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1
Folope, Vanessa, Caroline Meret, Ingrid Castres, Claire Tourny, Estelle Houivet, Sébastien Grigioni, Hélène Lelandais, et al. "Evaluation of a Supervised Adapted Physical Activity Program Associated or Not with Oral Supplementation with Arginine and Leucine in Subjects with Obesity and Metabolic Syndrome: A Randomized Controlled Trial." Nutrients 14, no. 18 (September 8, 2022): 3708. http://dx.doi.org/10.3390/nu14183708.
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Background: In patients with obesity and metabolic syndrome (MetS), lifestyle interventions combining diet, in particular, and physical exercise are recommended as the first line treatment. Previous studies have suggested that leucine or arginine supplementation may have beneficial effects on the body composition or insulin sensitivity and endothelial function, respectively. We thus conducted a randomized controlled study to evaluate the effects of a supervised adapted physical activity program associated or not with oral supplementation with leucine and arginine in MetS-complicated patients with obesity. Methods: Seventy-nine patients with obesity and MetS were randomized in four groups: patients receiving arginine and leucine supplementation (ALs group, n = 20), patients on a supervised adapted physical activity program (APA group, n = 20), patients combining ALs and APA (ALs+APA group, n = 20), and a control group (n = 19). After the baseline evaluation (m0), patients received ALs and/or followed the APA program for 6 months (m6). Body composition, MetS parameters, lipid and glucose metabolism markers, inflammatory markers, and a cardiopulmonary exercise test (CPET) were assessed at m0, m6, and after a 3-month wash-out period (m9). Results: After 6 months of intervention, we did not observe variable changes in body weight, body composition, lipid and glucose metabolism markers, inflammatory parameters, or quality of life scores between the four groups. However, during the CPET, the maximal power (Pmax and Ppeak), power, and O2 consumption at the ventilatory threshold (P(VT) and O2(VT)) were improved in the APA and ALs+APA groups (p < 0.05), as well as the forced vital capacity (FVC). Between m6 and m9, a gain in fat mass was only observed in patients in the APA and ALs+APA groups. Conclusion: In our randomized controlled trial, arginine and leucine supplementation failed to improve MetS in patients with obesity, as did the supervised adapted physical activity program and the combination of both. Only the cardiorespiratory parameters were improved by exercise training.
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Winkert, K., and J. Kirsten. "Cardiopulmonary exercise testing – methodological aspects." Deutsche Zeitschrift für Sportmedizin/German Journal of Sports Medicine 73, no. 5 (September 1, 2022): 184–88. http://dx.doi.org/10.5960/dzsm.2022.538.
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Cardiopulmonary exercise testing (CPET) allows for a non-invasive assessment of the integrative response of the pulmonary, cardiovascular, and skeletal muscle system during exercise. Therefore CPET in sports medicine covers a wide spectrum, ranging from diagnosis of disease, preoperative assessment, to athlete monitoring. High standards of reliability and validity are needed to ensure high-quality and diagnostically conclusive CPET data, necessitating a systematic process of quality assurance and control in the daily application of CPET. Therefore, methodological aspects such as CPET equipment principles, calibration, verification, maintenance, preparation, and plausibility checks need to be considered. As inter-technology, inter-device, and inter-unit differences in reliability and validity are reported for automated metabolic analyzers, the choice of the appropriate device should follow the purpose of use and comprehensible data on reliability and validity. To ensure high-quality measurements, careful calibration, and verification of all sensors, the integrated overall measurement performance, and maintenance of all equipment need to be performed and monitored longitudinally. Further, standardized ambient conditions, with adequate circulation and exchange of room air are essential. As the choice of the ergometer and protocol influences various target values in CPET, appropriateness for the selected diagnostic objective as well as a corresponding standardization is needed. While patients should receive pretest information that clearly outlines the test procedure, the correct attachment of the CPET equipment is of utmost importance. To detect and correct malfunctions of the metabolic analyzer and equipment, plausibility checks of the outcome measures validity should be performed during the resting, unloaded, loaded, and recovery test phase. A basic plausibility check should include adequate rest values and increases for a given workload rate of minute ventilation ( ˙VE), oxygen consumption ( ˙VO2) and respiratory exchange ratio (RER), using rules of thumb by Rühle. Before the final data interpretation is performed, e.g. ventilatory threshold or maximum oxygen consumption (˙VO2max) or ˙VO2peak determination, again a plausibility check should be performed and the patient‘s effort whether or not maximal should be determined. Consequently, a standard operating procedure for quality assurance and control, including an intuitive data visualization with thresholds for “pass”, “fail” or outliers and trends of concerns should be specifically defined, taught, and implemented in each facility. Key Words: CPET, Exercise Testing, Physical Fitness
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Laveneziana, Pierantonio, Marcello Di Paolo, and Paolo Palange. "The clinical value of cardiopulmonary exercise testing in the modern era." European Respiratory Review 30, no. 159 (January 6, 2021): 200187. http://dx.doi.org/10.1183/16000617.0187-2020.
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Cardiopulmonary exercise testing (CPET) has long been used as diagnostic tool for cardiac diseases. During recent years CPET has been proven to be additionally useful for 1) distinguishing between normal and abnormal responses to exercise; 2) determining peak oxygen uptake and level of disability; 3) identifying factors contributing to dyspnoea and exercise limitation; 4) differentiating between ventilatory (respiratory mechanics and pulmonary gas exchange), cardiovascular, metabolic and peripheral muscle causes of exercise intolerance; 5) identifying anomalies of ventilatory (respiratory mechanics and pulmonary gas exchange), cardiovascular and metabolic systems, as well as peripheral muscle and psychological disorders; 6) screening for coexistent ischaemic heart disease, peripheral vascular disease and arterial hypoxaemia; 7) assisting in planning individualised exercise training; 8) generating prognostic information; and 9) objectively evaluating the impact of therapeutic interventions. As such, CPET is an essential part of patients' clinical assessment. This article belongs to the special series on the “Ventilatory efficiency and its clinical prognostic value in cardiorespiratory disorders”, addressed to clinicians, physiologists and researchers, and aims at encouraging them to get acquainted with CPET in order to help and orient the clinical decision concerning individual patients.
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Sridhar, M. K., R. Carter, S. W. Banham, and F. Moran. "An Evaluation of Integrated Cardiopulmonary Exercise Testing in a Pulmonary Function Laboratory." Scottish Medical Journal 40, no. 4 (August 1995): 113–16. http://dx.doi.org/10.1177/003693309504000404.
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Clinical exercise testing has been used mainly to assess the cardiac response to exercise. Integrative cardiopulmonary exercise tests (CPET) involving the measurement of the ventilatory, circulatory and metabolic response to exercise has largely been a research tool. We analysed the results of one hundred tests randomly chosen from a total of 472 exercise tests performed between January 1992 and June 1993 as clinical investigation in a pulmonary function laboratory. CPET was used (a) to identify the cause of effort limitation in patients where more than one illness could be relevant (26); (b) to obtain an objective measure of the exercise capacity of patients with respiratory or cardiac disease (31); (c) as monitor of response to treatment (11) and (d) in the investigation of unexplained dyspnoea (32). In 94 of the 100 cases CPET was able to provide an answer to the specific clinical question posed. In patients with unexplained dyspnoea CPET identified a group who exhibit an inappropriate hyperventilatory response to exercise with no supportive evidence of cardiopulmonary disease. In a small minority of cases CPET gave non-specific results. We conclude that CPET is a useful investigation in the management of patients with cardiopulmonary disease and complements the various other investigations offered by a pulmonary function laboratory.
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Mazaheri, Reza, Christian Schmied, David Niederseer, and Marco Guazzi. "Cardiopulmonary Exercise Test Parameters in Athletic Population: A Review." Journal of Clinical Medicine 10, no. 21 (October 29, 2021): 5073. http://dx.doi.org/10.3390/jcm10215073.
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Although still underutilized, cardiopulmonary exercise testing (CPET) allows the most accurate and reproducible measurement of cardiorespiratory fitness and performance in athletes. It provides functional physiologic indices which are key variables in the assessment of athletes in different disciplines. CPET is valuable in clinical and physiological investigation of individuals with loss of performance or minor symptoms that might indicate subclinical cardiovascular, pulmonary or musculoskeletal disorders. Highly trained athletes have improved CPET values, so having just normal values may hide a medical disorder. In the present review, applications of CPET in athletes with special attention on physiological parameters such as VO2max, ventilatory thresholds, oxygen pulse, and ventilatory equivalent for oxygen and exercise economy in the assessment of athletic performance are discussed. The role of CPET in the evaluation of possible latent diseases and overtraining syndrome, as well as CPET-based exercise prescription, are outlined.
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Gille, Thomas, and Pierantonio Laveneziana. "Cardiopulmonary exercise testing in interstitial lung diseases and the value of ventilatory efficiency." European Respiratory Review 30, no. 162 (November 30, 2021): 200355. http://dx.doi.org/10.1183/16000617.0355-2020.
