Correlation analysis of cardiopulmonary exercise test indices and conditions of overweight patients with obstructive sleep apnea: a retrospective study

ABSTRACT BACKGROUND: The cardiopulmonary function of patients with obstructive sleep apnea (OSA) is significantly lower than that of patients with simple snoring and is significantly related to the severity of OSA. Currently, only a few studies have been conducted on cardiopulmonary exercise testing in overweight patients with OSA. OBJECTIVE: To analyze the correlation between cardiopulmonary exercise test (CPET) indices and the condition of overweight patients with OSA. DESIGN AND SETTING: Retrospective study in Guangdong Provincial Hospital of Chinese Medicine. METHODS: This study included 73 hospitalized overweight patients. The patients were divided into no, mild, moderate, and severe OSA groups. Differences in the CPET indices among the four groups were compared. The correlation between the CPET indices and conditions was analyzed. RESULTS: No, mild, moderate, and severe OSA groups had 18 men and 5 women, 11 men and 3 women, 12 men and 2 women, and 21 men and 1 woman, respectively (P > 0.05). No significant difference was observed in resting pulmonary function among the four groups (P > 0.05). In the CPET, the anaerobic threshold, maximum oxygen uptake, and oxygen pulse were significantly lower in the severe OSA group than those in the normal OSA group (P < 0.05). Moreover, CPET indices negatively correlated with the apnea-hypopnea index. CONCLUSION: Changes in CPET indices occurred earlier than changes in resting pulmonary function in patients with OSA. CPET might be a potential method for evaluating the severity of OSA combined with overweight status.

Application evaluation of cardiopulmonary exercise test to guide comprehensive pulmonary rehabilitation in patients with pneumoconiosis / 环境与职业医学

Background At present, the practice of pulmonary rehabilitation for pneumoconiosis in China is in a primary stage. The basis for formulating an individualized comprehensive pulmonary rehabilitation plan is still insufficient, which is one of the factors limiting the development of community-level rehabilitation work. Objective To formulate an exercise prescription based on maximum heart rate measured by cardiopulmonary exercise test (CPET), conduct an individualized comprehensive pulmonary rehabilitation program with the exercise prescription for patients with stable pneumoconiosis, and evaluate its role in improving exercise endurance and quality of life, thus provide a basis for the application and promotion of pulmonary rehabilitation. Methods A total of 68 patients were recruited from the Occupational Disease Prevention Hospital of Jinneng Holding Coal Industry Group Co., Ltd. from April to August 2022 , and were divided into an intervention group and a control group by random number table method, with 34 cases in each group. All the pneumoconiosis patients participated in a baseline test. The control group was given routine drug treatment, while the intervention group received multidisciplinary comprehensive pulmonary rehabilitation treatment on the basis of routine drug treatment, including health education, breathing training, exercise training, nutrition guidance, psychological intervention, and sleep management, whose exercise intensity was determined according to the maximum heart rate provided by CPET. The rehabilitation training lasted for 24 weeks. Patients were evaluated at registration and the end of study respectively. CPET was used to measure peak oxygen uptake per kilogram (pVO2/kg), anaerobic threshold (AT), carbon dioxide equivalent of ventilation (EqCO2), maximum metabolic equivalent (METs), and maximum work (Wmax). The modified British Medical Research Council Dyspnea Questionnaire (mMRC), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Chronic Obstructive Pulmonary Disease Assessment Test (CAT), and Short Form of Health Survey (SF-36) were used to evaluate the potential effect of the comprehensive pulmonary rehabilitation program. Results Among the included 68 patients, 63 patients were having complete data, then 31 cases were assigned in the control group and 32 cases in the interventional group. Before the intervention, there was no significant difference in pVO2/kg, AT, EqCO2, METs, or Wmax between the two groups (P>0.05). At the end of the trail, the indicators like pVO2/kg [(19.81±2.38) mL·(min·kg)−1], AT [(14.48±2.33) mL·(min·kg)−1], METs (5.64±0.69), and Wmax [(85.25±14) W] of patients in the intervention group were all higher than those [(13.90±2.37) mL·(min·kg)−1, (11.70±1.94) mL·(min kg)−1, (3.97±0.70), and (61.77±14.72) W, respectively] in the control group (P<0.001); there was no significant difference in EqCO2 between the two groups (P=0.083). Before the trial, there was no significant difference in mMRC, SAS, SDS, PSQI, or CAT scores between the two groups (P>0.05). At the end of the trail, the mMRC score (1.16±0.57), SAS score (27.93±2.12), SDS score (26.48±1.44), PSQI score (1.08±0.88), and CAT score (4.34±3.28) of patients in the intervention group were lower than those [(2.03±0.83), (35.87±6.91), (34.23±6.65), (5.37±3.03), and (13.87±7.53), respectively] in the control group (P<0.001). The SF-36 scores of bodily pain (94.13±10.72), general health (87.50±5.68), vitality (95.31±5.53), mental health (99.88±0.71), and health changes (74.22±4.42) in the intervention group were higher than those [(71.87±32.72), (65.81±15.55), (74.52±16.45), (86.97±16.56), and (29.84±13.50), respectively] in the control group (P<0.001), and no significant difference was found in social functioning and role emotional scores (P>0.05). Conclusion Comprehensive pulmonary rehabilitation can increase the oxygen intake and exercise endurance of pneumoconiosis patients, ameliorate dyspnea symptoms, elevate psychological state and sleep quality, and improve the quality of life.

