Evaluation of the “Step-Ramp-Step” Protocol: Accurate Aerobic Exercise Prescription with Different Steps and Ramp Slopes

MACKIE, MARY Z.; IANNETTA, DANILO; KEIR, DANIEL A.; MURIAS, JUAN M.

doi:10.1249/mss.0000000000003362

Cited by 5 publications

(1 citation statement)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The choice of ramp protocol steepness should be based on the patient's expected exercise tolerance, and the test should last between 8 and 12 min. Two advantages of ramp protocols are important considerations: first, the work rate increase does not have a brisk step increase used in step protocols (e.g., 25 Watts every 3 min); second, the trends in parameters during the test are not affected by protocol steps, making physiological responses linear and easier to interpret [8][9][10][11][12].…”

Section: Testing Protocols In Heart Failurementioning

confidence: 99%

Cardiopulmonary Exercise Testing in Heart Failure

Juarez,

Castillo-Rodriguez,

Soliman

et al. 2024

JCDD

View full text Add to dashboard Cite

Cardiopulmonary exercise testing (CPET) provides important information for the assessment and management of patients with heart failure. This testing measures the respiratory and cardiac responses to exercise and allows measurement of the oxygen uptake (V˙O2) max and the relationship between minute ventilation (V˙E) and carbon dioxide excretion (V˙CO2). These two parameters help classify patients into categories that help predict prognosis, and patients with a V˙O2 < 14 mL/kg/min and V˙E/V˙CO2 slope >35 have a poor prognosis. This testing has been used in drug trials to determine complex physiologic responses to medications, such as angiotensin-converting enzyme inhibitors. For example, a study with enalapril demonstrated that the peak V˙O2 was 14.6 ± 1.6 mL/kg/min on placebo and 15.8 ± 2.0 mL/kg/min on enalapril after 15 days of treatment. The V˙E/V˙CO2 slopes were 43 ± 8 on placebo and 39 ± 7 on enalapril. Chronic heart failure and reduced physical activity measured by cardiopulmonary exercise testing are associated with increases in BNP, and several studies have demonstrated that cardiac rehabilitation is associated with reductions in BNP and increases in V˙O2. Therefore, BNP measurements can help determine the benefits of cardiac rehabilitation and provide indirect estimates of changes in V˙O2. In addition, measurement of microRNAs can determine the status of skeletal muscle used during physical activity and the changes associated with rehabilitation. However, CPET requires complicated technology, and simpler methods to measure physical activity could help clinicians to manage their patients. Recent advances in technology have led to the development of portable cardiopulmonary exercise testing equipment, which can be used in various routine physical activities, such as walking upstairs, sweeping the floor, and making the bed, to provide patients and clinicians a better understanding of the patient’s current symptoms. Finally, current smart watches can provide important information about the cardiorespiratory system, identify unexpected clinical problems, and help monitor the response to treatment. The organized use of these devices could contribute to the management of certain aspects of these patients’ care, such as monitoring the treatment of atrial fibrillation. This review article provides a comprehensive overview of the current use of CPET in heart failure patients and discusses exercise principles, methods, clinical applications, and prognostic implications.

show abstract