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Bonikowske AR, Taylor JL, Larson KF, Hardwick J, Ozemek C, Harber MP, Kaminsky LA, Arena R, Lavie CJ. Evaluating current assessment techniques of cardiorespiratory fitness. Expert Rev Cardiovasc Ther 2024; 22:231-241. [PMID: 38855917 DOI: 10.1080/14779072.2024.2363393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Considerable and convincing global data from cohorts across the health spectrum (i.e. apparently healthy to known disease) indicate that cardiorespiratory fitness (CRF) is a major predictor of overall and cardiovascular disease (CVD)-survival, seemingly with greater prognostic resolution compared to other traditional CVD risk factors. Therefore, the assessment of CRF in research and clinical settings is of major importance. AREAS COVERED In this manuscript, we review the technology of measuring CRF assessed by the 'gold standard,' cardiopulmonary exercise testing (CPET), as well as with various other methods (e.g. estimated metabolic equivalents, 6-minute walk tests, shuttle tests, and non-exercise equations that estimate CRF), all of which provide significant prognostic information for CVD- and all-cause survival. The literature through May 2024 has been cited. EXPERT OPINION The promotion of physical activity in efforts to improve levels of CRF is needed throughout the world to improve lifespan and, more importantly, healthspan. The routine assessment of CRF should be considered a vital sign that is routinely assessed in clinical practice.
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Affiliation(s)
| | - Jenna L Taylor
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kathryn F Larson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joel Hardwick
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Matthew P Harber
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA
| | - Lenny A Kaminsky
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA, USA
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Huang J, Yin L, Li X, Xie Q, He Y, Wu L, Ni X, Liu Z, Tao L, Tao J, Chen L. Reference Standards of Cardiorespiratory Fitness Measured With the Cardiopulmonary Exercise Test Using the Treadmill in Chinese Adults Younger Than 60 Years. J Cardiopulm Rehabil Prev 2024; 44:212-218. [PMID: 38488145 DOI: 10.1097/hcr.0000000000000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE Cardiorespiratory fitness (CRF) is a strong predictor of cardiorespiratory diseases and varies by race. The purpose of this study was to provide CRF reference standards and a prediction equation for peak oxygen uptake (V˙O 2peak ) from treadmill-based cardiopulmonary exercise testing (CPX) in Chinese individuals. METHODS Healthy participants (n = 4199) who completed a CPX using a treadmill were studied. The percentiles of V˙O 2peak were determined for four age groups (decades). A regression prediction model was developed from the derivation cohort (n = 3361), validated in the independent validation cohort (n = 838), and compared with the widely used Wasserman equation and the Fitness Registry and the Importance of Exercise National Database (FRIEND) equation. RESULTS The mean V˙O 2peak values of four age groups (20-29, 30-39, 40-49, and 50-59 yr) were 42.6, 41.2, 38.7, and 35.9 mL/kg/min, respectively, for men, and 37.1, 34.7, 32.0, and 30.3 mL/kg/min, respectively, for women. The 50th percentiles of relative V˙O 2peak decreased with age for both sexes. The prediction equation was: Absolute V˙O 2peak (mL/min) = 236.68 - (504.64 × sex [male = 0; female = 1]) + (21.23× weight [kg]) - (14.31 × age [yr]) + (9.46 × height [cm]) (standard error of the estimate = 379.59 mL/min, R2 = 0.66, P < .001).Percentage predicted V˙O 2peak for the validation sample was 100.2%. The novel equation performed better than the other two equations. CONCLUSION This study reports the first CRF reference standards and prediction equation generated from treadmill CPX in China. These reference standards provide a framework for interpreting the CRF of the Chinese population and could be useful information for a global CRF database.
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Affiliation(s)
- Jia Huang
- Author Affiliations: College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China (Dr Huang, Mss Li and Xie, and Mr He); The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China (Dr Yin and Mss Wu and Ni); College of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China (Ms Li); National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China (Dr Liu); Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China (Dr L. Tao); and Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China (Drs J. Tao and Chen)
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Gravesteijn AS, Timmermans ST, Aarts J, Hulst HE, De Jong BA, Beckerman H, De Groot V. Relative aerobic load of walking in people with multiple sclerosis. J Rehabil Med 2024; 56:jrm13352. [PMID: 38353255 PMCID: PMC10875758 DOI: 10.2340/jrm.v56.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE To examine the energy demand of walking relative to aerobic capacity in people with multiple sclerosis. DESIGN Cross-sectional cohort study. PATIENTS A total of 45 people with multiple sclerosis (32 females), median disease duration 15 years (interquartile range (IQR) 9; 20), median Expanded Disability Status Scale 4 (min-max range: 2.0; 6.0). METHODS Aerobic capacity, derived from a cardiopulmonary exercise test and gas exchange measurements, assessed during a 6-min overground walk test at comfortable speed, were analysed. The relative aerobic load of walking was determined as the energy demand of walking relative to oxygen uptake at peak and at the first ventilatory threshold. Healthy reference data were used for clinical inference. RESULTS People with multiple sclerosis walk at a mean relative aerobic load of 60.0% (standard deviation 12.8%) relative to peak aerobic capacity, and 89.1% (standard deviation 19.9%) relative to the first ventilatory threshold. Fourteen participants walked above the first ventilatory threshold (31%). Peak aerobic capacity was reduced in 45% of participants, and energy demands were increased in 52% of participants. CONCLUSION People with multiple sclerosis walk at a relative aerobic load close to their first ventilatory threshold. A high relative aerobic load can guide clinicians to improve aerobic capacity or reduce the energy demands of walking.
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Affiliation(s)
- Arianne S Gravesteijn
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands.
| | - Sjoerd T Timmermans
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Jip Aarts
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Leiden University, Faculty of Social Sciences, Institute of Psychology, Health, Medical and Neuropsychology unit, Leiden, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Hanneke E Hulst
- Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands; Leiden University, Faculty of Social Sciences, Institute of Psychology, Health, Medical and Neuropsychology unit, Leiden, The Netherlands; MS Center Amsterdam, Anatomy and Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Brigit A De Jong
- Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands; MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Heleen Beckerman
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands
| | - Vincent De Groot
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands
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Kasiak P, Kowalski T, Rębiś K, Klusiewicz A, Ładyga M, Sadowska D, Wilk A, Wiecha S, Barylski M, Poliwczak AR, Wierzbiński P, Mamcarz A, Śliż D. Is the Ventilatory Efficiency in Endurance Athletes Different?-Findings from the NOODLE Study. J Clin Med 2024; 13:490. [PMID: 38256624 PMCID: PMC10816682 DOI: 10.3390/jcm13020490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Ventilatory efficiency (VE/VCO2) is a strong predictor of cardiovascular diseases and defines individuals' responses to exercise. Its characteristics among endurance athletes (EA) remain understudied. In a cohort of EA, we aimed to (1) investigate the relationship between different methods of calculation of VE/VCO2 and (2) externally validate prediction equations for VE/VCO2. Methods: In total, 140 EA (55% males; age = 22.7 ± 4.6 yrs; BMI = 22.6 ± 1.7 kg·m-2; peak oxygen uptake = 3.86 ± 0.82 L·min-1) underwent an effort-limited cycling cardiopulmonary exercise test. VE/VCO2 was first calculated to ventilatory threshold (VE/VCO2-slope), as the lowest 30-s average (VE/VCO2-Nadir) and from whole exercises (VE/VCO2-Total). Twelve prediction equations for VE/VCO2-slope were externally validated. Results: VE/VCO2-slope was higher in females than males (27.7 ± 2.6 vs. 26.1 ± 2.0, p < 0.001). Measuring methods for VE/VCO2 differed significantly in males and females. VE/VCO2 increased in EA with age independently from its type or sex (β = 0.066-0.127). Eleven equations underestimated VE/VCO2-slope (from -0.5 to -3.6). One equation overestimated VE/VCO2-slope (+0.2). Predicted and observed measurements differed significantly in nine models. Models explained a low amount of variance in the VE/VCO2-slope (R2 = 0.003-0.031). Conclusions: VE/VCO2-slope, VE/VCO2-Nadir, and VE/VCO2-Total were significantly different in EA. Prediction equations for the VE/VCO2-slope were inaccurate in EA. Physicians should be acknowledged to properly assess cardiorespiratory fitness in EA.
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Affiliation(s)
- Przemysław Kasiak
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Tomasz Kowalski
- Department of Physiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Kinga Rębiś
- Department of Physiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Andrzej Klusiewicz
- Department of Physical Education and Health in Biala Podlaska, Branch in Biala Podlaska, Jozef Pilsudski University of Physical Education, 00-968 Warsaw, Poland
| | - Maria Ładyga
- Department of Physiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Dorota Sadowska
- Department of Physiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Adrian Wilk
- Department of Kinesiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Szczepan Wiecha
- Department of Physical Education and Health in Biala Podlaska, Branch in Biala Podlaska, Jozef Pilsudski University of Physical Education, 00-968 Warsaw, Poland
| | - Marcin Barylski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, 90-419 Lodz, Poland
| | - Adam Rafał Poliwczak
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, 90-419 Lodz, Poland
| | - Piotr Wierzbiński
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Daniel Śliż
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
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Brochhagen J, Coll Barroso MT, Baumgart C, Wasmus DT, Freiwald J, Hoppe MW. Age, sex, endurance capacity, and chronic heart failure affect central and peripheral factors of oxygen uptake measured by non-invasive and continuous technologies: support of pioneer work using invasive or non-continuous measures. Front Sports Act Living 2023; 5:1218948. [PMID: 37731479 PMCID: PMC10507902 DOI: 10.3389/fspor.2023.1218948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction It is known that maximum oxygen uptake depends on age, sex, endurance capacity, and chronic heart failure. However, due to the required invasive or often applied non-continuous approaches, less is known on underlying central and peripheral factors. Thus, this study aimed to investigate the effects of age, sex, endurance capacity, and chronic heart failure on non-invasively and continuously measured central and peripheral factors of oxygen uptake. Methods 15 male children (11 ± 1 years), 15 male (24 ± 3 years) and 14 female recreationally active adults (23 ± 2 years), 12 male highly trained endurance athletes (24 ± 3 years), and 10 male elders (59 ± 6 years) and 10 chronic heart failure patients (62 ± 7 years) were tested during a cardiopulmonary exercise test on a cycling ergometer until exhaustion for: blood pressure, heart rate, stroke volume, cardiac output, cardiac power output, vastus lateralis muscle oxygen saturation, and (calculated) arterio-venous oxygen difference. For the non-invasive and continuous measurement of stroke volume and muscle oxygen saturation, bioreactance analysis and near-infrared spectroscopy were used, respectively. A two-factor repeated measure ANOVA and partial eta-squared effect sizes (η p 2 ) were applied for statistical analyses at rest, 80, and 100% of oxygen uptake. Results For the age effect, there were statistically significant group differences for all factors (p ≤ .033; η p 2 ≥ .169 ). Concerning sex, there were group differences for all factors (p ≤ .010; η p 2 ≥ .223 ), except diastolic blood pressure and heart rate (p ≥ .698; η p 2 ≤ .006 ). For the effect of endurance capacity, there were no group differences for any of the factors (p ≥ .065; η p 2 ≤ .129 ). Regarding chronic heart failure, there were group differences for the heart rate and arterio-venous oxygen difference (p ≤ .037; η p 2 ≥ .220 ). Discussion Age, sex, endurance capacity, and chronic heart failure affect central and peripheral factors of oxygen uptake measured by non-invasive and continuous technologies. Since most of our findings support pioneer work using invasive or non-continuous measures, the validity of our applied technologies is indirectly confirmed. Our outcomes allow direct comparison between different groups serving as reference data and framework for subsequent studies in sport science and medicine aiming to optimise diagnostics and interventions in athletes and patients.