Resistance training applied to the teaching of kung fu / Treinamento de resistência aplicado no ensino de kung fu / Entrenamiento de resistencia aplicado a la enseñanza del kung fu

ABSTRACT Introduction Many studies have explored different training methods to improve cardiorespiratory capacity, ensuring better oxygen demand to help students develop better sports skills and teaching outcomes. Objective Explore the effects of applying resistance training on kung fu teaching. Methods 40 kung fu athletes were selected as research volunteers. They were randomly divided into experimental and control groups; both were trained in a cardiopulmonary resistance protocol for 8 weeks, three times a week, using a breathing trainer. The control group trained at 20%, while the experimental group had their training at 50% of full capacity. Results The maximal inspiratory pressure, FEV1 / FVC, and mvv15 of the lung function indices increased significantly in the experimental group; the forced capacity and maximal ventilation of the oxygen uptake capacity indices also increased significantly. The blood oxygen saturation and the blood flow perfusion index of the oxygen utilization capacity indices had significant differences between the groups; the central balance and flexibility indices also showed significant differences. Conclusion After cardiopulmonary endurance training, the athletes' capacity was significantly improved, inferring a benefit in the quality of kung fu teaching. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Muitos estudos têm explorado explorando diferentes métodos de treinamento para melhorar a capacidade cardiorrespiratória, garantindo uma melhor demanda de oxigênio para ajudar os estudantes a desenvolverem melhores habilidades esportivas e resultados do ensino. Objetivo Explorar os efeitos da aplicação do treinamento de resistência sobre o ensino de kung fu. Métodos 40 atletas de kung fu foram selecionados como voluntários de pesquisa. Eles foram divididos aleatoriamente em grupo experimental e controle, ambos foram treinados num protocolo de resistência cardiopulmonar durante 8 semanas, três vezes por semana, utilizando um treinador respiratório. O grupo controle treinou a 20% enquanto o experimental teve seu treinamento a 50% de capacidade total. Resultados A pressão inspiratória máxima, VEF1 / FVC e mvv15 dos índices de função pulmonar aumentou significativamente no grupo experimental, a capacidade forçada e a ventilação máxima dos índices de capacidade de absorção de oxigênio também aumentaram significativamente. A saturação de oxigênio no sangue e o índice de perfusão do fluxo sanguíneo dos índices de capacidade de utilização de oxigênio tiveram diferenças significativas entre os grupos, o equilíbrio central e os índices de flexibilidade também evidenciaram diferenças significativas. Conclusão Após o treinamento de resistência cardiopulmonar, a capacidade dos atletas foi significativamente aprimorada, inferindo um benefício na qualidade do ensino de kung fu. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Muchos estudios han explorado diferentes métodos de entrenamiento para mejorar la capacidad cardiorrespiratoria, asegurando una mejor demanda de oxígeno para ayudar a los estudiantes a desarrollar mejores habilidades deportivas y resultados de enseñanza. Objetivo Explorar los efectos de la aplicación del entrenamiento de resistencia en la enseñanza del kung fu. Métodos Se seleccionaron 40 atletas de kung fu como voluntarios para la investigación. Se dividieron aleatoriamente en grupo experimental y grupo de control, ambos fueron entrenados en un protocolo de resistencia cardiopulmonar durante 8 semanas, tres veces por semana, utilizando un entrenador de respiración. El grupo de control entrenó al 20% mientras que el grupo experimental lo hizo al 50% de su capacidad. Resultados La presión inspiratoria máxima, VEF1 / FVC y mvv15 de los índices de función pulmonar aumentaron significativamente en el grupo experimental, la capacidad forzada y la ventilación máxima de los índices de capacidad de captación de oxígeno también aumentaron significativamente. La saturación de oxígeno en sangre y el índice de perfusión del flujo sanguíneo de los índices de capacidad de utilización de oxígeno presentaron diferencias significativas entre los grupos, los índices de equilibrio central y de flexibilidad también mostraron diferencias significativas. Conclusión Tras el entrenamiento de resistencia cardiopulmonar, la capacidad de los atletas mejoró significativamente, lo que infiere un beneficio en la calidad de la enseñanza del kung fu. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Influence of martial arts on the physique of practicing college students / Influência das artes marciais sobre o físico dos estudantes universitários praticantes / Influencia de las artes marciales en el físico de los estudiantes universitarios practicantes

