scholarly journals Endurance Training Improves Oxygen Uptake and Endurance Capacity in Patients With Moderate to Severe Valvular Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Karin Vonbank ◽  
Daniel Haubenberger ◽  
Raphael Rosenhek ◽  
Matthias Schneider ◽  
Stefan Aschauer ◽  
...  
Keyword(s):  
Heart Disease ◽  
Oxygen Uptake ◽  
Endurance Training ◽  
Valvular Heart Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Endurance Capacity ◽  
Working Capacity ◽  
Endurance Test ◽  
Cardiopulmonary Exercise

Aim: Peak oxygen uptake (peakVO2) is one of the strongest predictors of survival in patients with valvular heart disease. The purpose of this study was to determine whether endurance training improves peakVO2 and endurance capacity in patients with moderate-severe aortic and mitral valve disease.Methods: 30 patients with moderate-severe valvular heart disease were randomly assigned to 12 weeks of endurance training (TG) (n = 16) or standard care (SC) (n = 14). PeakVO2 and maximum working capacity (Wattmax) were assessed by cardiopulmonary exercise testing, as well as submaximal endurance test at 80% of peakVO2 at baseline and after 12 weeks.Results: There was a significant improvement in peakVO2 from 27.2 ± 5.9 ml/kg to 30.4 ± 6.3 ml/kg (P < 0.001) in TG compared to the SC (peakVO2 from 24.6 ± 4.4 to 24.7 ± 3.8) and in the Wattmax from 151.8 ± 41.0 Watt to 171.2 ± 49.7 Watt in the TG compared to the SC (152.9 ± 35.6 Watt to 149.2 ± 28.4 Watt). The endurance capacity increased significantly from 17.0 ± 9.4 min to 32.8 ± 16.8 min (p = 0.003) in the TG compared to the SC (11.7 ± 6.2 min to 11.2 ± 7.6 min). The heart rate during the endurance test decreased in the TG from 154 ± 14 b/min to 142 ± 20 b/min for the same workload. No changes could be seen in the SC.Conclusion: Endurance training in patients with moderate to severe valvular heart disease increased significantly the peakVO2 as well as the endurance capacity.

scholarly journals Mismatch between self-estimated and objectively assessed exercise capacity in patients with congenital heart disease varies in regard to complexity of cardiac defects

2020 ◽  
pp. 1-7
Author(s):  
Julius M. Woile ◽  
Stefan Dirks ◽  
Friederike Danne ◽  
Felix Berger ◽  
Stanislav Ovroutski
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Oxygen Uptake ◽  
Exercise Capacity ◽  
Congenital Heart ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Subjective Rating ◽  
Cardiac Defects ◽  
Cardiopulmonary Exercise

Abstract Aim: Regular evaluation of physical capacity takes a crucial part in long-term follow-up in patients with congenital heart disease (CHD). This study aims to examine the accuracy of self-estimated exercise capacity compared to objective assessments by cardiopulmonary exercise testing in patients with CHD of various complexity. Methods: We conducted a single centre, cross-sectional study with retrospective analysis on 382 patients aged 8–68 years with various CHD who completed cardiopulmonary exercise tests. Peak oxygen uptake was measured. Additionally, questionnaires covering self-estimation of exercise capacity were completed. Peak oxygen uptake was compared to patient’s self-estimated exercise capacity with focus on differences between complex and non-complex defects. Results: Peak oxygen uptake was 25.5 ± 7.9 ml/minute/kg, corresponding to 75.1 ± 18.8% of age- and sex-specific reference values. Higher values of peak oxygen uptake were seen in patients with higher subjective rating of exercise capacity. However, oxygen uptake in patients rating their exercise capacity as good (mean oxygen uptake 78.5 ± 1.6%) or very good (mean oxygen uptake 84.8 ± 4.8%) was on average still reduced compared to normal. In patients with non-complex cardiac defects, we saw a significant correlation between peak oxygen uptake and self-estimated exercise capacity (spearman-rho −0.30, p < 0.001), whereas in patients with complex cardiac defects, no correlation was found (spearman-rho −0.11, p < 0.255). Conclusion: The mismatch between self-estimated and objectively assessed exercise capacity is most prominent in patients with complex CHD. Registration number at Charité Universitätsmedizin Berlin Ethics Committee: EA2/106/14.

scholarly journals Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Laura Jones ◽  
Laura Tan ◽  
Suzanne Carey-Jones ◽  
Nathan Riddell ◽  
Richard Davies ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Low Cost ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Wearable Device ◽  
Cardiopulmonary Exercise

