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de Souza IPMA, Ramos JVSP, da Silveira AD, Stein R, Ribeiro RS, Pazelli AM, de Oliveira QB, Darzé ES, Ritt LEF. Independent and Added Value of Cardiopulmonary Exercise Testing to New York Heart Association Classification in Patients With Heart Failure. J Cardiopulm Rehabil Prev 2024:01273116-990000000-00146. [PMID: 38709847 DOI: 10.1097/hcr.0000000000000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
PURPOSE The objective of this study was to evaluate the independent and added value of a cardiopulmonary exercise test (CPX) to New York Heart Association (NYHA) functional analysis in patients with heart failure (HF) and ejection fraction (EF) <50%. METHODS Patients (n = 613) with HF and EF < 50% underwent CPX and were followed for 28 ± 17 mo with respect to primary outcomes (death or heart transplantation). RESULTS Mean patient age was 57 ± 12 yr and 64% were male. Most patients were classified as NYHA class II (41%). The composite rate of primary outcomes was 12%; death occurred in 9% and heart transplant in 4%. Independent predictors of primary outcomes were: EF (HR = 0.95: 95% CI, 0.92-0.98; P = .001) and NYHA (HR = 2.06: 95% CI, 1.54-2.75; P < .0001). When added to the model, peak oxygen uptake (peak) was an independent predictor (HR = 0.90: 95% CI, 0.84-0.96; P = .001), as was the percentage of predicted peak (HR = 0.03: 95% CI, 0.007-0.147; P < .001), minute ventilation/carbon dioxide production slope (HR = 1.02: 95% CI, 1.01-1.04; P = .012), and CPX score (HR = 1.16: 95% CI, 1.06-1.27; P = .001). CONCLUSIONS CPX variables were independent predictors of HJ prognosis, even when controlled by NYHA functional class. Despite being independent predictors, the value added to NYHA classification was modest and lacked statistical significance.
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Affiliation(s)
- Isabela Pilar Moraes Alves de Souza
- Author Affiliations: D'Or Institute for Research and Education, Cardio Pulmonar Hospital, Salvador, Bahia, Brazil (Mss de Souza and de Oliveira, Drs Darzé and Ritt); Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil (Ms de Souza, Drs Ramos, Ribeiro, Pazelli, Darzé, and Ritt); and Clinicas Hospital, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (Drs da Silveira and Stein)
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Ozemek C, Hardwick J, Bonikowske A, Christle J, German C, Reddy S, Arena R, Faghy M. How to interpret a cardiorespiratory fitness assessment - Key measures that provide the best picture of health, disease status and prognosis. Prog Cardiovasc Dis 2024; 83:23-28. [PMID: 38417770 DOI: 10.1016/j.pcad.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/01/2024]
Abstract
Graded exercise testing is a widely accepted tool for revealing cardiac ischemia and/or arrhythmias in clinical settings. Cardiopulmonary exercise testing (CPET) measures expired gases during a graded exercise test making it a versatile tool that helps reveal underlying physiologic abnormalities that are in many cases only present with exertion. It also characterizes one's health status and clinical trajectory, informs the therapeutic plan, evaluates the efficacy of therapy, and provides submaximal and maximal information that can be used to tailor an exercise intervention. Practitioners can also modify the mode and protocol to allow individuals of all ages, fitness levels, and most disease states to perform a CPET. When used to its full potential, CPET can be a key tool used to optimize care in primary and secondary prevention settings.