ABSTRACT Introduction The continuous practice of martial arts can lead to significant changes in the functioning of respiratory organs in the long term. This habit can improve the body's physical development, including the immune system. Objective To investigate the influence of martial arts classes on the physical fitness of college students who practice them. Methods 53 college students are evaluated. Influencing factors are martial arts dedication and training time. The experiment assesses cardiopulmonary function (cardiac function capacity, maximal oxygen consumption, blood pressure, heart rate, and other indexes). The secondary exercise stress tolerance test method was used to investigate cardiopulmonary exercise function in college students. Results 90% of the cardiopulmonary function assessment of the martial arts exercise group is excellent. The practitioners' heart rate and maximum oxygen volume are significantly higher (P<0.05). Systolic and diastolic blood pressure between the groups did not show significant changes (< 120/80mmhg). Martial arts did not change systolic, diastolic blood pressure, or heart rate in the long term. Conclusion Martial arts education has a good influence on students' physical fitness and significantly impacts students' strength and vital capacity. Evidence Level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução A prática contínua das artes marciais pode levar a mudanças significativas no funcionamento dos órgãos respiratórios à longo prazo. Este hábito pode melhorar o desenvolvimento físico corporal, incluindo o sistema imunológico. Objetivo Investigar a influência que as aulas de artes marciais provocam na aptidão física dos estudantes universitários que a praticam. Métodos 53 universitários são avaliados. Os fatores de influência são a dedicação às artes marciais e o tempo de treino. O experimento avalia a função cardiopulmonar (capacidade de função cardíaca, consumo máximo de oxigênio, pressão arterial, frequência cardíaca entre outros indexadores). Foi utilizado o método de prova de tolerância ao exercício de esforço secundário para investigar a função do exercício cardiopulmonar nos universitários. Resultados 90% da avaliação da função cardiopulmonar do grupo praticante de exercícios de artes marciais é excelente. A frequência cardíaca e o volume máximo de oxigênio dos praticantes são significativamente maiores (P<0,05). A pressão arterial sistólica e diastólica entre os grupos não apresentaram grandes alterações (< 120/80mmhg). As artes marciais não alteraram a pressão arterial sistólica, diastólica nem o ritmo cardíaco à longo prazo. Conclusão O ensino de artes marciais tem uma boa influência sobre a aptidão física dos estudantes além de um impacto significativo sobre a força e a capacidade vital dos estudantes. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción La práctica continuada de artes marciales puede provocar a largo plazo cambios significativos en el funcionamiento de los órganos respiratorios. Este hábito puede mejorar el desarrollo físico del cuerpo, incluyendo el sistema inmunológico. Objetivo Investigar la influencia que las clases de artes marciales ejercen sobre la aptitud física de los estudiantes universitarios que las practican. Métodos Se evaluaron 53 estudiantes universitarios. Los factores que influyen son la dedicación a las artes marciales y el tiempo de entrenamiento. El experimento evalúa la función cardiopulmonar (capacidad de la función cardíaca, consumo máximo de oxígeno, presión arterial, frecuencia cardíaca entre otros índices). Se utilizó el método de prueba de tolerancia al esfuerzo secundaria para investigar la función de ejercicio cardiopulmonar en estudiantes universitarios. Resultados El 90% de la evaluación de la función cardiopulmonar del grupo de ejercicios de artes marciales es excelente. La frecuencia cardíaca y el volumen máximo de oxígeno de los practicantes es significativamente mayor (P<0,05). La presión arterial sistólica y diastólica entre los grupos no mostró cambios importantes (< 120/80mmhg). Las artes marciales no modificaron la presión arterial sistólica y diastólica ni la frecuencia cardíaca a largo plazo. Conclusión La educación en artes marciales tiene una buena influencia en la aptitud física de los alumnos, además de un impacto significativo en la fuerza y la capacidad vital de los mismos. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

The application value of sakubatril valsartan in the treatment of chronic heart failure based on cardiopulmonary exercise test system / 中国医师进修杂志

Objective:To analyze the application value of sakubatril valsartan in the treatment of chronic heart failure (CHF) based on cardiopulmonary test system.Methods:One hundred and thirty-five CHF patients admitted to the Affiliated Hospital of Jining Medical Collegefrom January 2019 to August 2020 were divided into the observation group (67 cases) and the control group (68cases) by random number table method. Both groups were treated with bisoprolol. The observation group was treated with the combination of sakubatril valsartan, and the control group was treated with the combination of benapril. The efficacy and cardiac function indicators of the two groups were compared. The cardiopulmonary exercise test system was used to measure the patient′s maximum exercise time (Tmax), maximum exercise Watt (Wmax), peak volume oxygen (Peak VO 2) and volume of anaerobic threshold oxygen (VO 2AT), and the incidence of adverse reactions were calculated. Results:The total effective rate in the observation group was higher than that in the control group: 92.54% (62/67) vs. 77.94%(53/68), the difference was statistically significant ( χ2 = 5.70, P<0.05). After the treatment, the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and soluble ST2 (sST2) in the observation group were lower than those in the control group: (2 000.47 ± 517.85) ng/L vs. (2 777.39 ± 812.49) ng/L, (0.33 ± 0.10) μg/L vs. (0.37 ± 0.09) μg/L, and the left ventricular ejection fraction (LVEF) was higher than that in the control group: (8.12 ± 6.44)% vs. (41.93 ± 6.73)%, the differences were statistically significant ( P<0.05). After the treatment, the left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVEDs), left ventricular mass index (LVMI), left atrial volume index (LAVI) in the observation group were lower than those in the control group: (55.47 ± 6.93) mm vs. (62.00 ± 7.18) mm, (37.14 ± 6.36) mm vs. (41.35 ± 6.43) mm, (136.76 ± 7.13) mg/m 2 vs. (140.98 ± 7.47) mg/m 2, (28.23 ± 2.59) ml/m 2 vs. (31.98 ± 2.17) ml/m 2; the Tmax, Wmax, PeakVO 2 and VO 2AT in the observation group were higher than those in the control group: (619.08 ± 65.36) s vs. (58.70 ± 52.44) s, (142.96 ± 16.05) W vs. (124.19 ± 13.38) W, (20.00 ± 5.74) ml/(min·kg) vs. (18.13 ± 3.58) ml/(min·kg), (13.89 ± 3.69) ml/(min·kg) vs. (11.23 ± 2.36) ml/(min·kg), the differences were statistically significant ( P<0.05). However, there was no statistically significant in the incidence of adverse reactions between the two groups ( P>0.05). Conclusions:Sakubatril valsartan in the treatment of CHF can not only optimize the efficacy and improve cardiac function, but also benefit cardiac exercise rehabilitation of patients, and not increase the safety risk.

