
- Heartcentre HasseltJessa HospitalHasselt UniversityHasseltBelgium
| | - Dominique Hansen
- REVAL‐Rehabilitation Research CenterBIOMEDFaculty of Rehabilitation SciencesHasselt UniversityHasseltBelgium
| | - Marco Bonifazi
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports CardiologyTechnical University of MunichMunichGermany
| | - Flavio D’Ascenzi
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghPAUSA
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Cherneva RV, Youroukova VM, Cherneva ZV. Dynamic hyperinflation, chronotropic intolerance and abnormal heart rate recovery in non-severe chronic obstructive pulmonary disease patients-reflections in the mirror. Pulmonology 2021; 28:440-448. [PMID: 33419715 DOI: 10.1016/j.pulmoe.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The presence of abnormal heart rate recovery (HRR) and chronotropic incompetence (CI) suggests autonomic dysfunction (AD) and is associated with diminished physical activity and increased cardio-vascular (CV) risk. AIM Our aim is to analyse the correlation between AD and airflow obstruction - forced expiratory volume in 1s (FEV1), dynamic hyperinflation (DH) and disease prognosis - the BODE - index (BMI; Obstruction - FEV1;Dyspnea - mMRC;E - exercise capacity) in non-severe COPD patients without overt CV comorbidities. METHODS We used cardio-pulmonary exercise testing (CPET) with 67 subjects. Inspiratory capacity (IC) manouevres were performed for DH assessment. Echocardiography was executed before CPET and 1-2min after peak exercise. Stress left ventricular diastolic dysfunction (LVDD) was assumed if stress E/e'>15.Wilkoff method calculated the metabolic-chronotropic relationship (MCR). Chronotropic incompetence (CI) and abnormal HR recovery (HRR) were determined. MAIN RESULTS CI was detected in 44% of the mild and 65% of the moderate COPD patients. Abnormal HRR was present in 75% of the mild and 78% of the moderate COPD subjects. Multivariate regression analysis showed no association between FEV1, CPET parameters, BODE index, stress LVDD and AD. DH was the only independent predictor for both abnormal HRR and CI. CONCLUSION Evaluation of AD during incremental CPET unravels lung hyperinflation as a potential mechanism of attenuated HR response and diminished physical activity in non-severe COPD free of overt CV comorbidities. This multifaceted approach to dyspnea may facilitate the discrimination of its pathogenesis and improve its proper clinical management.
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Affiliation(s)
- R V Cherneva
- Medical University Sofia, Department of Respiratory Diseases, University Hospital for Respiratory Diseases "St. Sophia'', Sofia, bul. "Ivan Geshov 17", Bulgaria
| | - V M Youroukova
- Medical University Sofia, Department of Respiratory Diseases, University Hospital for Respiratory Diseases "St. Sophia'', Sofia, bul. "Ivan Geshov 19", Bulgaria
| | - Zh Vl Cherneva
- Department of Cardiology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria.
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Ferri Marini C, Sisti D, Leon AS, Skinner JS, Sarzynski MA, Bouchard C, Rocchi MBL, Piccoli G, Stocchi V, Federici A, Lucertini F. HRR and V˙O2R Fractions Are Not Equivalent: Is It Time to Rethink Aerobic Exercise Prescription Methods? Med Sci Sports Exerc 2021; 53:174-182. [PMID: 32694364 DOI: 10.1249/mss.0000000000002434] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION According to current guidelines, the intensity of health-enhancing aerobic exercise should be prescribed using a percentage of heart rate reserve (%HRR), which is considered to be more closely associated (showing a 1:1 relation) with the percentage of oxygen uptake reserve (%V˙O2R) rather than with the percentage of maximal oxygen uptake (%V˙O2max) during incremental exercise. However, the associations between %HRR and %V˙O2R and between %HRR and %V˙O2max are under debate; hence, their actual relationships were investigated in this study. METHODS Data from each stage of a maximal incremental exercise test performed by 737 healthy and physically inactive participants of the HERITAGE Family Study were screened and filtered then used to calculate the individual linear regressions between %HRR and either %V˙O2R or %V˙O2max. For each relationship, the mean slope and intercept of the individual linear regression were compared with 1 and 0 (i.e., the identity line), respectively, using one-sample t-tests. The individual root mean square errors of the actual versus the 1:1 predicted %HRR were calculated for both relationships and compared using a paired-sample t-test. RESULTS The mean slopes (%HRR-%V˙O2R, 0.972 ± 0.189; %HRR-%V˙O2max, 1.096 ± 0.216) and intercepts (%HRR-%V˙O2R, 8.855 ± 16.022; %HRR-%V˙O2max, -3.616 ± 18.993) of both relationships were significantly different from 1 and 0, respectively, with high interindividual variability. The average root mean square errors were high and revealed that the %HRR-%V˙O2max relationship was more similar to the identity line (P < 0.001) than the %HRR-%V˙O2R relationship (7.78% ± 4.49% vs 9.25% ± 5.54%). CONCLUSIONS Because both relationships are different from the identity line and using a single equation may not be appropriate to predict exercise intensity at the individual level, a rethinking of the relationships between the intensity variables may be necessary to ensure that the most suitable health-enhancing aerobic exercise intensity is prescribed.