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Affiliation(s)
- Joana Brochhagen
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | | | - Christian Baumgart
- Department of Movement and Training Science, Faculty of Humanities and Social Sciences, Institute of Sport Science, University of Wuppertal, Wuppertal, Germany
| | - Daniel T. Wasmus
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | - Jürgen Freiwald
- Department of Movement and Training Science, Faculty of Humanities and Social Sciences, Institute of Sport Science, University of Wuppertal, Wuppertal, Germany
| | - Matthias W. Hoppe
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
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Tamim M, Moustafa IM, Alaparthi GK, Oakley PA, Harrison DE. Translational and Rotational Postural Aberrations Are Related to Pulmonary Functions and Skill-Related Physical Fitness Components in Collegiate Athletes. J Clin Med 2023; 12:4618. [PMID: 37510736 PMCID: PMC10380693 DOI: 10.3390/jcm12144618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
This study assessed the relationship between body posture displacements, cardiopulmonary exercise testing (CPET), and skill-related physical fitness tests. One hundred male (60%) and female collegiate athletes (22.2 ± 4 yrs) with normal body mass indexes (BMI up to 24.9) were assessed via the PostureScreen Mobile® app to quantify postural displacements such as head, thorax, and pelvis rotations and translations. CPET and physical performance tests, including the agility t-test, vertical jump test, stork static balance test (SSBT), and dynamic Y-balance test (YBT), were performed. Spearman correlation (r) and p-values are reported. The postural parameters were found to have moderate-to-high associations with the CPET and agility test, moderate correlations with the vertical jump test and SSBT (head and pelvic postures only), and weak correlations with the YBT. As the postural parameters were more asymmetric, both the CPET and performance skills scores were worse. For example: (1) a medium positive correlation was found between cranio-vertebral angle (CVA) and the vertical jump test (r = 0.54; p-value < 0.001) and SSBT (r = 0.57; p-value < 0.001), while a strong negative correlation was found between CVA and the agility test (r = -0.86; p-value < 0.001). (2) A strong positive correlation was found between CVA and oxygen uptake efficiency slope, load watts VO2 at VT, VO2/kg, and load watts at the respiratory compensation point (RCP) (r = 0.65 and r = 0.71; p < 0.001). Conversely, a significant negative correlation was found between CVA and VE/VO2 at VT (r = -0.61; p < 0.001). Postural rotations and translations of the head, thorax, and pelvis were statistically correlated with the physical performance skills and CPET in the young collegiate athletes. There were moderate-to-high associations with cardiopulmonary functions and the agility tests, moderate correlations with the vertical jump test, and weak correlations with the YBT. Postural alignment may be important for optimal physical performance and optimal cardiopulmonary function. Further research is necessary to elucidate the reasons for these correlations found in our sample of young and healthy athletes.
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Affiliation(s)
- May Tamim
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Ibrahim M Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS-Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Gopala K Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Senior Lecturer, Department of Health Professions, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Paul A Oakley
- Kinesiology and Health Sciences, York University, Toronto, ON M3J 1P3, Canada
- Independent Researcher, Newmarket, ON L3Y 8Y8, Canada
| | - Deed E Harrison
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA
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Miętkiewska-Szwacka K, Domin R, Kwissa M, Żołyński M, Niziński J, Turska E, Cymerys M. Effect of COVID-19 on Blood Pressure Profile and Oxygen Pulse during and after the Cardiopulmonary Exercise Test in Healthy Adults. J Clin Med 2023; 12:4483. [PMID: 37445518 DOI: 10.3390/jcm12134483] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Several reports have shown the impact of COVID-19 history on exercise capacity. This study compared the blood pressure (BP) response and oxygen pulse (O2 pulse) characteristics in normotensive patients with and without a history of COVID-19 during the cardiopulmonary exercise test (CPET) and post-exercise recovery. This cross-sectional study involved 130 healthy Caucasian adult volunteers (71 participants with a history of COVID-19). All patients underwent the CPET with blood pressure measurements during exercise and post-exercise recovery. The post-COVID group had significantly higher systolic, diastolic, and mean blood pressure after 9 min of recovery and achieved a significantly lower max O2 pulse (2.02 mL/beat on average) than the controls. It should be noted that the COVID group tended to have higher blood pressure values in all steps, with no differences in heart rate, pulse pressure, and saturation at any step. The COVID-19 outbreak was associated with a higher blood pressure response, significantly, in post-exercise recovery, a lower maximum O2 pulse, and a lower maximum load achievement. Future studies are needed to determine if these abnormalities during the CPET and the blood pressure variation have prognostic value.
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Affiliation(s)
- Kamila Miętkiewska-Szwacka
- Department of Internal Medicine, Poznan University of Medical Sciences, 60-786 Poznan, Poland
- University Centre for Sports and Medical Studies, Poznan University of Medical Sciences, 60-802 Poznan, Poland
| | - Remigiusz Domin
- University Centre for Sports and Medical Studies, Poznan University of Medical Sciences, 60-802 Poznan, Poland
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Małgorzata Kwissa
- Department of Internal Medicine, Poznan University of Medical Sciences, 60-786 Poznan, Poland
- University Centre for Sports and Medical Studies, Poznan University of Medical Sciences, 60-802 Poznan, Poland
| | - Mikołaj Żołyński
- University Centre for Sports and Medical Studies, Poznan University of Medical Sciences, 60-802 Poznan, Poland
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Jan Niziński
- University Centre for Sports and Medical Studies, Poznan University of Medical Sciences, 60-802 Poznan, Poland
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, 60-355 Poznan, Poland
| | - Elżbieta Turska
- Institute of Pedagogy, University of Zielona Gora, 65-417 Zielona Gora, Poland
| | - Maciej Cymerys
- Department of Internal Medicine, Poznan University of Medical Sciences, 60-786 Poznan, Poland
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Kasiak PS, Wiecha S, Cieśliński I, Takken T, Lach J, Lewandowski M, Barylski M, Mamcarz A, Śliż D. Validity of the Maximal Heart Rate Prediction Models among Runners and Cyclists. J Clin Med 2023; 12:jcm12082884. [PMID: 37109218 PMCID: PMC10146295 DOI: 10.3390/jcm12082884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Maximal heart rate (HRmax) is a widely used measure of cardiorespiratory fitness. Prediction of HRmax is an alternative to cardiopulmonary exercise testing (CPET), but its accuracy among endurance athletes (EA) requires evaluation. This study aimed to externally validate HRmax prediction models in the EA independently for running and cycling CPET. A total of 4043 runners (age = 33.6 (8.1) years; 83.5% males; BMI = 23.7 (2.5) kg·m-2) and 1026 cyclists (age = 36.9 (9.0) years; 89.7% males; BMI = 24.0 (2.7) kg·m-2) underwent maximum CPET. Student t-test, mean absolute percentage error (MAPE), and root mean square error (RMSE) were applied to validate eight running and five cycling HRmax equations externally. HRmax was 184.6 (9.8) beats·min-1 and 182.7 (10.3) beats·min-1, respectively, for running and cycling, p = 0.001. Measured and predicted HRmax differed significantly (p = 0.001) for 9 of 13 (69.2%) models. HRmax was overestimated by eight (61.5%) and underestimated by five (38.5%) formulae. Overestimated HRmax amounted to 4.9 beats·min-1 and underestimated HRmax was in the range up to 4.9 beats·min-1. RMSE was 9.1-10.5. MAPE ranged to 4.7%. Prediction models allow for limited precision of HRmax estimation and present inaccuracies. HRmax was more often underestimated than overestimated. Predicted HRmax can be implemented for EA as a supplemental method, but CPET is the preferable method.
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Affiliation(s)
- Przemysław Seweryn Kasiak
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland
| | - Szczepan Wiecha
- Department of Physical Education and Health, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, 21-500 Biala Podlaska, Poland
| | - Igor Cieśliński
- Department of Physical Education and Health, Faculty in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, 21-500 Biala Podlaska, Poland
| | - Tim Takken
- Department of Medical Physiology, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, 3584 EA Utrecht, The Netherlands
| | - Jacek Lach
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland
| | - Marcin Lewandowski
- Department of Pharmacology and Clinical Pharmacology Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland
| | - Marcin Barylski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, 90-549 Łódź, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland
| | - Daniel Śliż
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 04-749 Warsaw, Poland
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Letnes JM, Nes BM, Wisløff U. Age-related decline in peak oxygen uptake: Cross-sectional vs. longitudinal findings. A review. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200171. [PMID: 36874046 PMCID: PMC9975246 DOI: 10.1016/j.ijcrp.2023.200171] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
Cardiorespiratory fitness is established as an important prognostic factor for cardiovascular and general health. In clinical settings cardiorespiratory fitness is often measured by cardiopulmonary exercise testing determining the gold-standard peak oxygen uptake (VO2peak). Due to the considerable impact of age and sex on VO2peak, results from cardiopulmonary exercise testing are typically assessed in the context of age- and sex-specific reference values, and multiple studies have been conducted establishing reference materials by age and sex using cross-sectional designs. However, crossectional and longitudinal studies have shown somewhat conflicting results regarding age-related declines of VO2peak, with larger declines reported in longitudinal studies. In this brief review, we compare findings from crossectional and longitudinal studies on age-related trajectories in VO2peak to highlight differences in these estimates which should be acknowledged when clinicians interpret VO2peak measurements repeated over time.
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Affiliation(s)
- Jon Magne Letnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Bjarne M Nes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,School of Human Movement and Nutrition Science, University of Queensland, Queensland, Australia
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10
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Wiecha S, Kasiak PS, Cieśliński I, Takken T, Palka T, Knechtle B, Nikolaidis PΤ, Małek ŁA, Postuła M, Mamcarz A, Śliż D. External validation of VO2max prediction models based on recreational and elite endurance athletes. PLoS One 2023; 18:e0280897. [PMID: 36696387 PMCID: PMC9876283 DOI: 10.1371/journal.pone.0280897] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
In recent years, numerous prognostic models have been developed to predict VO2max. Nevertheless, their accuracy in endurance athletes (EA) stays mostly unvalidated. This study aimed to compare predicted VO2max (pVO2max) with directly measured VO2max by assessing the transferability of the currently available prediction models based on their R2, calibration-in-the-large, and calibration slope. 5,260 healthy adult EA underwent a maximal exertion cardiopulmonary exercise test (CPET) (84.76% male; age 34.6±9.5 yrs.; VO2max 52.97±7.39 mL·min-1·kg-1, BMI 23.59±2.73 kg·m-2). 13 models have been selected to establish pVO2max. Participants were classified into four endurance subgroups (high-, recreational-, low- trained, and "transition") and four age subgroups (18-30, 31-45, 46-60, and ≥61 yrs.). Validation was performed according to TRIPOD guidelines. pVO2max was low-to-moderately associated with direct CPET measurements (p>0.05). Models with the highest accuracy were for males on a cycle ergometer (CE) (Kokkinos R2 = 0.64), females on CE (Kokkinos R2 = 0.65), males on a treadmill (TE) (Wasserman R2 = 0.26), females on TE (Wasserman R2 = 0.30). However, selected models underestimated pVO2max for younger and higher trained EA and overestimated for older and lower trained EA. All equations demonstrated merely moderate accuracy and should only be used as a supplemental method for physicians to estimate CRF in EA. It is necessary to derive new models on EA populations to include routinely in clinical practice and sports diagnostic.
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Affiliation(s)
- Szczepan Wiecha
- Faculty in Biala Podlaska, Department of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland
- * E-mail:
| | - Przemysław Seweryn Kasiak
- 3rd Department of Internal Medicine and Cardiology, Students’ Scientific Group of Lifestyle Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Igor Cieśliński
- Faculty in Biala Podlaska, Department of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland
| | - Tim Takken
- Department of Medical Physiology, Child Development & Exercise Center, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Tomasz Palka
- Faculty of Physical Education and Sport, Department of Physiology and Biochemistry, University of Physical Education in Krakow, Krakow, Poland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | | | - Łukasz A. Małek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | - Marek Postuła
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Daniel Śliż
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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11
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Tomlinson OW, Wadey CA, Williams CA. Normal reference values for aerobic fitness in cystic fibrosis: a scoping review. BMJ Open Sport Exerc Med 2022; 8:e001490. [DOI: 10.1136/bmjsem-2022-001490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
ObjectiveThe importance of aerobic fitness (VO2peak) in cystic fibrosis (CF) is well established, and regular exercise testing is recommended. To standardise VO2peak, a ‘percentage of predicted’ (%pred) derived from normative reference values (NRV), as promoted by the 2015 European Cystic Fibrosis Society Exercise Working Group (ECFS EWG), can be reported. However, the NRVs used in CF and their relative frequency is unknown.MethodA scoping review was performed via systematic database searches (PubMed, Embase, Web of Science, SciELO, EBSCO) and forward citation searches for studies that include people with CF and report VO2peakas %pred. Studies were screened using Covidence, and data related to patient demographics, testing modality and reference equations were extracted. Additional analyses were performed on studies published in 2016–2021, following the ECFS EWG statement in 2015.ResultsA total of 170 studies were identified, dating from 1984 to 2022, representing 6831 patients with CF, citing 34 NRV. Most studies (154/170) used cycle ergometry, 15/170 used treadmills, and the remainder used alternative, combination or undeclared modalities. In total, 61/170 failed to declare the NRV used. There were 61 studies published since the ECFS EWG statement, whereby 18/61 used the suggested NRV.ConclusionThere is a wide discrepancy in NRV used in the CF literature base to describe VO2peakas %pred, with few studies using NRV from the ECFS EWG statement. This high variance compromises the interpretation and comparison of studies while leaving them susceptible to misinterpretation and limiting replication. Standardisation and alignment of reporting of VO2peakvalues are urgently needed.
