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Santana EJ, Christle JW, Cauwenberghs N, Peterman JE, Busque V, Gomes B, Bagherzadeh SP, Moneghetti K, Kuznetsova T, Wheeler M, Ashley E, Harber MP, Arena R, Kaminsky LA, Myers J, Haddad F. Improving Reporting of Exercise Capacity Across Age Ranges Using Novel Workload Reference Equations. Am J Cardiol 2024; 215:32-41. [PMID: 38301753 DOI: 10.1016/j.amjcard.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/03/2024]
Abstract
Exercise capacity (EC) is an important predictor of survival in the general population and in subjects with cardiopulmonary disease. Despite its relevance, considering the percent-predicted workload (%pWL) given by current equations may overestimate EC in older adults. Therefore, to improve the reporting of EC in clinical practice, our main objective was to develop workload reference equations (pWL) that better reflect the relation between workload and age. Using the Fitness Registry and the Importance of Exercise National Database (FRIEND), we analyzed a reference group of 6,966 apparently healthy participants and 1,060 participants with heart failure who underwent graded treadmill cardiopulmonary exercise testing. For the first group, the mean age was 44 years (18 to 79); 56.5% of participants were males and 15.4% had obesity. Peak oxygen consumption was 11.6 ± 3.0 METs in males and 8.5 ± 2.4 METs in females. After partition analysis, we first developed sex-specific pWL equations to allow comparisons to a healthy weight reference. For males, pWL (METs) = 14.1-0.9×10-3×age2 and 11.5-0.87×10-3×age2 for females. We used those equations as denominators of %pWL, and based on their distribution, we determined thresholds for EC classification, with average EC defined by the range corresponding to 85% to 115%pWL. Compared with %pWL using current equations, the new equations yielded better-calibrated %pWL across different age ranges. We also derived body mass index-adjusted pWL equations that better assessed EC in subjects with heart failure. In conclusion, the novel pWL equations have the potential to impact the report of EC in practice.
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Affiliation(s)
- Everton J Santana
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University, Stanford, California; Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
| | - Jeffrey W Christle
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University, Stanford, California; Stanford Sports Cardiology, Department of Medicine, Stanford University, Stanford, California
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - James E Peterman
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana
| | - Vincent Busque
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Bruna Gomes
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University, Stanford, California; Department of Cardiology, Pneumology and Angiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Shadi P Bagherzadeh
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Kegan Moneghetti
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Matthew Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Euan Ashley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Department of Genetics, Stanford University School of Medicine, Stanford, California; Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, Indiana
| | - Ross Arena
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, Illinois; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinios
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana; Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, Indiana; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinios
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinios; Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, California.
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford University, Stanford, California; Stanford Diabetes Research Center, Stanford University, Stanford, California; Wu Tsai Performance Alliance, Stanford University, Stanford, California.
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Cundrič L, Bosnić Z, Kaminsky LA, Myers J, Peterman JE, Markovic V, Arena R, Popović D. A Machine Learning Approach to Developing an Accurate Prediction of Maximal Heart Rate During Exercise Testing in Apparently Healthy Adults. J Cardiopulm Rehabil Prev 2023; 43:377-383. [PMID: 36880964 DOI: 10.1097/hcr.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
PURPOSE Maximal heart rate (HR max ) continues to be an important measure of adequate effort during an exercise test. The aim of this study was to improve the accuracy of HR max prediction using a machine learning (ML) approach. METHODS We used a sample from the Fitness Registry of the Importance of Exercise National Database, which included 17 325 apparently healthy individuals (81% males) who performed a maximal cardiopulmonary exercise test. Two standard formulas for HR max prediction were tested: Formula1 = 220 - age (yr), root-mean-squared error (RMSE) 21.9, relative root-mean-squared error (RRMSE) 1.1; and Formula2 = 209.3 - 0.72 × age (yr), RMSE 22.7 and RRMSE 1.1. For ML model prediction, we used age, weight, height, resting HR, and systolic and diastolic blood pressure. The following ML algorithms to predict HR max were applied: lasso regression (LR), neural networks (NN), support vector machine (SVM) and random forests (RF). An evaluation was performed using cross-validation and by computing the RMSE and RRMSE, Pearson correlation, and Bland-Altman plots. The best predictive model was explained with Shapley Additive Explanations (SHAP). RESULTS The HR max for the cohort was 162 ± 20 bpm. All ML models improved HR max prediction and reduced RMSE and RRMSE compared with Formula1 (LR: 20.2%, NN: 20.4%, SVM: 22.2%, and RF: 24.7%). The predictions of all algorithms significantly correlated with HR max ( r = 0.49, 0.51, 0.54, 0.57, respectively; P < .001). Bland-Altman analysis demonstrated lower bias and 95% CI for all ML models in comparison with standard equations. The SHAP explanation showed a high impact of all selected variables. CONCLUSIONS Machine learning, particularly the RF model, improved prediction of HR max using readily available measures. This approach should be considered for clinical application to refine HR max prediction.