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Affiliation(s)
- Carlo Ferri Marini
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
| | - Davide Sisti
- Department of Biomolecular Sciences, Unit of Biostatistics, University of Urbino Carlo Bo, Urbino, ITALY
| | - Arthur S Leon
- Department of Kinesiology, University of Minnesota, Minneapolis, MN
| | - James S Skinner
- Department of Kinesiology, Indiana University, Bloomington, IN
| | - Mark A Sarzynski
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA
| | - Marco B L Rocchi
- Department of Biomolecular Sciences, Unit of Biostatistics, University of Urbino Carlo Bo, Urbino, ITALY
| | - Giovanni Piccoli
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
| | - Vilberto Stocchi
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
| | - Ario Federici
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
| | - Francesco Lucertini
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, ITALY
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Assessment of Measurement Reliability for the IPN Test in Cardiac Patients. J Clin Med 2020; 9:jcm9051552. [PMID: 32455568 PMCID: PMC7290293 DOI: 10.3390/jcm9051552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022] Open
Abstract
Cardiological diagnostics use maximal and submaximal tests with increasing load. Maximal stress tests are currently considered the gold standard. The Institut für Prävention und Nachsorge, Cologne (IPN) test may be an alternative when maximal patient load is not indicated. The universality of the test is well-documented in sport, but the reliability of this test is unknown. The aim of this study was to assess between-trial and between-day reliability for parameters assessed by the IPN stress test in cardiological patients.: In a study of 24 patients aged 39 to 79 years with cardiovascular diseases, the IPN cycle ergometer short test was performed (submaximal performance test). The reliability of heart rate, systolic and diastolic pressure, absolute power at submaximal load, relative performance at submaximal load and target heart rate were assessed. Good (Interclass Correlation Coefficient (ICC) values ranged from 0.832 to 0.894) and excellent (ICC values ranged from 0.904 to 0.969) between-trial reliability was noted. Between-day reliability was good (ICC values from 0.777 to 0.895) and excellent (ICC values from 0.922 to 0.950). The obtained results suggest that the IPN test may be a reliable tool for use in the assessment of cardiological patients, avoiding the implementation of maximal efforts when excessive patient load is not recommended.
