Cardiopulmonary exercise testing in severe osteoarthritis: a crossover comparison of four exercise modalities*

Abstract

Cardiopulmonary exercise testing is performed increasingly for cardiorespiratory fitness assessment and preoperative risk stratification. Lower limb osteoarthritis is a common comorbidity in surgical patients, meaning traditional cycle ergometry-based cardiopulmonary exercise testing is difficult. The purpose of this study was to compare cardiopulmonary exercise testing variables and subjective responses in four different exercise modalities. In this crossover study, 15 patients with osteoarthritis scheduled for total hip or knee arthroplasty (mean (SD) age 68 (7) years; body mass index 31.4 (4.1) kg.m-2) completed cardiopulmonary exercise testing on a treadmill, elliptical cross-trainer, cycle and arm ergometer. Mean (SD) peak oxygen consumption was 20-30% greater on the lower limb modalities (treadmill 21.5 (4.6) (p < 0.001); elliptical cross-trainer (21.2 (4.1) (p < 0.001); and cycle ergometer (19.4 (4.2) ml.min À1 .kg À1 (p = 0.001), respectively) than on the arm ergometer (15.7 (3.7) ml.min-1 .kg-1). Anaerobic threshold was 25-50% greater on the lower limb modalities (treadmill 13.5 (3.1) (p < 0.001); elliptical cross-trainer 14.6 (3.0) (p < 0.001); and cycle ergometer 10.7 (2.9) (p = 0.003)) compared with the arm ergometer (8.4 (1.7) ml.min À1 .kg À1). The median (95%CI) difference between preexercise and peak-exercise pain scores was greater for tests on the treadmill (2.0 (0.0-5.0) (p = 0.001); elliptical cross-trainer (3.0 (2.0-4.0) (p = 0.001); and cycle ergometer (3.0 (1.0-5.0) (p = 0.001)), compared with the arm ergometer (0.0 (0.0-1.0) (p = 0.406)). Despite greater peak exercise pain, cardiopulmonary exercise testing modalities utilising the lower limbs affected by osteoarthritis elicited higher peak oxygen consumption and anaerobic threshold values compared with arm ergometry.

Submaximal cardiopulmonary exercise testing to assess preoperative aerobic capacity in patients with knee osteoarthritis scheduled for total knee arthroplasty: a feasibility study

“…To our knowledge, this is the first study that explicitly investigated the feasibility of a submaximal clinical exercise test that evaluated aerobic capacity with submaximal parameters in a population of merely patients with knee OA prior to the TKA procedure. In accordance with results from previous studies in which patients were subjected to maximal exercise testing, no adverse events occurred and all patients reached the VAT (Philbin, Groff, Ries, and Miller, 1995;Ries et al, 1996;Roxburgh et al, 2021). The positive attitude toward CPET in our study was also seen in the study of Roxburgh et al (2021).…”

“…In accordance with results from previous studies in which patients were subjected to maximal exercise testing, no adverse events occurred and all patients reached the VAT (Philbin, Groff, Ries, and Miller, 1995;Ries et al, 1996;Roxburgh et al, 2021). The positive attitude toward CPET in our study was also seen in the study of Roxburgh et al (2021). It is remarkable that all included patients could perform submaximal CPET and were not hindered by restricted knee range of motion or pain, which was previously observed in approximately 40% of the patients during maximal CPET (Philbin, Groff, Ries, and Miller, 1995;Philbin, Ries, and French, 1995;Ries et al, 1996).…”

“…knee OA before surgery (Philbin, Ries, and French, 1995;Roxburgh et al, 2021). One study (n = 37) showed a median VO 2 at the VAT of 10.6 mL/kg/min (IQR 8.5-12.3) (Philbin, Ries, and French, 1995) and a recent study (n = 15) reported a mean ± SD VO 2 at the VAT of 10.7 ± 2.9 mL/kg/min and a mean ± SD OUES/kg of 21.5 ± 5.9 (Roxburgh et al, 2021).…”

“…joint and muscle pain) rather than generalized fatigue or dyspnea as a result of maximally stressing the cardiovascular or pulmonary system (Philbin, Ries, and French, 1995). In addition, maximal CPET can provoke and/or aggravate knee pain during moderate-to-high exercise intensities in the already affected knee joint (Roxburgh et al, 2021).…”

New Deconstruct Elliptical sports machine and Elliptical machine

“…Although it is important to note that the person must be aware during the execution when it comes to involving all the extremities, causing greater global muscle activation (Batté et al, 2003). On the other hand, the elliptical has been successfully included in a multitude of investigations and tests analyzing the HR or the oxygen consumption reached in various protocols (Mercer et al, 2001;Green et al, 2004;Joubert et al, 2011;Ozkaya et al, 2014), in populations with different pathologies and rehabilitation (Jackson et al, 2010;Orekhov et al, 2019;Roxburgh et al, 2021;Ismail, 2022), as well as in the field of athletic performance and recovery (Tan et al, 2014;Martínez Navarro et al, 2021).…”