Features of cardiopulmonary exercise test in patients with intermediate coronary stenosis / 中国康复理论与实践

ObjectiveTo review the clinical characteristics and capacity of cardiopulmonary exercise test in patients with intermediate coronary stenosis. MethodsFrom January, 2015 to January, 2020, the patients underwent coronary angiography and cardiopulmonary exercise test in Beijing Bo'ai Hospital were divided into intermediate coronary stenosis group (n = 184) and non-coronary heart disease group (n = 73). Symptoms, general information, laboratory and echocardiography information, results of cardiopulmonary exercise test were compared between two groups, and the main cardiovascular events during a year were observed. ResultsThe proportion of male (χ2 = 15.857, P < 0.001), smoking history (χ2 = 9.067, P = 0.003), hypertension history (χ2 = 15.087, P < 0.001) and hyperlipidemia history (χ2 = 13.507, P < 0.001) were more, and the level of hemoglobin A1c (Z = 2.431, P = 0.015) and high sensitivity C-reactive protein (Z = 2.108, P = 0.035) were higher in the intermediate coronary stenosis group, while less of them could reach anaerobic threshold (χ2 = 10.702, P = 0.001). The heard rate and respiratory exchange rate as anaerobic threshold decreased in the intermediate coronary stenosis group (Z > 2.156, P < 0.05). There was no significant difference in main cardiovascular events between the two groups within a year (P = 1.000). ConclusionCardiopulmonary capacity has been impaired in patients with intermediate coronary stenosis, who need to pay attention to the risk factors such as smoking, diabetes mellitus, hypertension and hyperlipidemia.

Prueba de ejercicio cardiopulmonar en militares colombianos con trauma torácico de guerra / Cardiopulmonary exercise test of Colombian military with war thoracic trauma

Introducción: Existen pocas publicaciones relacionadas con las pruebas de esfuerzo cardiopulmonar de soldados heridos en combate, y las diversas complicaciones que puede ocasionar el trauma de guerra. Objetivo: Describir las variables cardiopulmonares en soldados con trauma torácico de guerra, sometidos a pruebas de esfuerzo. Método: Se realizó un estudio descriptivo, entre los años 2010 - 2016, en el Hospital Militar Central de Bogotá, D.C., Colombia. La población de estudio estuvo constituida por 27 pacientes con antecedente de trauma torácico derivado de la guerra, quienes fueron sometidos a pruebas de esfuerzo cardiopulmonar. Se exploran las variables edad, sexo, síntomas, consumo de oxígeno, variables cardiopulmonares medidas por espirometría, tipo de cirugía, trauma y arma. Resultados: El consumo de oxígeno pico medio ml/min fue 2 891,8 (DE: 621,86), consumo de oxígeno pico mL/kg/min 43,25 (DS: 9,72), capacidad vital forzada prebroncodilatador (L) 4,5 (DS: 1, 3) y posbroncodilatador (L) 4,3 (DS: 1,01). El análisis exploratorio encontró diferencias significativas entre quienes tenían heridas por arma de fuego de alta velocidad, y heridas por otros tipos de armas. Conclusión: En pacientes con antecedentes de trauma de guerra, el consumo de oxígeno pico ml/min, oxígeno pico mL/kg/min y capacidad vital forzada, es menor que en población sana; aparentemente, el tipo de herida por arma de fuego de alta velocidad afecta en mayor medida a estas variables evaluadas por las pruebas de esfuerzo cardiopulmonar(AU)

Introduction: There are few publications related to cardiopulmonary stress tests in soldiers wounded in combat, and the various complications cause war trauma. Objective: To describe the cardiopulmonary variables in patients with war thoracic trauma submitted to stress tests. Methods: A descriptive study was carried out between 2010 and 2016, at the Hospital Militar Central de Bogotá, D.C., Colombia. The study population consisted of 27 patients with a history of war-derived thoracic trauma, who were submitted to cardiopulmonary stress tests. The variables of age, sex, symptoms, oxygen consumption, cardiopulmonary variables measured by spirometry, type of surgery, trauma and weapon were explored. Results: A total of 27 participants were included. Mean oxygen consumption peak ml / min was 2 891,8 (SD: 621,86), oxygen consumption peak mL/kg/min 43,25 (DS: 9,72), forced vital capacity pre-bronchodilator (L) 4,5 (DS: 1, 3) and post-bronchodilator (L) 4,3 (DS: 1,01). Exploratory analysis found significant differences among those who had a high velocity firearm wounds against other types of weapons. Conclusions: In patients with a history of trauma, peak oxygen consumption ml / min, peak oxygen mL/kg/min and forced vital capacity is lower than in the healthy population; Apparently, the type of high-velocity firearm wound has a greater effect on these variables evaluated by cardiopulmonary stress tests(AU)

A Risk Prediction Model for Cardiac Rehabilitation in Patients with Stable Coronary Artery Disease / 中国康复理论与实践

Objective:To create a prediction model that could be used to stratify the risk of cardiac rehabilitation in patients with stable coronary artery disease by using test data based on cardiopulmonary exercise testing (CPET) and general clinical data. Methods:A total of 114 patients with stable coronary artery disease were consecutively enrolled from the Cardiology Coronary Artery Disease Database of our hospital from December, 2014 to December, 2018, all the patients underwent CPET before coronary angiography. LASSO was used for feature selection. A nomogram was formulated based on the results of multivariate Logistic regression analysis using the RMS package of R. The predictive power was assessed with Receiver Operating Characteristic Curve. Results:Seven predictors were identified based on LASSO: coronary angiography results, the maximum value of ventilatory equivalent for carbon dioxide (EqCO2max), lymphocyte count, fasting blood glucose levels, cardiac muscle enzyme positivity, blood homocysteine and blood urea nitrogen levels. Combined with clinical experience and weighting analysis, the final four factors were included for Logistic regression modeling: coronary angiography results, EqCO2max, lymphocyte count and fasting blood glucose levels. The area under the curve was 0.875 for the model. Conclusion:EqCO2max and lymphocyte count are key predictors for stable coronary heart disease and can be used to identify patients at high risk for cardiac rehabilitation. A risk stratification model based on CPET and laboratory tests can be used to assess risk stratification for cardiac rehabilitation in patients with stable coronary artery disease.