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9
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Exercise Prescriptions for Training and Rehabilitation in Patients with Heart and Lung Disease. Ann Am Thorac Soc 2017; 14:S59-S66. [DOI: 10.1513/annalsats.201702-160fr] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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10
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Hulo S, Inamo J, Dehon A, Le Rouzic O, Edme JL, Neviere R. Chronotropic incompetence can limit exercise tolerance in COPD patients with lung hyperinflation. Int J Chron Obstruct Pulmon Dis 2016; 11:2553-2561. [PMID: 27799755 PMCID: PMC5074704 DOI: 10.2147/copd.s112490] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose Metabolic-chronotropic relationship is the only concept that assesses the entire chronotropic function during exercise, as it takes into account individual fitness. To better understand interrelationships between chronotropic incompetence (CI), dynamic hyperinflation (DH) and exercise limitation among Global initiative for chronic Obstructive Lung Disease (GOLD) stages of chronic obstructive pulmonary disease (COPD) disease severity, we evaluated cardiopulmonary responses to symptom-limited cycle exercise in stable patients. Patients and methods We prospectively studied 47 COPD patients classified by GOLD stage severity. Pulmonary function tests and cardiopulmonary responses to symptom-limited incremental exercise were studied. CI was defined by regression line between percent heart rate (HR) reserve and percent oxygen uptake (V’O2) reserve, ie, chronotropic-metabolic index (CMI). DH was defined from the knot resulting from the nonlinear regressions of inspiratory capacity changes from rest to peak (dynamic inspiratory capacity (ICdyn)) with percentage of maximal HR and CMI. Results Aerobic capacity (median interquartile ranges) peak V’O2, 24.3 (23.6; 25.2), 18.5 (15.5; 21.8), 17.5 (15.4; 19.1) mL·kg−1·min−1 and CMI worsened according to GOLD severity. The optimal knot of ICdyn was equal to −0.34 L. The multivariate logistic regression showed a strong relationship between CI (outcome) and DH (odds ratio [confidence interval 95]) 25 (3.5; 191.6). Conclusion COPD patients with DH have a poor cardiovascular response to exercise, which may be attributed to CI.
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Affiliation(s)
- Sébastien Hulo
- Université Lille, CHU Lille, EA 4483, IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | - Jocelyn Inamo
- Département de Cardiologie - CHU Fort de France, Martinique - Faculté de Médecine - Université des Antilles, France
| | - Aurélie Dehon
- Pôle d'Anesthésie Réanimation ADRU, CHU Nîmes, Nîmes, France
| | - Olivier Le Rouzic
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
| | - Jean-Louis Edme
- Université Lille, CHU Lille, EA 4483, IMPact de l'Environnement Chimique sur la Santé humaine, Lille, France
| | - Remi Neviere
- Université Lille, Inserm, CHU Lille, Lille Inflammation Research International Center, Lille, France
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Kuehl R, Scharhag-Rosenberger F, Schommer K, Schmidt ME, Dreger P, Huber G, Bohus M, Ulrich CM, Wiskemann J. Exercise intensity classification in cancer patients undergoing allogeneic HCT. Med Sci Sports Exerc 2016; 47:889-95. [PMID: 25202849 DOI: 10.1249/mss.0000000000000498] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Exercise intervention studies during and after cancer treatment show beneficial effects for various physical and psychosocial outcomes. Current exercise intensity guidelines for cancer patients are rather general and have been adapted from American College of Sports Medicine (ACSM) recommendations for healthy individuals. Intensive cancer treatment regimens such as allogeneic hematopoietic stem cell transplantation (allo-HCT) may change the cardiovascular response to acute exercise. Therefore, we evaluated the relationships between %V˙O2 reserve (%V˙O2R, reference) and %HRR, %HRmax, and %V˙O2max and compared calculated intensities with given intensities by ACSM. METHODS Measurements before and 180 d after allo-HCT from a randomized controlled trial were used. Only patients who reached maximal effort and at least two exercise stages in our maximal incremental cycling test were included. Before allo-HCT, 106 patients were included, and 180 d after treatment, 49 patients met our inclusion criteria. Individual regression lines were calculated with V˙O2R as the reference. Calculated exercise intensities for endurance training prescription were compared with ACSM values. RESULTS Before allo-HCT, %HRR values of patients were significantly lower than ACSM values, and %HRmax and %V˙O2max values were significantly higher (except 90% HRmax, which was significantly lower, all P < 0.01). One hundred eighty days after allo-HCT, values for %HRR were not significantly different to ACSM values (except 90%, which was significantly lower, P = 0.01), whereas %HRmax and %V˙O2max were significantly higher (all P < 0.05). Furthermore, regression models revealed no influence of beta-blockers on calculated intensities. CONCLUSIONS ACSM's exercise intensity recommendations for endurance training may not be applicable for cancer patients during and 180 d after allo-HCT because they may not meet the targeted intensity class, with the exception of %HRR 180 d after allo-HCT.