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Affiliation(s)
- Larsen Cundrič
- University of Ljubljana, Faculty of Computer and Information Science, Ljubljana, Slovenia (Mr Cundrič and Dr Bosnić); Fisher Institute of Health and Well-Being and Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Kaminsky and Peterman); VA Palo Alto Health Care System and Stanford University, Palo Alto, California (Dr Myers); Departments of Information Systems, Faculty of Organizational Sciences (Dr Markovic) and Physiology, Faculty of Pharmacy (Dr Popović), University of Belgrade, Belgrade, Serbia; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago (Dr Arena); Division of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia (Dr Popović); and Department for Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota (Dr Popović)
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Peterman JE, Arena R, Myers J, Ades PA, Bonikowske AR, Harber MP, Marzolini S, Savage PD, Squires RW, Lavie CJ, Kaminsky LA. A Nonexercise Prediction of Peak Oxygen Uptake for Patients With Cardiovascular Disease: DATA FROM THE FITNESS REGISTRY AND THE IMPORTANCE OF EXERCISE INTERNATIONAL DATABASE (FRIEND). J Cardiopulm Rehabil Prev 2023; 43:115-121. [PMID: 36137212 DOI: 10.1097/hcr.0000000000000722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Nonexercise predictions of peak oxygen uptake (V˙ o2peak ) are used clinically, yet current equations were developed from cohorts of apparently healthy individuals and may not be applicable to individuals with cardiovascular disease (CVD). Our purpose was to develop a CVD-specific nonexercise prediction equation for V˙ o2peak . METHODS Participants were from the Fitness Registry and Importance of Exercise International Database (FRIEND) with a diagnosis of coronary artery bypass surgery (CABG), myocardial infarction (MI), percutaneous coronary intervention (PCI), or heart failure (HF) who met maximal effort criteria during a cardiopulmonary exercise test (n = 15 997; 83% male; age 63.1 ± 10.4 yr). The cohort was split into development (n = 12 798) and validation groups (n = 3199). The prediction equation was developed using regression analysis and compared with a previous equation developed on a healthy cohort. RESULTS Age, sex, height, weight, exercise mode, and CVD diagnosis were all significant predictors of V˙ o2peak . The regression equation was:V˙ o2peak (mL · kg -1 · min -1 ) = 16.18 - (0.22 × age [yr]) + (3.63 × sex [male = 1; female = 0]) + (0.14 × height [cm]) - (0.12 × weight [kg]) + (3.62 × mode [treadmill = 1; cycle = 0]) - (2.70 × CABG [yes = 1, no = 0]) - (0.31 × MI [yes = 1, no = 0]) + (0.37 × PCI [yes = 1, no = 0]) - (4.47 × HF [yes = 1, no = 0]). Adjusted R 2 = 0.43; SEE = 4.75 mL · kg -1 · min -1 .Compared with measured V˙ o2peak in the validation group, percent predicted V˙ o2peak was 141% for the healthy cohort equation and 100% for the CVD-specific equation. CONCLUSIONS The new equation for individuals with CVD had lower error between measured and predicted V˙ o2peak than the healthy cohort equation, suggesting population-specific equations are needed for predicting V˙ o2peak ; however, errors associated with nonexercise prediction equations suggest V˙ o2peak should be directly measured whenever feasible.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago (Dr Arena); Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, California (Dr Myers); Division of Cardiology, University of Vermont College of Medicine, Burlington (Dr Ades and Mr Savage); Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Bonikowske and Squires); Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, Indiana (Dr Harber); KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada (Dr Marzolini); and John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana (Dr Lavie)
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Peterman JE, Arena R, Myers J, Harber MP, Bonikowske AR, Squires RW, Kaminsky LA. Reference Standards for Peak Rating of Perceived Exertion during Cardiopulmonary Exercise Testing: Data from FRIEND. Med Sci Sports Exerc 2023; 55:74-79. [PMID: 35977105 DOI: 10.1249/mss.0000000000003023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Peak rating of perceived exertion (RPE) is measured during clinical cardiopulmonary exercise testing (CPX) and is commonly used as a subjective indicator of maximal effort. However, no study to date has reported reference standards or the distribution of peak RPE across a large cohort of apparently healthy individuals. PURPOSE This study aimed to determine reference standards for peak RPE when using the 6-20 Borg scale for both treadmill and cycle tests. METHODS The analysis included 9551 tests (8821 treadmill, 730 cycle ergometer) from 13 laboratories within the Fitness Registry and Importance of Exercise National Database (FRIEND). Using data from tests conducted January 1, 1980, to January 1, 2021, percentiles of peak RPE for men and women were determined for each decade from 20 to 89 yr of age for treadmill and cycle exercise modes. Two-way ANOVA was used to compare differences in peak RPE values between sexes and across age groups. RESULTS There were statistically significant differences in RPE between age groups whether the test was performed on a treadmill or cycle ergometer ( P < 0.05). However, the mean and median RPE for each sex, age group, and test mode were between 18 and 19. In addition, 83% of participants met the traditional RPE criteria of ≥18 for indicating sufficient maximal effort. CONCLUSIONS This report provides the first normative reference standards for peak RPE in both male and female individuals performing CPX on a treadmill or cycle ergometer. Furthermore, these reference standards highlight the general consistency of peak RPE responses during CPX.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, IN
| | | | - Ray W Squires
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN
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Peterman JE, Harber MP, Fleenor BS, Whaley MH, Araújo CG, Kaminsky LA. Cardiorespiratory Optimal Point Is a Submaximal Exercise Test Variable and a Predictor of Mortality Risk: THE BALL STATE ADULT FITNESS LONGITUDINAL LIFESTYLE STUDY (BALL ST). J Cardiopulm Rehabil Prev 2022; 42:E90-E96. [PMID: 35861956 PMCID: PMC9662820 DOI: 10.1097/hcr.0000000000000711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The cardiorespiratory optimal point (COP) is the minimum ventilatory equivalent for oxygen. The COP can be determined during a submaximal incremental exercise test. Reflecting the optimal interaction between the respiratory and cardiovascular systems, COP may have prognostic utility. The aim of this investigation was to determine the relationship between COP and all-cause mortality in a cohort of apparently healthy adults. METHODS The sample included 3160 apparently healthy adults (46% females) with a mean age of 44.0 ± 12.5 yr who performed a cardiopulmonary exercise test. Cox proportional hazards models were performed to assess the relationship between COP and mortality risk. Prognostic peak oxygen uptake (V˙ o2peak ) and COP models were compared using the concordance index. RESULTS There were 558 deaths (31% females) over a follow-up period of 23.0 ± 11.9 yr. For males, all Cox proportional hazards models, including the model adjusted for traditional risk factors and V˙ o2peak , had a positive association with risk for mortality ( P < .05). For females, only the unadjusted COP model was associated with risk for mortality ( P < .05). The concordance index values indicated that unadjusted COP models had lower discrimination compared with unadjusted V˙ o2peak models ( P < .05) and V˙ o2peak did not complement COP models ( P ≥ .13). CONCLUSIONS Cardiorespiratory optimal point is related to all-cause mortality in males but not females. These findings suggest that a determination of COP can have prognostic utility in apparently healthy males aged 18-85 yr, which may be relevant when a maximal exercise test is not feasible or desirable.
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Affiliation(s)
- James E. Peterman
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Matthew P. Harber
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Bradley S. Fleenor
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Mitchell H. Whaley
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Claudio G. Araújo
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Leonard A. Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
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Peterman JE, Rouleau CR, Arena R, Aggarwal S, Wilton SB, Hauer T, MacDonald MK, Kaminsky LA. Cardiorespiratory fitness estimations and their ability to predict all-cause mortality in patients with cardiovascular disease. Int J Cardiol Cardiovasc Risk Prev 2022; 15:200154. [PMID: 36573187 PMCID: PMC9789345 DOI: 10.1016/j.ijcrp.2022.200154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
Background In cardiac rehabilitation programs, cardiorespiratory fitness is commonly estimated (eCRF) from the maximum workload achieved on a graded exercise test. This study compared four well-established eCRF equations in their ability to predict mortality in patients with cardiovascular disease (CVD). Methods A total of 7269 individuals with CVD were studied (81% male; age 59.4 ± 10.3yr). eCRF was calculated using equations from the American College of Sports Medicine, Bruce et al., the Fitness Registry and the Importance of Exercise International Database, and McConnell and Clark. The eCRF from each equation was compared with a RMANOVA. Cox proportional hazard models assessed the relationship between the eCRF equations and mortality risk. The predictive ability of the models was compared using the concordance index. Results There were 284 deaths (85% male) over a follow-up period of 5.8 ± 2.8yr. Although differences in eCRF were observed between each equation (P < 0.05), the eCRF from each of the four equations was predictive of mortality (P < 0.05). The concordance index values for each of the models were the same (0.77) indicating similar predictive performance. Conclusions The four well-established eCRF equations did not differ in their ability to predict mortality in patients with CVD, indicating any could be used for this purpose. However, the differences in eCRF from each of the equations suggest potential differences in their ability to guide clinical care and should be the focus of future research.