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Interstitial lung diseases (ILDs) are diverse parenchymal pulmonary disorders, primarily characterised by alveolar and interstitial inflammation and/or fibrosis, and sharing pathophysiological similarities. Thus, patients generally harbour common respiratory symptoms, lung function abnormalities and modified exercise adaptation. The most usual and disabling complaint is exertional dyspnoea, frequently responsible for premature exercise interruption. Cardiopulmonary exercise testing (CPET) is increasingly used for the clinical assessment of patients with ILD. This is because exercise performance or dyspnoea on exertion cannot reliably be predicted by resting pulmonary function tests. CPET, therefore, provides an accurate evaluation of functional capacity on an individual basis. CPET can unmask anomalies in the integrated functions of the respiratory, cardiovascular, metabolic, peripheral muscle and neurosensory systems in ILDs. CPET uniquely provides an evaluation of all above aspects and can help clinicians shape ILD patient management. Preliminary evidence suggests that CPET may also generate valuable prognostic information in ILDs and can be used to shed light on the presence of associated pulmonary hypertension. This review aims to provide comprehensive and updated evidence concerning the clinical utility of CPET in ILD patients, with particular focus on the physiological and clinical value of ventilatory efficiency (V˙E/V˙CO2).
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Pella, Eva, Afroditi Boutou, Marieta P. Theodorakopoulou, and Pantelis Sarafidis. "Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice." American Journal of Nephrology 52, no. 4 (2021): 264–78. http://dx.doi.org/10.1159/000515384.
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<b><i>Background:</i></b> Chronic kidney disease (CKD) is often characterized by increased prevalence of cardiovascular risk factors and increased incidence of cardiovascular events and death. Reduced cardiovascular reserve and exercise intolerance are common in patients with CKD and are associated with adverse outcomes. <b><i>Summary:</i></b> The gold standard for identifying exercise limitation is cardiopulmonary exercise testing (CPET). CPET provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic function during maximal or submaximal exercise. It is useful in clinical setting for differentiation of the causes of exercise intolerance, risk stratification, and assessment of response to relevant treatments. A number of recent studies have used CPET in patients with pre-dialysis CKD, aiming to assess the cardiovascular reserve of these individuals, as well as the effect of interventions such as exercise training programs on their functional capacity. This review provides an in-depth description of CPET methodology and an overview of studies that utilized CPET technology to assess cardiovascular reserve in patients with pre-dialysis CKD. <b><i>Key Messages:</i></b> CPET can delineate multisystem changes and offer comprehensive phenotyping of factors determining overall cardiovascular risk. Potential clinical applications of CPET in CKD patients range from objective diagnosis of exercise intolerance to preoperative and long-term risk stratification and providing intermediate endpoints for clinical trials. Future studies should delineate the association of CPET indexes, with cardiovascular and respiratory alterations and hard outcomes in CKD patients, to enhance its diagnostic and prognostic utility in this population.
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van Campen, C. (Linda) M. C., and Frans C. Visser. "Comparing Idiopathic Chronic Fatigue and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Males: Response to Two-Day Cardiopulmonary Exercise Testing Protocol." Healthcare 9, no. 6 (June 5, 2021): 683. http://dx.doi.org/10.3390/healthcare9060683.
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(1) Introduction: Multiple studies have shown that peak oxygen consumption is reduced in the majority of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS )patients, using the gold standard for measuring exercise intolerance: cardiopulmonary exercise testing (CPET). A 2-day CPET protocol has shown different results on day 2 in ME/CFS patients compared to sedentary controls. No comparison is known between ME/CFS and idiopathic chronic fatigue (ICF) for 2-day CPET protocols. We compared ME/CFS patients with patients with chronic fatigue who did not fulfill the ME/CFS criteria in a male population and hypothesized a different pattern of response would be present during the 2nd day CPET. (2) Methods: We compared 25 male patients with ICF who had completed a 2-day CPET protocol to an age-/gender-matched group of 26 male ME/CFS patients. Measures of oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure, workload (Work), and respiratory exchange ratio (RER) were collected at maximal (peak) and ventilatory threshold (VT) intensities. (3) Results: Baseline characteristics for both groups were similar for age, body mass index (BMI), body surface area, (BSA), and disease duration. A significant difference was present in the number of patients with fibromyalgia (seven ME/CFS patients vs. zero ICF patients). Heart rate at rest and the RER did not differ significantly between CPET 1 and CPET 2. All other CPET parameters at the ventilatory threshold and maximum exercise differed significantly (p-value between 0.002 and <0.0001). ME/CFS patients showed a deterioration of performance on CPET2 as reflected by VO2 and workload at peak exercise and ventilatory threshold, whereas ICF patients showed improved performance on CPET2 with no significant change in peak workload. (4) Conclusion: This study confirms that male ME/CFS patients have a reduction in exercise capacity in response to a second-day CPET. These results are similar to published results in male ME/CFS populations. Patients diagnosed with ICF show a different response on day 2, more similar to sedentary and healthy controls.
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van Campen, C. (Linda) M. C., and Frans C. Visser. "Female Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome or Idiopathic Chronic Fatigue: Comparison of Responses to a Two-Day Cardiopulmonary Exercise Testing Protocol." Healthcare 9, no. 6 (June 5, 2021): 682. http://dx.doi.org/10.3390/healthcare9060682.
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Introduction: Multiple studies have shown that peak oxygen consumption is reduced in the majority of ME/CFS patients, using the golden standard for measuring exercise intolerance: cardiopulmonary exercise testing (CPET). A 2-day CPET protocol has shown different results on day 2 in ME/CFS patients compared to sedentary controls. No comparison is known between ME/CFS and idiopathic chronic fatigue (ICF) for 2-day CPET protocols. We compared ME/CFS patients with patients with chronic fatigue who did not fulfil the ME/CFS criteria in a male population and hypothesized a different pattern of response would be present during the 2nd day CPET. Methods: Fifty-one female patients with ICF completed a 2-day CPET protocol and were compared to an age/sex-matched group of 50 female ME/CFS patients. Measures of oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure, workload (Work), and respiratory exchange ratio (RER) were collected at maximal (peak) and ventilatory threshold (VT) intensities. Results: Baseline characteristics for both groups were similar for age, BMI, BSA, and disease duration. A significance difference was present in the number of patients with fibromyalgia (seven ME/CFS patients vs zero ICF patients). Heart rate at rest and the RER did not differ significantly between CPET 1 and CPET 2. All other CPET parameters at the ventilatory threshold and maximum exercise differed significantly (p-value between 0.002 and <0.0001). ME/CFS patients showed a deterioration of performance on CPET2 as reflected by VO2 and workload at peak exercise and ventilatory threshold, whereas ICF patients showed improved performance on CPET2 with no significant change in peak workload. Conclusion: This study confirms that female ME/CFS patients have a reduction in exercise capacity in response to a second day CPET. These results are similar to published results in female ME/CFS populations. Patients diagnosed with ICF show a different response on day 2, more similar to sedentary and healthy controls.
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Miki, Keisuke. "Motor Pathophysiology Related to Dyspnea in COPD Evaluated by Cardiopulmonary Exercise Testing." Diagnostics 11, no. 2 (February 21, 2021): 364. http://dx.doi.org/10.3390/diagnostics11020364.
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In chronic obstructive pulmonary disease (COPD), exertional dyspnea, which increases with the disease’s progression, reduces exercise tolerance and limits physical activity, leading to a worsening prognosis. It is necessary to understand the diverse mechanisms of dyspnea and take appropriate measures to reduce exertional dyspnea, as COPD is a systemic disease with various comorbidities. A treatment focusing on the motor pathophysiology related to dyspnea may lead to improvements such as reducing dynamic lung hyperinflation, respiratory and metabolic acidosis, and eventually exertional dyspnea. However, without cardiopulmonary exercise testing (CPET), it may be difficult to understand the pathophysiological conditions during exercise. CPET facilitates understanding of the gas exchange and transport associated with respiration-circulation and even crosstalk with muscles, which is sometimes challenging, and provides information on COPD treatment strategies. For respiratory medicine department staff, CPET can play a significant role when treating patients with diseases that cause exertional dyspnea. This article outlines the advantages of using CPET to evaluate exertional dyspnea in patients with COPD.
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Stickland, Michael K., Scott J. Butcher, Darcy D. Marciniuk, and Mohit Bhutani. "Assessing Exercise Limitation Using Cardiopulmonary Exercise Testing." Pulmonary Medicine 2012 (2012): 1–13. http://dx.doi.org/10.1155/2012/824091.
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The cardiopulmonary exercise test (CPET) is an important physiological investigation that can aid clinicians in their evaluation of exercise intolerance and dyspnea. Maximal oxygen consumption (V˙O2max) is the gold-standard measure of aerobic fitness and is determined by the variables that define oxygen delivery in the Fick equation (V˙O2= cardiac output × arterial-venous O2content difference). In healthy subjects, of the variables involved in oxygen delivery, it is the limitations of the cardiovascular system that are most responsible for limiting exercise, as ventilation and gas exchange are sufficient to maintain arterial O2content up to peak exercise. Patients with lung disease can develop a pulmonary limitation to exercise which can contribute to exercise intolerance and dyspnea. In these patients, ventilation may be insufficient for metabolic demand, as demonstrated by an inadequate breathing reserve, expiratory flow limitation, dynamic hyperinflation, and/or retention of arterial CO2. Lung disease patients can also develop gas exchange impairments with exercise as demonstrated by an increased alveolar-to-arterial O2pressure difference. CPET testing data, when combined with other clinical/investigation studies, can provide the clinician with an objective method to evaluate cardiopulmonary physiology and determination of exercise intolerance.