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Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA.
| | - Joel Hardwick
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Amanda Bonikowske
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey Christle
- Division of Cardiovascular Medicine, Stanford University, School of Medicine, Stanford, CA, USA
| | - Charles German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Satyajit Reddy
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Mark Faghy
- Human Sciences Research Centre, College of Science and Engineering, University of Derby, UK
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Kaminsky LA, Myers J, Brubaker PH, Franklin BA, Bonikowske AR, German C, Arena R. 2023 update: The importance of cardiorespiratory fitness in the United States. Prog Cardiovasc Dis 2024; 83:3-9. [PMID: 38360462 DOI: 10.1016/j.pcad.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
The American Heart Association issued a Policy Statement in 2013 that characterized the importance of cardiorespiratory fitness (CRF) as an essential marker of health outcomes and specifically the need for increased assessment of CRF. This statement summarized the evidence demonstrating that CRF is "one of the most important correlates of overall health status and a potent predictor of an individual's future risk of cardiovascular disease." Subsequently, this Policy Statement led to the development of a National Registry for CRF (Fitness Registry and the Importance of Exercise: A National Data Base [FRIEND]) which established normative reference values for CRF for adults in the United States (US). This review provides an overview of the progress made in the past decade to further our understanding of the importance of CRF, specifically related to prevention and for clinical populations. Additionally, this review overviews the evolvement and additional uses of FRIEND and summarizes a hierarchy of assessment methods for CRF. In summary, continued efforts are needed to expand the representation of data from across the US, and to include data from pediatric populations, to further develop the CRF Reference Standards for the US as well as further develop Global CRF Reference Standards.
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Affiliation(s)
- Leonard A Kaminsky
- Clinical Exercise Physiology, Ball State University, Muncie, IN, United States of America; Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, United States of America
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, United States of America
| | - Barry A Franklin
- Corewell Health East, William Beaumont University Hospital, Preventive Cardiology and Cardiac Rehabilitation, Oakland University William Beaumont School of Medicine, Beaumont Health and Wellness Center, Royal Oak, MI, United States of America
| | - Amanda R Bonikowske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Charles German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, United States of America
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Kasiak P, Kowalski T, Rębiś K, Klusiewicz A, Ładyga M, Sadowska D, Wilk A, Wiecha S, Barylski M, Poliwczak AR, Wierzbiński P, Mamcarz A, Śliż D. Is the Ventilatory Efficiency in Endurance Athletes Different?-Findings from the NOODLE Study. J Clin Med 2024; 13:490. [PMID: 38256624 PMCID: PMC10816682 DOI: 10.3390/jcm13020490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Ventilatory efficiency (VE/VCO2) is a strong predictor of cardiovascular diseases and defines individuals' responses to exercise. Its characteristics among endurance athletes (EA) remain understudied. In a cohort of EA, we aimed to (1) investigate the relationship between different methods of calculation of VE/VCO2 and (2) externally validate prediction equations for VE/VCO2. Methods: In total, 140 EA (55% males; age = 22.7 ± 4.6 yrs; BMI = 22.6 ± 1.7 kg·m-2; peak oxygen uptake = 3.86 ± 0.82 L·min-1) underwent an effort-limited cycling cardiopulmonary exercise test. VE/VCO2 was first calculated to ventilatory threshold (VE/VCO2-slope), as the lowest 30-s average (VE/VCO2-Nadir) and from whole exercises (VE/VCO2-Total). Twelve prediction equations for VE/VCO2-slope were externally validated. Results: VE/VCO2-slope was higher in females than males (27.7 ± 2.6 vs. 26.1 ± 2.0, p < 0.001). Measuring methods for VE/VCO2 differed significantly in males and females. VE/VCO2 increased in EA with age independently from its type or sex (β = 0.066-0.127). Eleven equations underestimated VE/VCO2-slope (from -0.5 to -3.6). One equation overestimated VE/VCO2-slope (+0.2). Predicted and observed measurements differed significantly in nine models. Models explained a low amount of variance in the VE/VCO2-slope (R2 = 0.003-0.031). Conclusions: VE/VCO2-slope, VE/VCO2-Nadir, and VE/VCO2-Total were significantly different in EA. Prediction equations for the VE/VCO2-slope were inaccurate in EA. Physicians should be acknowledged to properly assess cardiorespiratory fitness in EA.
