Article

Noninvasive determinations of the anaerobic threshold. Reliability and validity in patients with COPD.

Division of Pulmonary Medicine, Cedars-Sinai Medical Center, Los Angeles.
Chest (Impact Factor: 5.85). 10/1992; 102(4):1028-34. DOI: 10.1378/chest.102.4.1028
Source: PubMed

ABSTRACT We compared the intraobserver and interobserver agreement of blood (BGT) and gas exchange (GET) methods for determination of the anaerobic threshold (AT) in patients with COPD. In addition, we determined the sensitivity and specificity of the gas exchange methods for determination of the AT. Two noninvasive methods, the V-slope (VS) and the ventilatory equivalents method (VEM) were compared with two blood sampling methods, the log standard HCO3 (SB) vs log VO2 (SBT) and base excess (BE) vs VO2 (BET). Twenty-nine patients with COPD (FEV1 < 60%) performed incremental exercise tests to exhaustion while breath-by-breath gas exchange measurements were made. Blood samples were drawn at the end of each minute for SB and BE. Two trained observers determined the VO2 at the threshold for each of the four indices on two separate occasions two weeks apart. Our results demonstrated the following: only modest interobserver and intraobserver agreement was noted by Spearman rank correlations; the VEM was as sensitive as the VS in COPD patients; and the presence of a true metabolic acidosis was not reliably predicted by GET methods. Moreover, although the blood methods accurately identified the presence of metabolic acidosis, there was disagreement on the actual point of the BGT. We conclude that gas exchange indices were not helpful for the determination of metabolic acidosis in patients with COPD.

0 Bookmarks
 · 
43 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Impaired ventilation on cardiopulmonary exercise test (CPET) is seen in patients with chronic obstructive pulmonary disease (COPD). However, evaluation of the differences of abnormal gas exchange in COPD according to GOLD severity criteria is limited. A retrospective review was performed on all COPD patients referred for CPET at our center between 1998 and 2010. There were 548 patients compared according to GOLD severity. GOLD groups were significantly different from each other in regards to pressure of end-tidal carbon dioxide ( [Formula: see text] ) with progressively higher [Formula: see text] with increasing GOLD severity. Ratio of minute ventilation to carbon dioxide production ( [Formula: see text] ) and exercise capacity as measured by and [Formula: see text] % and work rate in watts% was inversely proportional to GOLD severity. Breathing reserve, minute ventilation, and tidal volume at peak exercise were significantly decreased with increasing disease severity between GOLD groups. We concluded that gas exchange is distinctive among different GOLD severity groups; specifically, GOLD 3 and 4 have a significantly higher [Formula: see text] and a significantly lower [Formula: see text] than GOLD 2.
    Respiratory Physiology & Neurobiology 01/2013; · 2.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether the peak heart rate reached during a six-minute walk test (HR(6peak)) can be used to predict the heart rate determined at the gas exchange threshold (HR(GET)) during a maximal cardiopulmonary exercise test (CPET) in patients with cystic fibrosis (CF). To assess the test-retest reliability of HR(6peak). Case-control and reliability study. CF unit. Adults with CF (n=23) and age-matched sedentary subjects (control group, n=17). Not applicable. Six-minute walk test, HR(6peak), CPET, and HR(GET). HR(GET) and HR(6peak) were not significantly different and were highly correlated in both groups (CF, r=.91, P<.01; controls, r=.81, P<.01). The mean differences (HR(6peak)-HR(GET)) for patients with CF and control subjects were, respectively, -0.9 beats.min(-1) (bpm) and -0.1 bpm, with neither significantly different from 0. The limits of agreements were +/-11 bpm and +/-18 bpm, respectively. HR(6peak) demonstrated excellent relative reliability (intraclass correlation coefficient=.93) and was associated with low variability (standard error of measurement=4.9 bpm) in patients with CF. HR(6peak) is valid and demonstrates satisfactory test-retest reliability in patients with CF. These results might suggest the use of HR(6peak) as a simple alternative method to individualize exercise prescriptions in this population. Further studies are needed in a larger cohort of patients to confirm these preliminary findings.
    Archives of physical medicine and rehabilitation 04/2010; 91(4):602-7. · 2.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although β blockade (BB) in patients with chronic obstructive pulmonary disease (COPD) does not show signs of worsening pulmonary function or respiratory symptoms, the effects on cardiopulmonary exercise testing (CPET) remain unclear. The aim of this study was to determine whether BB affects exercise capacity, gas exchange, and hemodynamic responses in patients with COPD. Twenty-four COPD subjects on BB were matched to 24 COPD subjects without BB according to age, gender, body mass index, and severity of COPD. All subjects underwent resting pulmonary function and symptom-limited CPET. Comparing COPD patients with and without BB revealed that percent peak oxygen consumption and VE/VCO2 nadir were not significantly different (45 ± 16 vs. 51 ± 23 %, p = 0.30, and 35.1 ± 8.5 vs. 36.2 ± 11.6 %, p = 0.69). Systolic blood pressure and heart rate at peak exercise were significantly decreased in COPD patients with BB (168 ± 16 vs. 185 ± 20 mmHg, and 109 ± 16 vs. 122 ± 14 bpm, respectively, p < 0.05). Exercise capacity and gas exchange remain unaffected in patients with COPD in the presence of BB, although heart rate and blood pressure are lower. These findings imply that BB does not adversely affect functional capacity in patients with COPD.
    Beiträge zur Klinik der Tuberkulose 07/2013; · 2.06 Impact Factor

Full-text

View
0 Downloads
Available from