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Leem, Jong-Han, Hyoung-Eun Jeon, Hun Nam, Hwan-Cheol Kim, and Kyung-Lim Joa. "A 2-day cardiopulmonary exercise test in chronic fatigue syndrome patients who were exposed to humidifier disinfectants." Environmental Analysis Health and Toxicology 37, no. 4 (November 3, 2022): e2022033. http://dx.doi.org/10.5620/eaht.2022033.
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Some survivors of humidifier disinfectants (HDs) complain of chronic, inexplicable fatigue, and post-exertional malaise (PEM). Two-day cardiopulmonary exercise tests (CPETs) performed 24 hours apart (2-day CPET protocol) are increasingly employed to evaluate PEM and related disabilities among individuals with chronic fatigue syndrome (CFS). The purpose of this study was to assess the reproducibility of CPET variables in individuals who had been exposed to HD and to show that 2-day CPET is an objective means of differentiating between fatigue conditions in people with CFS symptoms who have been exposed to HDs. Twenty-nine HD survivors with CFS symptoms were enrolled in this study. To document and assess PEM in CFS, a 2-day CPET was conducted to measure baseline functional capacity (CPET1) and provoke PEM. Twenty-four hours later, a second CPET assessed changes in related variables, focusing on PEM effects on functional capacity. This CPET also measured changes in energy production and physiological function, objectively documenting PEM effects. In the 2-day CPET, the peak oxygen consumption (VO<sub>2</sub>peak), VO<sub>2</sub> at ventilatory threshold (VO<sub>2</sub>@VT), time to reach VO<sub>2</sub>peak, and time to reach VO<sub>2</sub>@VT were significantly decreased (p<0.001). The peak O<sub>2</sub> pulse and O<sub>2</sub> pulse at VT also decreased significantly (p<0.001). A 6-minute walk test revealed significantly decreased distance (p<0.01). This is the first study to conduct a 2-day consecutive CPET in previously exposed HD participants with CFS symptoms. Our results confirm previous work that demonstrated abnormal responses to PEM in CFS patients. Therefore, a 2-day CPET is an objective measure to differentiate fatigue conditions in people with CFS symptoms who have been exposed to HDs.
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Kersten, Johannes, Luis Hoyo, Alexander Wolf, Elina Hüll, Samuel Nunn, Marijana Tadic, Dominik Scharnbeck, Wolfgang Rottbauer, and Dominik Buckert. "Cardiopulmonary Exercise Testing Distinguishes between Post-COVID-19 as a Dysfunctional Syndrome and Organ Pathologies." International Journal of Environmental Research and Public Health 19, no. 18 (September 10, 2022): 11421. http://dx.doi.org/10.3390/ijerph191811421.
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(1) Background: Dyspnea is one of the most frequent symptoms among post-COVID-19 patients. Cardiopulmonary exercise testing (CPET) is key to a differential diagnosis of dyspnea. This study aimed to describe and classify patterns of cardiopulmonary dysfunction in post-COVID-19 patients, using CPET. (2) Methods: A total of 143 symptomatic post-COVID-19 patients were included in the study. All patients underwent CPET, including oxygen consumption, slope of minute ventilation to CO2 production, and capillary blood gas testing, and were evaluated for signs of limitation by two experienced examiners. In total, 120 patients reached a satisfactory level of exertion and were included in further analyses. (3) Results: Using CPET, cardiovascular diseases such as venous thromboembolism or ischemic and nonischemic heart disease were identified as either cardiac (4.2%) or pulmonary vascular (5.8%) limitations. Some patients also exhibited dysfunctional states, such as deconditioning (15.8%) or pulmonary mechanical limitation (9.2%), mostly resulting from dysfunctional breathing patterns. Most (65%) patients showed no signs of limitation. (4) Conclusions: CPET can identify patients with distinct limitation patterns, and potentially guide further therapy and rehabilitation. Dysfunctional breathing and deconditioning are crucial factors for the evaluation of post-COVID-19 patients, as they can differentiate these dysfunctional syndromes from organic diseases. This highlights the importance of dynamic (as opposed to static) investigations in the post-COVID-19 context.
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Zota, Ioana Mădălina, Cristian Stătescu, Radu Andy Sascău, Mihai Roca, Radu Sebastian Gavril, Teodor Flaviu Vasilcu, Daniela Boișteanu, et al. "CPAP Effect on Cardiopulmonary Exercise Testing Performance in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities." Medicina 56, no. 2 (February 15, 2020): 80. http://dx.doi.org/10.3390/medicina56020080.
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Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing (CPET) offers an integrated assessment of the individual’s aerobic capacity and helps distinguish the main causes of exercise limitation. The purpose of this study is to evaluate the aerobic capacity of OSA patients, before and after short-term continuous positive airway pressure (CPAP). Materials and Methods: Our prospective study included 64 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) 39.96 ± 19.04 events/h) who underwent CPET before and after CPAP. Thirteen patients were unable to tolerate CPAP or were lost during follow-up. Results: 49.29% of our patients exhibited a moderate or severe decrease in functional capacity (Weber C or D). CPET performance was influenced by gender but not by apnea severity. Eight weeks of CPAP induced significant improvements in maximal exercise load (Δ = 14.23 W, p = 0.0004), maximum oxygen uptake (Δ = 203.87 mL/min, p = 0.004), anaerobic threshold (Δ = 316.4 mL/min, p = 0.001), minute ventilation (Δ = 5.1 L/min, p = 0.01) and peak oxygen pulse (Δ = 2.46, p = 0.007) as well as a decrease in basal metabolic rate (BMR) (Δ = −8.3 kCal/24 h, p = 0.04) and average Epworth score (Δ = −4.58 points, p < 0.000001). Conclusions: Patients with moderate-severe OSA have mediocre functional capacity. Apnea severity (AHI) was correlated with basal metabolic rate, resting heart rate and percent predicted maximum effort but not with anaerobic threshold or maximum oxygen uptake. Although CPET performance was similar in the two apnea severity subgroups, short-term CPAP therapy significantly improved most CPET parameters, suggesting that OSA per se has a negative influence on effort capacity.
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Lin, Ching-Chi, Ke-Chang Chang, Kuo-Sheng Lee, Kun-Ming Wu, Chon-Shin Chou, and Ching-Kai Lin. "Effect of Treatment by Laser-Assisted Uvulopalatoplasty on Cardiopulmonary Exercise Test in Obstructive Sleep Apnea Syndrome." Otolaryngology–Head and Neck Surgery 133, no. 1 (July 2005): 55–61. http://dx.doi.org/10.1016/j.otohns.2005.03.025.
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OBJECTIVES: To evaluate the effects of successful laser-assisted uvulopalatoplasty (LAUP) on cardiopulmonary exercise testing (CPET) in patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN AND SETTING: Twenty-five subjects with moderately severe or severe OSAS who desired LAUP were enrolled. All patients had an overnight sleep study and CPET before and 3 months after LAUP. Patients were divided into 2 groups based on the success (group I) or failure (group II) of LAUP to improve their sleep apnea. RESULTS: Successful LAUP in group I was followed by improvement in right ventricular ejection fraction, maximal work rate (WRmax), VO2max/kg, anaerobic threshold, oxygen pulse, and a lower breathing reserve. CPET results were unchanged after LAUP in group II subjects. CONCLUSION: Patients with OSAS before LAUP had abnormal CPET as reflected by low VO2peak/kg, WRmax, anaerobic threshold, and oxygen pulse. All of these variables improved after LAUP that successfully ameliorated OSAS.
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Choi, Hee-Eun, Chul Kim, Hwan-Kwon Do, Hoo-Seok Lee, and Eun-Ho Min. "Development of a Cardiopulmonary Exercise Test Protocol Using Aquatic Treadmill in Healthy Adults: A Pilot Study." Healthcare 10, no. 8 (August 12, 2022): 1522. http://dx.doi.org/10.3390/healthcare10081522.
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Traditional cardiopulmonary exercise test (CPET) protocols are difficult to apply to patients who have difficulty walking on a treadmill. Therefore, this study aimed to develop an aquatic treadmill (AT) CPET protocol involving constant increments in exercise load (metabolic equivalents (METs)) at regular intervals. Fourteen healthy male participants were enrolled in this study. The depth of the water pool was set to the umbilicus level of each participant, and the water temperature was maintained at 28–29 °C. The testing protocol comprised a total of 12 stages at different speeds. The starting speed was 0.7 km/h, which was increased by 0.6 or 0.7 km/h every 2 min. Heart rate, blood pressure, oxygen uptake, minute ventilation, respiratory exchange ratio, and rate of perceived exertion were recorded at each stage. All values showed a significant increasing trend with stage progression (p < 0.001). Peak oxygen uptake and heart rate values were 29.76 ± 3.75 and 168.36 ± 13.12, respectively. We developed a new AT CPET protocol that brings about constant increments in METs at regular intervals. This new AT CPET protocol could be a promising alternative to traditional CPET protocols for patients who experience difficulty walking on a treadmill.