Application of Cardiopulmonary Exercise Testing in Patients with Lung Cancer Based on World Health Organization Family International Classifications: A Scoping Review / 中国康复理论与实践

Objective:To analyze the clinical application and main roles of Cardiopulmonary Exercise Test (CPET) in patients with lung cancer based on the theory of the World Health Organization Family International Classifications (WHO-FICs). Methods:An evidence-based scoping review was implemented. Literatures related to the applications of CPET in patients with lung cancer were retrieved, from databases including PubMed, Web of Science, CNKI and Wanfang data; from January, 2013 to April, 2021. The indications, contraindications, motor dysfunction, pulmonary rehabilitation interventions, evaluation methods and indicators, and the environment factors of CPET applicated in patients with lung cancer was reviewed based on WHO-FICs framework. Results:This paper analyzed the included literatures from five aspects: the type of disease, functioning, pulmonary rehabilitation exercise interventions, functioning evaluation and environment factors. The major diseases included different pathological types of non-small cell lung cancer (NSCLC) (2C25), and the most common complication of lung cancer was chronic obstructive pulmonary disease (COPD) (CA22). The obstacles of CPET conducted in lung cancer patients mainly included physical structure and functional activities and participation obstacles. Pulmonary rehabilitation based on the CPET was divided into therapeutic, preventive and health promotion interventions. The evaluation tools and indicators were oxygen intake, carbon dioxide output, oxygen pulse, heart rate, blood pressure, electrocardiogram, Borg Scale, 6-minute Walking Test, the MOS Item Short Form Health Survey (SF-36), etc. The classification and description of environmental factors were provided. Conclusion:The application of CPET in lung cancer mainly included preoperative evaluation and prognosis prediction, exercise prescription formulation and exercise effect assessment, anti-cancer treatment impact assessment. Based on WHO-FICs theory system, the applications of CPET mainly involved NSCLC, and COPD was the most common complication of lung cancer. Pulmonary rehabilitation for lung cancer is function- and demand-oriented. Based on CPET evaluation results, individualized therapeutic, preventive and health promotion interventions are conducted to improve the overall function and optimize the health outcomes of patients with lung cancer.

Time-dependent Changes of Blood Pressure in Cardiopulmonary Exercise Test for Females with Hypertension / 中国康复理论与实践

Objective:To explore the time-dependent changes of blood pressure with the increase of exercise intensity and its clinical significance in Cardiopulmonary Exercise Test for female patients with hypertension. Methods:From August, 2018 to August, 2019, 64 patients (hypertension group) who did not take β-receptor blockers and dihydropyridine calcium antagonists were selected from grade 1 and grade 2 hypertension women excluding myocardial ischemia with Cardiopulmonary Exercise Test. And 86 healthy women (non-hypertension group) excluding myocardial ischemia from the same period of Cardiopulmonary Exercise Test were selected as the controls for retrospective analysis. The time-dependent changes of blood pressure with the increase of exercise intensity were compared between two groups. Results:The blood pressures at resting for three minutes, anaerobic threshold and peak were significantly higher in the hypertension group than in the non-hypertension group (Z > 3.306, P < 0.001). There was no significant difference in peak oxygen uptake between two groups (Z = 1.549, P > 0.05). Conclusion:The blood pressure of the patients with grade 1 and grade 2 hypertension is prone to over elevation, who should pay more attention on blood pressure in sports and rehabilitation.

Predictive equations of maximum oxygen consumption by shuttle run test in children and adolescents: a systematic review / Equações preditivas do consumo máximo de oxigênio por meio do teste shuttle run em crianças e adolescentes: uma revisão sistemática

ABSTRACT Objective: To systematically review the literature as for the level of evidence of predictive equations of VO2peak through the 20-meter shuttle run test (20m-SRT) in children and adolescents. Data sources: Searches were conducted independently by two researchers, according to the procedures adopted by PRISMA, in the electronic databases MEDLINE via PubMed, ScienceDirect, Web of Science, LILACS and SciELO, for articles published until September 2017 in English and Portuguese. The inclusion criteria were: original studies, abstract available, using predictive equations of VO2peak through 20m-SRT, conducted with adolescents and/or children, non-athletes, and mentioning correlation analysis between predicted and measured VO2peak. The level of evidence of equations was based on the risk of bias of the studies using the following criteria: sample number, sample characteristics, and statistical analysis. Data synthesis: Eighteen studies were selected, in which fifteen equations were found and analyzed. The studies had been conducted with samples composed of subjects of both sexes, aged 8 to 19 years. Equations of Léger and Matsuzaka had their level of evidence classified as high, and estimation ranged between r=0.54-0.90 and r=0.65-0.90. Equations by Ruiz, Barnett and Matsuzaka had their level of evidence classified as moderate, and estimation ranged between r=0.75-0.96, r=0.66-0.84 and r=0.66-0.89, respectively. Conclusions: Matsuzaka's equation presented satisfactory parameters for estimates of VO2peak in children and adolescents. Although not explored in equations, body adiposity and pubertal stage are significantly associated with cardiorespiratory fitness in children and adolescents.