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Affiliation(s)
- James E. Peterman
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA,Healthy Living for Pandemic Event Protection (HL – PIVOT) Network, Chicago, IL, USA,Corresponding author. Fisher Institute of Health and Well-Being. Health and Physical Activity Building, Ball State University Muncie, IN, 47306, USA.
| | - Codie R. Rouleau
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,TotalCardiologyTM Research Network, Calgary, Alberta, Canada
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL – PIVOT) Network, Chicago, IL, USA,TotalCardiologyTM Research Network, Calgary, Alberta, Canada,Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Sandeep Aggarwal
- TotalCardiologyTM Research Network, Calgary, Alberta, Canada,Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B. Wilton
- TotalCardiologyTM Research Network, Calgary, Alberta, Canada,Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Trina Hauer
- TotalCardiologyTM Research Network, Calgary, Alberta, Canada
| | | | - Leonard A. Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA,Healthy Living for Pandemic Event Protection (HL – PIVOT) Network, Chicago, IL, USA
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Busque V, Myers J, Arena R, Kaminsky LA, Peterman JE. Peak Circulatory Power during Maximal Cardiopulmonary Exercise Testing: Reference Standards from the FRIEND Registry. Med Sci Sports Exerc 2022; 54:1919-1924. [DOI: 10.1249/mss.0000000000002985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rodriguez JC, Peterman JE, Fleenor BS, Whaley MH, Kaminsky LA, Harber MP. Cardiopulmonary Exercise Responses in Individuals with Metabolic Syndrome: The Ball State Adult Fitness Longitudinal Lifestyle Study. Metab Syndr Relat Disord 2022; 20:414-420. [DOI: 10.1089/met.2021.0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Julio C. Rodriguez
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
| | - James E. Peterman
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana, USA
| | - Bradley S. Fleenor
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
| | - Mitchell H. Whaley
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
| | - Leonard A. Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana, USA
| | - Matthew P. Harber
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
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Peterman JE, Arena R, Myers J, Marzolini S, Ades PA, Savage PD, Harber MP, Kaminsky LA. Abstract EP57: A Non-exercise Prediction Of Cardiorespiratory Fitness For Patients With Cardiovascular Disease: Data From The Fitness Registry And The Importance Of Exercise International Database (FRIEND). Circulation 2022. [DOI: 10.1161/circ.145.suppl_1.ep57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The importance of cardiorespiratory fitness (CRF) for stratifying mortality risk and guiding clinical care in patients with cardiovascular disease (CVD) is well-established. An American Heart Association Scientific Statement suggests routine clinical assessment of CRF using non-exercise prediction equations when direct assessment from a cardiopulmonary exercise test is not feasible. However, current prediction equations have been created from cohorts of apparently healthy individuals.
Hypothesis:
A CVD-specific non-exercise equation would have higher accuracy for predicting CRF compared to an equation developed from a cohort without known CVD.
Methods:
Participants from the Fitness Registry and Importance of Exercise International Database (FRIEND) with a diagnosis of coronary artery bypass surgery (CABG), myocardial infarction (MI), percutaneous coronary intervention (PCI), or heart failure (HF) who performed a cardiopulmonary exercise test were studied (83% [10,417 of 12,578] male; age 62.7 ± 10.3 years). The cohort (12,578 tests; 49% [6,190] treadmill tests) was split into development (10,062) and validation (2,516) groups. The prediction equation was developed using multiple regression analysis and comparisons were made with a CRF prediction equation developed on an apparently healthy cohort using FRIEND.
Results:
Age, sex, height, body mass, exercise mode, and CVD diagnosis were all significant predictors of CRF. The regression equation was: CRF (mL/kg/min) = 17.03 – (0.21 * age [years]) + (3.60 * sex [male = 1; female = 0]) + (0.12 * height [cm]) – (0.11 * body mass [kg]) + (3.75 * mode [treadmill = 1; cycle = 0]) – (2.40 * CABG [yes = 1, no = 0]) – (0.29 * MI [yes = 1, no = 0]) + (0.75 * PCI [yes = 1, no = 0]) – (3.90 * HF [yes = 1, no = 0]) (adjusted R
2
= 0.42, SEE = 4.74 mL/kg/min). When compared to measured CRF in the validation group (19.6 ± 6.2 mL/kg/min), predicted CRF was similar for the CVD equation (19.8 ± 4.1 mL/kg/min [101%]) and higher for the healthy cohort equation (28.2 ± 7.0 mL/kg/min [144%];
P
<0.05). Significant Pearson correlations were found when using either prediction equation although the correlation when using the CVD equation was higher (r = 0.65) than that for the healthy cohort equation (r = 0.48,
P
<0.05). Differences between equations were also observed for root mean square error (4.7 and 10.9 mL/kg/min for the CVD and healthy cohort equations, respectively).
Conclusions:
As hypothesized, the CVD-specific non-exercise equation was a better predictor of CRF in a cohort of individuals with CVD. The new equation for individuals with CVD provided a lower mean error between measured and predicted CRF than an equation developed from an apparently healthy cohort. Thus, population specific equations are needed for predicting CRF; however, the error associated with non-exercise prediction equations suggests CRF should be directly measured whenever feasible.
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Affiliation(s)
| | - Ross Arena
- UNIVERSITY ILLINOIS CHICAGO, Chicago, IL
| | | | - Susan Marzolini
- KITE, Toronto Rehabilitation Institute, Univ Health Network, Toronto, Canada
| | - Philip A Ades
- Div of Cardiology, Univ of Vermont College of Medicine, Burlington, VT
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Kaminsky LA, Arena R, Myers J, Peterman JE, Bonikowske AR, Harber MP, Medina Inojosa JR, Lavie CJ, Squires RW. Updated Reference Standards for Cardiorespiratory Fitness Measured with Cardiopulmonary Exercise Testing: Data from the Fitness Registry and the Importance of Exercise National Database (FRIEND). Mayo Clin Proc 2022; 97:285-293. [PMID: 34809986 DOI: 10.1016/j.mayocp.2021.08.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide updated reference standards for cardiorespiratory fitness (CRF) for the United States derived from cardiopulmonary exercise (CPX) testing when using a treadmill or cycle ergometer. PATIENTS AND METHODS Thirty-four laboratories in the United States contributed data to the Fitness Registry and the Importance of Exercise National Database. Analysis included 22,379 tests (16,278 treadmill and 6101 cycle ergometer) conducted between January 1, 1968, through March 31, 2021, from apparently healthy adults (aged 20 to 89 years). Percentiles of peak oxygen consumption for men and women were determined for each decade from 20 through 89 years of age for treadmill and cycle exercise modes, as well as when defining maximal effort as respiratory exchange ratio (RER) greater than or equal to 1.0 or RER greater than or equal to 1.1. RESULTS For both men and women, the 50th percentile scores for each exercise mode decreased with age and were higher in men across all age groups and higher for treadmill compared with cycle CPX. The average rate of decline per decade over a 6-decade period was 13.5%, 4.0 mLO2·kg-1·min-1 for treadmill CPX and 16.4%, 4.3 mLO2·kg-1·min-1 for cycle CPX. Observationally, the mean peak oxygen consumption was similar whether using an RER criterion of greater than or equal to 1.0 or greater than or equal to 1.1 across the different test modes, ages, and for both sexes. The updated reference standards for treadmill CPX were 1.5 - 4.6 mLO2·kg-1·min-1 lower compared with the previous 2015 standards whereas the updated cycling standards were generally comparable to the original 2017 standards. CONCLUSION These updated cardiorespiratory fitness reference standards improve the representativeness of the US population compared with the original standards.