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van Campen, C. (Linda) M. C., Peter C. Rowe, and Frans C. Visser. "Two-Day Cardiopulmonary Exercise Testing in Females with a Severe Grade of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Comparison with Patients with Mild and Moderate Disease." Healthcare 8, no. 3 (June 30, 2020): 192. http://dx.doi.org/10.3390/healthcare8030192.
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Introduction: Effort intolerance along with a prolonged recovery from exercise and post-exertional exacerbation of symptoms are characteristic features of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The gold standard to measure the degree of physical activity intolerance is cardiopulmonary exercise testing (CPET). Multiple studies have shown that peak oxygen consumption is reduced in the majority of ME/CFS patients, and that a 2-day CPET protocol further discriminates between ME/CFS patients and sedentary controls. Limited information is present on ME/CFS patients with a severe form of the disease. Therefore, the aim of this study was to compare the effects of a 2-day CPET protocol in female ME/CFS patients with a severe grade of the disease to mildly and moderately affected ME/CFS patients. Methods and results: We studied 82 female patients who had undergone a 2-day CPET protocol. Measures of oxygen consumption (VO2), heart rate (HR) and workload both at peak exercise and at the ventilatory threshold (VT) were collected. ME/CFS disease severity was graded according to the International Consensus Criteria. Thirty-one patients were clinically graded as having mild disease, 31 with moderate and 20 with severe disease. Baseline characteristics did not differ between the 3 groups. Within each severity group, all analyzed CPET parameters (peak VO2, VO2 at VT, peak workload and the workload at VT) decreased significantly from day-1 to day-2 (p-Value between 0.003 and <0.0001). The magnitude of the change in CPET parameters from day-1 to day-2 was similar between mild, moderate, and severe groups, except for the difference in peak workload between mild and severe patients (p = 0.019). The peak workload decreases from day-1 to day-2 was largest in the severe ME/CFS group (−19 (11) %). Conclusion: This relatively large 2-day CPET protocol study confirms previous findings of the reduction of various exercise variables in ME/CFS patients on day-2 testing. This is the first study to demonstrate that disease severity negatively influences exercise capacity in female ME/CFS patients. Finally, this study shows that the deterioration in peak workload from day-1 to day-2 is largest in the severe ME/CFS patient group.
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Huang, Fangwan, Xiuyu Leng, Mohan Vamsi Kasukurthi, Yulong Huang, Dongqi Li, Shaobo Tan, Guiying Lu, et al. "Utilizing Machine Learning Techniques to Predict the Efficacy of Aerobic Exercise Intervention on Young Hypertensive Patients Based on Cardiopulmonary Exercise Testing." Journal of Healthcare Engineering 2021 (April 21, 2021): 1–14. http://dx.doi.org/10.1155/2021/6633832.
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Recently, the incidence of hypertension has significantly increased among young adults. While aerobic exercise intervention (AEI) has long been recognized as an effective treatment, individual differences in response to AEI can seriously influence clinicians’ decisions. In particular, only a few studies have been conducted to predict the efficacy of AEI on lowering blood pressure (BP) in young hypertensive patients. As such, this paper aims to explore the implications of various cardiopulmonary metabolic indicators in the field by mining patients’ cardiopulmonary exercise testing (CPET) data before making treatment plans. CPET data are collected “breath by breath” by using an oxygenation analyzer attached to a mask and then divided into four phases: resting, warm-up, exercise, and recovery. To mitigate the effects of redundant information and noise in the CPET data, a sparse representation classifier based on analytic dictionary learning was designed to accurately predict the individual responsiveness to AEI. Importantly, the experimental results showed that the model presented herein performed better than the baseline method based on BP change and traditional machine learning models. Furthermore, the data from the exercise phase were found to produce the best predictions compared with the data from other phases. This study paves the way towards the customization of personalized aerobic exercise programs for young hypertensive patients.
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Ramos, Roberta P., Maria Clara N. Alencar, Erika Treptow, Flávio Arbex, Eloara M. V. Ferreira, and J. Alberto Neder. "Clinical Usefulness of Response Profiles to Rapidly Incremental Cardiopulmonary Exercise Testing." Pulmonary Medicine 2013 (2013): 1–25. http://dx.doi.org/10.1155/2013/359021.
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The advent of microprocessed “metabolic carts” and rapidly incremental protocols greatly expanded the clinical applications of cardiopulmonary exercise testing (CPET). The response normalcy to CPET is more commonly appreciated at discrete time points, for example, at the estimated lactate threshold and at peak exercise. Analysis of the response profiles of cardiopulmonary responses at submaximal exercise and recovery, however, might show abnormal physiologic functioning which would not be otherwise unraveled. Although this approach has long been advocated as a key element of the investigational strategy, it remains largely neglected in practice. The purpose of this paper, therefore, is to highlight the usefulness of selected submaximal metabolic, ventilatory, and cardiovascular variables in different clinical scenarios and patient populations. Special care is taken to physiologically justify their use to answer pertinent clinical questions and to the technical aspects that should be observed to improve responses’ reproducibility and reliability. The most recent evidence in favor of (and against) these variables for diagnosis, impairment evaluation, and prognosis in systemic diseases is also critically discussed.
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Andrade, Carolina Pieroni, Antonio Roberto Zamunér, Meire Forti, Thalita Fonseca de França, and Ester da Silva. "The Borg CR-10 scale is suitable to quantify aerobic exercise intensity in women with fibromyalgia syndrome." Fisioterapia e Pesquisa 24, no. 3 (September 2017): 267–72. http://dx.doi.org/10.1590/1809-2950/16558824032017.
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ABSTRACT Patients with Fibromyalgia syndrome (FMS) report higher ratings of perceived exertion (RPE) compared to healthy individuals for the same exercise intensity; however, to our knowledge, no studies have evaluated RPE at the ventilatory anaerobic threshold (VAT) for this population. This study aimed to assess RPE using the Borg CR-10 scale during a cardiopulmonary exercise test (CPET) in women with FMS. Twenty-four women with FMS and twenty healthy control subjects (HC) voluntarily participated in this study. Near the end of every 1-minute period during CPET, subjects were asked to report their RPE for fatigue in the lower limbs (RPE-L) and dyspnea (RPE-D), respectively, according to the Borg CR-10 scale. FMS subjects showed higher RPE-L and RPE-D compared to HC subjects at free wheel and at the first load increment. However, no significant difference was observed between groups for power output. There was no significant difference between groups for RPE-L and RPE-D reported at VAT and peak CPET. However, FMS subjects showed lower power output compared to HC subjects. The present results showed that FMS subjects present higher RPE compared to HC subjects. However, RPE reported at VAT and at peak CPET was not different between groups. The Borg CR-10 scale scores obtained at VAT can be used as an additional parameter for prescribing exercise intensity in aerobic training protocols for women with FMS.
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GU, Qing, and Zhi-min LIU. "Exercise and metabolic syndrome." Academic Journal of Second Military Medical University 36, no. 4 (2015): 434. http://dx.doi.org/10.3724/sp.j.1008.2015.00434.
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Takken, Tim, Wim G. Groen, Erik H. Hulzebos, Cornelia G. Ernsting, Peter M. van Hasselt, Berthil H. Prinsen, Paul J. Helders, and Gepke Visser. "Exercise Stress Testing in Children with Metabolic or Neuromuscular Disorders." International Journal of Pediatrics 2010 (2010): 1–6. http://dx.doi.org/10.1155/2010/254829.
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The role of exercise as a diagnostic or therapeutic tool in patients with a metabolic disease (MD) or neuromuscular disorder (NMD) is relatively underresearched. In this paper we describe the metabolic profiles during exercise in 13 children (9 boys, 4 girls, age 5–15 yrs) with a diagnosed MD or NMD. Graded cardiopulmonary exercise tests and/or a 90-min prolonged submaximal exercise test were performed. During exercise, respiratory gas-exchange and heart rate were monitored; blood and urine samples were collected for biochemical analysis at set time points. Several characteristics in our patient group were observed, which reflected the differences in pathophysiology of the various disorders. Metabolic profiles during exercises CPET and PXT seem helpful in the evaluation of patients with a MD or NMD.
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Huang, Ming-Hsuan, Sheng-Hui Tuan, Yun-Jeng Tsai, Wei-Chun Huang, Ta-Cheng Huang, Shin-Tsu Chang, and Ko-Long Lin. "Comparison of the Results of Cardiopulmonary Exercise Testing between Healthy Peers and Pediatric Patients with Different Echocardiographic Severity of Mitral Valve Prolapse." Life 13, no. 2 (January 21, 2023): 302. http://dx.doi.org/10.3390/life13020302.
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Patients with mitral valve prolapse (MVP) have been reported to have exercise intolerance. However, the underlying pathophysiological mechanisms and their physical fitness remain unclear. We aimed to determine the exercise capacity of patients with MVP through the cardiopulmonary exercise test (CPET). We retrospectively collected the data of 45 patients with a diagnosis of MVP. Their CPET and echocardiogram results were compared with 76 healthy individuals as primary outcomes. No significant differences regarding the patient’s baseline characteristics and echocardiographic data were found between the two groups, except for the lower body mass index (BMI) of the MVP group. Patients in the MVP group demonstrated a similar peak metabolic equivalent (MET), but a significantly lower peak rate pressure product (PRPP) (p = 0.048). Patients with MVP possessed similar exercise capacity to healthy individuals. The reduced PRPP may indicate compromised coronary perfusion and subtle left ventricular function impairment.