Abstract Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery. Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices. Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 males) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R = 0.57 (CI 0.29–0.76), R = 0.59 (CI 0.31–0.77) and R = 0.62 (CI 0.35–0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01–0.64), R = 0.39 (CI 0.04–0.66) and R = 0.42 (CI 0.07–0.68) respectively) and peak work (R = 0.56 (CI 0.27–0.75), R = 0.48 (CI 0.17–0.70) and R = 0.50 (CI 0.2–0.72) respectively). Receiver operator curve (ROC) analysis for direct and self-reported measures of 7-day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work. Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment. Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24 January 2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.

scholarly journals Prognostic value of cardiopulmonary exercise testing in valvular heart disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Cortina Camarero ◽  
M Sarrion Catala ◽  
V Suberviola Sanchez-Caballero ◽  
C Beltran Herrera ◽  
E Gomez Mariscal ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Prognostic Value ◽  
Cardiopulmonary Exercise Testing ◽  
Symptom Development ◽  
Ventilatory Efficiency ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2 ◽  
Echocardiographic Parameters

Abstract Introduction Cardiopulmonary exercise testing (CEPT) is not routinely used for the assessment of valvular heart disease (VHD) patients. The cutoff values of percentage of predicted peak VO2 and ventilatory efficiency parameters that carry out a bad prognosis have been predominantly validated in heart failure. The aim of this study was to analyze the prognostic value of CPET parameters in a broad population of VHD patients. Methods 163 patients (51% female) with moderate or severe VHD who underwent a CEPT (n=197) at their physician's discretion from 2017 until 2019 were included. We calculated the net reclassification index of CPET, compared to the classical clinical or echocardiographic parameters, regarding the need for surgical indication. Also, the predictive value of CPET for death and symptom development during follow-up was estimated using regression analysis. Results At inclusion, all patients were asymptomatic or with minimal equivocal symptoms. Aortic valvular lesions were the most common (47%), followed by mitral valvular disease (44%). There was a predominance of severe valvular heart disease (71%) and most of the CEPTs were performed on a treadmill (74%). The percentage of predicted peak VO2 was 76±18% and at anaerobic threshold was 61±18%. The mean follow-up time was 15±10 months. There were 5 deaths (3%) and 24 patients became symptomatic. The net reclassification index of CPET over either clinical or echocardiographic parameters was 46%. The CEPT parameters that predicted increased risk of death were VE/VCO2 slope (p=0.009), % of predicted peak VO2 (p=0.049) and Eq CO2 at anaerobic threshold (p=0.047). None of the CEPT parameters was predictive of symptom development during follow-up, however, in the subgroup of patients who became clearly symptomatic, the ventilatory efficiency parameters were similar to the cut off values that confer bad prognosis (see Table in Figure). Conclusion In our series, CPET added prognostic mortality value to patients with VHD. The cut off values used for patients with HF can also be applied in a VHD population. In addition, CEPT clearly improved the clinical decision for surgical referral. Nevertheless, these results need to be validated in a broader population. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Can wearable technology be used to approximate cardiopulmonary exercise testing metrics?

2020 ◽  
Author(s):  
Matt Morgan ◽  
Laura Jones ◽  
Laura Tan ◽  
Suzanne Carey-Jones ◽  
Nathan Riddell ◽  
...  
Keyword(s):  
Physical Activity ◽  
High Risk ◽  
Oxygen Uptake ◽  
Anaerobic Threshold ◽  
Low Cost ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Wearable Device ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2