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12
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Re-Visiting Maximal Heart Rate Prediction Using Cross-Validation in Population Aged 7–55 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148509. [PMID: 35886359 PMCID: PMC9320369 DOI: 10.3390/ijerph19148509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
The primary purpose of the present study was to re-visit HRmax prediction by two commonly used equations (i.e., Fox′s and Tanaka′s equation) compared to the direct measured HRmax using the large sample size of Asians. The second aim of the study was to focus on suggesting new equations for the Asian population by separating gender and specific age groups. A total of 672 participants aged from 7 to 55 years were recruited for the study (male: 280 and female: 392), and the maximal graded exercise test with Bruce protocol was used to measure HRmax. All data obtained from the study were analyzed by SPSS 25.0. Additionally, three statistical analysis methods (i.e., Mean Absolute Percent Errors (MAPE), Bland–Altman plots, and equivalence testing) were utilized to confirm the consistency between the measured HRmax and the two prediction equations. The main finding was that two equations showed significant differences in predicting the HRmax of Korean aged from 7 to 55 years. The outcome of children aged from 7 to 14 was a different fit in the agreement compared to other age groups. Fox′s equation had the best fit in the average of the difference closer to zero and completely included within the equivalence zone, but females over 15 years old revealed higher errors than males in the values calculated by the two equations compared to the direct measured HRmax. Consequently, the study demonstrated that both equations tended to overestimate the HRmax for males and females over 15 years old, and the two universal equations were not suitable to predict the HRmax of Koreans except for children aged from 7 to 14 years. The new HRmax prediction equations suggested in this study will more accurately predict the HRmax of Asians, and additional analyses should be examined the cross-validity of the developed HRmax equation by age and gender in the future study.
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13
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Jeong D, Oh YM, Lee SW, Lee SD, Lee JS. Comparison of Predicted Exercise Capacity Equations in Adult Korean Subjects. J Korean Med Sci 2022; 37:e113. [PMID: 35411731 PMCID: PMC9001184 DOI: 10.3346/jkms.2022.37.e113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Maximal oxygen uptake (VO₂ max) is a useful index to assess exercise capacity. However, there is no reference value for Koreans. This study aimed to compare actual VO₂ max and predicted VO₂ max using exercise capacity equations in Korean subjects. METHODS This retrospective study enrolled 383 patients who underwent cardiopulmonary exercise test (CPET) with incremental maximal cycle ergometer test at Asan Medical Center from January 2020 to May 2021. Stage 1 and 2 lung cancer patients with normal lung function and healthy persons of 50 subjects who had maximal CPET were analyzed. RESULTS The subjects were aged 65 ± 13 years and predominantly male (74%). CPET results were as follows: absolute VO₂ max, 1.2 ± 0.3 L/min; body weight referenced VO₂ max, 20 ± 3.9 mL/kg/min; peak work rate, 94 ± 24 watts; peak heart rate, 142 ± 21 bpm; peak O2 pulse, 10 ± 3 mL/beat; minute ventilation, 59 ± 14 L/min; peak respiratory rate, 34 ± 6 breaths per minute; and peak breathing reserve, 41 ± 18%. There was significant discordance between the measured and predicted absolute VO₂ max using the Jones, Hansen, and Wasserman prediction equations developed for Caucasian population (P < 0.001). Agreement using Bland-Altman test between true and predicted absolute VO₂ max was the best in Chinese equation (-0.03, 2SD = 0.55) compared to Jones (0.42, 2SD = 1.07), Hansen (0.44, 2SD = 0.86), and Wasserman (0.42, 2SD = 0.86) equations. CONCLUSION The reference value and prediction equation from studies including primarily Caucasians may not be appropriate for Koreans. Since the mean difference is the lowest in Chinese equation, the Chinese equation might be used for the Korean adult population.
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Affiliation(s)
- Daehyun Jeong
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei Won Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Do Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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14
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Choong Hou KOH. Utility of Cardiopulmonary Exercise Test in Mitral Valve Transcatheter Edge-to-Edge Repair. Curr Probl Cardiol 2022:101196. [DOI: 10.1016/j.cpcardiol.2022.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/02/2022] [Indexed: 11/03/2022]
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15
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Myers J, de Souza E Silva CG, Arena R, Kaminsky L, Christle JW, Busque V, Ashley E, Moneghetti K. Comparison of the FRIEND and Wasserman-Hansen Equations in Predicting Outcomes in Heart Failure. J Am Heart Assoc 2021; 10:e021246. [PMID: 34689609 PMCID: PMC8751827 DOI: 10.1161/jaha.121.021246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Percentage of age‐predicted peak oxygen uptake (VO2) achieved (ppVO2) has been widely used to stratify risk in patients with heart failure. However, there are limitations to traditional normal standards. We compared the recently derived FRIEND (Fitness Registry and the Importance of Exercise: A National Data Base) equation to the widely used Wasserman‐Hansen (WH) ppVO2 equation to predict outcomes in patients with heart failure. Methods and Results A subgroup of 4055 heart failure patients from the FRIEND registry (mean age 53±15 years) was followed for a mean of 28±16 months. The FRIEND and WH equations along with measured peak VO2 expressed in mL/kg−1 per min−1 were compared for mortality and composite cardiovascular events. ppVO2 was higher for the FRIEND versus the WH equation (66±30% versus 58±25%; P<0.001). The areas under the receiver operating characteristic curves were slightly but significantly higher for the FRIEND equation for mortality (0.74 versus 0.72; P=0.03) and cardiac events (0.70 versus 0.68; P=0.008). Area under the receiver operating characteristic curve for measured peak VO2 was 0.70 (P<0.001) for mortality and 0.73 (P<0.001) for cardiovascular events. For each 1‐SD higher ppVO2 for the FRIEND equation, mortality was reduced by 18% (hazard ratio, 0.82; 95% CI, 0.69–0.97; P<0.02); for each 1‐SD higher ppVO2 for the WH equation, the mortality was reduced by 17% (hazard ratio, 0.83; 95% CI, 0.71–0.97; P=0.02). The corresponding reductions in risk per 1 SD for cardiovascular events for the FRIEND and WH equations were 23 and 21%, respectively (both P<0.001). Conclusions Peak VO2 expressed as percentage of an age‐predicted standard strongly predicts mortality and major cardiovascular events in patients with heart failure. The FRIEND registry equation exhibited test characteristics slightly superior to the commonly used WH equation.
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Affiliation(s)
- Jonathan Myers
- Cardiology Division Veterans Affairs Palo Alto Health Care System Palo Alto CA.,Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA.,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL
| | - Christina G de Souza E Silva
- Exercise Medicine Clinic - CLINIMEX Rio de Janeiro Brazil.,Heart Institute Edson Saad Federal University of Rio de Janeiro Brazil
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL.,Department of Physical Therapy College of Applied Health Sciences University of Illinois at Chicago IL
| | - Leonard Kaminsky
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL.,Fisher Institute of Health and Well-Being and Clinical Exercise Physiology Laboratory Ball State University Muncie IN
| | - Jeffrey W Christle
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA.,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL
| | - Vincent Busque
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Euan Ashley
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
| | - Kegan Moneghetti
- Division of Cardiovascular Medicine Stanford University School of Medicine Stanford CA
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16
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Pritchard A, Burns P, Correia J, Jamieson P, Moxon P, Purvis J, Thomas M, Tighe H, Sylvester KP. ARTP statement on cardiopulmonary exercise testing 2021. BMJ Open Respir Res 2021; 8:e001121. [PMID: 34782330 PMCID: PMC8593741 DOI: 10.1136/bmjresp-2021-001121] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) has become an invaluable tool in healthcare, improving the diagnosis of disease and the quality, efficacy, assessment and safety of treatment across a range of pathologies. CPET's superior ability to measure the global exercise response of the respiratory, cardiovascular and skeletal muscle systems simultaneously in a time and cost-efficient manner has led to the application of CPET in a range of settings from diagnosis of disease to preoperative assessment. The Association for Respiratory Technology and Physiology Statement on Cardiopulmonary Exercise Testing 2021 provides the practitioner and scientist with an outstanding resource to support and enhance practice, from equipment to testing to leadership, helping them deliver a quality assured service for the benefit of all patient groups.
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Affiliation(s)
- Andrew Pritchard
- Respiratory Centre, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Paul Burns
- Respiratory and Sleep Physiology Department, Royal Hospital for Children, Glasgow, UK
| | | | | | - Peter Moxon
- Respiratory Centre, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Joanna Purvis
- Cardio-Respiratory Department, George Eliot Hospital NHS Trust, Nuneaton, UK
| | | | - Hannah Tighe
- Respiratory Physiology, Imperial College Healthcare NHS Trust, London, UK
| | - Karl Peter Sylvester
- Respiratory Physiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Respiratory Physiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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17
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Petek BJ, Tso JV, Churchill TW, Guseh JS, Loomer G, DiCarli M, Lewis GD, Weiner RB, Kim JH, Wasfy MM, Baggish AL. Normative cardiopulmonary exercise data for endurance athletes: the Cardiopulmonary Health and Endurance Exercise Registry (CHEER). Eur J Prev Cardiol 2021; 29:536-544. [PMID: 34487164 DOI: 10.1093/eurjpc/zwab150] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/05/2021] [Accepted: 08/24/2021] [Indexed: 11/14/2022]
Abstract
AIMS Accurate interpretation of cardiopulmonary exercise testing (CPET) relies on age, gender, and exercise modality-specific reference values. To date, clinically applicable CPET reference values derived from a source population of endurance athletes (EAs) have been lacking. The purpose of this study was to generate CPET reference values for use in the clinical assessment of EA. METHODS AND RESULTS Prospective data accrued during the clinical care of healthy EA were used to derive CPET reference values and to develop novel equations for V˙O2peak. The performance of these equations was compared to the contemporary standard of care equations and assessed in a discrete EA validation cohort. A total of 272 EA (age = 42 ± 15 years, female = 31%, V˙O2peak = 3.6 ± 0.83 L/min) met inclusion criteria and comprised the derivation cohort. V˙O2peak prediction equations derived from general population cohorts described a modest amount of V˙O2peak variability [R2 = 0.58-0.70, root mean square error (RMSE) = 0.46-0.54 L/min] but were mis-calibrated (calibration-in-the-large = 0.45-1.18 L/min) among EA leading to significant V˙O2peak underestimation. Newly derived, externally validated V˙O2peak prediction equations for EA that included age, sex, and height for both treadmill (R2 = 0.74, RMSE = 0.42 L/min) and cycle ergometer CPET (Cycle: R2 = 0.69, RMSE = 0.42 L/min) demonstrated improved accuracy. CONCLUSION Commonly used V˙O2peak prediction equations derived from general population cohorts perform poorly among competitive EA. Newly derived CPET reference values including novel V˙O2peak prediction equations may improve the clinical utility of CPET in this rapidly growing patient population.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Jason V Tso
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, 1462 Clifton Road, NE, Suite 502, Atlanta, GA 30322, USA
| | - Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - J Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Garrett Loomer
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Milena DiCarli
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Gregory D Lewis
- Division of Cardiology, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, 1462 Clifton Road, NE, Suite 502, Atlanta, GA 30322, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
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18
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Puente-Maestú L, Ortega F, Pedro JGD, Rodríguez-Nieto MJ, Gómez-Seco J, Gáldiz B, Ojanguren I, Muñoz X, Blanco I, Burgos F, Rodríguez-Chiaradía DA, Gea J, García-Rio F. Prediction Equations for Maximal Aerobic Capacity on Cycle Ergometer for the Spanish Adult Population. Arch Bronconeumol 2021; 57:471-478. [PMID: 35698953 DOI: 10.1016/j.arbr.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/13/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake (V?O2) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. METHODS 182 men and women, 20-85 years old, were included and exercised on cycle-ergometer to exhaustion. (V?O2) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. RESULTS Height, sex and age resulted predictive of both V?O2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas V?O2peak=0.017·height?(cm)-0.023·age?(years)+0.864·sex?(female=0/male=1)±179?l?min-1, and peak WR=1.345 · height (cm) - 2.074 · age (years)+76.54 · sex (female=0/male=1)±21.2W were the best compromise between accuracy and parsimony. CONCLUSIONS This study provides new and accurate V?O2 peak and WR rate reference values for individuals of European Spanish descent.