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Bernhardt, Vipa, and Tony G. Babb. "Exertional dyspnoea in obesity." European Respiratory Review 25, no. 142 (November 30, 2016): 487–95. http://dx.doi.org/10.1183/16000617.0081-2016.
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The purpose of cardiopulmonary exercise testing (CPET) in the obese person, as in any cardiopulmonary exercise test, is to determine the patient's exercise tolerance, and to help identify and/or distinguish between the various physiological factors that could contribute to exercise intolerance. Unexplained dyspnoea on exertion is a common reason for CPET, but it is an extremely complex symptom to explain. Sometimes obesity is the simple answer by elimination of other possibilities. Thus, distinguishing among multiple clinical causes for exertional dyspnoea depends on the ability to eliminate possibilities while recognising response patterns that are unique to the obese patient. This includes the otherwise healthy obese patient, as well as the obese patient with potentially multiple cardiopulmonary limitations. Despite obvious limitations in lung function, metabolic disease and/or cardiovascular dysfunction, obesity may be the most likely reason for exertional dyspnoea. In this article, we will review the more common cardiopulmonary responses to exercise in the otherwise healthy obese adult with special emphasis on dyspnoea on exertion.
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Yang, Chia-Hsin, Li-Yun Teng, Ming-Wei Lai, Ken-Pen Weng, Sen-Wei Tsai, and Ko-Long Lin. "Long-Term Results of Serial Exercise Testing and Echocardiography Examinations in Patients with Pulmonary Stenosis." Journal of Cardiovascular Development and Disease 10, no. 1 (January 16, 2023): 31. http://dx.doi.org/10.3390/jcdd10010031.
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Pulmonary stenosis (PS) affects cardiopulmonary function and exercise performance. Cardiopulmonary exercise testing (CPET) together with transthoracic echocardiography (TTE) can measure exercise performance, PS progression, and treatment effects. We assessed exercise capacity in PS patients using these methods. We enrolled 28 PS patients aged 6–35 years who received surgery, balloon pulmonary valvuloplasty, and follow-up care. The control population was selected by a 1:1 matching on age, sex, and body mass index. Baseline and follow-up peak pulmonary artery pulse wave velocity (PAV) were compared using TTE. Initial CPET revealed no significant differences in anaerobic metabolic equivalent (MET), peak oxygen consumption (VO2), and heart rate recovery between the two groups, nor were significant differences in pulmonary function identified. Within the PS group, there were no significant differences in MET, peak VO2, and heart rate recovery between the baseline and final CPET. Similarly, no significant differences were observed between the baseline and final PAV. The exercise capacity of patients with properly managed PS was comparable to that of healthy individuals. However, during the follow-up, declining trends in pulmonary function, aerobic metabolism, and peak exercise load capacity were observed among adolescents with PS. This study provides long-term data suggesting that PS patients should be encouraged to perform physical activity. Regular reevaluation should also be encouraged to limit performance deterioration.
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Joris, Maurice, Joël Pincemail, Camille Colson, Jean Joris, Doriane Calmes, Etienne Cavalier, Benoit Misset, Julien Guiot, Grégory Minguet, and Anne-Françoise Rousseau. "Exercise Limitation after Critical Versus Mild COVID-19 Infection: A Metabolic Perspective." Journal of Clinical Medicine 11, no. 15 (July 25, 2022): 4322. http://dx.doi.org/10.3390/jcm11154322.
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Exercise limitation in COVID-19 survivors is poorly explained. In this retrospective study, cardiopulmonary exercise testing (CPET) was coupled with an oxidative stress assessment in COVID-19 critically ill survivors (ICU group). Thirty-one patients were included in this group. At rest, their oxygen uptake (VO2) was elevated (8 [5.6–9.7] mL/min/kg). The maximum effort was reached at low values of workload and VO2 (66 [40.9–79.2]% and 74.5 [62.6–102.8]% of the respective predicted values). The ventilatory equivalent for carbon dioxide remained within normal ranges. Their metabolic efficiency was low: 15.2 [12.9–17.8]%. The 50% decrease in VO2 after maximum effort was delayed, at 130 [120–170] s, with a still-high respiratory exchange ratio (1.13 [1–1.2]). The blood myeloperoxidase was elevated (92 [75.5–106.5] ng/mL), and the OSS was altered. The CPET profile of the ICU group was compared with long COVID patients after mid-disease (MLC group) and obese patients (OB group). The MLC patients (n = 23) reached peak workload and predicted VO2 values, but their resting VO2, metabolic efficiency, and recovery profiles were similar to the ICU group to a lesser extent. In the OB group (n = 15), no hypermetabolism at rest was observed. In conclusion, the exercise limitation after a critical COVID-19 bout resulted from an altered metabolic profile in the context of persistent inflammation and oxidative stress. Altered exercise and metabolic profiles were also observed in the MLC group. The contribution of obesity on the physiopathology of exercise limitation after a critical bout of COVID-19 did not seem relevant.
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Semper, Hannes, Paul Kühnelt, and Philip Seipp. "Spiroergometrie – Schritt für Schritt." DMW - Deutsche Medizinische Wochenschrift 144, no. 01 (January 2019): 39–45. http://dx.doi.org/10.1055/a-0600-9233.
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AbstractCardiopulmonary Exercise Testing (CPET) is a non-invasive simultaneous measurement of the cardiovascular and respiratory system during exercise to assess a patient’s exercise capacity.It is used in a wide spectrum of clinical applications for the objective determination of functional capacity and impairment. Cardiopulmonary exercise testing involves measurements of respiratory oxygen uptake (VO2), carbon dioxide production (VCO2), and other cardiopulmonary and metabolic measures during a symptom‐limited exercise test.This article gives an overview of indications and contraindications and explains step by step how cardiopulmonary exercise testing is being performed.
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Phan, Vivian, Laura Caldarera, Ana Lucia Cortez, Kari Wheeler, Sandra K. Larkin, Sangah Nancy Park, Robin Yates Dulman, et al. "The Effect of Voxelotor on Exercise Capacity of Youths with Sickle Cell Anemia." Blood 138, Supplement 1 (November 5, 2021): 2045. http://dx.doi.org/10.1182/blood-2021-149163.
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Abstract Background/Hypothesis: Children and adults with sickle cell anemia (SCA) exhibit decreased cardiopulmonary fitness. Anemia is directly related to oxygen carrying capacity and is one factor that affects cardiopulmonary fitness. The new sickle cell drug voxelotor raises hemoglobin in patients with SCA treated or untreated with hydroxyurea. We hypothesized that voxelotor improves exercise capacity in youths with SCA. Methods: A single-center, open-label, single-arm longitudinal interventional pilot study was conducted for patients with SCA age > 12. Participants performed baseline Cardiopulmonary Exercise Testing (CPET#1), took 1500mg voxelotor for 2 months, then CPET was repeated (CPET#2). A modified Bruce Protocol using 2-minute stages was performed on a motorized treadmill, for a goal of 8-12 minutes of exercise. Breath by breath gas exchange data were collected and analyzed using a VMax Encore 29C metabolic cart. The metabolic test included standard monitoring of heart rate, EKG ST changes, arrhythmias, and O2 saturation. A respiratory quotient >1.1 was used as evidence of participant effort. Peak oxygen consumption (peak VO2), anaerobic threshold (AT), O2 pulse, VE/VCO2 slope, and time exercised in CPET#1 and CPET#2 were compared for each participant. The primary endpoint was peak VO2. Hemoglobin (Hgb), reticulocyte count, and bilirubin were measured before CPET#1 and CPET#2. Pill count was used to monitor medication adherence and left shift of the P50 oxygen dissociation curve was used to document biochemical effect of voxelotor. Patient Global Impression of Change (PGIC) and Clinician Global Impression of Change (CGIC) surveys were collected at the end of the study. Statistical analysis was performed using Student's paired T-test. Results: Nine SCA patients ages 12-20, including 4 males and 5 females, completed the study. All had Hgb SS and were stably maintained on hydroxyurea, which was continued without dose change during the study. After 2 months of voxelotor, all participants demonstrated expected hematologic changes, including mean rise in Hgb +1.3 g/dL (95% C.I.= 0.8, 1.7), mean decrease in reticulocyte count -2.4% (95% C.I.= -4.1, -0.8), and mean decrease in bilirubin -0.4 mg/dL (95% C.I.= -0.8, -0.1). All participants demonstrated voxelotor adherence and leftward shift of p50 (Table 1). Oxygen consumption, measured as percent predicted peak VO2 (ml/kg/min), ranged from 52% to 80% in CPET#1 and from 55% to 71% in CPET#2. The changes in peak VO2 for individual participants ranged from -10% to +10% of predicted peak VO2, with a mean difference of -2.2% (95% CI = -7.1, 2.7), which is insignificant (p=0.3). Using +/- 6% as variability in peak VO2 measurement, 5 participants exhibited no change, 3 participants had decrease in peak VO2 of -7%, -9%, and -10%, while peak VO2 increased by +10% for a single participant, who started to exercise on his own after starting voxelotor. Changes in individuals' anaerobic threshold, O2 pulse, VE/VCO2 slope, and time exercised were not significant and did not correlate with changes in peak VO2. All participants achieved respiratory quotient >1.1, assuring participant effort during CPET (Table 2). On the 7-point PGIC questionnaire evaluating activity limitations, symptoms, emotions, and overall quality of life, 7 out of 9 participants reported positive change, including "a great deal better," "definite," and "moderate" improvements. Two participants reported minimal to no change, and no participants reported worsening. In comparison, clinicians reported "minimal" to "much" improvement on CGIC for all participants. Overall, patient impression of improvement was higher than clinician impression of improvement. Conclusion: This pilot study demonstrated the feasibility of using CPET to evaluate exercise capacity longitudinally in youths with SCA. After addition of voxelotor to hydroxyurea for 2 months, all patients perceived global improvement. Peak VO2 did not change in 8 out of 9 participants and improved for 1 participant who exercised between the 2 CPETs. To increase peak VO2, higher Hgb increase, concurrent regular exercise, and longer exposure to voxelotor may be necessary. This study was funded by Global Blood Therapeutics Figure 1 Figure 1. Disclosures Larkin: Forma Therapeutics, Inc.: Research Funding. Dulman: Pfizer: Other: own stock. Kuypers: Forma Therapeutics, Inc.: Research Funding.
