Optimizing the exercise protocol for cardiopulmonary assessment

Abstract

Twelve normal men performed 1-min incremental exercise tests to exhaustion in approximately 10 min on both treadmill and cycle ergometer. The maximal O2 uptake (VO2 max) and anaerobic threshold (AT) were higher (6 and 13%, respectively) on the treadmill than the cycle; the AT was reached at about 50% of VO2 max on both ergometers. Maximal CO2 output, heart rate, and O2 pulse were also slightly, but significantly higher on the treadmill. Maximal ventilation, gas exchange ratio, and ventilatory equivalents for O2 and CO2 for both forms of exercise were not significantly different. To determine the optimum exercise test for both treadmill and cycle, we exercised five of the subjects at various work rate increments on both ergometers in a randomized design. The treadmill increments were 0.8, 1.7, 2.5, and 4.2%/min at a constant speed of 3.4 mph, and 1.7 and 4.2%/min at 4.5 mph. Cycle increments were 15, 30, and 60 W/min. The VO2 max was significantly higher on tests where the increment magnitude was large enough to induce test durations of 8-17 min, but the AT was independent of test duration. Thus, for evaluating cardiopulmonary function with incremental exercise testing by either treadmill or cycle, we suggest selecting a work rate increment to bring the subject to the limit of his tolerance in about 10 min.

Reproducibility of step tests in patients with bronchiectasis

“…Again, the load increment standard affects exercise duration; that is, larger increments predict shorter test times. However, the HR, ventilation values, and peak exercise symptom scores are independent of the protocol used [27][28][29] . Despite presenting different times, cardiopulmonary responses at peak exercise were similar for the MIST and CST among patients with BCT.…”

Influence of Cardiopulmonary Exercise Testing Protocol and Resting VO2Assessment on %HRmax, %HRR, %VO2maxand %VO2R Relationships

“…The ramp protocol incorporated workload increments that were individualized to elicit the subject's limit of tolerance within the test duration. A previous test used five participants to determine the initial and final workloads in the ramp protocol, the purpose of which was to confirm that the duration of the exercise testing protocols fell within the range of 8-12 minutes [8]. Initially a non-exercise model developed to estimate the VO2max of a healthy population aged 19 to 80 years was applied [24].…”

“…With the exception of two studies [25,30], the relationship between the %HRR and %VO2R has been determined using intermittent [10,18] or continuous step-incremented test protocols [6,11,13,16,23,32,40,41]. These test protocols possess characteristics that can reduce the VO2max value when compared to that derived from ramp protocols [8,28,29,46]. Prolonged step-incremented tests, and those that incorporate high treadmill grades, have been particularly implicated in being inappropriate for eliciting true VO2max [26].…”

Exercise Anaerobic Threshold and Ventilatory Efficiency Identify Heart Failure Patients for High Risk of Early Death

“…All patients performed upright bicycle exercise to maximum tolerance with the use of a progressively increasing work rate at 10 to 20 W/min after a period of resting and unloaded pedaling, as recommended by Buchfuhrer et al 20 Patients were encouraged to exercise until symptoms were intolerable. Investigator-determined exercise end points were severe ventricular tachycardia of Ͼ5 beats, high degree of AV block, ST-segment depression Ͼ3 mm, systolic blood pressure Ͼ250 mm Hg, or progressive decrease in blood pressure.…”