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Affiliation(s)
- Leonard A Kaminsky
- Fisher Institute for Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA; Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, IN, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, USA
| | - James E Peterman
- Fisher Institute for Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Amanda R Bonikowske
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, IN, USA
| | - Jose R Medina Inojosa
- Marriott Heart Disease Research Program, Mayo Clinic, Rochester, MN, USA; John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Ray W Squires
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Smith BE, Peterman JE, Harber MP, Imboden MT, Fleenor BS, Kaminsky LA, Whaley MH. Change in Metabolic Syndrome and Cardiorespiratory Fitness Following Exercise Training - The Ball State Adult Fitness Longitudinal Lifestyle Study (BALL ST). Diabetes Metab Syndr Obes 2022; 15:1553-1562. [PMID: 35619799 PMCID: PMC9129263 DOI: 10.2147/dmso.s352490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/02/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate how the changes in directly measured cardiorespiratory fitness (CRF) relate to the changes in metabolic syndrome (MetS) status following 4-6 months of exercise training. METHODS Maximal cardiopulmonary exercise (CPX) tests and MetS risk factors were analyzed prospectively from 336 adults (46% women) aged 45.8 ± 10.9 years. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III criteria, as updated by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). Pearson correlations, chi-squares, and dependent 2-tail t-tests were used to assess the relationship between the change in CRF and the change in MetS risk factors, overall number of MetS risk factors, and a MetS severity score following 4-6 months of participation in a self-referred, community-based exercise program. RESULTS Overall prevalence of MetS decreased from 23% to 14% following the exercise program (P < 0.05), while CRF improved 15% (4.7 ± 8.4 mL/kg/min, P < 0.05). Following exercise training, the number of positive risk factors declined from 1.4 ± 1.3 to 1.2 ± 1.2 in the overall cohort (P < 0.05). The change in CRF was inversely related to the change in the overall number of MetS risk factors (r = -0.22; P < 0.05) and the MetS severity score (r = -0.28; p < 0.05). CONCLUSION This observational cohort study indicates an inverse relationship between the change in CRF and the change in MetS severity following exercise training. These results suggest that participation in a community-based exercise program yields significant improvements in CRF, MetS risk factors, the prevalence of the binary MetS, and the MetS severity score. Improvement in CRF through exercise training should be a primary prevention strategy for MetS.
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Affiliation(s)
- Brittany E Smith
- Exercise Science and Exercise Physiology, Kent State University, Kent, OH, 44240, USA
| | - James E Peterman
- Fisher Institute of Health and Wellbeing, Ball State University, Muncie, IN, 47306, USA
| | - Matthew P Harber
- School of Kinesiology, Ball State University, Muncie, IN, 47306, USA
| | - Mary T Imboden
- Department of Exercise Science, George Fox University, Portland, OR, 97132, USA
| | - Bradley S Fleenor
- School of Kinesiology, Ball State University, Muncie, IN, 47306, USA
| | - Leonard A Kaminsky
- Fisher Institute of Health and Wellbeing, Ball State University, Muncie, IN, 47306, USA
| | - Mitchell H Whaley
- School of Kinesiology, Ball State University, Muncie, IN, 47306, USA
- Correspondence: Mitchell H Whaley, Email
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12
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Kaminsky LA, German C, Imboden M, Ozemek C, Peterman JE, Brubaker PH. The importance of healthy lifestyle behaviors in the prevention of cardiovascular disease. Prog Cardiovasc Dis 2021; 70:8-15. [PMID: 34922952 DOI: 10.1016/j.pcad.2021.12.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/12/2021] [Indexed: 12/29/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death globally. Advancements in the treatment of CVD have reduced mortality rates, yet the global burden of CVD remains high. Considering that CVD is still largely a preventable disease, prioritizing preventative measures through healthy lifestyle (HL) behaviors is necessary to lessen the burden of CVD. HL behaviors, such as regular exercise, healthy eating habits, adequate sleep, and smoking cessation, can influence a number of traditional CVD risk factors as well as a less commonly measured risk factor, cardiorespiratory fitness (CRF). It is important to note that cardiac rehabilitation programs, which traditionally have focused on secondary prevention, also emphasize the importance of making comprehensive HL behavior changes. This review discusses preventative measures to reduce the burden of CVD through an increased uptake and assessment of HL behaviors. An overview of the importance of CRF as a risk factor is discussed along with how to improve CRF and other risk factors through HL behavior interventions. The role of the clinician for promoting HL behaviors to prevent CVD is also reviewed.