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Gonze, Bárbara de Barros, Thatiane Lopes Valentim Di Paschoale Ostolin, Alan Carlos Brisola Barbosa, Agatha Caveda Matheus, Evandro Fornias Sperandio, Antônio Ricardo de Toledo Gagliardi, Rodolfo Leite Arantes, Marcello Romiti, and Victor Zuniga Dourado. "Dynamic physiological responses in obese and non-obese adults submitted to cardiopulmonary exercise test." PLOS ONE 16, no. 8 (August 9, 2021): e0255724. http://dx.doi.org/10.1371/journal.pone.0255724.
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Purpose Obese individuals have reduced performance in cardiopulmonary exercise testing (CPET), mainly considering peak values of variables such as oxygen uptake (V˙O2), carbon dioxide production (V˙CO2), tidal volume (Vt), minute ventilation (V˙E) and heart rate (HR). The CPET interpretation and prognostic value can be improved through submaximal ratios analysis of key variables like ΔHR/ΔV˙O2, ΔV˙E/ΔV˙CO2, ΔV˙C/Δlinearized (ln)V˙E and oxygen uptake efficiency slope (OUES). The obesity influence on these responses has not yet been investigated. Our purpose was to evaluate the influence of adulthood obesity on maximal and submaximal physiological responses during CPET, emphasizing the analysis of submaximal dynamic variables. Methods We analyzed 1,594 CPETs of adults (755 obese participants, Body Mass Index ≥ 30 kg/m2) and compared the obtained variables among non-obese (normal weight and overweight) and obese groups (obesity classes I, II and III) through multivariate covariance analyses. Result Obesity influenced the majority of evaluated maximal and submaximal responses with worsened CPET performance. Cardiovascular, metabolic and gas exchange variables were the most influenced by obesity. Other maximal and submaximal responses were altered only in morbidly obese. Only a few cardiovascular and ventilatory variables presented inconsistent results. Additionally, Vtmax, Vt/V˙E, Vt/Inspiratory Capacity, Vt/Forced Vital Capacity, Lowest V˙E/V˙CO2, ΔV˙E/ΔV˙CO2, and the y-intercepts of V˙E/V˙CO2 did not significantly differ regardless of obesity. Conclusion Obesity expressively influences the majority of CPET variables. However, the prognostic values of the main ventilatory efficiency responses remain unchanged. These dynamic responses are not dependent on maximum effort and may be useful in detecting incipient ventilatory disorder. Our results present great practical applicability in identifying exercise limitation, regardless of overweight and obesity.
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Gudim, A. L., L. B. Postnikova, M. V. Boldina, and E. V. Bychkova. "The role of hemodynamic limitations in the reduction of exercise capacity in patients with sarcoidosis." Almanac of Clinical Medicine 47, no. 4 (September 16, 2019): 342–49. http://dx.doi.org/10.18786/2072-0505-2019-47-024.
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Aim: To perform comprehensive evaluation of the Cardiopulmonary Exercise Testing (CPET) parameters with gas analysis in patients with pulmonary sarcoidosis (PS) and to assess the effects of hemodynamic limitations on the reduction of exercise capacity (EC).Materials and methods: We examined 42 PS patients (25 men, 17 women) aged from 22 to 62 years (34.5 [29; 41.5] years old). PS had been verified histologically in 33 (78.6%) patients. The group 1 included patients with decreased oxygen consumption per minute at the peak load (n = 20) with VO₂ peak pred ≤ 84%, i.e. with decreased EC. Group 2 consisted of 22 patients with normal VO₂ peak pred (> 84%). In all patients, echocardiographic and CPET parameters were assessed that characterize response of the cardiovascular system to physical exercise, such as oxygen consumption at the anaerobic threshold (VO₂ AT, % of predicted value); oxygen pulse (VO₂/HR, abs/% of predicted), the chronotropic-metabolic index (CMI), and blood pressure.Results: Thickening of the left ventricular posterior wall (p = 0.012) was found in the group 1, together with decreased VO₂ AT (р < 0.001), VО₂/HR (р < 0.001), and systolic blood pressure (p = 0.037) at the peak load during CPET, compared to the parameters in the group 2. Twelve patients from the group 1 demonstrated their VO₂ AT < 43%, 6 patients had decreased VО₂/HR < 80% of predicted, and 3 patients were diagnosed with the chronotropic incompetence phenomenon.Conclusion: Decreased EC was identified by CPET in 47.6% of PS patients without any functional abnormalities at rest. The reduction of EC in 17/20 PS patients from the group 1 was associated with abnormalities in CPET parameters, corresponding to the hemodynamic limitations (reduction of cardiac output and chronotropic incompetence).
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Chura, Robyn L., Darcy D. Marciniuk, Ron Clemens, and Scotty J. Butcher. "Test-Retest Reliability and Physiological Responses Associated with the Steep Ramp Anaerobic Test in Patients with COPD." Pulmonary Medicine 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/653831.
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The Steep Ramp Anaerobic Test (SRAT) was developed as a clinical test of anaerobic leg muscle function for use in determining anaerobic power and in prescribing high-intensity interval exercise in patients with chronic heart failure and Chronic Obstructive Pulmonary Disease (COPD); however, neither the test-retest reliability nor the physiological qualities of this test have been reported. We therefore, assessed test-retest reliability of the SRAT and the physiological characteristics associated with the test in patients with COPD. 11 COPD patients (mean FEV143% predicted) performed a cardiopulmonary exercise test (CPET) on Day 1, and an SRAT and a 30-second Wingate anaerobic test (WAT) on each of Days 2 and 3. The SRAT showed a high degree of test-retest reliability (ICC=0.99;CV=3.8%, and bias 4.5 W, error −15.3–24.4 W). Power output on the SRAT was 157 W compared to 66 W on the CPET and 231 W on the WAT. Despite the differences in workload, patients exhibited similar metabolic and ventilatory responses between the three tests. Measures of ventilatory constraint correlated more strongly with the CPET than the WAT; however, physiological variables correlated more strongly with the WAT. The SRAT is a highly reliable test that better reflects physiological performance on a WAT power test despite a similar level of ventilatory constraint compared to CPET.
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Osswald, Martin, Dario Kohlbrenner, Nora Nowak, Jörg Spörri, Pablo Sinues, David Nieman, Noriane Andrina Sievi, Johannes Scherr, and Malcolm Kohler. "Real-Time Monitoring of Metabolism during Exercise by Exhaled Breath." Metabolites 11, no. 12 (December 8, 2021): 856. http://dx.doi.org/10.3390/metabo11120856.
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Continuous monitoring of metabolites in exhaled breath has recently been introduced as an advanced method to allow non-invasive real-time monitoring of metabolite shifts during rest and acute exercise bouts. The purpose of this study was to continuously measure metabolites in exhaled breath samples during a graded cycle ergometry cardiopulmonary exercise test (CPET), using secondary electrospray high resolution mass spectrometry (SESI-HRMS). We also sought to advance the research area of exercise metabolomics by comparing metabolite shifts in exhaled breath samples with recently published data on plasma metabolite shifts during CPET. We measured exhaled metabolites using SESI-HRMS during spiroergometry (ramp protocol) on a bicycle ergometer. Real-time monitoring through gas analysis enabled us to collect high-resolution data on metabolite shifts from rest to voluntary exhaustion. Thirteen subjects participated in this study (7 female). Median age was 30 years and median peak oxygen uptake (VO2max) was 50 mL·/min/kg. Significant changes in metabolites (n = 33) from several metabolic pathways occurred during the incremental exercise bout. Decreases in exhaled breath metabolites were measured in glyoxylate and dicarboxylate, tricarboxylic acid cycle (TCA), and tryptophan metabolic pathways during graded exercise. This exploratory study showed that selected metabolite shifts could be monitored continuously and non-invasively through exhaled breath, using SESI-HRMS. Future studies should focus on the best types of metabolites to monitor from exhaled breath during exercise and related sources and underlying mechanisms.