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Affiliation(s)
- Rea Kuehl
- 1Division of Preventive Oncology, National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, GERMANY; 2Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, GERMANY; 3Department of Medicine VII, Heidelberg University Hospital, Heidelberg, GERMANY; 4Department of Medicine V, Heidelberg University Hospital, Heidelberg, GERMANY; 5Institute of Sports and Sport Science, Heidelberg University, Heidelberg, GERMANY; 6Central Institute of Mental Health, Mannheim, GERMANY; and 7Fred Hutchinson Cancer Research Centre, Seattle, WA
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12
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Magrì D, Corrà U, Di Lenarda A, Cattadori G, Maruotti A, Iorio A, Mezzani A, Giannuzzi P, Mantegazza V, Gondoni E, Sinagra G, Piepoli MF, Fiorentini C, Agostoni P. Cardiovascular mortality and chronotropic incompetence in systolic heart failure: the importance of a reappraisal of current cut-off criteria. Eur J Heart Fail 2013; 16:201-9. [DOI: 10.1002/ejhf.36] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/23/2013] [Accepted: 07/26/2013] [Indexed: 01/02/2023] Open
Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine; ‘Sapienza’ Università degli Studi di Roma; Roma Italy
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS; Istituto Scientifico di Veruno; Veruno Italy
| | - Andrea Di Lenarda
- Centro Cardiovascolare; Azienda per i Servizi Sanitari no. 1; Trieste Italy
| | | | - Antonello Maruotti
- Southampton Statistical Sciences Research Institute & School of Mathematics; University of Southampton; Southampton UK
- Department of Politic Sciences; Università ‘Roma Tre’; Roma Italy
| | - Annamaria Iorio
- Cardiovascular Department; Ospedali Riuniti and Università di Trieste; Trieste Italy
| | - Alessandro Mezzani
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS; Istituto Scientifico di Veruno; Veruno Italy
| | - Pantaleo Giannuzzi
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS; Istituto Scientifico di Veruno; Veruno Italy
| | | | | | - Gianfranco Sinagra
- Cardiovascular Department; Ospedali Riuniti and Università di Trieste; Trieste Italy
| | - Massimo F. Piepoli
- Heart Failure Unit, Cardiac Department; Guglielmo da Saliceto Hospital; Piacenza Italy
| | - Cesare Fiorentini
- Centro Cardiologico Monzino; IRCCS; Milano Italy
- Department of Clinical Sciences and Community Health; Università di Milano; Milano Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino; IRCCS; Milano Italy
- Department of Clinical Sciences and Community Health; Università di Milano; Milano Italy
- Department of Respiratory and Critical Care Medicine; University of Washington; Seattle USA
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13
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Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Canadian Association of Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2013; 32:327-50. [PMID: 23103476 DOI: 10.1097/hcr.0b013e3182757050] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.
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14
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Cunha FA, Midgley AW, Monteiro W, Freire R, Lima T, Farinatti PTV. How long does it take to achieve steady state for an accurate assessment of resting VO₂ in healthy men? Eur J Appl Physiol 2012; 113:1441-7. [PMID: 23241955 DOI: 10.1007/s00421-012-2571-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/03/2012] [Indexed: 11/28/2022]
Abstract
The time necessary to obtain a steady state for an accurate and reliable assessment of resting [Formula: see text] remains unclear and was the purpose of this study. Thirty healthy men, aged 17-28 years, visited the laboratory twice for the assessment of resting [Formula: see text], which was assessed as follows: (a) 24 h abstention from physical exercise, alcohol, soft drinks and caffeine, (b) fasting for at least 8 h, (c) an acclimation period of 10 min, and (d) 60 min assessment in a supine position. Resting [Formula: see text] significantly changed during the 60 min (F = 37.4, P < 0.001), exhibiting a monoexponential decrease before reaching an asymptote. Post hoc pairwise comparisons showed that significant differences existed between consecutive means until the 30 min time point, after which there were no significant differences. The [Formula: see text] response across trials exhibited high test-retest reliability, with within-subject coefficients of variations at each time point ranging from 2.8 to 7.0 % and intraclass correlation coefficients ranging from 0.90 to 0.99. The reliability was higher from the 25 min time point onwards. Based on these findings, the following recommendations are made to promote accurate assessment of resting [Formula: see text]: (a) initiate the resting [Formula: see text] measurement with 10 min of acclimation to the assessment apparatus, (b) determine resting [Formula: see text] for a minimum of 30 min, until an apparent [Formula: see text] steady state has been achieved; and (c) determine resting [Formula: see text] for a further 5 min, with the average of this last 5 min of data being regarding as the resting [Formula: see text].
