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Stress testing: A contribution from Dr Robert A. Bruce, father of exercise cardiology
Abstract
Recognizing the important physiological relationship between the heart and exercise, Dr Robert Arthur Bruce undertook research that revolutionized the way physicians approach cardiac disease. His contributions to exercise physiology and cardiology have shaped many concepts used today in clinical practice. He is best known for developing a protocol for the exercise treadmill test known as the Bruce protocol. Because of its universality, reproducibility, and practicality, the protocol remains one of the most widely used methods for diagnosing ischemic heart disease. Patients commonly start exercising on a treadmill set at 1.7 miles per hour and a 10% grade, and increase to a maximum speed of 6.0 miles per hour and a 22% grade. The aim of testing is to detect the presence of coronary artery disease by looking for electrocardiogram changes during times of stress. The sensitivity of exercise treadmill testing is estimated to be 70% and the specificity to be 80%. These values range broadly depending on multiple factors, including the definition of a positive test result. The strongest predictor of survival found on exercise treadmill testing is exercise capacity. Treadmill testing can also be combined with imaging modalities to further increase sensitivity and specificity, making it one of the first tests considered when coronary artery disease is suspected in a patient. © 2016, British Columbia Medical Association. All rights reserved.
... Exercise stress testing is used to assess the probability, extent and prognosis of having coronary disease. It is also useful for risk stratification of patients with known CAD [3,4]. ...
... www.tridhascholars.org | October-2018 117 While Relative contraindications include left main coronary stenosis, Moderate valvular stenotic disease, Uncorrected medical conditions, such as significant anemia, important electrolyte imbalance, and hyperthyroidism, Severe arterial hypertension with systolic BP>200 mmHg in addition to or diastolic BP >110 mmHg, tachyarrhythmia or bradyarrhythmia, High-degree (AV) block, hypertrophic obstructive cardiomyopathy or any other forms of outflow tract obstruction, Inability to exercise adequately due to mental or physical impairment and recent stroke or TIA [4]. ...
... Clinical developments of angina, hypotension in >10 mmHg SBP from baseline with ischemia, arrhythmia or signs of poor perfusion are absolute indication to stop the test [4]. An important reason to stop the test is ST elevation (> 1 mm) in leads without diagnostic Q waves (other than V 1 or a VR) [7]. ...
Exercise Treadmill Testing to identify CAD is now a widely available and relatively low-cost examination that has been used for more than 60 years. The use of the ETT has expanded to include testing for functional capacity, chronotropic incompetence, assess the effects of therapy and also useful for risk stratification of patients with known CAD. The test sensitivity ranges from 61% to 73%, as reported by various analysts, and Specificity ranges from 59% to 81%, depending on the study or article referenced. Due to the various criteria set for the exercise stress test interpretation and reporting, we have outlined the criteria needed to support high quality exercise stress testing practice throughout Health facilities.
... It is still widely accepted that the exercise treadmill test (ETT) can diagnose underlying CAD and determine the patient's maximal functional aerobic capacity, a term coined by Dr. Bruce himself. [6] An exercise test, or cardiovascular stress test, involves exercise followed by electrocardiography (ECG) and blood pressure monitoring. is type of stress test is usually administered using a treadmill or bicycle to perform the exercise. ...
Objectives
Exercise is the first step of a cardiovascular stress test, including electrocardiography (ECG) and blood pressure monitoring. Typically, a treadmill or bicycle is used to carry out the exercise for this stress test. Computer-derived criteria and a scoring system have been proposed and tested in hopes of improving the diagnostic accuracy of the exercise ECG for diagnosing coronary artery disease (CAD). Many treadmill scores have not been compared with one another in the same population, so questions remain concerning their diagnostic accuracy. The study aimed to correlate the diagnostic accuracy of ST segment response with various treadmill scores.