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Machado, Marcus Vinicius, Aline Bomfim Vieira, and Eduardo Tibiriçá. "Microcirculation, metabolic syndrome and exercise:." Physiology News, Autumn 2019 (September 1, 2019): 37–39. http://dx.doi.org/10.36866/pn.116.37.
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Chilibeck, Philip D., Faustino R. Pérez-López, Peter F. Bodary, Eun Seok Kang, and Justin Y. Jeon. "Adipocytokines, Metabolic Syndrome, and Exercise." International Journal of Endocrinology 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/597162.
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Golbidi, Saeid, Azam Mesdaghinia, and Ismail Laher. "Exercise in the Metabolic Syndrome." Oxidative Medicine and Cellular Longevity 2012 (2012): 1–13. http://dx.doi.org/10.1155/2012/349710.
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The metabolic syndrome is a clustering of obesity, diabetes, hyperlipidemia, and hypertension that is occurring in increasing frequency across the global population. Although there is some controversy about its diagnostic criteria, oxidative stress, which is defined as imbalance between the production and inactivation of reactive oxygen species, has a major pathophysiological role in all the components of this disease. Oxidative stress and consequent inflammation induce insulin resistance, which likely links the various components of this disease. We briefly review the role of oxidative stress as a major component of the metabolic syndrome and then discuss the impact of exercise on these pathophysiological pathways. Included in this paper is the effect of exercise in reducing fat-induced inflammation, blood pressure, and improving muscular metabolism.
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Lavie, Carl J., and Richard V. Milani. "Metabolic syndrome, inflammation, and exercise." American Journal of Cardiology 93, no. 10 (May 2004): 1334. http://dx.doi.org/10.1016/j.amjcard.2004.03.018.
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Koivisto, V. A., J. Eriksson, and S. Taimela. "Exercise and the metabolic syndrome." Diabetologia 40, no. 2 (January 28, 1997): 125–35. http://dx.doi.org/10.1007/s001250050653.
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De Sousa, Sunita M. C., and Robert J. Norman. "Metabolic syndrome, diet and exercise." Best Practice & Research Clinical Obstetrics & Gynaecology 37 (November 2016): 140–51. http://dx.doi.org/10.1016/j.bpobgyn.2016.01.006.
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Lim, Eun-Jin, Eun-Bum Kang, Eun-Su Jang, and Chang-Gue Son. "The Prospects of the Two-Day Cardiopulmonary Exercise Test (CPET) in ME/CFS Patients: A Meta-Analysis." Journal of Clinical Medicine 9, no. 12 (December 14, 2020): 4040. http://dx.doi.org/10.3390/jcm9124040.
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Background: The diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is problematic due to the lack of established objective measurements. Postexertional malaise (PEM) is a hallmark of ME/CFS, and the two-day cardiopulmonary exercise test (CPET) has been tested as a tool to assess functional impairment in ME/CFS patients. This study aimed to estimate the potential of the CPET. Methods: We reviewed studies of the two-day CPET and meta-analyzed the differences between ME/CFS patients and controls regarding four parameters: volume of oxygen consumption and level of workload at peak (VO2peak, Workloadpeak) and at ventilatory threshold (VO2@VT, Workload@VT). Results: The overall mean values of all parameters were lower on the 2nd day of the CPET than the 1st in ME/CFS patients, while it increased in the controls. From the meta-analysis, the difference between patients and controls was highly significant at Workload@VT (overall mean: −10.8 at Test 1 vs. −33.0 at Test 2, p < 0.05), which may reflect present the functional impairment associated with PEM. Conclusions: Our results show the potential of the two-day CPET to serve as an objective assessment of PEM in ME/CFS patients. Further clinical trials are required to validate this tool compared to other fatigue-inducing disorders, including depression, using well-designed large-scale studies.
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Pei-Yun Chen, Shin-Tsu Chang, and Ko-Long Lin. "Manifestation of cardiopulmonary exercise testing in an HIV-infected patient with highly active anti-retroviral therapy: A Case Report." International Journal of Life Science Research Archive 1, no. 2 (September 30, 2021): 013–17. http://dx.doi.org/10.53771/ijlsra.2021.1.2.0064.
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Background: Human immunodeficiency virus (HIV) is a retrovirus that causes severe immunodeficiency syndrome in most patients if left untreated. It has been a reportable disease in Taiwan since 1984, and was diagnosed in 41,679 patients until June 2020. However, there is no previous study evaluating aerobic capacity in HIV-infected patient in Taiwan. Case report: A 50-year-old male with HIV infection visited our rehabilitation center for cardiopulmonary exercise testing (CPET) due to dyspnea on exertion sometimes. He received a highly active antiretroviral therapy (HAART) regimen since 2015. He could achieve VO2max during CPET. The maximal aerobic ability was about 91.95% of the predicted, and functional aerobic impairment (FAI) was within normal limit. His VO2 peak was 8.3 MET, equal to 29.05 mL/kg/min. Additionally, VO2 AT was 4.5 MET, equal to 15.75 mL/kg/min. We make recommendations of physical exercise training program according to CPET results. Conclusion: The difference of disease duration, HAART regimen and time of HAART will affect the cardiopulmonary fitness results. However, our HIV-infected patient showed normal aerobic fitness following the CPET, and aerobic capacity did not impair in HIV-infected patient receiving HAART due to personalized life-style modification.
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Chapdelaine, Hugo, Denis Soulieres, and Claude Poirier. "Cardiopulmonary Testing and Pulmonary Hypertension in Patients with Sickle Cell Anemia." Blood 112, no. 11 (November 16, 2008): 4821. http://dx.doi.org/10.1182/blood.v112.11.4821.4821.
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Abstract Objectives: Sickle cell disease (SCD) is responsible for multiple complications that can lead to dyspnea, including pulmonary hypertension (PAH). PAH is a common cause of death among these patients and represents a prognosis feature, but can be clinically difficult to detect. We reviewed the charts of patients with SCD and analyse correlation between hemoglobin level, EKG, chest X-ray, pulmonary function tests, and cardiopulmonary exercise test (CPET) with echocardiography. Methods: We performed a retrospective chart review of 25 patients with SCD (11 patients with SC, 12 patients with SS and 2 patients with S-β thalassemia haplotype). All patients had pulmonary functions testing, CPET and resting echocardiography in the same period. PAH was defined as tricuspid regurgitant jet velocity (TRJV) >2,5 m/s on cardiac echography. Subjects underwent symptom-limited CPET using cycle ergometry and individualized ramp protocol. Exercise was stopped when subject showed criteria of maximality or inability to keep the pace. Breath-by-breath analysis was done. Results: Only 3 patients had PAH. All these patients were SS and suffered numerous acute thoracic syndrome. No correlation were made between lower hemoglobin level and higher TRJV; no patients had EKG or CXR anomaly. DLCO/VA appeared to be a independent risk factor: DLCO/VA < 75 % correlated with a TRJV > 2,5. CPET was abnormal in all patients, but were limited by patient fatigue and patterns were consistent with peripheral muscle disease except for one patient who had PAH; this patient showed a higher VE/VCO2 and a slower pulse kinetics, compatible with pulmonary vasculopathy. Conclusions: Decrease DLCO/VA may indicate a sickle pulmonary vasculopathy. and this factor appears to play a significant role in detecting PAH in SCD patients. CPET was a safe procedure and gave details about global aerobic performance and exercise tolerance. Because of peripheral muscle limitations, CPET still an unreliable diagnostic test for PAH. Peripheral muscle dysfunction could explain a large part of exercise intolerance, but physiopathologic mechanisms still underexplored.
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Chamley, Rebecca, David Holdsworth, Robert Barker-Davies, Alexander Bennett, Oliver O’Sullivan, Peter Ladlow, Andrew Houston, et al. "2 Cardiopulmonary exercise testing excludes clinically significant disease in military patients recovering from COVID-19." BMJ Military Health 168, no. 5 (September 26, 2022): e1.2-e1. http://dx.doi.org/10.1136/bmjmilitary-2022-rsmabstracts.2.
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BackgroundPost-COVID-19 syndrome presents a challenge when determining the occupational grading of symptomatic military personnel, and their ability to deploy. In particular, the accurate assessment of patients with post COVID-19 syndrome is complicated by health anxiety and coincident symptomatic autonomic dysfunction. We therefore sought to determine whether either symptoms or objective cardiopulmonary exercise testing could predict clinically significant findings in the UK Armed Forces.Methods113 consecutive patients were assessed in a post COVID-19 military clinical assessment pathway. This included symptom reporting, history, examination, spirometry, echocardiography and cardiopulmonary exercise testing (CPET) in all, with chest CT, dual-energy CTPA and cardiac MRI where indicated. Symptoms, CPET findings and presence/absence of significant pathology were reviewed. Data were analysed to identify diagnostic strategies that may be used to exclude significant disease.Results7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multi-disciplinary team. These patients had reduced fitness (&Vdot;O2 26.7(±5·1) vs. 34.6(±7·0) ml/kg/min; p = 0·002) and functional capacity (peak power 200 (±36) vs. 247 (±55) Watts; p = 0·026) compared to those without significant disease. Simple CPET criteria (&Vdot;O2 <100% predicted and VE/&Vdot;CO2 slope >30.0 or VE/&Vdot;CO2 slope >35.0 in isolation) excluded significant disease with sensitivity and specificity of 86% and 83% respectively (AUC 0.89). The addition of capillary blood gases to estimate A-a gradient improved diagnostic performance to 100% sensitivity and 78% specificity (AUC 0.92). Symptoms and spirometry did not discriminate significant disease.ConclusionUK Armed Forces personnel with persistent symptoms post SARS-CoV-2 infection demonstrate reassuringly little organ pathology. CPET and functional capacity testing, but not reported symptoms, allow the exclusion of clinically significant disease.