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Affiliation(s)
- Przemysław Kasiak
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Tomasz Kowalski
- Department of Physiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Kinga Rębiś
- Department of Physiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Andrzej Klusiewicz
- Department of Physical Education and Health in Biala Podlaska, Branch in Biala Podlaska, Jozef Pilsudski University of Physical Education, 00-968 Warsaw, Poland
| | - Maria Ładyga
- Department of Physiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Dorota Sadowska
- Department of Physiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Adrian Wilk
- Department of Kinesiology, Institute of Sport—National Research Institute, 01-982 Warsaw, Poland
| | - Szczepan Wiecha
- Department of Physical Education and Health in Biala Podlaska, Branch in Biala Podlaska, Jozef Pilsudski University of Physical Education, 00-968 Warsaw, Poland
| | - Marcin Barylski
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, 90-419 Lodz, Poland
| | - Adam Rafał Poliwczak
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, 90-419 Lodz, Poland
| | - Piotr Wierzbiński
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Daniel Śliż
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
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Edward JA, Peruri A, Rudofker E, Shamapant N, Parker H, Cotter R, Sabin K, Lawley J, Cornwell WK. Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID. J Cardiopulm Rehabil Prev 2023; 43:400-406. [PMID: 37646620 DOI: 10.1097/hcr.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The post-acute sequalae of SARS-CoV-2, also known as "Long COVID," is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected. This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients. Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.
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Affiliation(s)
- Justin A Edward
- Department of Medicine-Cardiology (Drs Edward, Rudofker, Shamapant, Parker, Cotter, and Cornwell and Ms Sabin) and Clinical Translational Research Center (Dr Cornwell), University of Colorado Anschutz Medical Campus, Aurora; Department of Medicine, Division of Cardiology, Parkview Medical Center, Pueblo, Colorado (Dr Peruri); and Department of Sport Science, Division of Physiology, University of Innsbruck, Innsbruck, Austria (Dr Lawley)
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Zannoni J, Guazzi M, Milani V, Bandera F, Alfonzetti E, Arena R. Prognostic value of cardiopulmonary exercise testing in a European cohort with cardiovascular risk factors absent of a cardiovascular disease diagnosis. Int J Cardiol 2023; 370:402-404. [PMID: 36228767 DOI: 10.1016/j.ijcard.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cardiorespiratory fitness (CRF) is now considered a vital sign. Cardiopulmonary exercise testing (CPET) is the gold-standard assessment of CRF; peak oxygen consumption (VO2) and the minute ventilation/carbon dioxide production (VE/VCO2) slope are considered primary CPET measures of CRF. More work is needed to determine the role of this exercise assessment in the primary care setting. METHODS 695 subjects (mean age: 62 ± 13 years, body mass index: 28.9 ± 5.3 kg/m2, 375 female and 320 male) underwent CPET using a cycle ergometer. 95% of the cohort had one or more major cardiovascular risk factor (i.e., obesity, smoking, dyslipidemia, hypertension, diabetes); no subject was diagnosed with cardiovascular disease (CVD) at the time of CPET. Subjects were tracked for the composite endpoint of cardiovascular mortality or hospital admission. RESULTS Mean peak VO2, VE/VCO2 slope and peak respiratory exchange ratio were 17.8 ± 5.8 mlO2•kg-1•min-1, 26.7 ± 4.1, and 1.18 ± 0.13, respectively. There were 42 composite events during the 64 ± 18 month tracking period. Both peak VO2 (Chi-square 16.3, p < 0.001) and the VE/VCO2 slope (Chi-square 14.9, p < 0.001) were significant univariate predictors of the composite endpoint. The VE/VCO2 slope added significant predictive value to peak VO2 and was retained in the multivariate regression (residual Chi-square 7.0, p = 0.008). DISCUSSION These results support the prognostic value of CPET prior to a CVD diagnosis. The prognostic value of the VE/VCO2 slope, not commonly the focus of CPET trials in patients with one or more major cardiovascular risk factors but without a confirmed CVD diagnosis, is a particularly novel finding in the current study.