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Affiliation(s)
- Luis Puente-Maestú
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Francisco Ortega
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Julia Garcia de Pedro
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Jesús Rodríguez-Nieto
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, IIS-Fundación Jiménez Diaz, Autónoma University Madrid, Madrid, Spain
| | | | - Batxi Gáldiz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Cruces Universitary Hospital, Barakaldo, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - Iñigo Ojanguren
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain
| | - Xavier Muñoz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain; Servicio Neumologia Hospital Vall d'Hebron, Barcelona, Spain; Ciber de Enfermedades respiratorias CIBERes, Barcelona, Spain; Departamento de Biología Celular, Fisiología e Inmunología Univertsidad Autónoma de Barcelona, Cataluña, Spain
| | - Isabel Blanco
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Felip Burgos
- University of Barcelona Respiratory Diagnostic Center Hospital Clínic, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradía
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Joaquim Gea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Francisco García-Rio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ-Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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19
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Petek BJ, Gustus SK, Wasfy MM. Cardiopulmonary Exercise Testing in Athletes: Expect the Unexpected. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23. [DOI: 10.1007/s11936-021-00928-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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20
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Loughney L, McCaffrey N, Timon CM, Grundy J, McCarren A, Cahill R, Moyna N, Mulsow J. Physical, psychological and nutritional outcomes in a cohort of Irish patients with metastatic peritoneal malignancy scheduled for cytoreductive surgery (CRS) and heated intrapertioneal chemotherapy (HIPEC): An exploratory pilot study. PLoS One 2020; 15:e0242816. [PMID: 33296392 PMCID: PMC7725307 DOI: 10.1371/journal.pone.0242816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Background Treatment for peritoneal malignancy (PM) can include cytoreductive surgery (CRS) and heated intrapertioneal chemotherapy (HIPEC) and is associated with morbidity and mortality. Physical, psychological and nutritional outcomes are important pre-operatively. The aim of this pilot study was to investigate these outcomes in patients with PM before and after CRS-HIPEC. Methods Between June 2018 and November 2019, participants were recruited to a single-centre study. Primary outcome was cardiopulmonary exercise testing (CPET) variables oxygen uptake (VO2) at anaerobic threshold (AT) and at peak. Secondary outcome measures were upper and lower body strength, health related quality of life (HRQoL) and the surgical fear questionnaire. Exploratory outcomes included body mass index, nutrient intake and post-operative outcome. All participants were asked to undertake assessments pre CRS-HIPEC and 12 weeks following the procedure. Results Thirty-nine patients were screened, 38 were eligible and 16 were recruited. Ten female and 6 male, median (IQR) age 53 (42–63) years. Of the 16 patients recruited, 14 proceeded with CRS-HIPEC and 10 competed the follow up assessment at week 12. Pre-operative VO2 at AT and peak was 16.8 (13.7–18) ml.kg-1.min-1 and 22.2 (19.3–25.3) ml.kg-1.min-1, upper body strength was 25.9 (20.3–41.5) kg, lower body strength was 14 (10.4–20.3) sec, HRQoL (overall health status) was 72.5 (46.3–80) % whilst overall surgical fear was 39 (30.5–51). The VO2 at AT decreased significantly (p = 0.05) and HRQoL improved (p = 0.04) between pre and post- CRS-HIPEC. There were no significant differences for any of the other outcome measures. Conclusion This pilot study showed a significant decrease in VO2 at AT and an improvement in overall HRQoL at the 12 week follow up. The findings will inform a larger study design to investigate a prehabilitation and rehabilitation cancer survivorship programme.
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Affiliation(s)
- Lisa Loughney
- ExWell Medical, Dublin, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- The Royal College of Surgeons in Ireland, Dublin, Ireland
- * E-mail:
| | - Noel McCaffrey
- ExWell Medical, Dublin, Ireland
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Claire M. Timon
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Joshua Grundy
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital Dublin, Dublin, Ireland
| | - Andrew McCarren
- Department of Computing, Dublin City University, Dublin, Ireland
| | - Ronan Cahill
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niall Moyna
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Jurgen Mulsow
- National Centre for Peritoneal Malignancy, Mater Misericordiae University Hospital Dublin, Dublin, Ireland
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21
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Pane C, Salzano A, Trinchillo A, Del Prete C, Casali C, Marcotulli C, Defazio G, Guardasole V, Vastarella R, Giallauria F, Puorro G, Marsili A, De Michele G, Filla A, Cittadini A, Saccà F. Safety and feasibility of upper limb cardiopulmonary exercise test in Friedreich ataxia. Eur J Prev Cardiol 2020; 29:445-451. [DOI: 10.1093/eurjpc/zwaa134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 12/25/2022]
Abstract
Abstract
Aims
To explore the feasibility of upper limbs cardiopulmonary exercise test (CPET) in Friedreich ataxia (FRDA) patients and to compare the results with sex, age, and body mass index (BMI) matched cohort of healthy controls (HC).
Methods and results
Cardiopulmonary exercise test was performed using an upper limbs cycle ergometer on fasting subjects. Peak oxygen uptake (peak VO2) was recorded as the mean value of VO2 during a 20 s period at the maximal effort of the test at an appropriate respiratory exchange rate. The ventilatory anaerobic threshold (AT) was detected by the use of the V-slope method. We performed echocardiography with an ultrasound system equipped with a 2.5 MHz multifrequency transducer for complete M-mode, two-dimensional, Doppler, and Tissue Doppler Imaging analyses. We studied 55 FRDA and 54 healthy matched controls (HC). Peak VO2 showed a significant 31% reduction in FRDA patients compared to HC (15.2 ± 5.7 vs. 22.0 ± 6.1 mL/kg/min; P < 0.001). Peak workload was reduced by 41% in FRDA (42.9 ± 12.5 vs. 73.1 ± 21.2 W; P < 0.001). In FRDA patients, peak VO2 is inversely correlated with the Scale for Assessment and Rating of Ataxia score, disease duration, and 9HPT performance, and directly correlated with activities of daily living. The AT occurred at 48% of peak workload time in FRDA patients and at 85% in HC (P < 0.001).
Conclusions
Upper limb CPET is useful in the assessment of exercise tolerance and a possible tool to determine the functional severity of the mitochondrial oxidative defect in patients with FRDA. The cardiopulmonary exercise test is an ideal functional endpoint for Phases II and III trials through a simple, non-invasive, and safe exercise test.
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Affiliation(s)
- Chiara Pane
- Department of Neurosciences, Reproductive and Odontostomatological Sciences (DNSRO), Federico II University, Via S. Pansini 5, Naples, Italy
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Via E Gianturco, Naples, 80143, Italy
| | - Assunta Trinchillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences (DNSRO), Federico II University, Via S. Pansini 5, Naples, Italy
| | - Claudia Del Prete
- Department of Neurosciences, Reproductive and Odontostomatological Sciences (DNSRO), Federico II University, Via S. Pansini 5, Naples, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Faggiana 34, Latina, Italy
| | - Christian Marcotulli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Faggiana 34, Latina, Italy
| | - Giovanni Defazio
- Department of Medical Sciences and Public Health, University of Cagliari, SS 554 km 4.500, Cagliari, Italy
| | - Vincenzo Guardasole
- Department of Translational Medical Sciences, Federico II University, Via S Pansini 5, Naples, 80131, Italy
| | - Rossella Vastarella
- Department of Translational Medical Sciences, Federico II University, Via S Pansini 5, Naples, 80131, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University, Via S Pansini 5, Naples, 80131, Italy
| | - Giorgia Puorro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences (DNSRO), Federico II University, Via S. Pansini 5, Naples, Italy
| | - Angela Marsili
- Department of Neurosciences, Reproductive and Odontostomatological Sciences (DNSRO), Federico II University, Via S. Pansini 5, Naples, Italy
| | - Giovanna De Michele
- Department of Neurosciences, Reproductive and Odontostomatological Sciences (DNSRO), Federico II University, Via S. Pansini 5, Naples, Italy
| | - Alessandro Filla
- Department of Neurosciences, Reproductive and Odontostomatological Sciences (DNSRO), Federico II University, Via S. Pansini 5, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Via S Pansini 5, Naples, 80131, Italy
| | - Francesco Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences (DNSRO), Federico II University, Via S. Pansini 5, Naples, Italy
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22
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Lewthwaite H, Elsewify O, Niro F, Bourbeau J, Guenette JA, Maltais F, Marciniuk DD, O'Donnell DE, Smith BM, Stickland MK, Tan WC, Jensen D. Normative Cardiopulmonary Exercise Test Responses at the Ventilatory Threshold in Canadian Adults 40 to 80 Years of Age. Chest 2020; 159:1922-1933. [PMID: 33217419 DOI: 10.1016/j.chest.2020.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Physiologic and symptom responses at the ventilatory threshold (Tvent) during incremental cardiopulmonary exercise testing (CPET) can provide important prognostic information. RESEARCH QUESTION This study aimed to develop an updated normative reference set for physiologic and symptom responses at Tvent during cycle CPET (primary aim) and to evaluate previously recommended reference equations from a 1985 study for predicting Tvent responses (secondary aim). STUDY DESIGN AND METHODS Participants were adults 40 to 80 years of age who were free of clinically relevant disease from the Canadian Cohort Obstructive Lung Disease. Rate of oxygen consumption (V˙O2) at Tvent was identified by two independent raters; physiologic and symptom responses corresponding to V˙O2 at Tvent were identified by linear interpolation. Reference ranges (5th-95th percentiles) for responses at Tvent were calculated according to participant sex and age for 29 and eight variables, respectively. Prediction models were developed for nine variables (oxygen pulse, V˙O2, rate of CO2 production, minute ventilation, tidal volume, inspiratory capacity, end-inspiratory lung volume [in liters and as percentage of total lung capacity], and end-expiratory lung volume) using quantile regression, estimating the 5th (lower limit of normal), 50th (normal), and 95th (upper limit of normal) percentiles based on readily available participant characteristics. The two one-sided test of equivalence for paired samples evaluated the measured and 1985-predicted V˙O2 at Tvent for equivalence. RESULTS Reference ranges and equations were developed based on 96 participants (49% men) with a mean ± SD age of 63 ± 9 years. Mean V˙O2 at Tvent was 50% of measured V˙O2 peak; the normal range was 33% to 66%. The 1985 reference equations overpredicted V˙O2 at Tvent: mean difference in men, -0.17 L/min (95% CI, -0.25 to -0.09 L/min); mean difference in women, -0.19 L/min (95% CI, -0.27 to -0.12 L/min). INTERPRETATION A contemporary reference set of CPET responses at Tvent from Canadian adults 40 to 80 years of age is presented that differs from the previously recommended and often used reference set from 1985. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00920348; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Hayley Lewthwaite
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal; UniSA: Allied Health and Human Performance, Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, SA, Australia.
| | - Omar Elsewify
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal
| | - Frank Niro
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal
| | - Jean Bourbeau
- Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital, Vancouver, BC; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, QC
| | - Darcy D Marciniuk
- Respiratory Research Centre and Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Denis E O'Donnell
- Laboratory of Clinical Exercise Physiology, Kingston Health Science Center & Queen's University, Kingston, ON, Canada
| | - Benjamin M Smith
- Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal
| | - Michael K Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, St. Paul's Hospital, Vancouver, BC
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal; Division of Respiratory Medicine, Faculty of Medicine, McGill University, Montréal; Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montréal
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23
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Puente-Maestú L, Ortega F, Pedro JGD, Rodríguez-Nieto MJ, Gómez-Seco J, Gáldiz B, Ojanguren I, Muñoz X, Blanco I, Burgos F, Rodríguez-Chiaradía DA, Gea J, García-Rio F. Prediction Equations for Maximal Aerobic Capacity on Cycle Ergometer for the Spanish Adult Population. Arch Bronconeumol 2020:S0300-2896(20)30375-6. [PMID: 33172709 DOI: 10.1016/j.arbres.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Frequently used reference values for clinical exercise testing have been derived from non-random samples and some with poorly defined maximal criteria. Our objective was to obtain population based reference values for peak oxygen uptake (V˙O2) and work rate (WR) for cardiopulmonary exercise testing in a representative sample of Caucasian Spanish men and women. METHODS 182 men and women, 20-85 years old, were included and exercised on cycle-ergometer to exhaustion. (V˙O2) and WR were measured. The equations obtained from this sample were validated in an independent cohort of 69 individuals, randomly sampled form the same population. Then a final equation merging the two cohorts (=251) was produced. RESULTS Height, sex and age resulted predictive of both V˙O2 peak and WR. Weight and physical activity added very little to the accuracy to the equations. The formulas V˙O2peak=0.017⋅height(cm)-0.023⋅age(years)+0.864⋅sex(female=0/male=1)±179lmin-1, and peak WR=1.345 · height (cm) - 2.074 · age (years)+76.54 · sex (female=0/male=1)±21.2W were the best compromise between accuracy and parsimony. CONCLUSIONS This study provides new and accurate V˙O2 peak and WR rate reference values for individuals of European Spanish descent.