Material and Methods
A total of 100 consecutive patients with suspected CAD referred for exercise testing at ACS Medical College and Hospital, Chennai, Tamil Nadu, between December 2021 and June 2022 were included in the study. The Institutional Review Board approved the study protocol at our institution, and all patients provided written informed consent. A treadmill test was conducted using commercially available equipment. All patients were subjected to symptom-limited exercise testing following the standard Bruce and modified Bruce protocols. A series of five scores were calculated using data collected from the patients to calculate the probability of CAD occurrence.
Results
The study included 100 patients with an average age of 48.4 ± 1 years. Obesity (41%), hypertension (80%), diabetes (86%), current smokers (62%), family history of CAD (46%), and hypercholesterolemia (46%) were all observed in the study. The receiver operator characteristic (ROC) plot’s area under the curve (AUC) (standard error) for the Detrano score was 0.46 ± 0.59. This was significantly lower than the AUC of each treadmill score. The AUC of the ROC plots of the Duke treadmill score (DTS), veterans affairs (VA), and consensus scores were 0.47 ± 0.58, 0.63 ± 0.56, and 0.61 ± 0.57, respectively.
Conclusion
The Morise score remains helpful in our study population for detecting CAD and determining risk strata. DTS and Detrano had comparable accuracy when calculated from intermediate and high probability scores and ST responses (44% and 43%, respectively). VA and consensus had lower accuracy than others (37% and 29%, respectively).
... However, this was not necessary in this population. Participants also underwent Bruce stress protocol treadmill exercise testing [9] the day prior to the first hot tub session to ascertain the primary outcome of changes in VO 2 max, along with other secondary outcome measurements ( Table 2). Measurement of VO 2 max and obtainment of blood samples were performed with the Bruce treadmill stress test protocol at two times: prior to the first heat therapy session and 24-48 h following the last emersion from the hot tub. Figure 1 illustrates the timeline of the study. ...
Background
Chronic heat therapy may have beneficial effects on cardiovascular function. These effects may be more pronounced in older adults. We performed a pilot feasibility study of repeated heat therapy sessions in a hot tub (40.5 °C) in older adults while wearing a noninvasive hemodynamic monitor. As part of the protocol, the volunteers underwent cardiovascular performance testing pre- and post-intervention.
Methods
Fifteen volunteers > 50 years old underwent 8–10 separate 45-min hot tub session over 14 days in this exploratory and mixed methods trial. The participants had maximal oxygen consumption (VO2 max) and other cardiovascular data measured via exercise treadmill testing prior to and after all hot tub sessions. The participants also wore noninvasive fingertip volume clamp monitors while immerged in hot water that calculated systemic vascular resistance, heart rate, blood pressure, and cardiac output in order to ascertain the feasibility and utility of this data. Other laboratory studies were obtained pre- and post-intervention. The protocol was determined feasible if the heat therapy and cardiovascular testing was completed by at least 90% (14/15 subjects). Feasibility of the noninvasive monitor was determined by the fidelity of the results. Secondary exploratory outcomes were analyzed for differences to identify if they are acceptable to include in an efficacy trial.
Results
All participants completed the study protocol identifying the feasibility of the protocol. The noninvasive hemodynamic monitors successfully recorded cardiac output, systemic vascular resistance, heart rate, and blood pressure with fidelity based on the analysis of recordings. In the secondary analyses, we found no difference in the pre- to post-intervention measurement of VO2 max but did find increased exercise duration following hot tub therapy compared with prior to the therapy (571 s versus 551 s).
Conclusions
The current pilot study protocol is feasible for the purpose of analyzing the effects of heat therapy and cardiovascular performance in older adults while wearing a noninvasive hemodynamic monitor and undergoing treadmill stress testing. Secondary analyses found increased exercise tolerance but no differences in VO2 max following heat sessions.
