Cardiopulmonary exercise testing (CPET)to evaluate the efficacy after intensive control of personalized precise exercise training for cardiovascular and cerebrovascular chronic diseases

doi:10.12047/j.cjap.0092.2021.109

Abstract

Abstract: Objective: To study the symptom-restricted extreme cardiopulmonary exercise testing (CPET) to evaluate the improvement of the overall function of patients with long-term chronic diseases after intensive control of personalized precise exercise training for 3 months. Methods: We selected 20 patients with chronic cardiovascular and cerebrovascular metabolic diseases who were intensively controlled by our team from 2014 to 2016. After signing the informed consent form, based on the results of CPET and continuous functional tests, we formulated the overall management plan with individualized moderate exercise intensity as the core. After 3 months, CPET was performed. The changes of CPET indicators before and after intensive control in each patient were analyzed individually. Then the difference value and percentage difference value were calculated. Results: In this study, 20 patients (18 males and 2 females) with chronic cardiovascular and cerebrovascular metabolic diseases, aged (55.75±10.80, 26~73) years, height (172.20±8.63, 153~190) cm, weight (76.35±15.63, 53~105) kg, all patients were not any dangerous events during the period of CPET and intensive control.①After intensive control, the static pulmonary function index, resting systolic blood pressure, rate blood pressure product and fasting blood glucose were significantly improved (P<0.05).②Before intensive control, the peak oxygen uptake is (55.60±15.69, 34.37~77.45) % pred and anaerobic threshold is (60.11±12.26, 43.29~80.63)% pred; after intensive control, the peak oxygen uptake is (71.85±21.04, 42.40~102.00) % pred and anaerobic threshold (74.95±17.03, 51.90~99.47) %pred. Compared with before the intensive control, the peak oxygen uptake and anaerobic threshold of all patients after intensive control were significantly increased by (29.09±7.38,17.78~41.80) % and(25.16±18.38, 1.77~81.86)%(all P<0.01). Other core indexes were also improved significantly, including peak oxygen uptake,peak heart rate, peak work rate, oxygen uptake efficiency plateau, lowest value of carbon dioxide ventilatory efficiency, slope of ventilatory equivalent for carbon dioxide, ramp exercise duration(all P<0.01).③In terms of individualized analysis, after intensive control, the above 8 CPET core indexes were all improved in 15 cases, and 7 indexes in 5 cases were improved; the peak oxygen uptakeof all cases increased by more than 15%, 16 cases > 20%, 13 cases > 25%, 10 cases > 30%. Conclusion: CPET can safely, objectively and quantitatively evaluate the overall functional status and therapeutic effects, and guide the formulation of individualized precise exercise intensity. The overall plan of individualized precision exercise for three months can safely and effectively reverse the overall functional status of patients with long-term cardio-cerebrovascular metabolism diseases.

Key words: cardiopulmonary exercise testing, objective quantitative overall function assessment, the overall program of personalized precise exercise training, effective diagnosis and treatment of chronic diseases, the improvement overall function

CLC Number:

SONG Ya, SUN Xing-guo, XIE You-hong, TAI Wen-qi, WANG Ji-nan, ZHANG Ye, ZHANG Yan-fang, SHI Chao, HE Long-lin, HAO Lu, LIU Fang, FENG Jing, ZHANG Zhen-ying, LIU Yan-ling, YU Hong. Cardiopulmonary exercise testing (CPET)to evaluate the efficacy after intensive control of personalized precise exercise training for cardiovascular and cerebrovascular chronic diseases[J]. CJAP, 2021, 37(1): 79-88.