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Affiliation(s)
- Luis Puente-Maestú
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Francisco Ortega
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Julia Garcia de Pedro
- Servicio de Neumología Hospital General Universitario Gregorio Marañón-Facultad de Medicina: Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - María Jesús Rodríguez-Nieto
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, IIS-Fundación Jiménez Diaz, Autónoma University Madrid, Madrid, Spain
| | | | - Batxi Gáldiz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Cruces Universitary Hospital, Barakaldo, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - Iñigo Ojanguren
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain
| | - Xavier Muñoz
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Cataluña, Spain; Servicio Neumologia Hospital Vall d'Hebron, Barcelona, Spain; Ciber de Enfermedades respiratorias CIBERes, Barcelona, Spain; Departamento de Biología Celular, Fisiología e Inmunología Univertsidad Autónoma de Barcelona, Cataluña, Spain
| | - Isabel Blanco
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Pulmonary Medicine, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Felip Burgos
- University of Barcelona Respiratory Diagnostic Center Hospital Clínic, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradía
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Joaquim Gea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital del Mar-Universitat Pompeu Fabra (UPF), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mediques (IMIM), CIBERES (ISCIII), Barcelona, Spain
| | - Francisco García-Rio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), (Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ-Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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24
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Kondo T, Okumura T, Oishi H, Arao Y, Kato H, Yamaguchi S, Kuwayama T, Haga T, Yokoi T, Hiraiwa H, Fukaya K, Sawamura A, Morimoto R, Mutsuga M, Fujimoto K, Usui A, Murohara T. Associations between hemodynamic parameters at rest and exercise capacity in patients with implantable left ventricular assist devices. Int J Artif Organs 2020; 44:174-180. [PMID: 32783493 DOI: 10.1177/0391398820949888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemodynamic parameters at rest are known to correlate poorly with peak oxygen uptake (VO2) in heart failure. However, we hypothesized that hemodynamic parameters at rest could predict exercise capacity in patients with left ventricular assist device (LVAD), because LVAD pump rotational speed does not respond during exercise. Therefore, we investigated the relationships between hemodynamic parameters at rest (measured with right heart catheterization) and exercise capacity (measured with cardiopulmonary exercise testing) in patients with implantable LVAD. METHODS We performed a retrospective medical record review of patients who received implantable LVAD at our institution from November 2013 to December 2017. RESULTS A total of 20 patients were enrolled in this study (15 males; mean age, 45.8 years; median duration of LVAD support, 356 days). The mean peak VO2 and cardiac index (CI) were 13.5 mL/kg/min and 2.6 L/min/m2, respectively. CI and hemoglobin level were significantly associated with peak VO2 (CI: r = 0.632, p = 0.003; hemoglobin: r = 0.520, p = 0.019). In addition, pulmonary capillary wedge pressure, right atrial pressure, and right ventricular stroke work index were also significantly associated with peak VO2. In multiple linear regression analysis, CI and hemoglobin level remained independent predictors of peak VO2 (CI: β = 0.559, p = 0.006; hemoglobin: β = 0.414, p = 0.049). CONCLUSIONS CI at rest and hemoglobin level are associated with poor exercise capacity in patients with LVAD.
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Affiliation(s)
- Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideo Oishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihito Arao
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Kato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shogo Yamaguchi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tasuku Kuwayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoaki Haga
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Yokoi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Fukaya
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinori Sawamura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuro Fujimoto
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Normative Peak Cardiopulmonary Exercise Test Responses in Canadian Adults Aged ≥40 Years. Chest 2020; 158:2532-2545. [PMID: 32679236 DOI: 10.1016/j.chest.2020.06.074] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Up-to-date normative reference sets for cardiopulmonary exercise testing (CPET) are important to aid in the accurate interpretation of CPET in clinical or research settings. RESEARCH QUESTION This study aimed to (1) develop and externally validate a contemporary reference set for peak CPET responses in Canadian adults identified with population-based sampling; and (2) evaluate previously recommended reference equations for predicting peak CPET responses. STUDY DESIGN AND METHODS Participants were healthy adults who were ≥40 years old from the Canadian Cohort Obstructive Lung Disease who completed an incremental cycle CPET. Prediction models for peak CPET responses were estimated from readily available participant characteristics (age, sex, height, body mass) with the use of quantile regression. External validation was performed with a second convenience sample of healthy adults. Peak CPET parameters that were measured and predicted in the validation cohort were assessed for equivalence (two one-sided tests of equivalence for paired-samples and level of agreement (Bland-Altman analyses). Two one-sided tests of equivalence for paired samples assessed differences between responses in the derivation cohort using previously recommended reference equations. RESULTS Normative reference ranges (5th-95th percentiles) for 28 peak CPET parameters and prediction models for 8 peak CPET parameters were based on 173 participants (47% male) who were 64 ± 10 years old. In the validation cohort (n = 84), peak CPET responses that were predicted with the newly generated models were equivalent to the measured values. Peak cardiac parameters predicted by the previously recommended reference equations by Jones and colleagues and Hansen and colleagues were significantly higher. INTERPRETATION This study provides reference ranges and prediction models for peak cardiac, ventilatory, operating lung volume, gas exchange, and symptom responses to incremental CPET and presents the most comprehensive reference set to date in Canadian adults who were ≥40 years old to be identified with population-based sampling.
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26
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Damen KMS, Takken T, de Groot JF, Backx FJG, Radder B, Roos ICPM, Bloemen MAT. 6-Minute Push Test in Youth Who Have Spina Bifida and Who Self-Propel a Wheelchair: Reliability and Physiologic Response. Phys Ther 2020; 100:1852-1861. [PMID: 32671398 PMCID: PMC7530576 DOI: 10.1093/ptj/pzaa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/21/2019] [Accepted: 06/09/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Despite the common occurrence of lower levels of physical activity and physical fitness in youth with spina bifida (SB) who use a wheelchair, there are very few tests available to measure and assess these levels. The purpose of this study was to determine reliability and the physiologic response of the 6-minute push test (6MPT) in youth with SB who self-propel a wheelchair. METHODS In this reliability and observational study, a sample of 53 youth with SB (5-19 years old; mean age = 13 years 7 months; 32 boys and 21 girls) who used a wheelchair performed 2 exercise tests: the 6MPT and shuttle ride test. Heart rate, minute ventilation, respiratory exchange ratio, and oxygen consumption were measured using a calibrated mobile gas analysis system and a heart rate monitor. For reliability, intraclass correlation coefficients (ICCs), SE of measurement, smallest detectable change for total covered distance, minute work, and heart rate were calculated. Physiologic response during the 6MPT was expressed as percentage of maximal values achieved during the shuttle ride test. RESULTS The ICCs for total distance and minute work were excellent (0.95 and 0.97, respectively), and the ICC for heart rate was good (0.81). The physiologic response during the 6MPT was 85% to 89% of maximal values, except for minute ventilation (70.6%). CONCLUSIONS For most youth with SB who use a wheelchair for mobility or sports participation, the 6MPT is a reliable, functional performance test on a vigorous level of exercise. IMPACT This is the first study to investigate physiologic response during the 6MPT in youth (with SB) who are wheelchair using. Clinicians can use the 6MPT to evaluate functional performance and help design effective exercise programs for youth with SB who are wheelchair using.
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Affiliation(s)
- Karlijn M S Damen
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Heidelberglaan 7, Postbus 12011, 3501 AA Utrecht, the Netherlands; and Master Program Physiotherapy, Specialisation Paediatric Physiotherapy, HU University of Applied Sciences Utrecht
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Janke F de Groot
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht and Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht
| | - Frank J G Backx
- Department of Rehabilitation, Physiotherapy Science and Sports, University Medical Center Utrecht
| | - Bob Radder
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht; and Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht
| | - Irene C P M Roos
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht and Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht
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Sovová M, Sovová E, Asswad AG, Sova M. Is population's cardiorespiratory fitness really declining? Cent Eur J Public Health 2020; 28:120-123. [DOI: 10.21101/cejph.a5912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 04/09/2020] [Indexed: 11/15/2022]
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Peterman JE, Harber MP, Imboden MT, Whaley MH, Fleenor BS, Myers J, Arena R, Finch WH, Kaminsky LA. Accuracy of Nonexercise Prediction Equations for Assessing Longitudinal Changes to Cardiorespiratory Fitness in Apparently Healthy Adults: BALL ST Cohort. J Am Heart Assoc 2020; 9:e015117. [PMID: 32458761 PMCID: PMC7428991 DOI: 10.1161/jaha.119.015117] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Repeated assessment of cardiorespiratory fitness (CRF) improves mortality risk predictions in apparently healthy adults. Accordingly, the American Heart Association suggests routine clinical assessment of CRF using, at a minimum, nonexercise prediction equations. However, the accuracy of nonexercise prediction equations over time is unknown. Therefore, we compared the ability of nonexercise prediction equations to detect changes in directly measured CRF. Methods and Results The sample included 987 apparently healthy adults from the BALL ST (Ball State Adult Fitness Longitudinal Lifestyle Study) cohort (33% women; average age, 43.1±10.4 years) who completed 2 cardiopulmonary exercise tests ≥3 months apart (3.2±5.4 years of follow‐up). The change in estimated CRF (eCRF) from 27 distinct nonexercise prediction equations was compared with the change in directly measured CRF. Analysis included Pearson product moment correlations, SEE values, intraclass correlation coefficient values, Cohen's κ coefficients, γ coefficients, and the Benjamini‐Hochberg procedure to compare eCRF with directly measured CRF. The change in eCRF from 26 of 27 equations was significantly associated to the change in directly measured CRF (P<0.001), with intraclass correlation coefficient values ranging from 0.06 to 0.63. For 16 of the 27 equations, the change in eCRF was significantly different from the change in directly measured CRF. The median percentage of participants correctly classified as having increased, decreased, or no change in CRF was 56% (range, 39%–61%). Conclusions Variability was observed in the accuracy between nonexercise prediction equations and the ability of equations to detect changes in CRF. Considering the appreciable error that prediction equations had with detecting even directional changes in CRF, these results suggest eCRF may have limited clinical utility.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being Ball State University Muncie IN
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory Ball State University Muncie IN
| | - Mary T Imboden
- Health and Human Performance Department George Fox University Newberg OR
| | | | - Bradley S Fleenor
- Clinical Exercise Physiology Laboratory Ball State University Muncie IN
| | - Jonathan Myers
- Division of Cardiology Veterans Affairs Palo Alto Healthcare System and Stanford University Palo Alto CA
| | - Ross Arena
- Department of Physical Therapy College of Applied Science University of Illinois Chicago IL
| | - W Holmes Finch
- Department of Educational Psychology Ball State University Muncie IN
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being Ball State University Muncie IN
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Reference Values and Predictive Equations for Cardiopulmonary Exercise Testing in Thai Adults. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.101808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: A series of racial specific predictive equations for exercise parameters are needed to determine a lack of cardiopulmonary fitness or having an exercise limitation on cardiopulmonary exercise testing (CPET). Objectives: The study aimed to develop a new set of predictive equations of CPET parameters during maximal cycling exercise for Thai adults. Methods: A sample of 580 Thai adults whom could pass screening tests were asked to fill a health questionnaire and the Global Physical Activity questionnaire. Participants with history of symptomatic heart and pulmonary diseases, current smokers, history of smoking ≥ 10 pack-years, and abnormal spirometry were excluded. The CPET was performed using a cycle ergometer with an incremental symptom-limited protocol. Values of CPET parameters at the peak exercise (oxygen uptake [V̇O2], work rate, heart rate, oxygen pulse, and minute ventilation), lactic acidosis threshold, and ventilatory equivalents for oxygen and carbon dioxide were documented. Analyses were stratified using age and gender criterion. Predictive equations for CPET parameters were established using multivariable linear regression with age (A), weight (W), height (H), and physical activity level (Act) as independent variables. Results: A total of 493 participants (208 men and 285 women) were analysed. The predictive equation of V̇O2peak (L.min-1) for males was: -2.268 + (0.037 × A) - (0.0005 × A2) + (0.016 × W) + (0.014 × H) + (0.104 × Act), (R2 = 0.41, SEE = 0.392), and for females, it was: -0.34 + (0.009 × A) - (0.0002 × A2) + (0.012 × W) + (0.005 × H) + (0.058 × Act), (R2 = 0.44, SEE = 0.220). Conclusions: This is the first study that constructed the predictive equations for cycling CPET parameters in Thai adults. These equations are useful to evaluate the cardiopulmonary health of the Thai population and may be generalized to other populations with geographical or ethnic proximity to the Thai people.