... Tests were considered positive for myocardial ischemia when they presented, at peak exercise or recovery phases, one of the following alterations: In patients with right bundle branch block, we did not analyze the V1, V2, and V3 leads since they presented alterations in ventricular repolarization when at rest, which could be intensified during exercise and hinder the electrocardiographic analysis of ischemia. 15 Arrhythmias were recorded during and after exercise and classified as complex ventricular arrhythmias: frequent ventricular extrasystoles (over 10% of QRS complexes in a 30-second period); bigeminy; or ventricular tachycardia. ...
... In the present study, a total of 10 stages were conducted for the Bruce treadmill test in which the first stage started with the walking rate of 2.74 km/h and a gradient set at 10%. Next, it should be noted that the gradient and speed were respectively increased at every level based on Bruce Protocol (Luong et al., 2016). Moreover, the participants were informed to grab onto the treadmill handrails if they need to stop for any reason during the test. ...
Novice and experienced runners consistently seek appropriate strategies that can maximise their performance which include wearing compression socks. The purpose of the present study was to observe the effects of compression socks (CS) and smooth socks (SS) on blood lactate (BLa) and maximal oxygen uptake (VO2max) in runners with different experience level. The result of this study may benefit the fitness industries and would promote new running strategy. A randomized cross-over design was used in this study. Accordingly, eight experienced and eight novice runners (23.56±1.41 years) were selected for the study. In particular, the participants were required to run on a Bruce treadmill for both conditions with random arrangement separated by seven days of the washout period. A mixed model ANOVA showed a significant difference (p<0.05) for VO2max in novice runners instead of experienced runners. Moreover, it was revealed that the VO2max (44.5 ml/ min/kg ± 1.1 ml/min/kg) in novice runners was higher while wearing CS. However, no significant differences were found for BLa between the conditions (CS/SS) for both groups (Novice/Experienced). Therefore, the overall finding suggests that the use of CS during running only increases the VO2max among novice runners.
... Resting HR was measured for a 3-minute period in a supine position in a calm environment (in the morning) after a 10-minute period of supine resting and was defined as the lowest one-minute average during the sampling period. Since the Bruce protocol can lead to ambulation difficulties and the large increments in workload between stages can likely lead to premature discontinuation of exercise test and an underestimation of our participants true workload capacity [31], the modified Bruce protocol that starts off at the same speed but with an initial grade of 0%, has a lighter initial increment, was used to assess _ VO 2max of the subjects with the unloaded, 5, 10, 15 and 20% BW backpacks carried on the mid-back region [32]. The mid-back region was specifically chosen as it was shown to be associated with a lower energy cost than most other forms of load carriage [33,34]. ...
The aim of this was to compare the effects of the graded exercise test (GXT) with or without load carriage on maximal oxygen uptake (VO2max) heart rate (HR), and expired ventilation (VE) and blood lactate in young healthy males and females. The study included ten females (age:20.2±0.7 yrs) and ten males (age:19.5±0.7 yrs) who performed the modified Bruce protocol at five load conditions; unloaded, 5, 10, 15, and 20% of body weight (BW) (kg). All the tests were performed in random order, at least 48 hours apart. During the GXTs, HR, VO2max, VE, workload and test duration were recorded and blood lactate concentration was measured before and immediately after the GXTs. VO2max remained unchanged during the GXTs in load and unloaded conditions for both sexes (p>0.05). Test duration was significantly less in females during the GXT with 15% BW (15.9±0.51 min vs. 18.1±1.14 min; p = 0.014) and 20% BW load carriage (15.2±0.75 min vs. 18.1±1.14 min; p = 0.020), compared to the unloaded GXT. Males showed significant decrease in the test duration during the GXT with load 15% BW (20.5±0.53 min vs. 22.8±0.61 min; p = 0.047) and with 20% BW (19.6±0.42 min vs. 22.8±0.71 min; p = 0.004), compared to the GXT with 5% BW. VE statistically decreased in female subjects only at 15% BW compared to 20% BW (15% BW = 77.9 ± 10.5 L/min vs. 15% BW = 72.0 ± 10.9 L/min; p = 0.045). There was no difference observed in maximal HR and blood lactate concentration between the GXTs in load and unloaded conditions. This study indicates that no matter the load % used during the GXT, VO2max, but not total exercise time, remains the same in young males and females.