RESUMO Objetivo: Revisar sistematicamente na literatura o nível de evidência das equações preditivas do pico de consumo de oxigênio (VO2pico) por meio do teste de shuttle run de 20 metros (SR-20m) em crianças e adolescentes. Fonte de dados: As buscas foram conduzidas nas bases de dados eletrônicas Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, ScienceDirect, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO), de agosto a setembro de 2017, nos idiomas inglês e português. Os critérios de inclusão utilizados foram: estudos originais, com resumo disponível, com equações para predição do VO2pico por meio do SR-20m, adolescentes e/ou crianças, não atletas e com análise correlacional do VO2pico predito e mensurado. O nível de evidência das equações foi caracterizado com base no risco de viés dos estudos, no qual se adotou os seguintes critérios: número da amostra, características da amostra e análise estatística. Síntese dos dados: Dezoito estudos foram selecionados, nos quais 12 equações foram encontradas e analisadas. Os estudos foram conduzidos com amostras de ambos os sexos com idades de oito a 19 anos. As equações de Léger e Matsuzaka foram classificadas com forte nível de evidência, com variação de amplitude de estimativa entre r=0,54-0,90 e r=0,65-0,90. Enquanto as equações Ruiz, Barnett e Matsuzaka foram consideradas de evidência moderada, com variação de amplitude de estimativa entre r=0,75-0,96, r=0,66-0,84 e r=0,66-0,89, respectivamente. Conclusões: A equação de Matsuzaka apresentou parâmetros satisfatórios para estimar o VO2pico em crianças e adolescentes. Embora não explorados em equações, a adiposidade corporal e o estágio puberal demonstram associações relevantes com a aptidão cardiorrespiratória em crianças e adolescentes.

Characteristics and Safety of Cardiopulmonary Exercise Testing in Elderly Patients with Cardiovascular Diseases in Korea

PURPOSE: Clinical use of cardiopulmonary exercise tests (CPETs) is increasing in elderly patients with cardiovascular (CV) diseases. However, data on Korean populations are limited. In this study, we aimed to examine the characteristics and safety of CPET in an elderly Korean population with CV disease. MATERIALS AND METHODS: We retrospectively analyzed records of 1485 patients (older than 65 years in age, with various underlying CV diseases) who underwent CPET. All CPET was performed using the modified Bruce ramp protocol. RESULTS: The mean age of patients was 71.6±4.7 years with 63.9% being men, 567 patients aged 60–65 years, 818 patients aged 70–79 years, and 100 patients aged 80–89 years. The mean respiratory exchange ratio was 1.09±0.14. During CPET, three adverse cardiovascular events occurred (total 0.20%), all ventricular tachycardia. All subjects showed an average exercise capacity of 21.3±5.5 mL/kg/min at peak VO2 and 6.1±1.6 metabolic equivalents of task, and men showed better exercise capacity than women on most CEPT parameters. A significant difference was seen in peak oxygen uptake according to age group (65–69 years, 22.9±5.8; 70–79 years, 20.7±5.1; 80–89 years, 17.0±4.5 mL/kg/min, p<0.001). The most common causes for CPET termination were dyspnea (64.8%) and leg pain (24.3%), with higher incidence of leg pain in octogenarians compared to other age groups (65–69 years, 22.4%; 70–79 years, 24.6%; 80–89 years, 32.0%, p<0.001). CONCLUSION: CPET was relatively a safe and useful modality to assess exercise capacity, even in an elderly Korean population with underlying CV diseases.

Validation of the two-minute step test in obese with comorbibities and morbidly obese patients

Cardiopulmonary fitness assessment is a valuable resource to obtain quantitative indicators of an individual's physical performance. The cardiopulmonary exercise test (CPX), considered the gold standard test for this evaluation, is costly and difficult to be accessed by the general population. In order to make this evaluation more accessible, and to better reflect the performance of daily life activities, alternative tests were proposed. Morbidly obese patients present limitations that impair physical performance assessment and could benefit from a test of shorter duration, provided it is validated. This observational study aimed to validate the two-minute step test (2MST) as a tool to evaluate functional capacity (FC) in obese with comorbidities and morbidly obese patients, compared the 2MST with CPX as a measure of physical performance, and developed a predictive equation to estimate peak oxygen uptake (VO2) in the 2MST. The CPX and the 2MST were performed and metabolic and ventilatory parameters were recorded in 31 obese individuals (BMI>35 kg/m2). Pearson correlation and multiple linear regression analyses were performed to evaluate the peak VO2 best predictors. Bland-Altman analysis was performed to assess the agreement between the two methods. Peak VO2 measured by CPX and 2MST showed a strong correlation (r=0.70, P<0.001) and there was a moderate correlation between peak VO2 of the 2MST and the number of up-and-down step cycles (UDS) (r=0.55; P=0.01). The reference equation obtained was: VO2 (mL·kg-1·min-1) = 13.341 + 0.138 × total UDS - (0.183 × BMI), with an estimated standard error of 1.3 mL·kg-1·min-1. The 2MST is a viable, practical, and easily accessible test for FC. UDS and BMI can predict peak VO2 satisfactorily.