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Takken T, Sonbahar Ulu H, Hulzebos EHJ. Clinical recommendations for cardiopulmonary exercise testing in children with respiratory diseases. Expert Rev Respir Med 2020; 14:691-701. [PMID: 32252564 DOI: 10.1080/17476348.2020.1752195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) quantitates and qualitates the integrated physiological response of a person to incremental exercise and provides additional information compared to static lung function tests alone. AREAS COVERED This review covers rationale for the use of CPET parameters beyond the usual parameters like peak oxygen uptake and peak minute ventilation in children with respiratory disease. EXPERT OPINION CPET provides a wealth of data from rest, submaximal and maximal exercise and data during recovery from exercise. In this review, an interpretative approach is described for analyzing CPET data in children with respiratory disease.
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Affiliation(s)
- Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Hazal Sonbahar Ulu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University , Samanpazari/Ankara, Turkey
| | - Erik H J Hulzebos
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, The Netherlands
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31
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Letnes JM, Nes B, Vaardal-Lunde K, Slette MB, Mølmen-Hansen HE, Aspenes ST, Støylen A, Wisløff U, Dalen H. Left Atrial Volume, Cardiorespiratory Fitness, and Diastolic Function in Healthy Individuals: The HUNT Study, Norway. J Am Heart Assoc 2020; 9:e014682. [PMID: 31986991 PMCID: PMC7033857 DOI: 10.1161/jaha.119.014682] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Left atrial (LA) size and cardiorespiratory fitness (CRF) are predictors of future cardiovascular events in high-risk populations. LA dilatation is a diagnostic criterion for left ventricular diastolic dysfunction. However, LA is dilated in endurance athletes with high CRF, but little is known about the association between CRF and LA size in healthy, free-living individuals. We hypothesized that in a healthy population, LA size was associated with CRF and leisure-time physical activity, but not with echocardiographic indexes of left ventricular diastolic dysfunction. Methods and Results In this cross-sectional study from HUNT (Nord-Trøndelag Health Study), 107 men and 138 women, aged 20 to 82 years, without hypertension, cardiovascular, pulmonary, or malignant disease participated. LA volume was assessed by echocardiography and indexed to body surface area LAVI (left atrial volume index). CRF was measured as peak oxygen uptake (VO2peak) using ergospirometry, and percent of age- and-sex-predicted VO2peak was calculated. Indexes of left ventricular diastolic dysfunction were assessed in accordance with latest recommendations. LAVI was >34 mL/m2 in 39% of participants, and LAVI was positively associated with VO2peak and percentage of age- and-sex-predicted VO2peak (β [95% CI], 0.11 [0.06-0.16] and 0.18 [0.09-0.28], respectively) and weighted minutes of physical activity per week (β [95% CI], 0.01 [0.003-0.015]). LAVI was not associated with other indexes of left ventricular diastolic dysfunction. There was an effect modification between age and VO2peak/percentage of age- and-sex-predicted VO2peak showing higher LAVI with advanced age and higher VO2peak/percentage of age- and-sex-predicted VO2peak as presented in prediction diagrams. Conclusions Interpretation of LAVI as a marker of diastolic dysfunction should be done in relation to age-relative CRF. Studies on the prognostic value of LAVI in fit subpopulations are needed.
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Affiliation(s)
- Jon Magne Letnes
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.,Clinic of Cardiology St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - Bjarne Nes
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.,Clinic of Cardiology St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | | | | | | | - Stian Thoresen Aspenes
- Department of Health Registries Norwegian Directorate of Health Oslo Norway.,Centre for Fertility and Health Norwegian Institute of Public Health Oslo Norway
| | - Asbjørn Støylen
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.,Clinic of Cardiology St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging Norwegian University of Science and Technology Trondheim Norway.,Clinic of Cardiology St. Olavs Hospital Trondheim University Hospital Trondheim Norway.,Department of Medicine Levanger Hospital Nord-Trøndelag Hospital Trust Levanger Norway
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Reference Values for Cardiorespiratory Fitness in Healthy Koreans. J Clin Med 2019; 8:jcm8122191. [PMID: 31842294 PMCID: PMC6947150 DOI: 10.3390/jcm8122191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/30/2019] [Accepted: 12/09/2019] [Indexed: 01/16/2023] Open
Abstract
We investigated reference values for cardiorespiratory fitness (CRF) for healthy Koreans and Koreans with coronary heart disease (CHD) and used them to identify inter-ethnic differences in CRF, differences over time in CRF, and differences in CRF between the healthy population and patients with CHD. The study population for healthy Koreans was derived from the database of KISS FitS (Korea Institute of Sports Science Fitness Standards) between 2014 and 2015. The study population for Koreans with CHD was derived from the database of the Korea University Guro Hospital Cardiac Rehabilitation Registry between June 2015 and December 2018. In healthy Koreans, there was a significant difference between sex and age groups for VO2 max. The VO2 max of healthy Koreans differed from that of Westerners in age-related reference values. Our results were not significantly different from those of the Korean population in the past, except for a small decline in the young population. There seemed to be a clear inter-ethnic difference in CRF. We could also identify signs of small change in CRF in younger age groups. Therefore, CRF should be assessed according to ethnic or national standards, and it will be necessary to establish a reference for each nation or ethnicity with periodic updates.
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33
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Peterman JE, Whaley MH, Harber MP, Fleenor BS, Imboden MT, Myers J, Arena R, Kaminsky LA. Comparison of non-exercise cardiorespiratory fitness prediction equations in apparently healthy adults. Eur J Prev Cardiol 2019; 28:142–148. [PMID: 33838037 DOI: 10.1177/2047487319881242] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 11/17/2022]
Abstract
AIMS A recent scientific statement suggests clinicians should routinely assess cardiorespiratory fitness using at least non-exercise prediction equations. However, no study has comprehensively compared the many non-exercise cardiorespiratory fitness prediction equations to directly-measured cardiorespiratory fitness using data from a single cohort. Our purpose was to compare the accuracy of non-exercise prediction equations to directly-measured cardiorespiratory fitness and evaluate their ability to classify an individual's cardiorespiratory fitness. METHODS The sample included 2529 tests from apparently healthy adults (42% female, aged 45.4 ± 13.1 years (mean±standard deviation). Estimated cardiorespiratory fitness from 28 distinct non-exercise prediction equations was compared with directly-measured cardiorespiratory fitness, determined from a cardiopulmonary exercise test. Analysis included the Benjamini-Hochberg procedure to compare estimated cardiorespiratory fitness with directly-measured cardiorespiratory fitness, Pearson product moment correlations, standard error of estimate values, and the percentage of participants correctly placed into three fitness categories. RESULTS All of the estimated cardiorespiratory fitness values from the equations were correlated to directly measured cardiorespiratory fitness (p < 0.001) although the R2 values ranged from 0.25-0.70 and the estimated cardiorespiratory fitness values from 27 out of 28 equations were statistically different compared with directly-measured cardiorespiratory fitness. The range of standard error of estimate values was 4.1-6.2 ml·kg-1·min-1. On average, only 52% of participants were correctly classified into the three fitness categories when using estimated cardiorespiratory fitness. CONCLUSION Differences exist between non-exercise prediction equations, which influences the accuracy of estimated cardiorespiratory fitness. The present analysis can assist researchers and clinicians with choosing a non-exercise prediction equation appropriate for epidemiological or population research. However, the error and misclassification associated with estimated cardiorespiratory fitness suggests future research is needed on the clinical utility of estimated cardiorespiratory fitness.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being, Ball State University, USA
| | | | - Matthew P Harber
- Clinical Exercise Physiology Laboratory, Ball State University, USA
| | | | - Mary T Imboden
- Health and Human Performance Department, George Fox University, USA
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, USA
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, University of Illinois at Chicago, USA
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Zeiher J, Ombrellaro KJ, Perumal N, Keil T, Mensink GBM, Finger JD. Correlates and Determinants of Cardiorespiratory Fitness in Adults: a Systematic Review. SPORTS MEDICINE-OPEN 2019; 5:39. [PMID: 31482208 PMCID: PMC6722171 DOI: 10.1186/s40798-019-0211-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/05/2019] [Indexed: 01/17/2023]
Abstract
Background Enhanced cardiorespiratory fitness (CRF) is now a well-established predictor of numerous adverse health outcomes. Knowledge about the pathways leading to enhanced CRF is essential for developing appropriate interventions. Hence, the aim of this review was to provide a detailed overview of the current state of research regarding individual factors associated with or influencing CRF among the general adult population. Methods We searched the PubMed, EMBASE, and Cochrane Library databases and also conducted a search for grey literature (Google Scholar). Eligible indicators of CRF were objectively assessed measures of CRF by submaximal or maximal exercise testing measured using treadmill or cycle ergometer tests. We included quantitative observational studies of the general adult population. Using a semi-quantitative approach, we compiled summary tables aggregating the study results for each potential correlate or determinant of CRF. Results We identified 3005 studies, 78 of which met the inclusion criteria. Almost all of these studies were conducted in high-income countries. Study quality scores assessing the risk of bias in the individual studies ranged from 40 to 100%. Male sex, age (inverse), education, socioeconomic status, ethnicity, body mass index (inverse), body weight (inverse), waist circumference, body fat (inverse), resting heart rate (inverse), C-reactive protein (inverse), smoking (inverse), alcohol consumption, and multiple measures of leisure-time physical activity were independently and consistently associated with CRF. Conclusions In synthesizing the current research on the correlates and determinants of CRF among adults, this systematic review identified gaps in the current understanding of factors influencing CRF. Beyond the scope of this review, environmental and interpersonal determinants should be further investigated. Systematic Review Registration PROSPERO, CRD42017055456. Electronic supplementary material The online version of this article (10.1186/s40798-019-0211-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes Zeiher
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany.
| | - Katherine J Ombrellaro
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Nita Perumal
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Thomas Keil
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Institute for Health Resort Medicine and Health Promotion, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gert B M Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
| | - Jonas D Finger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, 12101, Berlin, Germany
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Takken T, Mylius C, Paap D, Broeders W, Hulzebos H, Van Brussel M, Bongers B. Reference values for cardiopulmonary exercise testing in healthy subjects – an updated systematic review. Expert Rev Cardiovasc Ther 2019; 17:413-426. [DOI: 10.1080/14779072.2019.1627874] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- T. Takken
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C.F. Mylius
- Research Group Healthy Ageing, Hanze University of Applied Sciences, Allied Health Care and Nursing, Groningen, The Netherlands
| | - D. Paap
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W. Broeders
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H.J. Hulzebos
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. Van Brussel
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B.C. Bongers
- Department of Nutrition and Movement Sciences, Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Van de Poppe DJ, Hulzebos E, Takken T. Reference values for maximum work rate in apparently healthy Dutch/Flemish adults: data from the LowLands fitness registry. Acta Cardiol 2019; 74:223-230. [PMID: 29933724 DOI: 10.1080/00015385.2018.1478763] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The peak oxygen uptake (VO2peak) test is the gold standard for cardiorespiratory fitness. However, the test is demanding, requiring sophisticated apparatus for measuring the oxygen uptake. Peak work rate (WRpeak) testing is a promising substitute for peak VO2peak testing. However, there is a paucity of research conducted to determine reference values (RVs) for WRpeak. Methods: The database from the LowLands fitness registry was used, containing data from health checks from apparently healthy subjects among various professions. Exercise tests were performed using a cycle ergometer and a calibrated metabolic cart. Analysis was executed on 3463 subjects, 2868 male and 595 female. Reference values with corresponding centiles were developed using the LMS method. Results: VO2peak and WRpeak where highly associated with Pearson's correlation of 0.9 (p = .001). Weight, height, maximum heart rate, and the respiratory exchange ratio had a positive significant effect (p < .001) on WRpeak, and age a negative significant effect, in both males and females. The following formulas were computed for RVs: WRpeak=-102+(1.5 * weight[kg])+(1.9 * height[cm])-(2.0 * age)-(sex * 60[M:0;V:1]) WRpeak/kg=2.45-(0.026 * weight[kg])+(0.024 * height[cm])-(0.024 * age)-(sex * 0.84 [M:0;V:1]) Conclusions: WRpeak can be used as a substitute for VO2peak when a respiratory gas-analysis system is not available. This study provides RVs for WRpeak and WRpeak/kg in a healthy Dutch/Flemish adult population using cycle ergometry. Further research is needed to obtain RVs for elderly subjects, specific diseases, ethnicities and ergometers.