... All capillary samples were measured by author A.R. The timing of sampling with respect to day of ICU treatment was not registered, but the patients were included shortly after ICU admission. The healthy volunteers underwent a VO2-max test on treadmill (Modified Bruce Protocol) with an arterial line and a peripheral venous catheter during the test [17]. Repeated measurements of arterial, venous and capillary blood lactate in this group were recorded at rest, directly after the VO2max test and at 3, 5, 10 and 20 min after the test was completed. ...
Abstract Background The measurement of lactate in emergency medical services has the potential for earlier detection of shock and can be performed with a point-of-care handheld device. Validation of a point-of-care handheld device is required for prehospital implementation. Aim The primary aim was to validate the accuracy of Lactate Pro 2 in healthy volunteers and in haemodynamically compromised intensive care patients. The secondary aim was to evaluate which sample site, fingertip or earlobe, is most accurate compared to arterial lactate. Methods Arterial, venous and capillary blood samples from fingertips and earlobes were collected from intensive care patients and healthy volunteers. Arterial and venous blood lactate samples were analysed on a stationary hospital blood gas analyser (ABL800 Flex) as the reference device and compared to the Lactate Pro 2. We used the Bland-Altman method to calculate the limits of agreement and used mixed effect models to compare instruments and sample sites. A total of 49 intensive care patients with elevated lactate and 11 healthy volunteers with elevated lactate were included. Results There was no significant difference in measured lactate between Lactate Pro 2 and the reference method using arterial blood in either the healthy volunteers or the intensive care patients. Capillary lactate measurement in the fingertip and earlobe of intensive care patients was 47% (95% CI (29 to 68%), p
... All capillary samples were measured by author A.R. The timing of sampling with respect to day of ICU treatment was not registered, but the patients were included shortly after ICU admission. The healthy volunteers underwent a VO2-max test on treadmill (Modi ed Bruce Protocol) with an arterial line and a peripheral venous catheter during the test (17). Repeated measurements of arterial, venous and capillary blood lactate in this group were recorded at rest, directly after the VO2-max test and at 3, 5, 10 and 20 min after the test was completed. ...
Background: The measurement of lactate in emergency medical services has the potential for earlier detection of shock and can be performed with a point-of-care handheld device. Validation of a point-of-care handheld device is required for prehospital implementation.
Aim: The primary aim was to validate the accuracy of Lactate Pro 2 in healthy volunteers and in haemodynamically compromised intensive care patients. The secondary aim was to evaluate which sample site, fingertip or earlobe, is most accurate compared to arterial lactate.
Methods: Arterial, venous and capillary blood samples from fingertips and earlobes were collected from intensive care patients and healthy volunteers. Arterial and venous blood lactate samples were analysed on a stationary hospital blood gas analyser (ABL800 Flex) as the reference device and compared to the Lactate Pro 2. We used the Bland-Altman method to calculate the limits of agreement and used mixed effect models to compare instruments and sample sites. A total of 49 intensive care patients with elevated lactate and 11 healthy volunteers with elevated lactate were included.
Results: There was no significant difference in measured lactate between Lactate Pro 2 and the reference method using arterial blood in either the healthy volunteers or the intensive care patients. Capillary lactate measurement in the fingertip and earlobe of intensive care patients was 47% (95% CI (29% to 68%), p<0.001) and 27% (95% CI (11% to 45%), p<0.001) higher, respectively, than the corresponding arterial blood lactate. In the healthy volunteers, we found that capillary blood lactate in the fingertip was 14% higher than arterial blood lactate (95% CI (4% to 24%), p= 0.003) and no significant difference between capillary blood lactate in the earlobe and arterial blood lactate.
Conclusion: Our results showed that the handheld Lactate Pro 2 had good agreement with the reference method using arterial blood in both intensive care patients and healthy volunteers. However, we found that the agreement was poorer using venous blood in both groups. Furthermore, the earlobe may be a better sample site than the fingertip in intensive care patients.