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Affiliation(s)
- Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Charles German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mary Imboden
- George Fox University, USA; Health Enhancement Research Organization, USA
| | - Cemal Ozemek
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - James E Peterman
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
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13
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Peterman JE, Arena R, Myers J, Marzolini S, Ades PA, Savage PD, Lavie CJ, Kaminsky LA. Reference Standards for Cardiorespiratory Fitness by Cardiovascular Disease Category and Testing Modality: Data From FRIEND. J Am Heart Assoc 2021; 10:e022336. [PMID: 34747182 PMCID: PMC8751972 DOI: 10.1161/jaha.121.022336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The importance of cardiorespiratory fitness for stratifying risk and guiding clinical decisions in patients with cardiovascular disease is well‐established. To optimize the clinical value of cardiorespiratory fitness, normative reference standards are essential. The purpose of this report is to extend previous cardiorespiratory fitness normative standards by providing updated cardiorespiratory fitness reference standards according to cardiovascular disease category and testing modality. Methods and Results The analysis included 15 045 tests (8079 treadmill, 6966 cycle) from FRIEND (Fitness Registry and the Importance of Exercise National Database). Using data from tests conducted January 1, 1974, through March 1, 2021, percentiles of directly measured peak oxygen consumption (VO2peak) were determined for each decade from 30 through 89 years of age for men and women with a diagnosis of coronary artery bypass surgery, myocardial infarction, percutaneous coronary intervention, or heart failure. There were significant differences between sex and age groups for VO2peak (P<0.001). The mean VO2peak was 23% higher for men compared with women and VO2peak decreased by a mean of 7% per decade for both sexes. Among each decade, the mean VO2peak from treadmill tests was 21% higher than the VO2peak from cycle tests. Differences in VO2peak were observed among the age groups in both sexes according to cardiovascular disease category. Conclusions This report provides normative reference standards by cardiovascular disease category for both men and women performing cardiopulmonary exercise testing on a treadmill or cycle ergometer. These updated and enhanced reference standards can assist with patient risk stratification and guide clinical care.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-BeingCollege of HealthBall State University Muncie IN.,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL.,Department of Physical Therapy College of Applied Science University of Illinois at Chicago Chicago IL
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL.,Division of Cardiology Veterans Affairs Palo Alto Healthcare System and Stanford University Palo Alto CA
| | - Susan Marzolini
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL.,KITEToronto Rehabilitation InstituteUniversity Health Network Toronto Ontario Canada
| | - Philip A Ades
- Division of Cardiology University of Vermont College of Medicine Burlington VT
| | - Patrick D Savage
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL.,Division of Cardiology University of Vermont College of Medicine Burlington VT
| | - Carl J Lavie
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL.,John Ochsner Heart and Vascular InstituteOchsner Clinical SchoolThe University of Queensland School of Medicine New Orleans LA
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-BeingCollege of HealthBall State University Muncie IN.,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network Chicago IL
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14
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Peterman JE, Bassett DR, Finch WH, Harber MP, Whaley MH, Fleenor BS, Kaminsky LA. Associations Between Active Commuting and Cardiovascular Disease in the United States. J Phys Act Health 2021; 18:1525-1531. [PMID: 34689123 DOI: 10.1123/jpah.2021-0245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/06/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Active commuting is inversely related with cardiovascular disease (CVD) risk factors yet associations with CVD prevalence in the US population are unknown. METHODS Aggregate data from national surveys conducted in 2017 provided state-level percentages of adults who have/had coronary heart disease, myocardial infarction, and stroke, and who actively commuted to work. Associations between active commuting and CVD prevalence rates were assessed using Pearson correlations and generalized additive models controlling for covariates. RESULTS Significant correlations were observed between active commuting and all CVD rates (r range = -.31 to -.47; P < .05). The generalized additive model analyses for active commuting (walking, cycling, or public transport) in all adults found no relationships with CVD rates; however, a significant curvilinear association was observed for stroke within men. The generalized additive model curves when examining commuting via walking or cycling in all adults demonstrated nuanced, generally negative linear or curvilinear associations between coronary heart disease, myocardial infarction, and stroke. CONCLUSION Significant negative correlations were observed between active commuting and prevalence rates of coronary heart disease, myocardial infarction, and stroke. Controlling for covariates influenced these associations and highlights the need for future research to explore the potential of active commuting modes to reduce CVD in the United States.
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15
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Quesada DA, Peterman JE, Kaminsky LA, Whaley MH, Fleenor BS, Harber MP. Peak Exercise Ventilation And Mortality In Apparently Healthy Men And Women. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764332.69494.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Fleenor BS, Peterman JE, Kaminsky LA, Whaley MH, Harber MP. The Association Between Pulse Pressure And All-cause Mortality Is Dependent On Cardiorespiratory Fitness. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764388.90731.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Johnson L, Remington H, Peterman JE, Kaminsky LA, Fleenor BS, Harber MP. Cardiopulmonary Exercise Test Responses Are Related To Aortic Stiffness. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764336.81806.f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Lynch K, Riccardi MP, Peterman JE, Fleenor BS, Whaley MH, Kaminsky LA, Harber MP. Ventilatory Threshold And All-cause Mortality In Apparently Healthy Adults. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764328.46368.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Novelli D, Peterman JE, Fleenor BS, Whaley MH, Kaminsky LA, Harber MP. Oxygen Uptake Efficiency Slope (OUES) Is Related To Mortality In Apparently Healthy Adults. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764340.04794.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Peterman JE, Harber MP, Chaudhry S, Arena R, Kaminsky LA. Peak oxygen pulse and mortality risk in healthy women and men: The Ball State Adult Fitness Longitudinal Lifestyle Study (BALL ST). Prog Cardiovasc Dis 2021; 68:19-24. [PMID: 34242652 DOI: 10.1016/j.pcad.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 02/08/2023]
Abstract
Peak oxygen pulse (O2 pulsepeak) may have predictive utility for health outcomes yet, presently, has only been examined in men and only using a single baseline measure. PURPOSE The primary aim of this investigation was to evaluate the relationship between O2 pulsepeak and all-cause mortality in apparently healthy women and men. A secondary aim was to explore the relationship between longitudinal changes to O2 pulsepeak and mortality. METHODS The sample included 3877 participants (43% women) for the primary aim and 759 participants (32% women) who performed two cardiopulmonary exercise tests ≥1 year apart for the secondary aim. Cox proportional hazard models were performed to determine the relationship between O2 pulsepeak and mortality. Prognostic peak oxygen consumption (VO2peak) and O2 pulsepeak models were compared using the concordance index and Akaike information criterion (AIC). RESULTS In the assessment from baseline, there were 730 deaths over a 24.7 ± 11.8 year follow-up period. For men, a single measure of O2 pulsepeak was inversely associated with risk for mortality (P < 0.05). However, the concordance index and AIC indicated lower discrimination compared to VO2peak models and O2 pulsepeak did not provide complementary benefit to VO2peak models. For women, O2 pulsepeak was not associated with mortality risk. In the longitudinal analysis, there were 168 deaths over a follow-up of 20.1 ± 11.4 years. Changes to O2 pulsepeak were not significantly related to mortality in either sex. CONCLUSIONS Within an apparently healthy cohort, a single assessment of O2 pulsepeak is related to all-cause mortality in men but not women. Further, longitudinal changes to O2 pulsepeak are not predictive of mortality in either sex. These findings suggest O2 pulsepeak may have limited prognostic utility in healthy individuals, particularly within healthy women.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Matthew P Harber