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Affiliation(s)
- D. J. Van de Poppe
- Faculty of Medicine, Utrecht University, UMC Utrecht, Utrecht, The Netherlands
| | - E. Hulzebos
- Child Development & Exercise, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
- The Physiology Academy, Alphen aan den Rijn, The Netherlands
| | - T. Takken
- Child Development & Exercise, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
- The Physiology Academy, Alphen aan den Rijn, The Netherlands
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Runte K, Brosien K, Salcher-Konrad M, Schubert C, Goubergrits L, Kelle S, Schubert S, Berger F, Kuehne T, Kelm M. Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients-A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2019; 6:43. [PMID: 31024935 PMCID: PMC6467940 DOI: 10.3389/fcvm.2019.00043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/22/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction: Exercise testing has become a diagnostic standard in the evaluation and management of heart disease. While different methods of exercise and pharmacological stress testing exist, only little is known about their comparability. We aimed to assess hemodynamic changes during dynamic exercise, isometric exercise, and dobutamine stress testing at different stress intensities in healthy subjects and patients with aortic stenosis (AS) and aortic coarctation (CoA). Methods: A systematic literature search (PROSPERO 2017:CRD42017078608) in MEDLINE of interventional trials was conducted to identify eligible studies providing evidence of changes in hemodynamic parameters under different stress conditions acquired by MRI or echocardiography. A random effects model was used to estimate pooled mean changes in hemodynamics. Results: One hundred and twenty-eight study arms with a total of 3,139 stress-examinations were included. In healthy subjects/(where available) in AS, pooled mean changes (95% CIs) during light dynamic stress were 31.78 (27.82–35.74) bpm in heart rate (HR) and 6.59 (2.58–10.61) ml in stroke volume (SV). Changes during light pharmacological stress were 13.71 (7.87–19.56)/14.0 (9.82–18.18) bpm in HR, and 5.47 (0.3–10.63)/8.0 (3.82–12.18) ml in SV. Changes during light isometric stress were 18.44 (10.74–26.14)/5.0 (−1.17–11.17) bpm in HR and −4.17 (−14.37–6.03)/−4.0 (−16.43–8.43) ml in SV. Changes during moderate dynamic stress were 49.57 (40.03–59.1)/46.45 (42.63–50.27) bpm in HR and 11.64 (5.87–17.42) ml in SV. During moderate pharmacological stress, changes in HR were 42.83 (36.94–48.72)/18.66 (2.38–34.93) bpm and in SV 6.29 (−2.0–14.58)/13.11 (7.99–18.23) ml. During high intensity dynamic stress changes in HR were 89.31 (81.46–97.17)/55.32 (47.31–63.33) bpm and in SV 21.31 (13.42–29.21)/−0.96 (−5.27–3.35) ml. During high pharmacological stress, changes in HR were 53.58 (36.53–70.64)/42.52 (32.77–52.28) bpm, and in SV 0.98 (−9.32–11.27)/14.06 (−1.62–29.74) ml. HR increase and age were inversely correlated at high stress intensities. In CoA, evidence was limited to single studies. Conclusion: This systematic review and meta-analysis presents pooled hemodynamic changes under light, moderate and high intensity exercise and pharmacological stress, while considering the potential influence of age. Despite limited availability of comparative studies, the reference values presented in this review allow estimation of the expected individual range of a circulatory response in healthy individuals and patients with AS and may contribute to future study planning and patient-specific models even when stress testing is contraindicated.
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Affiliation(s)
- Kilian Runte
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Kay Brosien
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Salcher-Konrad
- Personal Social Services Research Unit, London School of Economics and Political Science, London, United Kingdom.,LSE Health, London School of Economics and Political Science, London, United Kingdom
| | - Charlotte Schubert
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Titus Kuehne
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Marcus Kelm
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
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Mylius CF, Krijnen WP, van der Schans CP, Takken T. Peak oxygen uptake reference values for cycle ergometry for the healthy Dutch population: data from the LowLands Fitness Registry. ERJ Open Res 2019; 5:00056-2018. [PMID: 30949491 PMCID: PMC6441675 DOI: 10.1183/23120541.00056-2018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 02/06/2019] [Indexed: 11/05/2022] Open
Abstract
Peak oxygen uptake (V′O2peak) is recognised as the best expression of aerobic fitness. Therefore, it is essential that V′O2peak reference values are accurate for interpreting a cardiopulmonary exercise test (CPET). These values are country specific and influenced by underlying biological ageing processes. They are normally stratified per paediatric and adult population, resulting in a discontinuity at the transition point between prediction equations. There are currently no age-related reference values available for the lifespan of individuals in the Dutch population. The aim of this study is to determine the best-fitting regression model for V′O2peak in the healthy Dutch paediatric and adult populations in relation to age. In this retrospective study, CPET cycle ergometry results of 4477 subjects without reported somatic diseases were included (907 females, age 7.9–65.0 years). Generalised additive models were employed to determine the best-fitting regression model. Cross-validation was performed against an independent dataset consisting of 3518 subjects (170 females, age 6.8–59.0 years). An additive model was the best fitting with the largest predictive accuracy in both the primary (adjusted R2=0.57, standard error of the estimate (see)=556.50 mL·min−1) and cross-validation (adjusted R2=0.57, see=473.15 mL·min−1) dataset. This study provides a robust additive regression model for V′O2peak in the Dutch population. Peak oxygen uptake has a nonlinear dependence on years of age in the paediatric and adult Dutch populationshttp://ow.ly/H3fH30nIjRy
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Affiliation(s)
- Caspar Frederik Mylius
- Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, The Netherlands.,Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands
| | - Wilhelmus Petrus Krijnen
- Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, The Netherlands.,Johann Bernoulli Institute for Mathematics and Computer Science, University of Groningen, Groningen, The Netherlands
| | - Cornelis Peter van der Schans
- Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Dept of Rehabilitation Medicine, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Health Psychology Research, Groningen, The Netherlands
| | - Tim Takken
- University Medical Center Utrecht, Utrecht, The Netherlands
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Determining Cardiorespiratory Fitness With Precision: Compendium of Findings From the FRIEND Registry. Prog Cardiovasc Dis 2019; 62:76-82. [DOI: 10.1016/j.pcad.2018.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023]
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Predictive Modeling of VO2max Based on 20 m Shuttle Run Test for Young Healthy People. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8112213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study presents mathematical models for predicting VO2max based on a 20 m shuttle run and anthropometric parameters. The research was conducted with data provided by 308 young healthy people (aged 20.6 ± 1.6). The research group includes 154 females (aged 20.3 ± 1.2) and 154 males (aged 20.8 ± 1.8). Twenty-four variables were used to build the models, including one dependent variable and 23 independent variables. The predictive methods of analysis include: the classical model of ordinary least squares (OLS) regression, regularized methods such as ridge regression and Lasso regression, artificial neural networks such as the multilayer perceptron (MLP) and radial basis function (RBF) network. All models were calculated in R software (version 3.5.0, R Foundation for Statistical Computing, Vienna, Austria). The study also involved variable selection methods (Lasso and stepwise regressions) to identify optimum predictors for the analysed study group. In order to compare and choose the best model, leave-one-out cross-validation (LOOCV) was used. The paper presents three types of models: for females, males and the whole group. An analysis has revealed that the models for females ( RMSE C V = 4.07 mL·kg−1·min−1) are characterised by a smaller degree of error as compared to male models ( RMSE C V = 5.30 mL·kg−1·min−1). The model accounting for sex generated an error level of RMSE C V = 4.78 mL·kg−1·min−1.
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Ventilatory efficiency response is unaffected by fitness level, ergometer type, age or body mass index in male athletes. Biol Sport 2018; 35:393-398. [PMID: 30765925 PMCID: PMC6358533 DOI: 10.5114/biolsport.2018.78060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/13/2017] [Accepted: 06/29/2018] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate the ventilatory efficiency (VE/VCO2 slope) and the respiratory control (Vt/Ti slope) in a wide range of athletes and describe the influence of fitness level, age, ergometer type or BMI on these parameters. Ninety-one males (30.4±10.53 years; 175.52±7.45 cm; 71.99±9.35 kg) were analysed retrospectively for the study. Ventilatory efficiency reacted similarly in athletes independently of the fitness level, age, BMI or the ergometer used for testing. No significant differences were found in VE/VCO2 slope and the Vt/Ti slope between variables analyzed (P>0.05). The slope of the predictive equations was similar in all cases studied in VE/VCO2 slope and the Vt/Ti slope. Moreover, the central control impulse of respiration was not affected by the variables studied. These observations suggest that ventilatory efficiency (VE/VCO2 slope) could be a variable fixed by the respiratory system which tends to respond similarly in athletes.
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Comparison of Physical Fitness and Cardiopulmonary Exercise Test Performance Using Arm Versus Leg Cycling in Patients With Cardiovascular or Pulmonary Disease–A Systematic Review and Meta-analysis. Cardiopulm Phys Ther J 2018. [DOI: 10.1097/cpt.0000000000000081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Feasibility of Exercise Testing in Patients Who Are Critically Ill: A Prospective, Observational Multicenter Study. Arch Phys Med Rehabil 2018; 100:239-246. [PMID: 30142315 DOI: 10.1016/j.apmr.2018.07.430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and safety of exercise testing and to describe the physiological response to exercise of patients in the Intensive Care Unit (ICU). DESIGN A prospective observational multicenter study. SETTING Two mixed medical-surgical ICUs. PARTICIPANTS Patients (N=37; with no primary neurological disorders, 59% men; median age 50y; ICU length of stay 14.5d; Acute Physiology and Chronic Health Evaluation IV 73.0) who had been mechanically ventilated for more than 48 hours and were hemodynamically stable enough to perform physical exercise. INTERVENTIONS A passive or active incremental exercise test, depending on muscle strength, on a bed-based cycle ergometer. MAIN OUTCOME MEASURES Feasibility and safety were evaluated based on protocol adherence and adverse events. Physiological responses to exercise quantified as changes in respiratory frequency (RF), oxygen uptake (Vo2), carbon dioxide output (Vco2), respiratory exchange ratio (RER), and blood lactate. RESULTS Thirty-seven patients of whom 18 were mechanically ventilated underwent the exercise test. The active incremental test was performed by 28, and the passive test by 9 participants. Thirty-three (89%) accomplished the test according to the protocol and 1 moderate severe adverse event (bradycardia; heart rate 44) occurred shortly after the test. RF, Vo2, Vco2, and lactate increased significantly, whereas RER did not change during the active incremental exercise test. No changes were observed during the passive exercise test. CONCLUSIONS It is safe and feasible to perform exercise testing on a bed-based cycle ergometer in patients who are critically ill and a physiological response could be measured. Future research should investigate the clinical value of exercise testing in daily ICU practice and whether exercise capacity and its limiting factors could be determined by incremental exercise testing.
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Wagner J, Agostoni P, Arena R, Belardinelli R, Dumitrescu D, Hager A, Myers J, Rauramaa R, Riley M, Takken T, Schmidt-Trucksäss A. The Role of Gas Exchange Variables in Cardiopulmonary Exercise Testing for Risk Stratification and Management of Heart Failure with Reduced Ejection Fraction. Am Heart J 2018; 202:116-126. [PMID: 29933148 DOI: 10.1016/j.ahj.2018.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/18/2018] [Indexed: 01/14/2023]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is common in the developed world and results in significant morbidity and mortality. Accurate risk assessment methods and prognostic variables are therefore needed to guide clinical decision making for medical therapy and surgical interventions with the ultimate goal of decreasing risk and improving health outcomes. The purpose of this review is to examine the role of cardiopulmonary exercise testing (CPET) and its most commonly used ventilatory gas exchange variables for the purpose of risk stratification and management of HFrEF. We evaluated five widely studied gas exchange variables from CPET in HFrEF patients based on nine previously used systematic criteria for biomarkers. This paper provides clinicians with a comprehensive and critical overview, class recommendations and evidence levels. Although some CPET variables met more criteria than others, evidence supporting the clinical assessment of variables beyond peak V̇O2 is well-established. A multi-variable approach also including the V̇E-V̇CO2 slope and EOV is therefore recommended.