Rowing-Ramp Protocol as A Cardiopulmonary Exercise Test for Hemiparetic Stroke Survivors

@#Cardiopulmonary capacity should be evaluated accurately to determine exercise intolerance and training intensity of stroke survivors before an exercise rehabilitation programme is prescribed. However, no cardiopulmonary exercise test (CPET) is suitable because of the stroke victims’ physical impairment. The aim of this study was to develop and validate a new rowing-ramp protocol as a CPET for stroke survivors. Eleven stroke patients (6 male; 5 female; age, 45 + 16.01 years, performed two incremental exercise tests on a Concept II rowing ergometer to determine the peak oxygen consumption (VO2 peak). Test-retest reliability for VO2 peak, measured 1-week apart, resulted in an intra-class correlation of 0.97 and 0.95, respectively. A linear regression equation was developed to predict the VO2 peak from final stage stroke power. Validity and reliability of the prediction equation were established. The regression equation for predicted VO2 peak was VO2 peak=11.429±+ 0.232 (Final Stage Stroke Power) + 12.63 (F=25.326, p<0.01; R=0.859, R2=0.738). Limits of agreement between predicted and measured VO2 peak were acceptable, with a mean bias of 0.37 ml/kg/min. The validity coefficient (R) was 0.83 (p<0.01) and 0.81 (p<0.01) in both trials. Test-Retest reliability coefficient for predicted VO2 peak 0.95 (p<0.01). The positive relationship between Final Stage Stroke Power and VO2 peak suggests that the Rowing-Ramp protocol could be used to measure VO2 peak of stroke survivors. Additional studies are needed to cross-validate the regression equation using larger sample size, different type and severity of stroke.

The Influence of Maximal Aerobic Capacity on the Two Years Cardiac Related Re-Hospitalization in Patients with Heart Failure with Reduced Ejection Fraction in Korean Society

PURPOSE: This study examined the influence of the maximal aerobic capacity on the two-year cardiac-related re-hospitalization in patients with heart failure with a reduced ejection fraction (HFrEF) in Korean society.METHODS: The maximal aerobic capacity of the study population (n=95, male 63%) was evaluated using a cardiopulmonary exercise (CPX) testing system. Each patient was followed up for two years to divide the HFrEF patients into two groups according to cardiac-related re-hospitalization: re-hospitalization (RH) group (n=29, 30%) and no re-hospitalization (NRH) group (n=66, 70%).RESULTS: The relative peak VO₂ (mL/kg/min, p<0.001), exercise duration (p<0.001), respiratory exchange ratio (VCO₂/VO₂, p=0.001), systolic blood pressure (SBP) reserve (p=0.004), heart rate (HR) reserve (p=0.007), SBP max (p=0.02), and HR max (p=0.039) were significantly lower in the RH group than the NRH group during the CPX test. On the other hand, the ventilatory efficiency (VE/VCO₂ slope, p=0.02) and age (p=0.022) were significantly higher in the RH group than in the NRH group. In binary logistic regression analysis, the relative peak VO₂ (p=0.001, Wald Chi-square 10.137) was the strongest predictive factor on cardiac-related re-hospitalization, which was followed by VCO₂/VO₂ (p=0.019, Wald Chi-square 5.54). On the other hand, age (p=0.063, Wald Chi-square 3.445) did not have a significant influence on cardiac related re-hospitalization.CONCLUSION: The maximal aerobic capacity, especially the relative peak VO₂, is the strongest factor on cardiac-related re-hospitalization within two years in patients with HFrEF in Korean society.

Effect of ventricular function and volumes on exercise capacity in adults with repaired Tetralogy of Fallot

Objectives Investigate the effects of left and right ventricular function and severity of pulmonary valve regurgitation, quantified by cardiac magnetic resonance (CMR), on exercise tolerance in adult patients who underwent ToF repair at a young age. Methods This is a retrospective cohort study of 52 patients after ToF surgery and 33 age- and sex-matched healthy volunteers. CMR and cardiopulmonary exercise testing (CPET) were performed on all patients; CPET was performed on control subjects. Results The main finding of CPET was a severe decrease in oxygen uptake at peak exercise VO2peak in TOF patients. The patients were characterized also by lower pulse O2peak and heart rate at peak exercise. Ejection fraction of the right and left ventricles was correlated (r = 0,32; p = 0,03). Left ventricle ejection fraction was negatively correlated with right ventricular volumes (r = −0,34; p = 0,01) and right ventricular mass (r = −046; p < 0,00). Right ventricular mass was positively correlated with left ventricular variables (left ventricle end diastolic volume, r = 0,43; p = 0,002; left ventricle end systolic volume, r = 0,54; p < 0,00) as was VO2peak: LVEDV (r = 0,38; p = 0,01); LVESV (r = 0,33; p = 0,03) and LV mass (r = 0,42; p = 0,006). Conclusion Exercise intolerance in adults with repaired ToF is markedly depressed. The decreased exercise capacity is correlated with impaired RV function and may be associated also with LV dysfunction, which suggests right-to-left ventricular interaction.

Cinética de la inmunoglobulina-A salival (IgAs) en adultos jóvenes con capacidad aeróbica promedio o excelente antes y después de una prueba de esfuerzo máximo / Salivary immunoglobulin A (sIgA) kinetics in young adults with an average or excellent aerobic capacity before and after a cardiopulmonary graded exercise test

Background: Aim: To compare the concentration of secretory immunoglobulin-A (sIgA) in young adults with average or excellent aerobic capacity before and after a cardiopulmonary graded exercise test. Methods: Participants were nine apparently healthy physically active males (Mean age = 21.3 ± 2.1 yr.), randomly allocated in two groups based on their VO2max: a) average aerobic capacity (AEC, n = 5) or b) excellent aerobic capacity (EAC, n = 4). Participants performed the Bruce protocol to determine their aerobic capacity. The sIgA was measured before the test, immediately after the test and 60-, 120-, 240-, and 1440-min after the test. Results: Mixed factorial 2 x 6 ANOVA indicated no significant interactions between groups and measurements (p = 0.956), and main effect groups on sIgA (AEC = 85.4 ± 19.3 μg/mL vs. EAC = 79.2 ± 21.5 μg/mL, p = 0.836). Tukey's post hoc analysis revealed significant differences measurement obtained immediately after the test and between the initial measurement (p = 0.020), 60-min (p = 0.030), 240-min (p = 0.016), and 1440-min (p = 0.028) following the test. Conclusion: There is no change in sIgA kinetics depending on the aerobic capacity of the participants following an aerobic capacity cardiopulmonary graded exercise test.