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Clinical Exercise Physiology Laboratory, Ball State University, Muncie, IN, United States of America
| | - Sundeep Chaudhry
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; MET-Test, Roswell, GA, United States of America
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America
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21
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Arena R, Myers J, Harber M, Phillips SA, Severin R, Ozemek C, Peterman JE, Kaminsky LA. The V˙E/V˙co2 Slope During Maximal Treadmill Cardiopulmonary Exercise Testing: REFERENCE STANDARDS FROM FRIEND (FITNESS REGISTRY AND THE IMPORTANCE OF EXERCISE: A NATIONAL DATABASE). J Cardiopulm Rehabil Prev 2021; 41:194-198. [PMID: 33470730 DOI: 10.1097/hcr.0000000000000566] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Cardiopulmonary exercise testing (CPX) is the gold standard approach for the assessment of cardiorespiratory fitness (CRF). The primary aim of the current study was to determine reference standards for the minute ventilation/carbon dioxide production (V˙E/V˙co2) slope in a cohort from the "Fitness Registry and the Importance of Exercise: A National Database" (FRIEND) Registry. METHODS The current analysis included 2512 tests from 10 CPX laboratories in the United States. Inclusion criteria included CPX data on apparently healthy men and women: (1) age ≥20 yr; and (2) with a symptom-limited exercise test performed on a treadmill. Ventilation and V˙co2 data, from the initiation of exercise to peak, were used to calculate the V˙E/V˙co2 slope via least-squares linear regression. Reference values were determined for men and women by decade of life. RESULTS On average, V˙E/V˙co2 slope values were lower in men and increased with age independent of sex. Fiftieth percentile values increased from 27.1 in the second decade to 33.9 in the eighth decade in men and from 28.5 in the second decade to 33.7 in the eighth decade in women. In the overall group, correlations with baseline characteristics and the V˙E/V˙co2 slope were statistically significant (P < .05) although generally weak, particularly for age and body mass index. CONCLUSION The results of the current study establish reference values for the V˙E/V˙co2 slope when treadmill testing is performed, and all exercise data are used for the slope calculation. These results may prove useful in enhancing the interpretation of CPX results when assessing CRF.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago (Drs Arena, Phillips, Severin, and Ozemek); Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois (Drs Arena, Myers, Harber, Phillips, Severin, Ozemek, Peterman, and Kaminsky); VA Palo Alto Health Care System and Stanford University, Palo Alto, California (Dr Myers); Clinical Exercise Physiology, Ball State University, Muncie, Indiana (Dr Harber); and Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky)
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22
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Peterman JE, Harber MP, Imboden MT, Whaley MH, Fleenor BS, Myers J, Arena R, Kaminsky LA. Accuracy of Exercise-based Equations for Estimating Cardiorespiratory Fitness. Med Sci Sports Exerc 2021; 53:74-82. [PMID: 32694370 DOI: 10.1249/mss.0000000000002435] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Equations are often used to predict cardiorespiratory fitness (CRF) from submaximal or maximal exercise tests. However, no study has comprehensively compared these exercise-based equations with directly measured CRF using data from a single, large cohort. PURPOSE This study aimed to compare the accuracy of exercise-based prediction equations with directly measured CRF and evaluate their ability to classify an individual's CRF. METHODS The sample included 4871 tests from apparently healthy adults (38% female, age 44.4 ± 12.3 yr (mean ± SD)). Estimated CRF (eCRF) was determined from 2 nonexercise equations, 3 submaximal exercise equations, and 10 maximal exercise equations; all eCRF calculations were then compared with directly measured CRF, determined from a cardiopulmonary exercise test. Analysis included Pearson product-moment correlations, standard error of estimate values, intraclass correlation coefficients, Cohen κ coefficients, and the Benjamini-Hochberg procedure to compare eCRF with directly measured CRF. RESULTS All eCRF values from the prediction equations were associated with directly measured CRF (P < 0.01), with intraclass correlation coefficient estimates ranging from 0.07 to 0.89. Although significant agreement was found when using eCRF to categorize participants into fitness tertiles, submaximal exercise equations correctly classified an average of only 51% (range, 37%-58%) and maximal exercise equations correctly classified an average of only 59% (range, 43%-76%). CONCLUSIONS Despite significant associations between exercise-based prediction equations and directly measured CRF, the equations had a low degree of accuracy in categorizing participants into fitness tertiles, a key requirement when stratifying risk within a clinical setting. The present analysis highlights the limited accuracy of exercise-based determinations of eCRF and suggests the need to include cardiopulmonary measures with maximal exercise to accurately assess CRF within a clinical setting.
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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 at Chicago, Chicago, IL
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN
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Franklin BA, Arena R, Kaminsky LA, Peterman JE, Kokkinos P, Myers J. Maximizing the cardioprotective benefits of exercise with age-, sex-, and fitness-adjusted target intensities for training. Eur J Prev Cardiol 2020; 29:e1-e3. [PMID: 34724044 DOI: 10.1093/eurjpc/zwaa094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Barry A Franklin
- Beaumont Health, Preventive Cardiology and Cardiac Rehabilitation, Oakland University William Beaumont School of Medicine, Beaumont Health and Wellness Center, 4949 Coolidge Highway, Royal Oak, MI 48073, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN 47306, USA
| | - James E Peterman
- Ball State University Fisher Institute of Health and Well-Being 2000 W. University Ave. Muncie, IN 47306, USA
| | - Peter Kokkinos
- Department of Kinesiology and Health, Rutgers University, Veterans Affairs Medical Center, Georgetown University School of Medicine, Washington, DC 20422, USA
| | - Jonathan Myers
- Cardiology Division, VA Palo Alto Health Care System, Stanford University, Palo Alto, CA 94304, USA
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Abstract
Physical activity (PA) is beneficial for both mental and physical health, yet many individuals do not meet PA recommendations. There are a multitude of approaches to increase levels of PA and the role of the community is one area of growing interest. This review discusses the community environment as well as programs within the community and their influence on PA levels. Despite some research limitations, there are clear factors associated with community-based PA. Strategies that improve the built environment along with community-based programs have shown success, although differences between the characteristics of communities can mean strategies to promote PA are not universally effective. Additional research is needed on effective strategies that can be tailored to the characteristics of the community to increase PA. Further, public health interventions and policies should consider the role of the community when aiming to increase PA levels.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States
| | - Steven Loy
- Department of Kinesiology, California State University Northridge, Northridge, CA, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States
| | - Joshua Carlos
- Department of Kinesiology, California State University Northridge, Northridge, CA, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States.