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Affiliation(s)
- Jonathan Wagner
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy & Department of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Romualdo Belardinelli
- Department of Cardiovascular Sciences, Cardiac Rehabilitation Lancisi, Ancona, Italy
| | - Daniel Dumitrescu
- Herzzentrum der Universitaet zu Koeln, Klinik III fuer Innere Medizin, Cologne, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technical University of Munich, Germany
| | - Jonathan Myers
- Cardiology Division, VA Palo Alto Health Care System and Stanford University, Palo Alto, CA
| | - Rainer Rauramaa
- Foundation for Research in Health, Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Marshall Riley
- Department of Medicine, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Tim Takken
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
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Applying current normative data to prognosis in heart failure: The Fitness Registry and the Importance of Exercise National Database (FRIEND). Int J Cardiol 2018. [DOI: 10.1016/j.ijcard.2018.02.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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de Souza e Silva CG, Kaminsky LA, Arena R, Christle JW, Araújo CGS, Lima RM, Ashley EA, Myers J. A reference equation for maximal aerobic power for treadmill and cycle ergometer exercise testing: Analysis from the FRIEND registry. Eur J Prev Cardiol 2018. [DOI: 10.1177/2047487318763958] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Maximal oxygen uptake (VO2max) is a powerful predictor of health outcomes. Valid and portable reference values are integral to interpreting measured VO2max; however, available reference standards lack validation and are specific to exercise mode. This study was undertaken to develop and validate a single equation for normal standards for VO2max for the treadmill or cycle ergometer in men and women. Methods Healthy individuals ( N = 10,881; 67.8% men, 20–85 years) who performed a maximal cardiopulmonary exercise test on either a treadmill or a cycle ergometer were studied. Of these, 7617 and 3264 individuals were randomly selected for development and validation of the equation, respectively. A Brazilian sample (1619 individuals) constituted a second validation cohort. The prediction equation was determined using multiple regression analysis, and comparisons were made with the widely-used Wasserman and European equations. Results Age, sex, weight, height and exercise mode were significant predictors of VO2max. The regression equation was: VO2max (ml kg–1 min–1) = 45.2 – 0.35*Age – 10.9*Sex (male = 1; female = 2) – 0.15*Weight (pounds) + 0.68*Height (inches) – 0.46*Exercise Mode (treadmill = 1; bike = 2) ( R = 0.79, R2 = 0.62, standard error of the estimate = 6.6 ml kg–1 min–1). Percentage predicted VO2max for the US and Brazilian validation cohorts were 102.8% and 95.8%, respectively. The new equation performed better than traditional equations, particularly among women and individuals ≥60 years old. Conclusion A combined equation was developed for normal standards for VO2max for different exercise modes derived from a US national registry. The equation provided a lower average error between measured and predicted VO2max than traditional equations even when applied to an independent cohort. Additional studies are needed to determine its portability.
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Affiliation(s)
- Christina G de Souza e Silva
- Heart Institute Edson Saad, Federal University of Rio de Janeiro, Brazil
- Cardiology Division, Veterans Affairs Palo Alto Health System/Stanford University, USA
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being and Clinical Exercise Physiology, Ball State University, Muncio, USA
| | | | | | | | - Ricardo M Lima
- Faculty of Physical Education, University of Brasília, Brazil
| | - Euan A Ashley
- Stanford Center for Inherited Cardiovascular Disease, Stanford University, USA
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health System/Stanford University, USA
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Rapp D, Scharhag J, Wagenpfeil S, Scholl J. Reference values for peak oxygen uptake: cross-sectional analysis of cycle ergometry-based cardiopulmonary exercise tests of 10 090 adult German volunteers from the Prevention First Registry. BMJ Open 2018; 8:e018697. [PMID: 29506981 PMCID: PMC5855221 DOI: 10.1136/bmjopen-2017-018697] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study aims to construct quantile reference values for peak oxygen uptake (V̇O2peak) measured by cycle ergometry-based incremental cardiopulmonary exercise tests. DESIGN Cross-sectional study using quantile regressions to fit sex-specific and age-specific quantile curves. Exercise tests were conducted using cycle ergometry. Maximal effort in the exercise tests wass assumed when respiratory exchange ratio ≥1.1 or lactate ≥8 mmol/L or maximal heart rate ≥90% of the age-predicted maximal heart rate. This was assessed retrospectively for a random subsample with an a priori calculated sample size of n=252 participants. SETTING A network of private outpatient clinics in three German cities recorded the results of cycle ergometry-based cardiopulmonary exercise tests to a central database (Prevention First Registry) from 2001 to 2015. PARTICIPANTS 10 090 participants (6462 men, 3628 women) from more than 100 local companies volunteered in workplace health promotion programmes. Participants were aged 21 to 83 years, were free of acute complaints and had primarily sedentary working environments. MAIN OUTCOME MEASURE Peak oxygen uptake was measured as absolute V̇O2peak in litres of oxygen per minute and relative V̇O2peak in millilitres of oxygen per kilogram of body mass per minute. RESULTS The mean age for both men and women was 46 years. Median relative V̇O2peak was 36 and 30 mL/kg/min at 40 to 49 years, as well as 32 and 26 mL/kg/min at 50 to 59 years for men and women, respectively. An estimated proportion of 97% of the participants performed the exercise test until exertion. CONCLUSIONS Reference values and nomograms for V̇O2peak were derived from a large sample of preventive healthcare examinations of healthy white-collar workers. The presented results can be applied to participants of exercise tests using cycle ergometry who are part of a population that is comparable to this study.
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Affiliation(s)
- Daniel Rapp
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Saarbrücken, Saarland, Germany
| | - Jürgen Scharhag
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Saarland, Germany
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Saarbrücken, Saarland, Germany
| | - Johannes Scholl
- Dr. Scholl Prevention First GmbH, Rüdesheim am Rhein, Hessen, Germany
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Königstein K, Klenk C, Rossmeissl A, Baumann S, Infanger D, Hafner B, Hinrichs T, Hanssen H, Schmidt-Trucksäss A. The Obesity Factor: How Cardiorespiratory Fitness is Estimated More Accurately in People with Obesity. Obesity (Silver Spring) 2018; 26:291-298. [PMID: 29230967 DOI: 10.1002/oby.22078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/20/2017] [Accepted: 10/26/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cardiopulmonary exercise testing is clinically used to estimate cardiorespiratory fitness (CRF). The relation to total body mass (TBM) leads to an underestimation of CRF in people with obesity and to inappropriate prognostic and therapeutic decisions. This study aimed to determine body composition-derived bias in the estimation of CRF in people with obesity. METHODS Two hundred eleven participants (58.8% women; mean BMI 35.7 kg/m2 [± 6.94; 20.7-58.6]) were clinically examined, and body composition (InBody720; InBody Co., Ltd., Seoul, South Korea) and spiroergometrical peak oxygen consumption (VO2 peak) were assessed. The impacts of TBM, lean body mass (LBM), and skeletal muscle mass (SMM) on CRF estimates were analyzed by the application of respective weight models. Linear regression and plotting of residuals against BMI were performed on the whole study population and two subgroups (BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 ). RESULTS For every weight model, Δmean VO2 peak (expected - measured) was positive. LBM and SMM had a considerable impact on VO2 peak demand (P = 0.001; ΔR2 = 2.3%; adjusted R2 = 56% and P = 0.001; ΔR2 = 2.7%; adjusted R2 = 56%), whereas TBM did not. Confounding of body composition on VO2 peak did not differ in LBM and SMM. CONCLUSIONS TBM-adjusted overestimation of relative VO2 demand is much higher in people with obesity than in those without. LBM or SMM adjustment may be superior alternatives, although small residual body composition-derived bias remains.
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Affiliation(s)
- Karsten Königstein
- Department of Sport, Exercise and Health, Division of Rehabilitative & Regenerative Sport Medicine, University of Basel, Basel Stadt, Switzerland
| | - Christopher Klenk
- Department of Sport, Exercise and Health, Division of Rehabilitative & Regenerative Sport Medicine, University of Basel, Basel Stadt, Switzerland
| | - Anja Rossmeissl
- Department of Sport, Exercise and Health, Division of Rehabilitative & Regenerative Sport Medicine, University of Basel, Basel Stadt, Switzerland
| | - Sandra Baumann
- Department of Sport, Exercise and Health, Division of Rehabilitative & Regenerative Sport Medicine, University of Basel, Basel Stadt, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, Division of Rehabilitative & Regenerative Sport Medicine, University of Basel, Basel Stadt, Switzerland
| | - Benjamin Hafner
- Department of Sport, Exercise and Health, Division of Rehabilitative & Regenerative Sport Medicine, University of Basel, Basel Stadt, Switzerland
| | - Timo Hinrichs
- Department of Sport, Exercise and Health, Division of Rehabilitative & Regenerative Sport Medicine, University of Basel, Basel Stadt, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Division of Rehabilitative & Regenerative Sport Medicine, University of Basel, Basel Stadt, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Division of Rehabilitative & Regenerative Sport Medicine, University of Basel, Basel Stadt, Switzerland
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Kaafarani M, Schroer C, Takken T. Reference values for blood pressure response to cycle ergometry in the first two decades of life: comparison with patients with a repaired coarctation of the aorta. Expert Rev Cardiovasc Ther 2017; 15:945-951. [DOI: 10.1080/14779072.2017.1385392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mirna Kaafarani
- Honors College, College of Natural Science, Michigan State University, East Lansing, MI, USA
- Child Development & Exercise, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christian Schroer
- Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, Maxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - Tim Takken
- Child Development & Exercise, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Bloemen MA, de Groot JF, Backx FJ, Benner J, Kruitwagen CL, Takken T. Wheelchair Shuttle Test for Assessing Aerobic Fitness in Youth With Spina Bifida: Validity and Reliability. Phys Ther 2017; 97:1020-1029. [PMID: 29029556 PMCID: PMC5803772 DOI: 10.1093/ptj/pzx075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/16/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Testing aerobic fitness in youth is important because of expected relationships with health. OBJECTIVE The purpose of the study was to estimate the validity and reliability of the Shuttle Ride Test in youth who have spina bifida and use a wheelchair for mobility and sport. DESIGN Ths study is a validity and reliability study. METHODS The Shuttle Ride Test, Graded Wheelchair Propulsion Test, and skill-related fitness tests were administered to 33 participants for the validity study (age = 14.5 ± 3.1 y) and to 28 participants for the reliability study (age = 14.7 ± 3.3 y). RESULTS No significant differences were found between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test for most cardiorespiratory responses. Correlations between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test were moderate to high (r = .55-.97). The variance in peak oxygen uptake (VO2peak) could be predicted for 77% of the participants by height, number of shuttles completed, and weight, with large prediction intervals. High correlations were found between number of shuttles completed and skill-related fitness tests (CI = .73 to -.92). Intraclass correlation coefficients were high (.77-.98), with a smallest detectable change of 1.5 for number of shuttles completed and with coefficients of variation of 6.2% and 6.4% for absolute VO2peak and relative VO2peak, respectively. CONCLUSIONS When measuring VO2peak directly by using a mobile gas analysis system, the Shuttle Ride Test is highly valid for testing VO2peak in youth who have spina bifida and use a wheelchair for mobility and sport. The outcome measure of number of shuttles represents aerobic fitness and is also highly correlated with both anaerobic performance and agility. It is not possible to predict VO2peak accurately by using the number of shuttles completed. Moreover, the Shuttle Ride Test is highly reliable in youth with spina bifida, with a good smallest detectable change for the number of shuttles completed.
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Affiliation(s)
- Manon A.T. Bloemen
- M.A.T. Bloemen, MSc, Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Bolognalaan 101, PO Box 85182 3508 AD, Utrecht, the Netherlands; Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; and Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, the Netherlands.,Address all correspondence to Ms Bloemen at:
| | - Janke F. de Groot
- J.F. de Groot, PhD, Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, and Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | - Frank J.G. Backx
- F.J.G. Backx, MD, PhD, Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht
| | - Joyce Benner
- J. Benner, MSc, Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht
| | - Cas L.J.J. Kruitwagen
- C.L.J.J. Kruitwagen, MSc, Department of Biostatistics and Research Support, Julius Center, University Medical Center Utrecht
| | - Tim Takken
- T. Takken, PhD, Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht
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