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Affiliation(s)
- Jessica Zannoni
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Guazzi
- University of Milano School of Medicine, Department of Biological Sciences, Milano, Italy; San Paolo Hospital, Cardiology Division, Milano, Italy
| | - Valentina Milani
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bandera
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy; University of Milano School of Medicine, Department of Biological Sciences, Milano, Italy; San Paolo Hospital, Cardiology Division, Milano, Italy
| | - Eleonora Alfonzetti
- University of Milano School of Medicine, Department of Biological Sciences, Milano, Italy; San Paolo Hospital, Cardiology Division, Milano, Italy
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
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Peterman JE, Arena R, Myers J, Harber MP, Bonikowske AR, Squires RW, Kaminsky LA. Reference Standards for Peak Rating of Perceived Exertion during Cardiopulmonary Exercise Testing: Data from FRIEND. Med Sci Sports Exerc 2023; 55:74-79. [PMID: 35977105 DOI: 10.1249/mss.0000000000003023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Peak rating of perceived exertion (RPE) is measured during clinical cardiopulmonary exercise testing (CPX) and is commonly used as a subjective indicator of maximal effort. However, no study to date has reported reference standards or the distribution of peak RPE across a large cohort of apparently healthy individuals. PURPOSE This study aimed to determine reference standards for peak RPE when using the 6-20 Borg scale for both treadmill and cycle tests. METHODS The analysis included 9551 tests (8821 treadmill, 730 cycle ergometer) from 13 laboratories within the Fitness Registry and Importance of Exercise National Database (FRIEND). Using data from tests conducted January 1, 1980, to January 1, 2021, percentiles of peak RPE for men and women were determined for each decade from 20 to 89 yr of age for treadmill and cycle exercise modes. Two-way ANOVA was used to compare differences in peak RPE values between sexes and across age groups. RESULTS There were statistically significant differences in RPE between age groups whether the test was performed on a treadmill or cycle ergometer ( P < 0.05). However, the mean and median RPE for each sex, age group, and test mode were between 18 and 19. In addition, 83% of participants met the traditional RPE criteria of ≥18 for indicating sufficient maximal effort. CONCLUSIONS This report provides the first normative reference standards for peak RPE in both male and female individuals performing CPX on a treadmill or cycle ergometer. Furthermore, these reference standards highlight the general consistency of peak RPE responses during CPX.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, IN
| | | | - Ray W Squires
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN
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Smer A, Squires RW, Bonikowske AR, Allison TG, Mainville RN, Williams MA. Cardiac Complications of COVID-19 Infection and the Role of Physical Activity. J Cardiopulm Rehabil Prev 2023; 43:8-14. [PMID: 35839441 PMCID: PMC9828583 DOI: 10.1097/hcr.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Since December 2019, the newly emerging coronavirus has become a global pandemic with >250 million people infected and >5 million deaths worldwide. Infection with coronavirus disease-2019 (COVID-19) causes a severe immune response and hypercoagulable state leading to tissue injury, organ damage, and thrombotic events. It is well known that COVID-19 infection predominately affects the lungs; however, the cardiovascular complications of the disease have been a major cause of morbidity and mortality. In addition, patients with cardiovascular disease are vulnerable to contract a severe form of the illness and increased mortality. A significant number of patients who survived the disease may experience post-COVID-19 syndrome with a variety of symptoms and physical limitations. Here, we review the cardiac complications of COVID-19 infection and the results of cardiopulmonary exercise testing and guidelines for exercise training after infection.