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Imboden MT, Kaminsky LA, Peterman JE, Hutzler HL, Whaley MH, Fleenor BS, Harber MP. Normalizing Cardiorespiratory Fitness To Fat-free Mass Improves Mortality Risk Prediction In Overweight Adults From The Ball St Cohort. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000681236.44758.4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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James DR, Peterman JE, Fleenor BS, Whaley MH, Kaminsky LA, Harber MP. Influence Of Fasting Blood Glucose On Cardiopulmonary Responses To Maximal Exercise. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000671524.81491.9c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Peterman JE, Arena R, Myers J, Marzolini S, Ross R, Lavie CJ, Wisløff U, Stensvold D, Kaminsky LA. Development of Global Reference Standards for Directly Measured Cardiorespiratory Fitness: A Report From the Fitness Registry and Importance of Exercise National Database (FRIEND). Mayo Clin Proc 2020; 95:255-264. [PMID: 31883698 DOI: 10.1016/j.mayocp.2019.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/06/2019] [Accepted: 06/12/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To begin the process of developing global reference standards for adults from directly measured cardiorespiratory fitness (CRF). METHODS Percentiles of maximal oxygen consumption (VO2max) for men and women were determined for each decade from 20 through 79 years of age using International data from the Fitness Registry and Importance of Exercise: A National Database (FRIEND-I) along with previously published data from seven studies. FRIEND-I data from January 1, 2014, through January 1, 2019, included 11,678 maximal treadmill tests from three countries, whereas the previously published reports included 32,329 maximal treadmill tests from six countries. RESULTS FRIEND-I data revealed significant differences between sex and age groups for VO2max (P<0.01). For the 20- to 29-years of age group, the 50th percentile VO2max in men and women were 49.5 mLO2⋅kg-1⋅min-1 and 40.6 mLO2⋅kg-1⋅min-1, respectively. VO2max declined an average of 9% per decade with the 50th percentile for the 70- to 79-years of age group having a VO2max of 30.8 mLO2⋅kg-1⋅min-1 in men and 25.0 mLO2⋅kg-1⋅min-1 in women. These results were similar in magnitude and direction to the previously published literature. Within both the FRIEND-I and previously published data there were CRF differences between countries. CONCLUSION This report begins to establish global reference standards for CRF. Continued development of FRIEND-I will increase global representation providing an improved ability to identify and stratify CRF risk categories.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Science, University of Illinois, Chicago, IL
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, CA
| | - Susan Marzolini
- KITE, Toronto Rehab-University Health Network, Ontario, Canada
| | - Robert Ross
- School of Medicine, Department of Endocrinology and Metabolism, Faculty of Health Sciences, Queens University, Kingston, Ontario, Canada
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dorthe Stensvold
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Peterman JE, Grim AP, Kaminsky LA, Whaley MH, Fleenor BS, Harber MP. Methodological considerations for calculating ventilatory efficiency in healthy adults. Eur J Prev Cardiol 2019; 27:1566-1567. [PMID: 31349770 DOI: 10.1177/2047487319865726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being, Ball State University, USA
| | - Adam P Grim
- Clinical Exercise Physiology Program, Ball State University, USA
| | | | | | | | - Matthew P Harber
- Clinical Exercise Physiology Program, Ball State University, USA
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Peterman JE, Grim A, Kaminsky LA, Whaley MH, Fleenor BS, Harber MP. Methodological Considerations for Calculating Ventilatory Efficiency from a Maximal Exercise Test in Apparently Healthy Adults. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561379.10316.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Peterman JE, Healy GN, Winkler EAH, Moodie M, Eakin EG, Lawler SP, Owen N, Dunstan DW, LaMontagne AD. A cluster randomized controlled trial to reduce office workers’ sitting time: effect on productivity
outcomes. Scand J Work Environ Health 2019; 45:483-492. [DOI: 10.5271/sjweh.3820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Peterman JE, Morris KL, Kram R, Byrnes WC. Cardiometabolic Effects of a Randomized Workplace Cycling Intervention. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535252.79699.d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kim S, Peterman JE, Carver TM, Getter GY, Byrnes WC. Road Bicycle Saddle Shape Preference and its Potential Determinants. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538460.31436.be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Homestead EP, Peterman JE, Kane LA, Contini EJ, Byrnes WC. Estimating Energy Expenditure using Individualized, Power-Specific Gross Efficiencies. Int J Sports Med 2016; 37:1129-1135. [PMID: 27737488 DOI: 10.1055/s-0042-110655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Our purpose was to determine if using an individual's power-specific gross efficiency improves the accuracy of estimating energy expenditure from cycling power. 30 subjects performed a graded cycling test to develop 4 gross efficiencies: individual power-specific gross efficiencies, a group mean power-specific gross efficiency, individual fixed gross efficiencies, and a group mean fixed gross efficiency. Energy expenditure was estimated from power using these different gross efficiencies and compared to measured energy expenditure during moderate- and hard-intensity constant-power and 2 variable-power cycling bouts. Estimated energy expenditures using individual or group mean power-specific gross efficiencies were not different from measured energy expenditure across all cycling bouts (p>0.05). To examine the intra-individual variability of the estimates, absolute difference scores (absolute value of estimated minus measured energy expenditure) were compared, where values closer to zero represent more accurate individual estimates. The absolute difference score using individual power-specific gross efficiencies was significantly lower compared to the other gross efficiencies across all cycling bouts (p<0.01). Significant and strong correlations (r≥0.97, p<0.001) were found across all cycling bouts between estimated and measured energy expenditures using individual power-specific gross efficiencies. In conclusion, using an individual's power-specific gross efficiency significantly improves their energy expenditure estimate across different power outputs.
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Affiliation(s)
- E P Homestead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, United States
| | - J E Peterman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, United States
| | - L A Kane
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, United States
| | - E J Contini
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, United States
| | - W C Byrnes
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, United States
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Peterman JE, Morris KL, Kram R, Byrnes WC. Pedelecs as a physically active transportation mode. Eur J Appl Physiol 2016; 116:1565-73. [DOI: 10.1007/s00421-016-3408-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/31/2016] [Indexed: 11/24/2022]
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Peterman JE, Morris KL, Kram R, Byrnes WC. Commuting with Electric Assist Bicycles as a Means to Improve Cardiometabolic Risk Factors. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486834.02978.8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Peterman JE, Wright KP, Melanson EL, Kram R, Byrnes WC. Motor-Driven (Passive) Cycling: A Potential Physical Inactivity Countermeasure? Med Sci Sports Exerc 2016; 48:1821-8. [PMID: 27054677 DOI: 10.1249/mss.0000000000000947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED We have previously shown that motor-driven (passive) stationary cycling elevates energy expenditure (EE). PURPOSE This study aimed to quantify how acute passive cycling affects glucose and insulin responses to an oral glucose tolerance test (OGTT) and basic cognition compared with sitting and moderate-intensity active cycling. METHODS Twenty-four physically inactive healthy males completed three trials in randomized order involving 30-min conditions of sitting, passive cycling, and moderate-intensity cycling. During each condition, EE was measured, and participants performed cognitive tests. After each condition, a 2-h OGTT was performed. RESULTS EE was significantly higher during the cycling conditions compared with sitting (1.36 ± 0.58 and 6.50 ± 1.73 kcal·min greater than sitting for passive and moderate-intensity, respectively). A significant correlation was found between body fat percentage and postsitting OGTT 2-h postplasma glucose (r = 0.30, P < 0.05); thus, participants were divided into lean (n = 11) and nonlean (n = 13) groups. In the nonlean group, compared with sitting, passive cycling lowered 2-h postplasma glucose (7.7 ± 1.3 vs 6.9 ± 1.6 mmol·L, respectively, P < 0.05), and the Matsuda whole-body insulin sensitivity index (WBISI) was higher (2.74 ± 0.86 vs 3.36 ± 1.08, P < 0.05). In addition, passive and moderate-intensity cycling had similar beneficial effects on 2-h postplasma glucose and WBISI. Cognitive performance did not significantly differ between the sitting and passive cycling conditions. CONCLUSIONS Two-hour postplasma glucose was lower and WBISI after acute passive cycling was higher in nonlean participants. Given that and the increase in EE without changes in cognitive performance, we propose passive cycling as a promising intervention to counteract some of the deleterious effects of prolonged sitting in the workplace.