... The timing of sampling with respect to day of ICU treatment was not registered, but the patients were included fairly early as the ICU nurses called A.R. when an eligible patient was admitted to the ICU. The healthy volunteers underwent a VO2-max test on treadmill (Modi ed Bruce Protocol) with an arterial line and a peripheral venous catheter during the test (17). Anaesthesiologists conducted the arterial cannulation. ...
Background: The measurement of lactate in emergency medical services has the potential for earlier detection of shock and can be performed with a point-of-care handheld device. Validation of a point-of-care handheld device is required for prehospital implementation.
Aim: The primary aim was to validate the accuracy of Lactate Pro 2 in healthy volunteers and in haemodynamically compromised intensive care patients. The secondary aim was to evaluate which sample site, fingertip or earlobe, is most accurate compared to arterial lactate.
Methods: Arterial, venous and capillary blood samples from fingertips and earlobes were collected from intensive care patients and healthy volunteers. Arterial and venous blood lactate samples were analysed on a stationary hospital blood gas analyser (ABL800 Flex) as the reference device and compared to the Lactate Pro 2. We used the Bland-Altman method to calculate the limits of agreement and used mixed effect models to compare instruments and sample sites. A total of 49 intensive care patients with elevated lactate and 11 healthy volunteers with elevated lactate were included.
Results: There was no significant difference in measured lactate between Lactate Pro 2 and the reference method using arterial blood in either the healthy volunteers or the intensive care patients. Capillary lactate measurement in the fingertip and earlobe of intensive care patients was 47% (95% CI (29% to 68%), p<0.001) and 27% (95% CI (11% to 45%), p<0.001) higher, respectively, than the corresponding arterial blood lactate. In the healthy volunteers, we found that capillary blood lactate in the fingertip was 14% higher than arterial blood lactate (95% CI (4% to 24%), p= 0.003) and no significant difference between capillary blood lactate in the earlobe and arterial blood lactate.
Conclusion: Our results showed that the handheld Lactate Pro 2 had good agreement with the reference method using arterial blood in both intensive care patients and healthy volunteers. However, we found that the agreement was poorer using venous blood in both groups. Furthermore, the earlobe may be a better sample site than the fingertip in intensive care patients.
... The healthy volunteers underwent a VO2-max test on treadmill (Modified Bruce Protocol) with an arterial line and a peripheral venous catheter during the test (15). Anaesthesiologists conducted the arterial cannulation. ...
Background: The measurement of lactate in emergency medical services has the potential for earlier detection of shock and can be performed with a point-of-care handheld device. Validation of a point-of-care handheld device is required for prehospital implementation.
Aim: The primary aim was to validate the accuracy of Lactate Pro 2 in healthy volunteers and in haemodynamically compromised intensive care patients. The secondary aim was to evaluate which sample site, fingertip or earlobe, is most accurate compared to arterial lactate.
Methods: Arterial, venous and capillary blood samples from fingertips and earlobes were collected from intensive care patients and healthy volunteers. Arterial and venous blood lactate samples were analysed on a stationary hospital blood gas analyser (ABL800 Flex) as the reference device and compared to the Lactate Pro 2. We used the Bland-Altman method to calculate the limits of agreement and used mixed effect models to compare instruments and sample sites.
Results: A total of 49 intensive care patients with elevated lactate and 11 healthy volunteers who performed a maximal oxygen consumption test to obtain elevated blood lactate levels were included. There was no significant difference in measured lactate between Lactate Pro 2 and the reference method using arterial blood in either the healthy volunteers or the intensive care patients. Capillary lactate measurement in the fingertip and earlobe of intensive care patients was 47% (95% CI (29% to 68%), p<0.001) and 27% (95%CI (11% to45%), p<0.001) higher, respectively, than the corresponding arterial blood lactate.
