Exercise training increases oxygen uptake efficiency slope in chronic heart failure

Gademan, Maaike G.J.; Swenne, Cees A.; Verwey, Harriëtte F.; Vooren, Hedde van de; Haest, Joris C.W.; Exel, Henk J. van; Lucas, Caroline; Cleuren, Ger; Schalij, Martin J.; Wall, Ernst E. van der

doi:10.1097/hjr.0b013e3282ef19986

Cited by 43 publications

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“…The OUES has also been assessed before and after exercise training [74][75][76][77] and heart transplantation. 78 It has been demonstrated to improve after these interventions, indicating that the OUES has promise as a CPX marker sensitive to clinical change.…”

Section: Oxygen Uptake Efficiency Slopementioning

confidence: 99%

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

et al. 2016

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Abstract-In the past several decades, cardiopulmonary exercise testing (CPX) has seen an exponential increase in its evidence base. The growing volume of evidence in support of CPX has precipitated the release of numerous scientific statements by societies and associations. In 2012, the European Association for Cardiovascular Prevention & Rehabilitation and the American Heart Association developed a joint document with the primary intent of redefining CPX analysis and reporting in a way that would streamline test interpretation and increase clinical application. Specifically, the 2012 joint scientific statement on CPX conceptualized an easy-to-use, clinically meaningful analysis based on evidence-vetted variables in color-coded algorithms; single-page algorithms were successfully developed for each proposed test indication. Because of an abundance of new CPX research in recent years and a reassessment of the current algorithms in light of the body of evidence, a focused update to the 2012 scientific statement is now warranted. The purposes of this update are to confirm algorithms included in the initial scientific statement not requiring revision, to propose revisions to algorithms included in the initial scientific statement, to propose new algorithms based on emerging scientific evidence, to further clarify the application of oxygen consumption at ventilatory threshold, to describe CPX variables with an emerging scientific evidence base, to describe the synergistic value of combining CPX with other assessments, to discuss personnel considerations for CPX laboratories, and to provide recommendations for future CPX research. (Circulation. 2016;133:e694-e711.

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Section: Oxygen Uptake Efficiency Slopementioning

confidence: 99%

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

et al. 2016

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“…[1][2][3] We postulated that management of such patients could be improved by adding more sensitive predictors, further refi ning well-known predictors, or by combining predictors. Currently, in such patients, gas exchange measurements during incremental cardiopulmonary exercise testing (CPET) such as peak oxygen uptake (peak o 2 ) at standard conditions of 0ºC, 760 mm Hg, dry (STPD); anaerobic threshold (AT); peak oxygen pulse; lowest ratio of minute ventilation ( e) at body temperature, ambient atmospheric pressure, saturated with water vapor to minute CO 2 output ( co 2 ) STPD; e -vs-co 2 slope; oscillatory breathing (OB) pattern [3][4][5][6][7][8][9][10] ; and the slope of o 2 to log e (oxygen uptake effi ciency slope [OUES]) [11][12][13][14][15][16][17][18][19][20][21] have been found to be useful in predicting mortality and morbidity and guiding therapy. [3][4][5][6][7][8][9][10] However, the full exercise response pattern of oxygen uptake effi ciency (OUE) ( o 2 / e , mL/L) and specifi cally the measurement of its highest average plateau (OUEP) (mL/L) have not been evaluated.…”

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confidence: 99%

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Sun

Hansen

Stringer

2012

Chest

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Despite recent improvements in therapy, chronic left heart failure (HF) frequently requires hospitalization or is lethal. [1][2][3] We postulated that management of such patients could be improved by adding more sensitive predictors, further refi ning well-known predictors, or by combining predictors. Currently, in such patients, gas exchange measurements during incremental cardiopulmonary exercise testing (CPET) such as peak oxygen uptake (peak o 2 ) at standard conditions of 0ºC, 760 mm Hg, dry (STPD); anaerobic threshold (AT); peak oxygen pulse; lowest ratio of minute ventilation ( e) at body temperature, ambient atmospheric pressure, saturated with water vapor to minute CO 2 output ( co 2 ) STPD; e -vs-co 2 slope; oscillatory breathing (OB) pattern [3][4][5][6][7][8][9][10] ; and the slope of o 2 to log e (oxygen uptake effi ciency slope [OUES]) [11][12][13][14][15][16][17][18][19][20][21] have been found to be useful in predicting mortality and morbidity and guiding therapy. 3-10 However, the full exercise response pattern of oxygen uptake effi ciency (OUE) ( o 2 / e , mL/L) and specifi cally the measurement of its highest average plateau (OUEP) (mL/L) have not been evaluated.As the CPET core laboratory for two St. Jude Medical multicenter studies 3,22,23 involving 508 patientsBackground: The responses of oxygen uptake effi ciency (ie, oxygen uptake/ventilation 5 O 2 / E ) and its highest plateau (OUEP) during incremental cardiopulmonary exercise testing (CPET) in patients with chronic left heart failure (HF) have not been previously reported. We planned to test the hypothesis that OUEP during CPET is the best single predictor of early death in HF. Methods: We evaluated OUEP, slope of O 2 to log( E) ( oxygen uptake effi ciency slope ) , oscillatory breathing, and all usual resting and CPET measurements in 508 patients with low-ejectionfraction ( , 35%) HF. Each had further evaluations at other sites, including cardiac catheterization. Outcomes were 6-month all-reason mortality and morbidity (death or . 24 h cardiac hospitalization). Statistical analyses included area under curve of receiver operating characteristics, ORs, univariate and multivariate Cox regression, and Kaplan-Meier plots. Results: OUEP, which requires only moderate exercise, was often reduced in patients with HF. A low % predicted OUEP was the single best predictor of mortality ( P , .0001), with an OR of 13.0 ( P , .001). When combined with oscillatory breathing, the OR increased to 56.3, superior to all other resting or exercise parameters or combinations of parameters. Other statistical analyses and morbidity analysis confi rmed those fi ndings. Conclusions: OUEP is often reduced in patients with HF. Low % predicted OUEP ( , 65% predicted) is the single best predictor of early death, better than any other CPET or other cardiovascular measurement. Paired with oscillatory breathing, it is even more powerful.