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Affiliation(s)
- Aiman Smer
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Ray W. Squires
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Amanda R. Bonikowske
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Thomas G. Allison
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Rylie N. Mainville
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
| | - Mark A. Williams
- Department of Cardiovascular Medicine, CHI Health Creighton University School of Medicine, Omaha, Nebraska (Drs Smer and Williams); and Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Squires, Bonikowske, and Allison and Ms Mainville)
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Jin Y, Liu S, Lin M, Xu Y, Zhou S, Ye B, Lin S, Guan X, Wang L. High Pulse Pressure Decreases Cardiopulmonary Ability among Older Chinese Patients with Primary Hypertension. Int Heart J 2022; 63:1134-1140. [DOI: 10.1536/ihj.22-378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Yan Jin
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine
| | - Sipei Liu
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine
| | - Meilan Lin
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine
| | - Yiye Xu
- Division of Cardiovascular Rehabilitation, Rui An Hospital of Traditional Chinese Medicine
| | - Shiwei Zhou
- Division of Cardiovascular Rehabilitation, Rui An Hospital of Traditional Chinese Medicine
| | - Bingbing Ye
- Division of Cardiovascular Rehabilitation, Rui An Hospital of Traditional Chinese Medicine
| | - Shuman Lin
- Division of Cardiovascular Rehabilitation, Rui An Hospital of Traditional Chinese Medicine
| | - Xiafei Guan
- Division of Cardiovascular Rehabilitation, Rui An Hospital of Traditional Chinese Medicine
| | - Lei Wang
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine
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Peterman JE, Harber MP, Fleenor BS, Whaley MH, Araújo CG, Kaminsky LA. Cardiorespiratory Optimal Point Is a Submaximal Exercise Test Variable and a Predictor of Mortality Risk: THE BALL STATE ADULT FITNESS LONGITUDINAL LIFESTYLE STUDY (BALL ST). J Cardiopulm Rehabil Prev 2022; 42:E90-E96. [PMID: 35861956 PMCID: PMC9662820 DOI: 10.1097/hcr.0000000000000711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The cardiorespiratory optimal point (COP) is the minimum ventilatory equivalent for oxygen. The COP can be determined during a submaximal incremental exercise test. Reflecting the optimal interaction between the respiratory and cardiovascular systems, COP may have prognostic utility. The aim of this investigation was to determine the relationship between COP and all-cause mortality in a cohort of apparently healthy adults. METHODS The sample included 3160 apparently healthy adults (46% females) with a mean age of 44.0 ± 12.5 yr who performed a cardiopulmonary exercise test. Cox proportional hazards models were performed to assess the relationship between COP and mortality risk. Prognostic peak oxygen uptake (V˙ o2peak ) and COP models were compared using the concordance index. RESULTS There were 558 deaths (31% females) over a follow-up period of 23.0 ± 11.9 yr. For males, all Cox proportional hazards models, including the model adjusted for traditional risk factors and V˙ o2peak , had a positive association with risk for mortality ( P < .05). For females, only the unadjusted COP model was associated with risk for mortality ( P < .05). The concordance index values indicated that unadjusted COP models had lower discrimination compared with unadjusted V˙ o2peak models ( P < .05) and V˙ o2peak did not complement COP models ( P ≥ .13). CONCLUSIONS Cardiorespiratory optimal point is related to all-cause mortality in males but not females. These findings suggest that a determination of COP can have prognostic utility in apparently healthy males aged 18-85 yr, which may be relevant when a maximal exercise test is not feasible or desirable.