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Affiliation(s)
- Felipe A Cunha
- Medical Sciences Graduate Program, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
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15
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Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA, Urhausen A, Williams MA. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol 2012; 20:442-67. [PMID: 23104970 DOI: 10.1177/2047487312460484] [Citation(s) in RCA: 293] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.
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Affiliation(s)
- Alessandro Mezzani
- Salvatore Maugeri Foundation IRCCS, Scientific Institute of Veruno, Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, Italy.
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Carvalho VO. Aerobic exercise prescription in patients with chronic heart failure: a review in the beta-blocker era. J Cardiovasc Med (Hagerstown) 2012; 13:570-4. [PMID: 22828773 DOI: 10.2459/jcm.0b013e328356a3b2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aerobic exercise training is a well-established nonpharmacological tool in patients with clinically stable chronic heart failure. In recent years, β-blocker therapy has become a primary pharmacologic intervention in patients with chronic heart failure. Despite the undeniable improvements in patients, the β-blocker era has aroused uncertainties about aerobic exercise intensity prescription. It is well known that aerobic exercise prescription is performed by a percentage of the patient's heart rate reserve and the use of β-blockers could interfere in this method. For this reason, the aim of this review is to provide an update about aerobic exercise prescription in patients with chronic heart failure who are using β-blockers.
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Affiliation(s)
- Vitor Oliveira Carvalho
- Unidade de Cirurgia Cardíaca Pediátrica - Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP), São Paulo, Brazil.
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Vanhees L, Rauch B, Piepoli M, van Buuren F, Takken T, Börjesson M, Bjarnason-Wehrens B, Doherty P, Dugmore D, Halle M. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III). Eur J Prev Cardiol 2012; 19:1333-56. [DOI: 10.1177/2047487312437063] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - B Rauch
- Centre for Ambulatory Cardiac and Angiologic Rehabilitation, Ludwigshafen, Germany
| | - M Piepoli
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - T Takken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Börjesson
- Sahlgrenska University Hospital/Ostra, Goteborg, Sweden
| | | | | | - D Dugmore
- Wellness International Medical Centre, Stockport, UK
| | - M Halle
- University Hospital ‘Klinikum rechts der Isar’, Technische Universitaet Muenchen, Munich, Germany
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Cunha FAD, Farinatti PDTV, Midgley AW. Methodological and practical application issues in exercise prescription using the heart rate reserve and oxygen uptake reserve methods. J Sci Med Sport 2011; 14:46-57. [DOI: 10.1016/j.jsams.2010.07.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 02/11/2010] [Accepted: 07/29/2010] [Indexed: 10/19/2022]
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Mendez-Villanueva A, Landaluce JP, García BF, Terrados N, Bishop D. Inaccuracy of the HR reserve vs. V˙O2 reserve relationship during prone arm-paddling exercise in surfboard riders. J Physiol Anthropol 2010; 29:189-95. [PMID: 21139320 DOI: 10.2114/jpa2.29.189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Previous studies have demonstrated that during lower-body exercise the percentage of heart rate reserve (%HRR) is equivalent to the percentage of the oxygen consumption reserve (%V˙O(2R)) but not to a percentage of the peak oxygen consumption (%V˙O(2peak)). The current study examined these relationships in trained surfboard riders (surfers) during upper-body exercise. Thirteen well-trained competitive surfers performed a stepwise, incremental, prone arm-paddling exercise test to exhaustion. For each subject, data obtained at the end of each stage (i.e., HR and V˙O(2) values) were expressed as a percentage of HRR, V˙O(2peak), and V˙O(2R) respectively and used to determine the individual %HRR-%V˙O(2peak) and %HRR-%V˙O(2R) relationships. Mean slope and intercept were calculated and compared with the line of identity (slope=1, intercept=0). The %HRR versus %V˙O(2R) regression mean slope (0.88±0.06) and intercept (20.82±4.57) were significantly different (p<0.05) from 1 and 0, respectively. Similarly, the regression of %HRR versus %V˙O(2peak) resulted in a line that differed in the slope (p<0.05) but not in the intercept (p=0.94) from the line of identity. Predicted values of %HRR were significantly higher (p<0.05) from indicated values of %V˙O(2R) for all the intensities ranging from 35% to 95% V˙O(2R). Unlike results found for lower-body exercise, a given %HRR during prone upper-body exercise was not equivalent to its corresponding %V˙O(2R). Thus, to ensure more targeted exercise intensity during arm-paddling exercise, individual HR-V˙O(2) equations should be used.
