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Cardiopulmonary Exercise Testing - Science topic

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Exploring the intersection of cardiac health and exercise, this inquiry delves into potential contraindications and precautions when prescribing physical activity for individuals with heart conditions. Examining the delicate balance between promoting fitness and safeguarding cardiac well-being, this exploration seeks insights into tailored exercise recommendations for cardiac patients.
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Please do share any review of literature you come across. It would be very helpful.
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I have seen some patients recently with history of HAPE at low altitude and also SIPE and wondered what their standard CPET profiles would look like.
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No suggestion
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When supervising phase II cardiac rehabilitation patients, we control the intensity using Watts on an exercise bike and Heart Rate HR. Some patients when completing their program are above their target HR calculated at their initial exercise test. Most of them are recovering from valve or artery replacement. In wich case should one prohibit going above the target HR?
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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.
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From the previous experience, we know that many pulse oximetries can't monitor pulse saturation well during exercise and low perfusion conditions, so we would like to ask which type pulse oximetry is more sensitivity and specificity for exercise monitoring. Thank you.
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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. 
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diagnosis of atypical chest pain
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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!
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We have tried a few catheter variations, but have found the results to be variable and unreliable. Ideally we want to modify a catheter that is available to purchase, but the stiffness and size of the catheter plays a huge role. Anyone with information/suggestions based on experience in this area would be great!
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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.
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Patients with elevated blood pressure should follow a weight-reducing diet, take regular exercise, and restrict alcohol and salt intake. Available evidence does not support relaxation therapies, calcium, magnesium or potassium supplements to reduce blood pressure.
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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.  
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I just have these:
ACC/AHA. American College of Cardiology Foundation e American Heart Association. Guideline Update for Exercise Testing: Circulation, 2002.
ATS/ACCP. ATS/ACCP Statement on Cardiopulmonary Exercise Testing. American Journal of Respiratory and Critical Care Medicine, v. 167, p. 211–77, 2003.
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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
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Obese subjects have a low plasma concentration for atrial natriuretic peptide (ANP). Even during exercise, the ANP response is not optimal. We are searching a good exercise testing protocol (maximal or submaximal) in order to further investigate this impaired response.
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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.
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Is there a portable gas analyzer which can examine physiological parameters within movements and dynamic actions? Where? And is it cheap to buy for our department?
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Thanks a million, Jonas Rubenson and Páblius Silva. Rrgards
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A longer sample tube could determine a time lag between the respiratory cycle and the measurement of inhaled and exhaled gases in breath by breath analysis. Could this problem be avoided reducing the thickness of the sample tube in order to maintain the same volume while improving its length?
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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.
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If a person has a peak workload with 200W in CPET, what weight is adequate for strength training for this man?
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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.