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Affiliation(s)
- James E Peterman
- 1Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO; 2Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO; and 3Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Peterman JE, Lim AC, Ignatz RI, Edwards AG, Byrnes WC. Field-measured drag area is a key correlate of level cycling time trial performance. PeerJ 2015; 3:e1144. [PMID: 26290797 PMCID: PMC4540006 DOI: 10.7717/peerj.1144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/10/2015] [Indexed: 12/02/2022] Open
Abstract
Drag area (Ad) is a primary factor determining aerodynamic resistance during level cycling and is therefore a key determinant of level time trial performance. However, Ad has traditionally been difficult to measure. Our purpose was to determine the value of adding field-measured Ad as a correlate of level cycling time trial performance. In the field, 19 male cyclists performed a level (22.1 km) time trial. Separately, field-determined Ad and rolling resistance were calculated for subjects along with projected frontal area assessed directly (AP) and indirectly (Est AP). Also, a graded exercise test was performed to determine \documentclass[12pt]{minimal}
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}{}$\dot {V}{O}_{2}$\end{document}V˙O2 peak, lactate threshold (LT), and economy. \documentclass[12pt]{minimal}
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}{}$\mathrm{l}~\min ^{-1}$\end{document}lmin−1) and power at LT were significantly correlated to power measured during the time trial (r = 0.83 and 0.69, respectively) but were not significantly correlated to performance time (r = − 0.42 and −0.45). The correlation with performance time improved significantly (p < 0.05) when these variables were normalized to Ad. Of note, Ad alone was better correlated to performance time (r = 0.85, p < 0.001) than any combination of non-normalized physiological measure. The best correlate with performance time was field-measured power output during the time trial normalized to Ad (r = − 0.92). AP only accounted for 54% of the variability in Ad. Accordingly, the correlation to performance time was significantly lower using power normalized to AP (r = − 0.75) or Est AP (r = − 0.71). In conclusion, unless normalized to Ad, level time trial performance in the field was not highly correlated to common laboratory measures. Furthermore, our field-measured Ad is easy to determine and was the single best predictor of level time trial performance.
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Affiliation(s)
- James E Peterman
- Department of Integrative Physiology, University of Colorado Boulder , Boulder, CO , USA
| | - Allen C Lim
- Department of Integrative Physiology, University of Colorado Boulder , Boulder, CO , USA
| | - Ryan I Ignatz
- Department of Integrative Physiology, University of Colorado Boulder , Boulder, CO , USA
| | - Andrew G Edwards
- Department of Integrative Physiology, University of Colorado Boulder , Boulder, CO , USA
| | - William C Byrnes
- Department of Integrative Physiology, University of Colorado Boulder , Boulder, CO , USA
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Homestead EP, Peterman JE, Contini EJ, Kane LA, Byrnes WC. The Influence of Individual Power-specific Gross Efficiency on Estimating Energy Expenditure from Power. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000495184.18683.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Peterman JE, Kram R, Wright KP, Melanson EL, Byrnes WC. Passive Cycling as a Physical Inactivity Countermeasure. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000494011.91422.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Exercise efficiency at low power outputs, energetically comparable to daily living activities, can be influenced by homeostatic perturbations (e.g., weight gain/loss). However, an appropriate efficiency calculation for low power outputs used in these studies has not been determined. Fifteen active subjects (seven females, eight males) performed 14, 5-min cycling trials: two types of seated rest (cranks vertical and horizontal), passive (motor-driven) cycling, no-chain cycling, no-load cycling, cycling at low (10, 20, 30, 40 W), and moderate (50, 60, 80, 100, 120 W) power outputs. Mean delta efficiency was 57% for low power outputs compared to 41.3% for moderate power outputs. Means for gross (3.6%) and net (5.7%) efficiencies were low at the lowest power output. At low power outputs, delta and work efficiency values exceeded theoretical values. In conclusion, at low power outputs, none of the common exercise efficiency calculations gave values comparable to theoretical muscle efficiency. However, gross efficiency and the slope and intercept of the metabolic power vs mechanical power output regression provide insights that are still valuable when studying homeostatic perturbations.
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Affiliation(s)
- M Reger
- Department of Integrative Physiology, University of Colorado at Boulder, Boulder, Colorado, USA
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Lim AC, Peterman JE, Turner BM, Livingston LR, Byrnes WC. Comparison of male and female road cyclists under identical stage race conditions. Med Sci Sports Exerc 2011; 43:846-52. [PMID: 21499053 DOI: 10.1249/mss.0b013e3181fcea8d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare the demands of a 6-d stage race using field measures of power output and HR in male (n=8) and female (n=10) competitive cyclists. METHODS HR and power output were monitored in males and females competing in separate races on identical courses including a prolog (4 km), four circuit/road races (mean ± SD: 118 ± 23 km), and a criterium (47 km). All subjects participated in laboratory-based exercise testing within 2 wk of the race. RESULTS Compared with females, males took 10%, 22%, and 10% less time to complete the prolog, circuit/road races, and criterium, respectively. For males, power output in the prolog, circuit/road races, and criterium averaged 405, 247, and 278 W, respectively. For females, power output averaged 295, 160, and 205 W, respectively. During the prolog, the percent time spent below, at, and above the lactate threshold was 29%, 9%, and 62%, respectively, for males and 24%, 7%, and 69%, respectively, for females. For the circuit/road races, these values were 57%, 10%, and 33%, respectively, for males and 62%, 10%, and 28%, respectively, for females. During the criterium, these values were 51%, 6%, and 43%, respectively, for males, and 50%, 8%, and 42%, respectively, for females. CONCLUSIONS Although men had faster finishing times and higher absolute power outputs, no significant difference was found between men and women in their relative power response. These findings suggest that pacing strategy is based on relative exercise responses and not on absolute exercise responses.
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Affiliation(s)
- Allen C Lim
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA.
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Peterman JE, Kram R, Byrnes WC. Energy Expenditure During Passive Cycling: The Effects of Leg Mass, Cadence, and Adaptation. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000401663.31038.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lim AC, Peterman JE, Turner BM, Sweeney LR, Byrnes WC. Comparison of Male and Female Road Cyclists Under Identical Stage Race Conditions. Med Sci Sports Exerc 2010. [DOI: 10.1249/mss.0b013e3181fcea8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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