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Direct versus indirect methods of determining the exercise intensity in cardiovascular rehabilitation


Authors: L. Mífková 1,2;  F. Várnay 1;  P. Homolka 1,3;  J. Jančík 1;  R. Panovský 3,4;  P. Dobšák 1,2,3;  J. Siegelová 1,2;  L. Špinarová 3,4
Authors place of work: Klinika tělovýchovného lékařství a rehabilitace LF MU a FN u sv. Anny v Brně 1;  Katedra fyzioterapie a rehabilitace, LF MU, Brno 2;  Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 3;  I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně 4
Published in the journal: Kardiol Rev Int Med 2015, 17(2): 141-148
Category: Cardiology Review

Summary

Objective:
Determination of both ventilatory anaerobic thresholds (VT1 and VT2) using spiroergometry testing and the assessment of the applicability of indirect methods of determining the training parameters in cardiac patients before the initiation of a cardiovascular rehabilitation programme.

Methods:
Of 107 ramp spiroergometric tests carried out in cardiac patients before cardiac rehabilitation programme initiation, 57 tests were selected (43 men –  mean age 61.3 ± 10.3 years, and 14 women –  mean age 63.4 ± 10.9 years), where VT1 and VT2 were detectable and the test completed with adequate metabolic load (RERpeak ≥ 1.10). To assess the applicability of indirect methods the oxygen uptake reserve (VO2R) and heart rate reserve (heart rate reserve –  HRR) were also calculated from results of the spiroergometric testing.

Results:
Absolute values of VO2VT1 were lower in women compared to men. However, VT1 was higher in women (59% VO2peak) than in men (53% VO2peak). VT1 (expressed as % of VO2R and % of HRR) in men was at 43% of VO2R and at 44% of HRR –  the difference between these values was not statistically significant. In women, the VT1 was at 45% of VO2R and at 47% of HRR (also in this case the difference was not statistically significant). The correlation between %HRR and %VO2R was statistically significant both in men (p<0.001) and women (p<0.01), but with low coefficient of determination (R2 in men = 0.32; R2 in women = 0.44) suggesting a low power of linear dependence. In case of noticeable variance of values, the equal values of %HRR may correspond significantly to different values of %VO2R. In 39% of patients, chronotropic incompetence (CTI) was present and the achieved maximum heart rate (HRpeak) was lower than the 80% HRmax value corresponding to age. It should be pointed out that the training HR calculated by indirect methods very often differs substantially from the correct values set by spiroergometry.

Conclusion:
The only correct and accurate method to determine the train­ing intensity is the spiroergometric testing. Indirect methods have their importance for a healthy population, but from the point of view of cardiovascular rehabilitation they are unreliable and thus their use cannot be recommended.

Keywords:
excercise training –  spiroergometry –  ventilatory thresholds –  cardiovascular rehabilitation –  oxygen uptake –  heart rate


Zdroje

1. Mezzani A, Hamm LF, Jones AM et al. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Policy statement. Eur J Prev Cardiol 2012; 20: 442– 467. doi: 10.1177/ 2047487312460484.

2. Wasserman K, Hansen JE, Sue DY et al. Principles of Exercise Testing and Interpretation. Including Pathophysiology and Clinical Applications. 5th ed. Philadelphia: Lippincott Williams & Wilkins 2012.

3. Kroidl RF, Swarz S, Lehnigk B. Kursbuch Spiroergometrie. 3rd ed. Stuttgart: Georg Thieme Verlag 2014.

4. Guazzi M, Adams V, Conraads V et al. EACPR/ AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation 2012; 126: 2261– 2274. doi: 10.1161/ CIR.0b013e31826fb946.

5. Carvalho VO, Mezzani A. Aerobic exercise train­ing intensity in patients with chronic heart failure: principles of assessment and prescription. Eur J Cardiovasc Prev Rehabil 2011; 18: 5– 14. doi: 10.1097/ HJR.0b013e32833a9c63.

6. Piepoli MF, Conraads V, Corra U et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Position statement. Eur J Heart Fail 2011; 13: 347– 357. doi: 10.1093/ eurjhf/ hfr017.

7. Cooper CB, Storer TW. Exercise testing and interpretation. A practical approach. Cambridge: Cambridge University press 2004.

8. Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Part III: Interpretation of cardiopulmonary exercise testing in chronic heart failure and future applications. Eur J Cardiovasc Prev Rehabil 2006; 13: 485– 494.