Abstract Background Consumer wrist-worn wearable activity monitors are widely available, low cost and are able to provide a direct measurement of several markers of physical activity. Despite this, there is limited data on their use in perioperative risk prediction. We explored whether these wearables could accurately approximate metrics (anaerobic threshold, peak oxygen uptake and peak work) derived using formalised cardiopulmonary exercise testing (CPET) in patients undergoing high-risk surgery. Methods Patients scheduled for major elective intra-abdominal surgery and undergoing CPET were included. Physical activity levels were estimated through direct measures (step count, floors climbed and total distance travelled) obtained through continuous wear of a wrist worn activity monitor (Garmin Vivosmart HR+) for 7 days prior to surgery and self-report through completion of the short International Physical Activity Questionnaire (IPAQ). Correlations and receiver operating characteristic (ROC) curve analysis explored the relationships between parameters provided by CPET and physical activity. Device selection Our choice of consumer wearable device was made to maximise feasibility outcomes for this study. The Garmin Vivosmart HR+ had the longest battery life and best waterproof characteristics of the available low-cost devices. Results Of 55 patients invited to participate, 49 (mean age 65.3 ± 13.6 years; 32 male) were enrolled; 37 provided complete wearable data for analyses and 36 patients provided full IPAQ data. Floors climbed, total steps and total travelled as measured by the wearable device all showed moderate correlation with CPET parameters of peak oxygen uptake (peak VO2) (R=0.57 (CI 0.29-0.76), R=0.59 (CI 0.31-0.77) and R=0.62 (CI 0.35-0.79) respectively), anaerobic threshold (R = 0.37 (CI 0.01-0.64), R = 0.39 (CI 0.04-0.66) and R = 0.42 (CI 0.07-0.68) respectively) and peak work (R = 0.56 (CI 0.27-0.75), R = 0.48 (CI 0.17-0.70) and R = 0.50 (CI 0.2-0.72) respectively). Receiver Operator Curve (ROC) analysis for direct and self-reported measures of 7 day physical activity could accurately approximate the ventilatory equivalent for carbon dioxide (VE/VCO2) and the anaerobic threshold. The area under these curves was 0.89 for VE/VCO2 and 0.91 for the anaerobic threshold. For peak VO2 and peak work, models fitted using just the wearable data were 0.93 for peak VO2 and 1.00 for peak work. Conclusions Data recorded by the wearable device was able to consistently approximate CPET results, both with and without the addition of patient reported activity measures via IPAQ scores. This highlights the potential utility of wearable devices in formal assessment of physical functioning and suggests they could play a larger role in pre-operative risk assessment. Ethics This study entitled “uSing wearable TEchnology to Predict perioperative high-riSk patient outcomes (STEPS)” gained favourable ethical opinion on 24/1/2017 from the Welsh Research Ethics Committee 3 reference number 17/WA/0006. It was registered on ClinicalTrials.gov with identifier NCT03328039.

Effect of endurance training on muscle TCA cycle metabolism during exercise in humans

2004 ◽  
Vol 97 (2) ◽  
pp. 579-584 ◽  
Author(s):  
Krista R. Howarth ◽  
Paul J. LeBlanc ◽  
George J. F. Heigenhauser ◽  
Martin J. Gibala
Keyword(s):  
Oxygen Uptake ◽  
Endurance Training ◽  
Citrate Synthase ◽  
Vastus Lateralis ◽  
Tca Cycle ◽  
Peak Oxygen Uptake ◽  
Endurance Capacity ◽  
Exercise Induced ◽  
Cycle Endurance ◽  
Pretraining Trial

We tested the theory that links the capacity to perform prolonged exercise with the size of the muscle tricarboxylic acid (TCA) cycle intermediate (TCAI) pool. We hypothesized that endurance training would attenuate the exercise-induced increase in TCAI concentration ([TCAI]); however, the lower [TCAI] would not compromise cycle endurance capacity. Eight men (22 ± 1 yr) cycled at ∼80% of initial peak oxygen uptake before and after 7 wk of training (1 h/day, 5 days/wk). Biopsies (vastus lateralis) were obtained during both trials at rest, after 5 min, and at the point of exhaustion during the pretraining trial (42 ± 6 min). A biopsy was also obtained at the end of exercise during the posttraining trial (91 ± 6 min). In addition to improved performance, training increased ( P < 0.05) peak oxygen uptake and citrate synthase maximal activity. The sum of four measured TCAI was similar between trials at rest but lower after 5 min of exercise posttraining [2.7 ± 0.2 vs. 4.3 ± 0.2 mmol/kg dry wt ( P < 0.05)]. There was a clear dissociation between [TCAI] and endurance capacity because the [TCAI] at the point of exhaustion during the pretraining trial was not different between trials (posttraining: 2.9 ± 0.2 vs. pretraining: 3.5 ± 0.2 mmol/kg dry wt), and yet cycle endurance time more than doubled in the posttraining trial. Training also attenuated the exercise-induced decrease in glutamate concentration (posttraining: 4.5 ± 0.7 vs. pretraining: 7.7 ± 0.6 mmol/kg dry wt) and increase in alanine concentration (posttraining: 3.3 ± 0.2 vs. pretraining: 5.6 ± 0.3 mmol/kg dry wt; P < 0.05), which is consistent with reduced carbon flux through alanine aminotransferase. We conclude that, after aerobic training, cycle endurance capacity is not limited by a decrease in muscle [TCAI].