Conclusion: Our results showed that the handheld Lactate Pro 2 had good agreement with the reference method using arterial blood in both intensive care patients and healthy volunteers. However, we found that the agreement was poorer using venous blood in both groups. Furthermore, the earlobe may be a better sample site than the fingertip in intensive care patients.
... All of these evaluations were performed for both the study group and the control group. Patients were then subjected to stress test according to Bruce protocol [25]. When 88% of the maximal heart rate was reached, the test was terminated. ...
Background: Chronic obstructive pulmonary disease (COPD) is associated with increased risk of cardiovascular morbidity and mortality. The aim of this study is to investigate the effect of effort test on corrected QT (QTc) and corrected QT dispersion (QTcd) in patients with newly diagnosed and untreated COPD patients.
... The exercise stress test has been available for decades and it is safe, effective and inexpensive. 1,2,3 Exercise stress test was favoured in view of its advantage that can evaluate the threshold at which angina occurs, and this information is useful for patients' clinical management. 4 A review of meta-analyses of test performance characteristics of exercise testing, scintigraphy and stress echocardiography, the sensitivity and specificity of the tests are 68% and 77%, 79% and 73%, and 76% and 88% respectively. ...
Background: The issue of premature termination of exercise stress test in Asian people due to intolerance to rapid exercise workload increment in Bruce protocol has been pointed out. In this study, we want to compare the exercise stress test tolerance using Bruce and Balke-Ware protocols.
Methods: This was a cross-over experimental study involving 30 male subjects aged 40-65 year-old performing exercise stress test using Bruce and Balke-Ware protocols. Hemodynamic responses, electrocardiographic pattern and exercise duration were monitored
during the test and the reason for termination was recorded.
Results: Bruce protocol achieved equivalent hemodynamic responses, completion rate and test findings to Balke-Ware (P>0.001). C50% of the subjects were able to complete the stress test using both protocols. 46.7% (n=14) of subjects terminate the test prematurely for Bruce and 50% (n=15) for Balke-Ware protocol. Fatigue was the commonest cause with (57.2% n=8, 60% n=9), followed by achieved target heart rate (35.5% n=5, 33.3% n=5) and shortness of breath (7.1% n=1, 6.7% n=1) for Bruce and Balke-Ware respectively. The exercise capacity (Metabolic Equivalent) attained during exercise was similar in both protocol (p>0.001), and exercise duration in Balke-Ware was significantly longer than the Bruce protocol (p<0.001).
Conclusions: We found that protocol selection does not affect the completion rate and outcome of the exercise stress test and their tolerance was similar regardless of the protocols used. For Asian peoples who were unable to complete the exercise stress test due to any reasons, their cardiac status is best evaluated using other methods.
Keyword: Exercise test, Workload, Exercise tolerance, Coronary Artery Disease, Electrocardiography
... Anyway, the exercise stress test known as the Bruce protocol or cyclo-ergometer protocol continues to play an important role in diagnosing coronary artery disease in intermediaterisk patients 10 . The Ex-ECG test can reveal cardiovascular abnormalities that are not seen at rest by taking measurements that unmask these during aerobic exercise when the heart responds to the body's demand for more oxygen by increasing heart rate, stroke volume, and cardiac output. ...
The identification and treatment of coronary artery disease (CAD)
remain a great challenge for physicians in all the world. In this
case report, the author explains how physicians can be able
to detect a subtle coronary artery disease in otherwise healthy
paucisymptomatic individuals, as athletes or ex-athletes, using
only the exercise ECG stress (Ex-ECG) testing and clinical common
sense, in the era of advanced technologies like cardiovascular
imaging.
... exercise stress testing (eSt) has been widely documented as a safe and effective noninvasive procedure with an extensive history of use for more than 60 years. 4 eSt aids the diagnosis and prognosis of a range of pathologies, including caD, arrhythmia provocation, chronotropic incompetence, syncope investigation, prediction of cardiovascular all-cause mortality, and effects of medical interventions. 5 Patients are exercised by an incremental protocol until maximal volitional fatigue or resultant signs or symptoms dictate premature termination of the test. ...
