Cardiopulmonary Exercise Testing - Science topic

Please do share any review of literature you come across. It would be very helpful.

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Alexandra,

Even though this is an old question, maybe this ansewer could help someone on this.

Any patient undergoing a Cardiac Rehabilitation Program (CRP), must be completed a protocol. This means, No limited by clinical conditions, A stress testing realized and an object to get with this.

In a phase II of CRP, one must be caution on target limits HR for  every exercise session. Obviously, when this phase is reached, the basal cardiovascular variables are in better status than those at beginning days.

So, this is a good moment to repeat another exercise stress test, establishing with this a new HR target.

So never, try to extralimite the HR target.

Nonin pulse oximetry are commonly used in clinical and rehabilitation settings. They are considered to be very reliable. All of the clinical settings that I have worked in have used them. 

In Low risk CAS, predictive negative is cuasi 100%. Good CTCoronary.....other strategy,low cost, is Score clinic EDACP-ADP (Than et al) : Score <16 without alt tropo/ECG at home. Most relevant CTAngiocoronary in intermedie risk!

Thank you for your response Alessio.

I will give that a try next time. Unfortunately, we wish to keep the chest closed so we  need to be very careful when implanting the catheter.

Daily sodium excretion by kidneys is depends on blood hydro static pressure on kidneys arterioles. The more blood pressure, the more daily sodium excretion. In order to  balance total daily sodium input and out put, kidneys regulate blood pressure at a point that it would maintain sodium balance. Therefore more sodium intake needs more blood pressure in order to kidneys can excrete same amount of sodium. Relationship between pressure and sodium excretion by kidneys is demonstrated as pressure-natriuresis curve.This curve vary in different people and depends on genetic and acquired variables.  

Hi Gabriel: There have been a few statements after the ones you mentioned.

The AHA's writing group led by Gerald Fletcher, recently updated their guidelines and it is available free online. The citation and the link are given below

Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA,

Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA; American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular and Stroke Nursing, and

Council on Epidemiology and Prevention. Exercise standards for testing and

training: a scientific statement from the American Heart Association.

Circulation. 2013 Aug 20;128(8):873-934

Before that, the EACPR and AHA produced a wonderful joint statement led by Marco Guazzi.

Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, Arena R,

Fletcher GF, Forman DE, Kitzman DW, Lavie CJ, Myers J; European Association for

Cardiovascular Prevention & Rehabilitation; American Heart Association. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012 Oct 30;126(18):2261-74

Apart from that there are also specific reviews on CPX in heart failure, PAH among other diseased conditions

I suppose that one might resort to modification of the basic conditions under which the exercise is applied. Assuming that your obese subjects are healthy, pre-loading with salt, e.g., using a 5-7 day high salt diet prior to testing could augment the effect of exercise, since high salt intake per se raises ANP [ Hypertension. 2002 May;39(5):996-9]. I presume that another aspect that you may choose to consider is the lipolytic response to ANP which is diminished in obese subjects, but shown to improve with endurance training.

Thanks a million, Jonas Rubenson and Páblius Silva. Rrgards

Hi Elisabeth

I agree with the comments by Ferran; there are a number of problems that can arise, but most important is that you may change the characteristics in the lag phase. However, some systems can account for this during calibration when you calibrate with the longer sample line. I do not think that changing the internal diameter is a good plan to compensate for increased length of the sample tube as that may well interefere with the rate at which the pump can deliver expired air to the oxygen and carbon dioxide sensors; so you may create other problems. When I tried this it did not seem to make any difference to results: I got a well trained cyclist to cycle at a submax workload and then swopped between a longer tube set-up and the standard set-up and compared results and they seemed the same. But see what the manufacturers have to say as well.

Pantelis is correct that aerobic fitness cannot be converted to a strength measure. However, there are health considerations when asking some one to perform a one repetition max (1-RM) due to the increased intrathoracic pressure as a result of the breath hold (valsalva manoeuvre) during lifting. It may be preferable (at least initially) to determine an appropriate weight by asking the client / patient for their rating of effort.