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“…El EA prolonga la fase I de la cinética del consumo de oxígeno e incrementa la eficiencia en la pendiente de captación de oxígeno, lo cual es una medida de la función cardiopulmonar de reserva y tiene un alto valor pronóstico en la IC 8, 45 . El ejercicio aeróbico o combinado con entrenamiento de fuerza mejora significativamente la capacidad física y el VO2 max 25, 46 ; hay una tendencia hacia la superioridad del ejercicio intenso intermitente o de intervalos vs el aeróbico continuo 46 y hay evidencia de que el entrenamiento combinado maximiza los beneficios 14, 17, 46 .…”

Section: Efectos Del Ejercicio En La Capacidad Física Y El Vo2 Maxunclassified

Beneficios Del Ejercicio en La Insuficiencia Cardíaca

Márquez

Suárez

Márquez³

2013

Rev Chil Cardiol

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Recibido 31 agosto 2012/ Aceptado el 12 de marzo 2013La insuficiencia cardíaca es un síndrome incapacitante y frecuente que genera gran morbimortalidad y sus principales síntomas son fatiga, disnea e intolerancia al ejercicio. El ejercicio aeróbico, el de fuerza o el entrenamiento combinado tienen beneficios sobre la patogénesis, sínto-mas específicos, tolerancia al ejercicio, capacidad física, fuerza muscular, pronóstico, calidad de vida y aspectos psicosociales de los pacientes. El entrenamiento regular se asocia con múltiples adaptaciones centrales y periféricas con mecanismos claros que explican la mejoría del paciente con insuficiencia cardíaca; entre ellos están el cambio de la función cardíaca, respiratoria, vascular, neurohumoral, muscular, inflamatoria, antioxidante, etc. Revisiones sistemáticas, meta-análisis y estudios con buen diseño metodológico han encontrado disminución de las admisiones hospitalarias, tiempo de hospitalización, disminución de los costos, mejoría de los síntomas y efectos adversos y reducción de la mortalidad. El ejercicio adecuadamente prescrito es seguro y eficaz en el paciente con insuficiencia cardíaca. Para optimizar los beneficios del ejercicio regular se debe garantizar una buena adherencia al plan de entrenamiento.Palabras claves: Ejercicio, ejercicio aeróbico, entrenamiento de resistencia, insuficiencia cardíaca. 59Beneficios del ejercicio en la insuficiencia cardíaca Márquez J, et al.Heart failure is a common and disabling syndrome that generates high morbidity and mortality and its main symptoms are fatigue, dyspnea and exercise intolerance. Aerobic exercise, strength training or combined exercise have benefits on the pathogenesis, specific symptoms, exercise tolerance, physical capacity, muscle strength, prognosis, quality of life and psychosocial aspects of patients. Regular training is associated with multiple central and peripheral adaptations explained with clear mechanisms explaining the improvement of patients with heart failure. Included are the changes in cardiac, respiratory, vascular, neurohormonal and muscular functions, anti-inflammatory and anti-oxidant effects. Systematic reviews, meta-analysis and studies with good methodological design found decreased hospital admissions, length of stay, lower costs, improved symptoms and adverse effects and mortality reduction. Properly prescribed exercise is safe and effective in patients with heart failure. Good adhesion to the training plan is required to maximize the benefits of regular exercise in patients with heart failure.Keywords: Exercise, aerobic exercise, resistance training, heart failure. Beneficial effects of exercise in patients with heart failure IntroducciónLa Insuficiencia Cardíaca (IC) es un síndrome incapacitante y la mayoría de las veces es secundario a enfermedad coronaria o hipertensión arterial 1,2 . Es una de las enfermedades cardiovasculares más frecuentes y genera alta morbi-mortalidad1-3. Su prevalencia varía, según la edad, de 1-2% en personas de 55-64 años a ≥10% en los mayores de 70 año...

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Exercise training increases oxygen uptake efficiency slope in chronic heart failure

Cited by 43 publications

References 26 publications

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations

Oxygen Uptake Efficiency Plateau Best Predicts Early Death in Heart Failure

Beneficios Del Ejercicio en La Insuficiencia Cardíaca

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