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Carvalho VO, Bocchi EA, Pascoalino LN, Guimarães GV. The relationship between heart rate and oxygen consumption in heart transplant recipients during a cardiopulmonary exercise test. Int J Cardiol 2010; 145:158-60. [DOI: 10.1016/j.ijcard.2009.07.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 07/25/2009] [Indexed: 11/25/2022]
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Magrì D, Palermo P, Cauti FM, Contini M, Farina S, Cattadori G, Apostolo A, Salvioni E, Magini A, Vignati C, Alimento M, Sciomer S, Bussotti M, Agostoni P. Chronotropic incompentence and functional capacity in chronic heart failure: no role of β-blockers and β-blocker dose. Cardiovasc Ther 2010; 30:100-8. [PMID: 20553283 DOI: 10.1111/j.1755-5922.2010.00184.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIM To assess the effect of chronotropic incompetence on functional capacity in chronic heart failure (CHF) patients, as evaluated as NYHA and peak oxygen consumption (pVO(2) ), focusing on the presence and dose of β-blocker treatment. METHODS Nine hundred and sixty-seven consecutive CHF patients were evaluated, 328 of whom were discarded because they failed to meet the study criteria. Of the 639 analyzed, 90 were not treated with β-blockers whereas the other 549 were. The latter were further subdivided in high (n = 184) and low (n = 365) β-blockers daily dose group in accordance with an arbitrary cut-off of 25 mg for carvedilol and of 5 mg for bisoprolol. Failure to achieve 80% of the percentage of maximum age predicted peak heart rate (%Max PHR) or of HR reserve (%HRR) constituted chronotropic incompetence. RESULTS No differences were found in NYHA or pVO2 between patients with and without β-blockers and, similarly, between high and low β-blocker dose groups. Twenty and sixty-nine percent of not β-blocked patients showed chronotropic incompetence according to %Max PHR and %HRR, respectively, whereas this prevalence rose to 61% and 84% in those on β-blocker therapy. Patients taking β-blockers without chronotropic incompetence, as inferable from both %Max PHR and %HRR, showed higher NYHA and pVO2 regardless of drug dose, whereas, in not β-blocked patients, only %HRR revealed a difference in functional capacity. At multivariable analysis, HR increase during exercise (ΔHR) was the variable most strongly associated to pVO2 (β: 0.572; SE: 0.008; P < 0.0001) and NYHA class (β: -0.499; SE: 0.001; P < 0.0001). CONCLUSIONS ΔHR is a powerful predictor of CHF severity regardless of the presence of β-blocker therapy and of β-blocker daily dose.