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Affiliation(s)
- James E. Peterman
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Matthew P. Harber
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Bradley S. Fleenor
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Mitchell H. Whaley
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Claudio G. Araújo
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Leonard A. Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
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Choi HE, Min EH, Kim HK, Kim HJ, Jang HJ. Peak oxygen uptake and respiratory muscle performance in patients with chronic obstructive pulmonary disease: Clinical findings and implications. Medicine (Baltimore) 2022; 101:e31244. [PMID: 36281098 PMCID: PMC9592275 DOI: 10.1097/md.0000000000031244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The maximal oxygen uptake (VO2max) is the gold standard measure of aerobic exercise capacity and is an important outcome measure in patients with chronic obstructive pulmonary disease (COPD). And respiratory muscle performance is also an important functional parameter for COPD patients. In addition to the traditional respiratory muscle strength test, the Test of Incremental Respiratory Endurance has recently been introduced and validated in patients with COPD. However, the relationship between VO2 and respiratory muscle performance in COPD is not well understood. Therefore, this study investigated the correlations among VO2 and respiratory muscle performance and other functional markers in COPD. A total of 32 patients with COPD were enrolled. All study participants underwent the following assessments: cardiopulmonary exercise test, pulmonary function test, respiratory muscle strength test, peripheral muscle strength test, and bioelectrical impedance analysis. When comparing VO2peak and respiratory muscle parameters, the sustained maximal inspiratory pressure (SMIP) was the only factor with a significant relationship with VO2peak. Among other functional parameters, the forced expiratory volume in one second (FEV1) showed the strongest correlation with VO2peak. It was followed by phase angle values of lower limbs, leg extension peak torque, age, and total skeletal muscle mass. When comparing respiratory muscle performance with other functional parameters, the SMIP showed the strongest correlation with hand grip strength, followed by peak cough flow, forced vital capacity, maximal inspiratory pressure, and FEV1. The results showed that the SMIP was more significantly correlated with VO2peak than the static measurement of respiratory muscle strength. This suggests that TIRE may be a useful assessment tool for patients with COPD. Additionally, FEV1 and other functional markers were significantly correlated with VO2peak, suggesting that various parameters may be used to evaluate aerobic power indirectly.
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Affiliation(s)
- Hee-Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Eun-Ho Min
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Busan, Korea
- *Correspondence: Eun-Ho Min, Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, 875, Haeun-daero, Haeundae-gu, Busan, Korea (e-mail: )
| | - Hyun-Kuk Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hyo-Jung Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hang-Jea Jang
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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12
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Poty A, Krim F, Lopes P, Garaud Y, Leprêtre PM. Benefits of a Supervised Ambulatory Outpatient Program in a Cardiovascular Rehabilitation Unit Prior to a Heart Transplant: A Case Study. Front Cardiovasc Med 2022; 9:811458. [PMID: 35665250 PMCID: PMC9160327 DOI: 10.3389/fcvm.2022.811458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Preoperative peak oxygen uptake (V.O2peak) and ventilatory efficiency (V.E/V.CO2slope) are related to the vital prognosis after cardiac transplantation (HTx). The objective of our study was to evaluate the effects of exercise-based cardiac rehabilitation (ECR) program on the preoperative exercise capacity of a HTx candidate. A male patient, aged 50–55 years, with chronic heart failure was placed on the HTx list and performed 12 weeks of intensive ECR (5 sessions-a-week). Our results showed that the cardiac index continuously increased between the onset and the end of ECR (1.40 vs. 2.53 L.min–1.m2). The first 20 sessions of ECR induced a V.O2peak increase (15.0 vs. 19.3 ml.min–1.kg–1, corresponding to 42.0 and 53.0% of its maximal predicted values, respectively). The peak V.O2 plateaued between the 20th and the 40th ECR session (19.3 vs. 19.4 ml.min–1.kg–1) then progressively increased until the 60th ECR session to reach 25.7 ml.min–1.kg–1, i.e., 71.0% of the maximal predicted values. The slope of V.E/V.CO2 showed a biphasic response during the ECR program, with an increase between the onset and the 20th ECR session (58.02 vs. 70.48) and a decrease between the 20th and the 40th ECR session (70.48 vs. 40.94) to reach its minimal value at the 60th ECR session (31.97). After the first 40 sessions of the ECR program, the Seattle Heart Failure Model score predicted median survival time was estimated at 7.2 years. In conclusion, the improvement in exercise capacity and cardiorespiratory function following the ECR helped delay the heart transplant surgery in our patient awaiting heart transplantation.