Do we need cardiopulmonary exercise to determine the optimal time for intervention in valvular heart disease?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Cortina ◽  
M Sarrion ◽  
C Beltran ◽  
V Suberviola ◽  
A Sanchez ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Nyha Class ◽  
Cardiopulmonary Exercise Testing ◽  
Surrogate Marker ◽  
Exercise Duration ◽  
Surgical Indication ◽  
Optimal Time ◽  
Kappa Index ◽  
Cardiopulmonary Exercise

Abstract Introduction Cardiopulmonary exercise testing (CPET) is underused in many clinical conditions other than HF. In valvular heart disease (VHD), CEPT can aid in choosing the right timing for surgery. The goals of this study were to compare the assessment of functional capacity (FC) by CEPT and NYHA scale, and to analyze the relationship between ventilatory efficiency (VE) parameters and time to surgery. Methods 197 CPET were performed in 163 patients with moderate or severe VHD (51% female). Real METS (RM) were calculated as indexed peak VO2/3.5 (1 MET = 3.5 ml O2/kg/min) and compared to estimated METS (EM) derived by the exercise duration. An agreement analysis between RM, EM and NYHA was performed. The association among VE/VCO2 slope, pet CO2 at anaerobic threshold (AT), OUES and time to surgical indication was also studied using Cox logistic regression analysis. Results See Table. The RM and EM were 4,7±1,7and 6,2±2,9, respectively (p&lt;0.01), and the correlation was low (ICC=0,7, p&lt;0.001). The agreement between NYHA class and % of peak predicted V02 was very low (kappa index = 0.1, p&lt;0.001). VE parameters were predictive of an earlier surgical indication: petCO2 AT (p=0.02), VE/VCO2 slope (p=0.069), OUES (p=0.014). Conclusions In asymptomatic VHD patients, the surgical indication should not rely solely in their FC assessed by either NYHA scale or EM derived by duration of exercise. In our series, these parameters clearly overestimated the FC of the population. Also, the ventilatory inefficiency may be a surrogate marker of advanced disease and lead to a closer surveillance for an earlier intervention. Real and estimated METS by type of VHD Funding Acknowledgement Type of funding source: None

MO611CARDIOPULMONARY RESERVE EXAMINED WITH CARDIOPULMONARY EXERCISE TESTING IN INDIVIDUALS WITH AND WITHOUT CHRONIC KIDNEY DISEASE; A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Eva Pella ◽  
Marieta Theodorakopoulou ◽  
Afroditi Boutou ◽  
Maria Eleni Alexandrou ◽  
Dimitra Bakaloudi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oxygen Uptake ◽  
Meta Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

Abstract Background and Aims Patients with chronic kidney disease (CKD) often present with reduced physical activity and exercise performance due to a number of factors relevant to co-existing disturbances of the cardiac, nervous and muscular systems. Cardiopulmonary exercise testing (CPET) is widely applied in daily clinical practice used for clinical evaluation of exercise intolerance and related symptoms (i.e. dyspnea, fatigue), as well risk stratification, and other applications in several medical fields. Method This is a systematic review and meta-analysis of studies which used CPET technology in adult patients with CKD to examine cardiopulmonary reserve in individuals with versus individuals without CKD. The primary outcome was peak oxygen uptake (VO2peak). Literature search involved PubMed, Web of Science and Scopus databases; manual search of article references and of grey literature was also performed. Newcastle-Ottawa Scale was applied to evaluate the quality of retrieved studies. Results From an initial 4944 literature records, we identified 29 studies fulfilling the inclusion criteria; of these, 25 studies with complete data including 2213 participants were included in final meta-analysis. Peak oxygen uptake (VO2peak) was significantly lower in CKD patients compared to controls without CKD (standardized-mean-difference, SMD:-1.40, 95%CI[-1.68, -1.13]) (Figure). Oxygen consumption at anaerobic threshold (VO2AT) (SMD:-1.06, 95%CI[-1.34, -0.79]), maximum workload (weighted-mean-difference, WMD:-58.26, 95%CI[-74.14, -42.38]) and respiratory exchange ratio (RER) (WMD:-0.02, 95%CI[-0.05, 0.01]) were also impaired in CKD patients compared to non-CKD individuals. In 3 studies comparing patients with CKD versus patients with heart failure without CKD VO2peak was higher in the former (WMD:6.60, 95%CI[3.02, 10.18]). Sensitivity analyses confirmed the robustness of these findings. Conclusion VO2peak and other commonly analyzed CPET variables were lower in CKD patients compared to controls, indicating reduced functional cardiopulmonary reserve in the former. In contrast, CKD patients performed better when compared patients with heart failure.

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