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Affiliation(s)
- Damiano Magrì
- U.O. Cardiologia, S. Andrea Hospital, Sapienza University, Rome, Italy
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Carvalho VO, Rodrigues Alves RX, Bocchi EA, Guimarães GV. Heart rate dynamic during an exercise test in heart failure patients with different sensibilities of the carvedilol therapy. Int J Cardiol 2010; 142:101-4. [DOI: 10.1016/j.ijcard.2008.11.140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 11/15/2008] [Accepted: 11/22/2008] [Indexed: 11/26/2022]
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Aerobic exercise training intensity in patients with chronic heart failure: principles of assessment and prescription. ACTA ACUST UNITED AC 2010; 18:5-14. [DOI: 10.1097/hjr.0b013e32833a9c63] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. ACTA ACUST UNITED AC 2009; 16:249-67. [PMID: 19440156 DOI: 10.1097/hjr.0b013e32832914c8] [Citation(s) in RCA: 250] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cardiopulmonary exercise testing (CPET) is a methodology that has profoundly affected the approach to patients' functional evaluation, linking performance and physiological parameters to the underlying metabolic substratum and providing highly reproducible exercise capacity descriptors. This study provides professionals with an up-to-date review of the rationale sustaining the use of CPET for functional evaluation of cardiac patients in both the clinical and research settings, describing parameters obtainable either from ramp incremental or step constant-power CPET and illustrating the wealth of information obtainable through an experienced use of this powerful tool. The choice of parameters to be measured will depend on the specific goals of functional evaluation in the individual patient, namely, exercise tolerance assessment, training prescription, treatment efficacy evaluation, and/or investigation of exercise-induced adaptations of the oxygen transport/utilization system. The full potentialities of CPET in the clinical and research setting still remain largely underused and strong efforts are recommended to promote a more widespread use of CPET in the functional evaluation of cardiac patients.
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Carvalho VO, Bocchi EA, Guimarães GV. The Borg Scale as an Important Tool of Self-Monitoring and Self-Regulation of Exercise Prescription in Heart Failure Patients During Hydrotherapy. Circ J 2009; 73:1871-6. [DOI: 10.1253/circj.cj-09-0333] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vitor Oliveira Carvalho
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
| | - Edimar Alcides Bocchi
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
| | - Guilherme Veiga Guimarães
- Unidade Clínica de Insuficiência Cardíaca e Transplante do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP (InCor HC-FMUSP)
- Laboratório de Atividade Física e Saúde do Centro de Práticas Esportivas da Universidade de São Paulo (CEPEUSP)
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Carvalho VO, Guimarães GV, Bocchi EA. The relationship between heart rate reserve and oxygen uptake reserve in heart failure patients on optimized and non-optimized beta-blocker therapy. Clinics (Sao Paulo) 2008; 63:725-30. [PMID: 19060991 PMCID: PMC2664269 DOI: 10.1590/s1807-59322008000600003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 07/30/2008] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The relationship between the percentage of oxygen consumption reserve and percentage of heart rate reserve in heart failure patients either on non-optimized or off beta-blocker therapy is known to be unreliable. The aim of this study was to evaluate the relationship between the percentage of oxygen consumption reserve and percentage of heart rate reserve in heart failure patients receiving optimized and non-optimized beta-blocker treatment during a treadmill cardiopulmonary exercise test. METHODS A total of 27 sedentary heart failure patients (86% male, 50+/-12 years) on optimized beta-blocker therapy with a left ventricle ejection fraction of 33+/-8% and 35 sedentary non-optimized heart failure patients (75% male, 47+/-10 years) with a left ventricle ejection fraction of 30+/-10% underwent the treadmill cardiopulmonary exercise test (Naughton protocol). Resting and peak effort values of both the percentage of oxygen consumption reserve and percentage of heart rate reserve were, by definition, 0 and 100, respectively. RESULTS The heart rate slope for the non-optimized group was derived from the points 0.949+/-0.088 (0 intercept) and 1.055+/-0.128 (1 intercept), p<0.0001. The heart rate slope for the optimized group was derived from the points 1.026+/-0.108 (0 intercept) and 1.012+/-0.108 (1 intercept), p=0.47. Regression linear plots for the heart rate slope for each patient in the non-optimized and optimized groups revealed a slope of 0.986 (almost perfect) for the optimized group, but the regression analysis for the non-optimized group was 0.030 (far from perfect, which occurs at 1). CONCLUSION The relationship between the percentage of oxygen consumption reserve and percentage of heart rate reserve in patients on optimized beta-blocker therapy was reliable, but this relationship was unreliable in non-optimized heart failure patients.
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Affiliation(s)
- Vitor Oliveira Carvalho
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.
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