Clinical observation and research on the use of precise electromagnetic power meter (arm dynamometer) for upper limbs to evaluate the holistic function of cardiopulmonary metabolism

doi:10.12047/j.cjap.0091.2021.111

Abstract

Abstract: Objective: Subjects used upper limb (arm dynamometer) and lower limb precision electromagnetic power meter (cycle ergometer) to perform symptom-restricted limit cardiopulmonary exercise testing (CPET). Then we analyzed the clinical value of arm ergometer CPET. Methods: The upper limb and lower limb precision electromagnetic power meters were used to complete the CPET in two different days for 6 normal people and 9 chronic patients. We analyzed CPET data, calculated related core indicators, and compared normal subjects and chronic patients to analyze the similarities and differences between upper and lower extremities and their correlations. Results: ①Compared with 9 patients with chronic diseases, there were significant differences in age ((33.2±12.7) vs (53.6±8.5) years) and diagnosis in 6 normal people. ②The Peak HR ((131.0±19.0) vs (153.0±22.0) bpm,P<0.05) of upper limb CPET of 15 subjects were lower than lower limb CPET, but the difference in blood pressure was not statistically significant (P>0.05). The Peak V_T ((1.3±0.4) vs (1.8±0.4) L) and Peak VE ((51.4±21.1) vs (67.9±22.1) L/min) of lower limb CPET were significantly higher than that of upper limb (all P<0.05), and there was no significant difference in Peak BF When upper limb CPET was used, EX-time ((6.4±0.6) vs (8.5±1.2) min) was shorter than lower limb CPET; Peak Work Rate((73.2±19.6) vs (158.5±40.3) W/min), Peak VO₂((1.1±0.4) vs (1.7±0.4) L/min), AT ((0.6±0.2) vs (0.9±0.2) L/min), Peak VO₂/HR ((8.6±2.3) vs (10.9±2.6) ml/beat), OUEP (34.7±4.3 vs 39.8±5.3)were lower, and the Lowest VE/VCO₂(32.6±3.8 vs 28.7±4.9), VE/VCO₂Slope (33.9±4.3 vs 28.3±6.2)were higher than those of lower limb CPET (all P<0.05). The comparison results of the two subgroups of normal and chronic patients were the same as the holistic comparison results. ③EX-time, Peak HR, Peak BF, Peak VT and Peak VE of upper limb CPET had good correlation with the results of lower limb CPET. Besides, the measured value and percentage of the projected value of Peak Work Rate, the measured value, kilogram weight value of Peak VO₂ and AT, and percentage of the projected value of Peak VO₂, the measured value of Peak VO₂/HR also had good correlation. The measured value of OUEP, the measured value and percentage of the projected value of Lowest VE/VCO₂and VE/VCO₂Slope were also the same, when the other indicators had no significant correlation. Conclusion: As a supplement to lower limb CPET, upper limb CPET is highly feasible and safe for holistic functional status assessment. It provides an important supplement to guide the implementation of the holistic plan of individualized precision exercise, which is worthy of our further exploration.

Key words: upper limb precision electromagnetic power meter (arm dynamometer), lower limb precision electromagnetic power meter (power bicycle), cardiopulmonary exercise testing, feasibility, safety

CLC Number:

R339.4

TAI Wen-qi, SUN Xing-guo, SONG Ya, HAO Lu, WANG Ji-nan, ZHOU Qing-qing, SHI Chao, XU Fan, ZHANG Ye, LIU Fang. Clinical observation and research on the use of precise electromagnetic power meter (arm dynamometer) for upper limbs to evaluate the holistic function of cardiopulmonary metabolism[J]. CJAP, 2021, 37(1): 96-103.

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] Ross RM.ATS/ACCP statement on cardiopulmonary exercise testing[J]. Am J Respir Crit Care Med, 2003, 167(10): 1451.
[3] 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.
[4] 钱贞,陈伟,李瑾,等.四肢联动在健康青年人心肺适能评估中应用的可行性分析[J].中国全科医学, 2018, 21(35): 4340-4345.
[5] 胡菱,姜森林,赵冬琰,等.两种心肺运动试验在脑卒中偏瘫患者心肺功能评价中的对比研究[J].中国老年保健医学, 2019, 17(2): 3-6.
[6] 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.
[7] 卢志南,黄洁,孙兴国,等.终末期慢性心力衰竭患者运动中摄氧通气效率指标的临床应用[J].中华心血管病杂志, 2015, 43(1): 44-50.
[8] Wasserman K, Hansen JE, Sue DY, et al. Principles of exercise testing and interpretation-Including pathophysiology and clinical applications[M]. 5th ed, Philadelphia: LIPPINCOTT WILLIAMS & WILKINS, 2012.
[9] Sun XG, Hansen JE, Oudiz RJ, et al. Exercise pathophysiologyin patients with primary pulmonary hypertension[J]. Circulation, 2001, 104(4): 429-435.
[10] Sun XG, Hansen JE, Oudiz RJ, et al.Gas exchange detection of exercise-induced right-to-left shunt in patients with primary pulmonary hypertension[J].Circulation, 2002, 105(1): 54-60.
[11] 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.
[12] 卢志南,孙兴国,胡盛寿,等.应用峰值摄氧量、N末端B 型利钠肽原和超声心动图评估慢性心力衰竭患者心功能的比较[J].中华心血管病杂志, 2015, 43(3): 206-211.
[13] Wasserman K,Sun X,Hansen JE.Effect of biventricular pacing on the exercise pathophysiology of heart failure[J]. Chest, 2007, 132(1): 250-261.
[14] Sun XG,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.
[15] Sun XG, Hansen JE, Stringer WW.Oxygen uptake efficiency plateau best predicts early death in heart failure[J].Chest, 2012, 141(5): 1284-1294.
[16] 孙兴国,代雅琪,张也,等.心肺运动试验终止指征: 85%最大预计心率及特定收缩压界值的探讨[J].中国全科医学, 2018, 21(30): 3672-3679.
[17] 张也,孙兴国,郝璐,等. Max试验验证个体化症状限制性心肺运动试验为最大极限运动临床研究[J].中国全科医学, 2019, 22(20): 2441-2447.
[18] Bernasconi S, Tordi N, Perrey S, et al. Is the VO₂ slow component in heavy arm-cranking exercise associated with recruitment of type II muscle fibers as assessed by an increase in surface EMG?[J]. Appl Physiol Nutr Metab, 2006, 31(4): 414-422.
[19] Sousa A, Borrani F, Rodríguez FA, et al. Oxygen uptake kinetics is slower in swimming than arm cranking and cycling during heavy intensity[J]. Front Physiol, 2017, 8: 639.
[20] 徐泉,潘钰,张啸飞,等.脑卒中偏瘫患者心肺运动功能评估临床研究[J].中国康复医学杂志, 2016, 31(12): 1334-1338.
[21] Lennon OC, Denis RS, Grace N, et al. Feasibility, criterion validity and retest reliability of exercise testing using the Astrand-rhyming test protocol with an adaptive ergometerin stroke patients[J]. Disabil Rehabil, 2012, 34(14): 1149-1156.
[22] Olivier C, Doré J, Blanchet S, et al. Maximal cardiorespiratory fitness testing in individuals with chronic stroke with cognitive impairment: practice test effects and test-retest reliability[J]. Arch Phys Med Rehabil, 2013, 94(11): 2277-2282.