Background:
Exercise stress testing (EST) is a noninvasive procedure that aids the diagnosis and prognosis of a range of cardiac pathologies. Reduced access is recognized as a limiting factor in enabling early access to treatment or safe and appropriate discharge. Increased accessibility can be achieved by utilizing nonphysician health practitioners to supervise tests. To implement nonphysician-led EST in clinical environments, there is a need for the development and administration of feasible and effective models.
Objective:
Via inpatient and outpatient referral, this article aims to present 2 standardized models of care for patients requiring EST for diagnostic and prognostic evaluation of numerous pathologies.
Method:
An inpatient and outpatient model was implemented at the Royal Brisbane and Women's Hospital and Logan Hospital in Queensland, Australia between July 2013 and December 2015. Tests were performed by 2 cardiac scientists employed by each hospital. All tests were immediately reported by a cardiology advanced trainee registrar or consultant cardiologist.
Results:
A total of 2095 tests were performed via the 2 models. Overall, 73 had a positive result (3.5%), 120 equivocal (5.7%), 129 inconclusive/submaximal (6.2%), and 1773 negative (85.2%). After further testing, 38 of the patients with positive and equivocal results were diagnosed with flow-limiting coronary artery disease. The remaining patients were resolved as negative through further diagnostic testing or lost to follow up.
Conclusions:
After implementation of the 2 models, patient flow was improved for earlier discharge, reduced waiting times, or timely identification of possible cardiac pathologies, thereby optimizing patient care.
Introducción:
El Centro de Investigaciones del Deporte Cubano, en estrecha relación con el Instituto de Medicina Deportiva, ha realizado en el Área de control cardiorrespiratorio numerosas pruebas funcionales a los deportistas de alto rendimiento. Como parte del control médico a los deportistas, se han ejecutado pruebas ergométricas cardiopulmonares en el laboratorio, con la novedad de ajustarse los protocolos a las necesidades especiales del atleta en función de su modalidad deportiva.
Objetivos:
Fundamentar la importancia de la ergometría cardiovascular para el entrenamiento deportivo y rediseñar protocolos de ergometría deportiva acordes a las especificidades de la modalidad atlética.
Métodos:
Se realizó un estudio descriptivo, longitudinal, en el periodo entre noviembre de 2019 y febrero de 2020. Muestra selectiva intencional, todos los deportistas de los equipos nacionales en cada modalidad: judo, boxeo y luchas (libre y grecorromana).
Resultados:
Se rediseñaron los protocolos de ergometría sobre la base de los convencionales estandarizados en medicina deportiva, para judo, boxeo y lucha. Se obtuvieron parámetros óptimos (frecuencia cardíaca, volumen máximo de oxígeno y equivalente metabólico) para cada modalidad deportiva.
Conclusiones:
Las pruebas ergoespirométricas constituyen una herramienta científica útil en la medicina deportiva. Rediseñar protocolos ergométricos permite una mejor valoración funcional del atleta y proporciona un adecuado soporte científico al entrenamiento individual. La ergometría cardiopulmonar es un instrumento disponible para evaluar, recuperar y mejorar las capacidades funcionales y deportivas de los atletas de alto rendimiento, especialmente en la etapa pos-COVID-19.
Background
The beneficial effects of high intensity interval training (HIIT) and chlorella vulgaris (CV) on body composition and mitochondrial biogenesis have been shown in some mechanistic studies. This study aimed to determine the effects of CV and/or HIIT on mitochondrial biogenesis, performance and body composition among overweight/obese women.
Methods
In this randomized clinical trial, 46 overweight/obese women were assigned to four groups including CV+HIIT and HIIT+placebo groups that received three capsules of CV (300 mg capsules, 3 times a day) or corn starch, in combination with three sessions/week of HIIT. CV and placebo groups only received 900mg of CV or corn starch, daily, for 8 weeks. Biochemical assessments, performance assessment and body composition were obtained at the beginning and end of the intervention.