References

[1] 张珊,姜莹莹,董文兰,等. 2007-2016年中国居民慢性非传染性疾病死亡水平与变化趋势[J]. 中国慢性病预防与控制, 2018, 26(11): 801-804, 809.
[2] 王一然,王奇金. 慢性病防治的重点和难点:《中国防治慢性病中长期规划(2017——2025年)》解读[J]. 第二军医大学学报, 2017, 38(7): 828-831.
[3] 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2019概要[J]. 中国循环杂志, 2020, 35(9): 833-854.
[4] 孙兴国. 整体整合生理学医学新理论体系概论Ⅲ:呼吸循环代谢一体化调控环路中神经体液作用模式[J]. 中国应用生理学杂志, 2015, 31(4): 308-315.
[5] 孙兴国. 整体整合生理学医学新理论体系概论Ⅱ:循环调控新视野[J]. 中国应用生理学杂志, 2015, 31(4): 302-307.
[6] 孙兴国. 整体整合生理学医学新理论体系概论Ⅰ:呼吸调控新视野[J]. 中国应用生理学杂志, 2015, 31(4): 295-301.
[7] Whipp BJ, Ward SA.Cardiopulmonary coupling during exercise[J]. J Exp Biol, 1982, 100: 175-193.
[8] 孙兴国. 原始创新的生理学医学理论体系推动慢病有效防治和人民健康——”整体整合生理学医学”新理论体系介绍[J]. 中国科技成果, 2020, 21(1): 59-61.
[9] 孙兴国. 心肺运动试验在临床心血管病学中的应用价值和前景[J]. 中华心血管病杂志, 2014, 42(4): 347-351.
[10] 孙兴国. 生命整体调控新理论体系与心肺运动试验[J]. 医学与哲学:人文社会医学版, 2013, 34(3): 22-27.
[11] Booth FW, Roberts CK, Laye MJ.Lack of exercise is a major cause of chronic diseases[J]. Compr Physiol, 2012, 2(2): 1143.
[12] 孙兴国,胡大一. 心肺运动试验的实验室和设备要求及其临床实施难点的质量控制[J]. 中华心血管病杂志, 2014, 42(10): 817-821.
[13] 孙兴国. 心肺运动试验的规范化操作要求和难点-数据分析图示与判读原则[J]. 中国应用生理学杂志, 2015, 31(4): 361-365.
[14] ATS/ACCP statement on cardiopulmonary exercise testing[J]. Am J Respir Crit Care Med, 2003, 167(2): 211-277.
[15] Hansen JE, Sun XG, Stringer WW.A simple new visualization of exercise data discloses pathophysiology and severity of heart failure[J]. J Am Heart Assoc, 2012, 1(3): e1883.
[16] Hansen JE, Sun X, Wasserman K.Calculating gambling odds and lung ages for smokers[J]. Eur Respir J, 2010, 35(4): 776-780.
[17] Balady GJ, Arena R, Sietsema K, et al. Clinician's guide to cardiopulmonary exercise testing in adults[J]. Circulation, 2010, 122(2): 191-225.
[18] Sun X, Hansen JE, Oudiz RJ, et al. Pulmonary function in primary pulmonary hypertension[J]. J Am Coll Cardiol, 2003, 41(6): 1028-1035.
[19] Sun X, Hansen JE, Beshai JF, et al. Oscillatory breathing and exercise gas exchange abnormalities prognosticate early mortality and morbidity in heart failure[J]. J Am Coll Cardiol, 2010, 55(17): 1814-1823.
[20] 郑宏超,丁跃有,孙兴国,等. 经皮冠状动脉腔内血管成形术改变稳定性冠心病患者整体功能的临床研究[J]. 中国应用生理学杂志, 2015, 31(4): 378-382.
[21] 孙兴国. 更为强化心肺代谢等整体功能的心肺运动试验新9图图解[J]. 中国应用生理学杂志, 2015, 31(4): 369-373.
[22] Beaver WL, Wasserman K, Whipp BJ.A new method for detecting anaerobic threshold by gas exchange[J]. J Appl Physiol (1985), 1986, 60(6): 2020.
[23] 刘艳玲,孙兴国,高华,等. 心肺运动指导个体化心衰患者康复的初步总结报告[J]. 中国应用生理学杂志, 2015, 31(4): 374-377.
[24] 葛万刚,孙兴国,刘艳玲,等. 心肺运动试验精准制定个体化适度强度运动康复处方治疗高血压的疗效研究[J]. 中国全科医学, 2016, 19(35): 4316-4322.
[25] Low A, McCraty R. Heart rate variability: new perspectives on assessment of stress and health risk at the workplace[J]. Heart Mind, 2018, 2(1): 16-27.
[26] Sun Y, Bao Y, Ravindran A, et al. Mental health challenges raised by rapid socioeconomictransformations in China: Lessons learned andprevention strategies[J]. Heart Mind, 2020, 4(3): 59-66.
[27] 邓维,孙兴国,郭志勇,等.心肺运动试验定量评估PCI前后心肺功能的临床研究[J].重庆医科大学学报, 2019, 44(5): 668-673.
[28] Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease[J]. Eur Heart J, 2021, 42(1):17-96.
[29] Sun X, Hansen JE, Stringer WW.Oxygen uptake efficiency plateau: physiology and reference values[J]. Eur J Appl Physiol, 2012, 112(3): 919-928.
[30] Sun X, Hansen JE, Garatachea N, et al. Ventilatory efficiency during exercise in healthy subjects[J]. Am J Respir Crit Care Med, 2002, 166(11): 1443-1448.
[31] 张振英,孙兴国,席家宁,等. 心肺运动试验在慢性心力衰竭患者高强度个体化运动康复处方制定和运动康复效果评估中的作用研究[J]. 中国全科医学, 2016, 19(17): 2061-2067.
[32] 张振英,王立中,席家宁,等. 运动锻炼为核心的家庭心脏康复项目对慢性心力衰竭患者康复治疗效果影响的临床研究[J]. 中国心血管病研究, 2019, 17(8): 709-714.
[33] 王晓东,谢友红,孙兴国,等. 心肺运动试验精准制定个体化强度运动处方对代谢综合征患者心肺功能的影响[J]. 中国运动医学杂志, 2019, 38(1): 3-9.
[34] 刘彦表,陈浩,薛欣. 有氧运动对舒张期心力衰竭患者心肺功能及生活质量的影响[J]. 现代中西医结合杂志, 2015, 24(7): 726-728.
[35] 孙兴国. 心肺运动试验的原理和解读——病理生理及临床应用(第5版)[M]. 北京:北京大学医学出版社, 2018.1.