Introducción. Objetivo: Comparar la cinética en la concentración de inmunoglobulina A salival (IgAs) en adultos jóvenes con capacidad aeróbica promedio (n: 5) o excelente (n: 4) antes y después de una prueba de esfuerzo. Método: 9 adultos jóvenes (edad 21,3 ± 2,1), divididos de acuerdo su VO2máx, realizaron una prueba de esfuerzo mediante el protocolo de Bruce. La concentración de IgAs fue determinada mediante el Salimetrics IgA Kit®, evaluando inicial, inmediatamente finalizada la prueba, +60, +120, +240, +1.440 min. Resultados: La prueba ANOVA 2x6 mixta indicó que no existieron interacciones significativas entre grupos y mediciones (p = 0,956). Tampoco se encontró una diferencia significativa en la media de IgAs en los grupos (Promedio = 85,4 ± 19.3 μg/mL vs Excelente=79,2 ± 21.5 μg/mL, p = 0,836). Independientemente de las mediciones, el análisis post hoc de Tukey indicó que las diferencias se encontraron en la medición obtenida inmediatamente después de la prueba y entre la medición inicial (p: 0,020), la medición obtenida 60 min (p: 0,030), 240 min (p: 0,016) y 1.440 min (p = 0,028) posteriores a la prueba. Conclusión: Los datos encontrados sugieren que no hay un cambio en la concentración de IgAs a través del tiempo en función de la capacidad aeróbica de los participantes.

Blood lactate and oxygen consumption in soccer players: comparison between different positions on the field / Lactato sanguíneo e consumo de oxigênio em jogadores de futebol: comparação entre posições na equipe

OBJECTIVE: We hypothesize that in players with better aerobic fitness, lactate production was not inhibited after high-intensity exercise, regardless of the footballer's position on the field. METHOD: Sixty professional male soccer players performed cardiopulmonary exercise tests on an ergometric treadmill; respiratory gas exchanges were monitored throughout and blood lactate levels at peak effort was measured, using a portable device. The heart rate response was determined by computerized EKG. Training sessions took place over an average of ten hours per week, and the players had 6.8 years of experience in competitive soccer; they were tested a third of way into the season. The positions tested were (centerback, fullback, midfielder and striker). RESULTS: The following results (mean ± std. dev.) were obtained: (1) peak oxygen consumption of 58.8 ± 4.5 ml.kg-1.min.-1; (2), blood peak lactate of 12.3 ± 1.6 mmol.L-1; (3) maximum heart rate of 193 ± 3.3 beats. min-1; (4); oxygen consumption at the second ventilatory threshold of 49.6 ± 5.0 mL. kg-1.min-1; (5); running speed at the second ventilatory threshold of 13.3 ± 0.8 km.h-1; (6) percentage of oxygen consumption in the second ventilatory threshold of 84 ± 6%. There was no correlation between maximum aerobic level vs. peak lactate concentration (r = -0,031; p = 0.812), nor between submaximal aerobic level vs. peak lactate concentration (r = -0.146; p = 0.335) in the positions tested. CONCLUSION: Better or worse aerobic profiles according to game positions in soccer players do not influence peak lactate levels following high-intensity exercise, and confirms the study hypothesis.

OBJETIVO: Nossa hipótese era que em jogadores com melhor condicionamento aeróbio, a produção de lactato não seria inibida após o exercício de alta intensidade, independentemente da posição do jogador no campo. MÉTODOS: Sessenta jogadores de futebol profissional masculino foram submetidos a testes de exercício cardiopulmonar em um analisador metabólico troca gasosa respiratória em esteira ergométrica, com medição dos níveis de lactato no sangue no pico do esforço, usando um dispositivo portátil. A resposta da frequência cardíaca foi determinada por eletrocardiograma computadorizado. As sessões de treinamento duraram uma média de dez horas por semana, e os jogadores participantes tinham 6,8 anos de experiência no futebol competitivo. Os jogadores foram testados a um terço para o final da temporada. As posições testadas foram (defesa-central, defesa lateral, meio-campista e atacante). RESULTADOS: Os resultados obtidos foram: consumo de oxigênio pico de 58,8 ± 4,5 mL.Kg-1min-1, pico de lactato no sangue 12,3 ± 1,6 mmol.L-1; frequência cardíaca máxima de 193 ± 3,3 batimentos.min-1; consumo de oxigênio no segundo limiar ventilatório de 49,6 ± 5,0 mL.Kg-1min-1; velocidade de corrida no segundo limiar ventilatório de 13,3 ± 0,8 km.h-1 e porcentual do consumo de oxigênio no segundo limiar ventilatório de 84 ± 6%. Não houve correlação entre o nível de aeróbio máximo (r = -0,031; p = 0,812) e o nível de aeróbio submáximo (r = -0,146; p = 0,335) nas posições testadas e na concentração pico de lactato. CONCLUSÃO: Melhor ou pior perfil aeróbio nas posições de jogo em jogadores de futebol não influenciam os níveis de lactato de pico durante a realização de exercício de alta intensidade, e confirmam a hipótese do estudo.