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Affiliation(s)
- Antoine Poty
- Exercise Physiology and Rehabilitation Laboratory, Picardie Jules Verne University, Amiens, France
- Fundation Léopold Bellan, Chateau d’Ollencourt, Unit of Cardiac Rehabilitation, Tracy-le-Mont, France
| | - Florent Krim
- Service de Réadaptation Cardiovasculaire, Centre Hospitalier de Corbie, Corbie, France
- Association Picardie de Recherche en Réadaptation Cardiaque, Association Picardie de Recherche en Réadaptation Cardiaque, Corbie, France
| | - Philippe Lopes
- Laboratoire de Biologie de l’Exercice Pour la Performance et la Santé, Université d’Évry Val d’Essonne, Évry, France
| | - Yves Garaud
- Fundation Léopold Bellan, Chateau d’Ollencourt, Unit of Cardiac Rehabilitation, Tracy-le-Mont, France
| | - Pierre-Marie Leprêtre
- Exercise Physiology and Rehabilitation Laboratory, Picardie Jules Verne University, Amiens, France
- Service de Réadaptation Cardiovasculaire, Centre Hospitalier de Corbie, Corbie, France
- Association Picardie de Recherche en Réadaptation Cardiaque, Association Picardie de Recherche en Réadaptation Cardiaque, Corbie, France
- *Correspondence: Pierre-Marie Leprêtre,
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13
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Rodriguez JC, Peterman JE, Fleenor BS, Whaley MH, Kaminsky LA, Harber MP. Cardiopulmonary Exercise Responses in Individuals with Metabolic Syndrome: The Ball State Adult Fitness Longitudinal Lifestyle Study. Metab Syndr Relat Disord 2022; 20:414-420. [DOI: 10.1089/met.2021.0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Julio C. Rodriguez
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
| | - James E. Peterman
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana, USA
| | - Bradley S. Fleenor
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
| | - Mitchell H. Whaley
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
| | - Leonard A. Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana, USA
| | - Matthew P. Harber
- Clinical Exercise Physiology, Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
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14
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Kaminsky LA, Arena R, Myers J, Peterman JE, Bonikowske AR, Harber MP, Medina Inojosa JR, Lavie CJ, Squires RW. Updated Reference Standards for Cardiorespiratory Fitness Measured with Cardiopulmonary Exercise Testing: Data from the Fitness Registry and the Importance of Exercise National Database (FRIEND). Mayo Clin Proc 2022; 97:285-293. [PMID: 34809986 DOI: 10.1016/j.mayocp.2021.08.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide updated reference standards for cardiorespiratory fitness (CRF) for the United States derived from cardiopulmonary exercise (CPX) testing when using a treadmill or cycle ergometer. PATIENTS AND METHODS Thirty-four laboratories in the United States contributed data to the Fitness Registry and the Importance of Exercise National Database. Analysis included 22,379 tests (16,278 treadmill and 6101 cycle ergometer) conducted between January 1, 1968, through March 31, 2021, from apparently healthy adults (aged 20 to 89 years). Percentiles of peak oxygen consumption for men and women were determined for each decade from 20 through 89 years of age for treadmill and cycle exercise modes, as well as when defining maximal effort as respiratory exchange ratio (RER) greater than or equal to 1.0 or RER greater than or equal to 1.1. RESULTS For both men and women, the 50th percentile scores for each exercise mode decreased with age and were higher in men across all age groups and higher for treadmill compared with cycle CPX. The average rate of decline per decade over a 6-decade period was 13.5%, 4.0 mLO2·kg-1·min-1 for treadmill CPX and 16.4%, 4.3 mLO2·kg-1·min-1 for cycle CPX. Observationally, the mean peak oxygen consumption was similar whether using an RER criterion of greater than or equal to 1.0 or greater than or equal to 1.1 across the different test modes, ages, and for both sexes. The updated reference standards for treadmill CPX were 1.5 - 4.6 mLO2·kg-1·min-1 lower compared with the previous 2015 standards whereas the updated cycling standards were generally comparable to the original 2017 standards. CONCLUSION These updated cardiorespiratory fitness reference standards improve the representativeness of the US population compared with the original standards.
