Effect of different work rate increasing rate on the overall function evaluation of cardiopulmonary exercise testing II— sub-peak parameters

doi:10.12047/j.cjap.0084.2021.114

Abstract

Abstract: Objective: To observe the effect of healthy volunteers different work rate increasing rate cardiopulmonary exercise testing (CPET) on the sub-peak parameters . Methods: Twelve healthy volunteers were randomly assigned to a moderate (30 W/min), a relatively low (10 W/min) and relatively high (60 W/min) three different work rate increasing rate CPET on different working days in a week. The core indicators related to CPET sub-peak exercise of 12 volunteers were compared according to standard Methods: anaerobic threshold (AT), oxygen uptake per unit power (ΔVO₂/ΔWR), oxygen uptake eficiency plateau,（OUEP), the lowest average of 90 s of carbon dioxide ventilation equivalent (Lowest VE/ VCO₂), the slope of carbon dioxide ventilation equivalent (VE/ VCO₂ Slope) and intercept and anaerobic threshold oxygen uptake ventilation efficiency value (VO₂/ VE@AT) and the anaerobic threshold carbon dioxide ventilation equivalent value (VE/ VCO₂@AT). Paired t test was performed on the difference of each parameter in the three groups of different work rate increasing rate. Results: Compared with the relatively low and relatively high work rate increasing rate group, the moderate work rate increasing rate group uptake eficiency plateau, (42.22±4.76 vs 39.54±3.30 vs 39.29±4.29) and the lowest average of 90 s of carbon dioxide ventilation equivalent (24.13±2.88 vs 25.60±2.08 vs 26.06±3.05) was significantly better, and the difference was statistically significant (P<0.05); Compared with the moderate work rate increasing rate group, the oxygen uptake per unit work rate of the relatively low and relatively high work rate increasing rate group increased and decreased significantly ((8.45±0.66 vs 10.04±0.58 vs 7.16±0.60) ml/(min·kg)), difference of which was statistically significant (P<0.05); the anaerobic threshold did not change significantly ((0.87±0.19 vs 0.87±0.19 vs 0.89±0.19) L/min), the difference was not statistically significant (P>0.05). Conclusion: Relatively low and relatively high power increase rate can significantly change the CPET sub-peak sports related indicators such as the effectiveness of oxygen uptake ventilation, the effectiveness of carbon dioxide exhaust ventilation, and the oxygen uptake per unit work rate. Compared with the moderate work rate increasing rate CPET, the lower and higher work rate increasing rate significantly reduces the effectiveness of oxygen uptake ventilation and the effectiveness of carbon dioxide exhaust ventilation in healthy individuals. The standardized operation of CPET requires the selection of a work rate increasing rate suitable for the subject, so that the CPET sub-peak related indicators can best reflect the true functional state of the subject.

Key words: cardiopulmonary exercise test, work rate increasing rate, sub-peak exercise related indicators, ventilation efficiency

CLC Number:

R332

HAO Lu, SUN Xing-guo, SONG Ya, LIU Fang, TAI Wen-qi, GE Wan-gang, LI Hao, ZHANG Ye, CHEN Rong, , ZOU Yu-xin, , MA Ming-xin, , XIA Rui, , HUANG Yan, XIE You-hong. Effect of different work rate increasing rate on the overall function evaluation of cardiopulmonary exercise testing II— sub-peak parameters[J]. CJAP, 2021, 37(2): 120-124.

References

[1] 宁亮,孙兴国.心肺运动试验在医学领域的临床应用[J].中国全科医学, 2013, 16(39): 3898-3902.
[2] Arena R, Myers J, Guazzi M.The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review[J]. Heart Fail Rev, 2008, 13(2): 245-269.
[3] Tsai HY, Tsai WJ, Kuo LY, et al. Oxygen consumption at anaerobic threshold predicts cardiac events after heart transplantation[J]. Transplant Proc, 2018, 50(9): 2742-2746.
[4] Gitt AK, Wasserman K, Kilkowski C, et al. Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death[J].Circulation, 2002, 106(24): 3079-3084.
[5] 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.
[6] Yao YX, Sun XG, Zheng Z, et al. Better parameters of ventilation-CO2 output relationship predict death in CHF patients[J]. Chin J Appl Physiol, 2015 , 31(6): 508-516.
[7] Sun XG, Hansen JE.Oxygen uptake efficiency plateau best predicts early death in heart failure[J]. Chest, 2012, 141(5): 1284-1294.
[8] Kleber FX, Vietzke G, Wernecke KD, et al. Impairment of ventilatory efficiency in heart failure: prognostic impact[J]. Circulation, 2000, 101(24): 2803-2809.
[9] Bard RL, Gillespie BW, Clarke NS, et al. Determining the best ventilatory efficiency measure to predict mortality in patients with heart failure[J]. J Heart Lung Transplant, 2006, 25(5): 589-595.
[10] Arena RA, Guazzi M, Myers J, et al. The prognostic value of ventilatory efficiency with beta-blocker therapy in heart failure[J]. Med Sci Sports Exerc, 2007, 39(2): 213-219.
[11] Tabet JY, Beauvais F, Thabut G, et al. A critical appraisal of the prognostic value of the VE/VCO₂ slope in chronic heart failure[J]. Eur J Cardiovasc Prev Rehabil, 2003, 10(4): 267-272.
[12] Sun XG, Hansen JE, Stringer WW.Oxygen uptake efficiency plateau: physiology and reference values[J]. Eur J Appl Physiol, 2012, 112(3): 919-928.
[13] Sun XG, 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.
[14] 郝璐,孙兴国,宋雅,等.不同功率递增速率对心肺运动试验整体功能评估的影响Ⅰ—峰值运动相关指标及呼吸交换率的变化[J]. 中国应用生理学杂志, 2021, 37(2): 113-119.
[15] Wasserman K.The anaerobic threshold measurement to evaluate exercise performance[J]. Am Rev Respir Dis, 1984, 129(2 Pt 2): S35-40.
[16] Hansen JE, Sue DY, Oren A, et al. Relation of oxygen uptake to work rate in normal men and men with circulatory disorders[J]. Am J Cardiol, 1987, 59(6): 669-674.
[17] Hansen JE, Casaburi R, Cooper DM, et al. Oxygen uptake as related to work rate increment during cycle ergometer exercise[J]. Eur J Appl Physiol Occup Physiol, 1988, 57(2): 140-145.
[18] 孙兴国,王桂芝, 吕婧,等.摄氧和二氧化碳排出通气效率是反映循环功能的指标[J].中华心血管病杂志, 2014, 42(12): 1022-1028.
[19] Arena R, Myers J, Aslam SS, et al. Peak VO₂ and VE/VCO₂ slope in patients with heart failure: a prognostic comparison[J]. Am Heart J, 2004, 147(2): 354-360.
[20] Guazzi M, De Vita S, Cardano P, et al. Normalization for peak oxygen uptake increases the prognostic power of the ventilatory response to exercise in patients with chronic heart failure[J]. Am Heart J, 2003, 146(3): 542-548.
[21] Tsurugaya H, Adachi H, Kurabayashi M, et al. Prognostic impact of ventilatory efficiency in heart disease patients with preserved exercise tolerance[J]. Circ J, 2006, 70(10): 1332-1336.
[22] Myers J, Arena R, Oliveira RB, et al. The lowest VE/VCO₂ ratio during exercise as a predictor of outcomes in patients with heart failure[J]. J Card Fail, 2009, 15(9): 756-762.
[23] Arena R, Myers J, Abella J, et al. Development of a ventilatory classification system in patients with heart failure[J]. Circulation, 2007, 115(18): 2410-2417.