9. Balady GJ, Arena R, Sietsema K et al. Clinician’sGuide to cardiopulmonary exercise testing in adults. A scientific statement from the American Heart Association. Circulation 2010; 122: 191– 225. doi: 10.1161/ CIR.0b013e3181e52e69.

10. Arena R, Sietsema KE. Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation 2011; 123: 668– 680. doi: 10.1161/ CIRCULATIONAHA.109.914788.

11. Guazzi M, Volker A, Conraads V et al. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J 2012; 33: 2917– 2927. doi: 10.1093/ eurheartj/ ehs221.

12. Mífková L, Várnay F, Fišer B et al. Spiroergometry before and after ambulatory exercise training in patients after acute myocardial infarction. Scripta Medica 2010; 83: 115– 120.

13. Chaloupka V. Aerobní kapacita u nemocných s ischemickou chorobou srdeční. Kardiol Rev 2008; 10: 92– 95.

14. Chaloupka V, Siegelová J, Špinarová L et al. Rehabilitace u nemocných s kardiovaskulárním onemocněním. Cor Vasa 2006; 48: K127– K145.

15. Mífková L, Havelková A, Homolka P et al. Ambulantní rehabilitační program u mužů a žen po akutním infarktu myokardu. Med Sport Boh Slov 2014; 23: 55– 65.

16. Støylen A, Conraads V, Halle M et al. Control­led study of myocardial recovery after interval train­ing in heart failure: SMARTEX-HF-rationale and design. Eur J Prev Cardiol 2012; 19: 813–821. doi: 10.117/1741826711403252.

17. Wisløff U, Støylen A, Loennechen JP et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: A randomized study. Circulation 2007; 115: 3086–3094. doi: 10.1161/CIRCULATIONAHA.106.675041.

18. Dimopulos S, Anastasiou-Nana M, Sakellariou Det al. Effects of exercise rehabilitaion program on heart rate recovery in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2006; 13: 67–73.

19. Mezzani A, Agostoni P, Cohen-Solal A et al. Standards for use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2009; 16: 249–267. doi: 10.1097/HJR.0b013e32832914c8.

20. Mezzani A, Corrá U, Giordano A et al. Upper intensity limit for prolonged aerobic exercise in chronic heart failure. Med Sci Exerc 2010; 42: 633–639. doi: 10.1249/MSS.0b013e3181bdc69d.

21. Hill DW. The critical power concept. A review. Sports Med 1993; 16: 237–254.

22. Brubaker PH, Kitzman DW. Chronotropic incompetence: causes, consequences and management. Circulation 2011; 123: 1010–1020. doi: 10.1161/CIRCULATIONAHA.110.940577.

23. Magri D, Palermo P, Cauti FM et al. Chronotropic incompetence and functional capacity in chronic heart failure: no role of β-Blocker and β-Blocker dose. Cardiovasc Ther 2012; 30: 100–108. doi: 10.1111/j.1755-5922.2010.00184.x.

24. Pescatello LS, Ross A, Riebe D et al. ACSM´s Guidelines for exercise testing and prescription. 9th ed. Philadelphia: Lippincott Williams & Wilkins 2014.

25. Soska V, Dobsak P, Pohanka M et al. Exercise train­ing combined with electromyostimulation in the rehabilitation of patients with chronic heart failure: A randomized trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158: 98–106. doi: 10.5507/bp.2012.096.

26. Dobsak P, Tomandl J, Spinarova L et al. Effects of neuromuscular electrical stimulation and aerobic exercise training on arterial stiffness and autonomic functions in patients with chronic heart failure. Artif Organs 2012; 36: 920–930. doi: 10.1111/j.1525-1594.2012.01474.x.

27. Tanaka H, Monahan KD, Seals DR. Age-Predicted Maximal Heart Rate Revisited. J Am Coll Cardiol 2001; 37: 153–156.

28. Mezzani A, Corra U, Giordano A et al. Unreliability of the %VO2 reserve versus % heart rate reserve relationship for aerobic effort relative intensity assessment in chronic heart failure patients on or off beta-blocking therapy. Eur J Cardiovasc Prev Rehabil 2007; 14: 92–98. doi: 10.1097/HJR.0b013e328011649b.

29. Placheta Z, Siegelová J. Štejfa M et al. Zátěžová diagnostika v ambulantní a klinické praxi. 1. vyd. Brno: Grada Publishing 1999.

Štítky
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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