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Affiliation(s)
- Leonard A Kaminsky
- Fisher Institute for Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA; Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, IN, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Division of Cardiology, Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, USA
| | - James E Peterman
- Fisher Institute for Health and Well-Being, College of Health, Ball State University, Muncie, IN, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Amanda R Bonikowske
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory, College of Health, Ball State University, Muncie, IN, USA
| | - Jose R Medina Inojosa
- Marriott Heart Disease Research Program, Mayo Clinic, Rochester, MN, USA; John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Ray W Squires
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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15
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Andonian BJ, Hardy N, Bendelac A, Polys N, Kraus WE. Making Cardiopulmonary Exercise Testing Interpretable for Clinicians. Curr Sports Med Rep 2021; 20:545-552. [PMID: 34622820 PMCID: PMC8514056 DOI: 10.1249/jsr.0000000000000895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Cardiopulmonary exercise testing (CPET) is a dynamic clinical tool for determining the cause for a person's exercise limitation. CPET provides clinicians with fundamental knowledge of the coupling of external to internal respiration (oxygen and carbon dioxide) during exercise. Subtle perturbations in CPET parameters can differentiate exercise responses among individual patients and disease states. However, perhaps because of the challenges in interpretation given the amount and complexity of data obtained, CPET is underused. In this article, we review fundamental concepts in CPET data interpretation and visualization. We also discuss future directions for how to best use CPET results to guide clinical care. Finally, we share a novel three-dimensional graphical platform for CPET data that simplifies conceptualization of organ system-specific (cardiac, pulmonary, and skeletal muscle) exercise limitations. Our goal is to make CPET testing more accessible to the general medical provider and make the test of greater use in the medical toolbox.
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Affiliation(s)
| | | | | | | | - William E. Kraus
- Duke Molecular Physiology Institute, Duke University, Durham, NC
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16
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Nevill AM, Myers J, Kaminsky LA, Arena R, Myers TD. Comparing individual and population differences in minute ventilation/carbon dioxide production slopes using centile growth curves and log-linear allometry. ERJ Open Res 2021; 7:00088-2021. [PMID: 34322548 PMCID: PMC8311134 DOI: 10.1183/23120541.00088-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022] Open
Abstract
Identifying vulnerable groups and/or individuals’ cardiorespiratory fitness (CRF) is an important challenge for clinicians/researchers alike. To quantify CRF accurately, the assessment of several variables is now standard practice including maximal oxygen uptake (VʹCO2) and ventilatory efficiency, the latter assessed using the minute ventilation/carbon dioxide production (VʹE/VʹCO2) slope. Recently, reference values (centiles) for VʹE/VʹCO2 slopes for males and females aged 20 to 80 have been published, using cardiopulmonary exercise testing (CPX) data (treadmill protocol) from the Fitness Registry and the Importance of Exercise National Database (FRIEND Registry). In the current observational study we provide centile curves for the FRIEND Registry VʹE/VʹCO2 slopes, fitted using the generalised additive model for location, scale and shape (GAMLSS), to provide individuals with a more precise estimate of where their VʹE/VʹCO2 slopes fall within the population. We also confirm that by adopting allometric models (incorporating a log transformation), the resulting ANCOVAs provided more normal and homoscedastic residuals, with superior goodness-of-fit using the Akaike information criterion (AIC)=14 671 (compared with traditional ANCOVA's AIC=15 008) that confirms allometric models are vastly superior to traditional ANCOVA models. In conclusion, providing sex-by-age centile curves rather than referring to reference tables for ventilatory efficiency (VʹE/VʹCO2 slopes) will provide more accurate estimates of where an individual's particular VʹE/VʹCO2 slope falls within the population. Also, by adopting allometric models researchers are more likely to identify real and valid inferences when analysing population/group differences in VʹE/VʹCO2 slopes. This article provides centile curves of VʹE/VʹCO2slopes and demonstrates that by adopting log-linear models, more trustworthy inferences with group differences will also be foundhttps://bit.ly/3uitACS
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Affiliation(s)
- Alan M Nevill
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto Healthcare System, Palo Alto, CA, USA.,Stanford University, Stanford, CA, USA
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being and Clinical Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Ross Arena
- Dept of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Tony D Myers
- Sport and Health, Newman University, Birmingham, UK
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