Results
There was a significant reduction in the fat mass of the CV+HIIT group, as compared with the placebo group (p=0.005). A marginal significant increase in body water (p=0.050) and peroxisome proliferator-activated receptor-γ coactivator 1 ɑ (p=0.050) was also found only in the CV+HIIT group, as compared with the placebo. Relative (p<0.001) and absolute (p<0.001) VO2max, as well as Bruce MET (p<0.001), was significantly increased in the HIIT and HIIT+CV groups. Besides, the synergistic effect of CV and HIIT on the Bruce MET increment was found (interaction p-value =0.029). No significant changes were, observed in BMI, fat free mass, visceral fat, silent information regulator 1 and fibroblast growth factor-21.
Conclusions
HIIT may be, therefore, effective in improving mitochondrial biogenesis, performance and body composition in overweight/obese women.
Background:
The implementation of nonphysician-led exercise stress testing (EST) has increased over the last 30 years, with endorsement by many cardiovascular societies around the world. The comparable safety of nonphysician-led EST to physician-led studies has been demonstrated, with some studies also showing agreement in diagnostic preliminary interpretations.
Objective:
The study aim was to firstly confirm the safety of nonphysician-led EST in a large cohort and secondly compare the interobserver agreement and diagnostic accuracy of cardiac scientist and junior medical officer (JMO)-led EST reports to cardiology consultant overreads.
Methods:
All ESTs performed between 1/7/2010 and 30/6/2013 were included in the study for JMO led tests (n = 1332). ESTs performed for the investigation of coronary artery disease between 1/7/2013 and 30/6/2016 were included for scientist-led testing (n = 1904).
Results:
There was one adverse event, an ST segment myocardial infarction during the recovery phase of a JMO-led EST. Interobserver agreement was superior between the cardiologist and the scientist compared with the cardiologist and the JMO (P < 0.0001). Sensitivity for JMO-led tests differed from the cardiologist overread (86.96% vs. 96.77%, P = 0.03). There were no other significant differences between the cardiologist overread and the JMO- or scientist-led interpretation.
Conclusions:
Scientist-led EST is safe in intermediate risk patients and their preliminary reports are equally diagnostic as cardiologist overreads. While JMO-led ESTs are just as safe, the preliminary reports differ significantly from cardiologist overread particularly with respect to sensitivity.
Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) are at an increased risk of Cardiovascular Disease (CVD) with >50% mortality risk. In cases where a resting Electrocardiograph (ECG) fails to detect the abnormal cardiac function, serum High-Sensitivity C-Reactive Protein (hsCRP) levels and Tread Mill Test (TMT) variables are prescribed independently for the CVD risk prediction. A possible link between TMT variables and underlying inflammation needs to be substantiated clinically. Aim: Evaluation of correlation between serum hsCRP levels and TMT variables in patients with T2DM. Materials and Methods: Over a period of three months, Thirty T2DM patients without clinical evidence of Coronary Artery Disease (CAD) were evaluated for complete haemogram, fasting and post prandial blood sugar, lipid profile, and serum hsCRP levels. Standard multistage maximal exercise test was conducted on a motorized treadmill according to Bruce protocol. Spearmen’s correlation coefficient was used for statistical analysis. Results: T2DM patients with higher serum hsCRP levels had lower exercise tolerance (r=-0.067; p=0.0001) and serum hsCRP levels increased with the duration of T2DM (r=0.55; p=0.002). Serum hsCRP levels and Heart Rate Recovery (HRR) at the end of first (r=-0.57) and second (r=-0.67) minute were statistically significant and showed negative correlation. Conclusion: The results suggested a possible role of inflammation in the stress test responses in patients with T2DM without overt heart disease. Incorporating both serum hsCRP levels and TMT for the assessment and evaluation of T2DM patients can improve the predictive risk for CVD.