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WORCESTER, SHARON. "Diet + Exercise Beats Exercise Alone for Metabolic Syndrome." Family Practice News 35, no. 12 (June 2005): 16. http://dx.doi.org/10.1016/s0300-7073(05)70845-8.
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Zimatore, Giovanna, Cassandra Serantoni, Maria Chiara Gallotta, Laura Guidetti, Giuseppe Maulucci, and Marco De Spirito. "Automatic Detection of Aerobic Threshold through Recurrence Quantification Analysis of Heart Rate Time Series." International Journal of Environmental Research and Public Health 20, no. 3 (January 21, 2023): 1998. http://dx.doi.org/10.3390/ijerph20031998.
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During exercise with increasing intensity, the human body transforms energy with mechanisms dependent upon actual requirements. Three phases of the body’s energy utilization are recognized, characterized by different metabolic processes, and separated by two threshold points, called aerobic (AerT) and anaerobic threshold (AnT). These thresholds occur at determined values of exercise intensity(workload) and can change among individuals. They are considered indicators of exercise capacities and are useful in the personalization of physical activity plans. They are usually detected by ventilatory or metabolic variables and require expensive equipment and invasive measurements. Recently, particular attention has focused on AerT, which is a parameter especially useful in the overweight and obese population to determine the best amount of exercise intensity for weight loss and increasing physical fitness. The aim of study is to propose a new procedure to automatically identify AerT using the analysis of recurrences (RQA) relying only on Heart rate time series, acquired from a cohort of young athletes during a sub-maximal incremental exercise test (Cardiopulmonary Exercise Test, CPET) on a cycle ergometer. We found that the minima of determinism, an RQA feature calculated from the Recurrence Quantification by Epochs (RQE) approach, identify the time points where generic metabolic transitions occur. Among these transitions, a criterion based on the maximum convexity of the determinism minima allows to detect the first metabolic threshold. The ordinary least products regression analysis shows that values of the oxygen consumption VO2, heart rate (HR), and Workload correspondent to the AerT estimated by RQA are strongly correlated with the one estimated by CPET (r > 0.64). Mean percentage differences are <2% for both HR and VO2 and <11% for Workload. The Technical Error for HR at AerT is <8%; intraclass correlation coefficients values are moderate (≥0.66) for all variables at AerT. This system thus represents a useful method to detect AerT relying only on heart rate time series, and once validated for different activities, in future, can be easily implemented in applications acquiring data from portable heart rate monitors.
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Eckstein, Max L., Paul Zimmermann, Maximilian P. Erlmann, Nadine B. Wachsmuth, Sandra Haupt, Rebecca T. Zimmer, Janis Schierbauer, et al. "Glucose and Fructose Supplementation and Their Acute Effects on Electrocardiographic Time Intervals during Anaerobic Cycling Exercise in Healthy Individuals: A Secondary Outcome Analysis of a Double-Blind Randomized Crossover-Controlled Trial." Nutrients 14, no. 16 (August 9, 2022): 3257. http://dx.doi.org/10.3390/nu14163257.
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The impact of glucose and fructose supplementation on acute cardiac effects during cardiopulmonary exercise testing (CPET) is a topic that is rarely investigated. The aim of the presented secondary outcome analysis of a double-blind, randomized crossover-controlled trial was to investigate the impact of glucose (Glu), fructose (Fru), glucose and fructose (GluFru), and sucralose on electrocardiogram (ECG), heart rate variability (HRV), premature ventricular complexes (PVCs), and heart rate turn points (HRTP) during CPET. Fourteen healthy individuals (age 25.4 ± 2.5 years, body mass index (BMI) 23.7 ± 1.7 kg/m2, body mass (BM) of 76.3 ± 12.3 kg) participated in this study, of which 12 were included for analysis. Participants received 1 g/kg BM of Glu, 1 g/kg BM of Fru, 0.5 g/kg BM of GluFru (each), and 0.2 g sucralose dissolved in 300 mL 30 min prior to each exercise session. No relevant clinical pathology or significant inter-individual differences between our participants could be revealed for baseline ECG parameters, such as heart rate (HR) (mean HR 70 ± 16 bpm), PQ interval (146 ± 20 ms), QRS interval (87 ± 16 ms) and the QT (405 ± 39 ms), and QTc interval (431 ± 15 ms). We found preserved cardiac autonomic function by analyzing the acute effects of different Glu, Fru, GluFru, or sucralose supplementation on cardiac autonomic function by Schellong-1 testing. SDNN and RMSSD revealed normal sympathetic and parasympathetic activities displaying a balanced system of cardiac autonomic regulation across our participating subjects with no impact on the metabolism. During CPET performance analyses, HRV values did not indicate significant changes between the ingested drinks within the different time points. Comparing the HRTP of the CPET with endurance testing by variable metabolic conditions, no significant differences were found between the HRTP of the CPET data (170 ± 12 bpm), Glu (171 ± 10 bpm), Fru (171 ± 9 bpm), GluFru (172 ± 9 bpm), and sucralose (170 ± 8 bpm) (p = 0.83). Additionally, the obtained time to reach HRTP did not significantly differ between Glu (202 ± 75 s), Fru (190 ± 88 s), GluFru (210 ± 89 s), and sucralose (190 ± 34 s) (p = 0.59). The significance of this study lies in evaluating the varying metabolic conditions on cardiac autonomic modulation in young healthy individuals. In contrast, our participants showed comparable cardiac autonomic responses determined by ECG and CPET.
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Puta, Tiberiu, Claudiu Avram, and Alexandra Mihaela Rusu. "Smart training equals performance." Timisoara Physical Education and Rehabilitation Journal 11, no. 20 (September 1, 2018): 53–58. http://dx.doi.org/10.2478/tperj-2018-0008.
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Abstract Introduction: Training individualization is a key element for optimal sports performance and protection of the athlete’s health. The training program should be adjusted according to each athlete's characteristics and should be based on data obtained using proper evaluation. Cardiopulmonary exercise testing (CPET) is considered the gold standard for aerobic exercise capacity assessment and provides an increased quantity of information in regard to body reaction to effort, offering a complete perspective over the O2 transportation system and its utilization in metabolic processes. The aim of this study was to highlight the importance of a scientific approach regarding the physical training, starting from junior level. Methods: For a 3 years period (2013 - 2016) we followed the evolution of a professional cyclist (14 years old at baseline), in terms of cardiopulmonary parameters. During this period, he was tested 5 times and he followed a special training program adapted according the tests results. The CPET was performed in the laboratory using a stationary electronically braked cycle ergometer (Lode Corival, Netherland) and a breath by breath gas analyzer device (Cortex Metalyzer 3B, Germany). Results: We observed an improvement trend in almost all parameters investigated during the 3 years evaluation period. Comparing post-season records from 2013 and 2016, we noticed an increase of 54% in maximal aerobic power and 50% in peak oxygen uptake at anaerobic threshold and an even greater increase (59%) of these parameters at maximal effort achieved during CPET. After these 3 years of training we observed a significant improvement of ventilatory efficiency and cardiac performance during exercise. Conclusions: The study indicate that proper training adaptation according to data obtained using CPET, can bring an important progress in terms of performance.
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Pitsavos, Christos, Demosthenes Panagiotakos, Michael Weinem, and Christodoulos Stefanadis. "Diet, Exercise and the Metabolic Syndrome." Review of Diabetic Studies 3, no. 3 (2006): 118. http://dx.doi.org/10.1900/rds.2006.3.118.
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Katzmarzyk, P. T., A. S. Leon, J. H. Wilmore, J. S. Skinner, D. C. Rao, T. Rankinen, and C. Bouchard. "TARGETING THE METABOLIC SYNDROME WITH EXERCISE." Medicine & Science in Sports & Exercise 35, Supplement 1 (May 2003): S72. http://dx.doi.org/10.1097/00005768-200305001-00385.
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Gkaliagkousi, Eugenia, Eleni Gavriilaki, and Stella Douma. "Exercise-induced benefits in metabolic syndrome." Journal of Clinical Hypertension 20, no. 1 (October 25, 2017): 19–21. http://dx.doi.org/10.1111/jch.13124.
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BELL, JOHN R. "Moderate Exercise Improves Metabolic Syndrome Parameters." Clinical Endocrinology News 3, no. 2 (February 2008): 28. http://dx.doi.org/10.1016/s1558-0164(08)70070-1.
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