Arm ergometry exercise testing in patients with dysvascular amputations

The purpose of this study was to test the agreement between the heart rate (HR) response and rating of perceived exertion (RPE) on an arm ergometry graded exercise test (GXT) in deconditioned persons with acute dysvascular amputations before and after an inpatient rehabilitation program. Twenty-six men were studied at admission, and 11 were retested after completion of the program. After obtaining resting measurements of HR and systolic and diastolic blood pressures, each patient performed the GXT using an arm ergometer. Patients maintained a cranking rate of 50rpm, which was monitored electronically. The workloads started with a warm-up period of 0 watts (stage 1) and increased by increments of 5 watts. Each stage lasted three minutes-2.5 minutes of exercise and 30 seconds of rest. The RPE was taken five seconds before the end of each exercise stage. During the rest period, HR and blood pressures were recorded. Scatter plots and linear regression analyses revealed no statistically significant relationship, either at early stages of GXT or at peak work, between HR and RPE. The results suggest that RPE cannot be used reliably as a surrogate for direct pulse measurement in exercise training of persons with acute dysvascular amputations.     

Exercise testing in patients with musculoskeletal handicaps

To determine safe and effective exercise testing techniques for musculoskeletally handicapped individuals, 20 patients (mean age, 61 years) were studied. Types of handicaps included various degrees of paralysis of arms and legs, and leg amputations. Seventeen of the 20 patients had concurrent cardiovascular problems. All were currently hospitalized, engaged in various physical therapy exercises, and referred for exercise testing to increase rehabilitation therapy or for cardiovascular evaluation. Of 20 tests, arm ergometry was used in 15, leg or combination arm-leg ergometry in four, and treadmill in one. All patients completed testing with mean increases in heart rate (82 to 106 bpm arm, 88 to 125 other) and systolic blood pressure (114 to 127 mmHg arm, 118 to 146 other). Low-grade atrial and ventricular ectopy occurred in eight patients, decrease or plateauing of systolic blood pressure in three, increased diastolic blood pressure in two, and significant (greater than or equal to 1mm) ECG S-T segment displacement in one. With the use of appropriate equipment for each patient, exercise testing can be done safely and effectively in musculoskeletally handicapped individuals.     

Variations in cardiovascular response accompanying differences in arm-cranking rate

Arm ergometry may be the only means of exercise testing for persons who cannot perform treadmill or bicycle ergometer testing. To determine the effects of arm-cranking rate on cardiovascular responses, ten healthy college students underwent maximal graded exercise testing on the arm ergometer. Each subject completed randomly ordered tests using 30-, 60-, and 70-rpm cranking rates at least seven days apart. Analysis of variance (ANOVA) indicated that both peak heart rate (HR) and rate pressure product (RPP) increased significantly with increases in cranking rate across the three tests (p less than .05). Peak systolic blood pressure (SBP) and oxygen uptake (VO2) for the 60- and 70- rpm tests was significantly higher than for the 30-rpm test (p less than .05). Peak work rate (WR) was significantly higher for the 70-rpm than for the 30-rpm test (p less than .05). Because RPP is an accepted index of myocardial oxygen consumption, the results indicated that the metabolic load on the heart was increased by increments in the cranking rate. The increases in RPP occurred as a function of the combined increases in HR and SBP as rpm increased from 60 to 70. Since increases in WR and VO2 did not occur as rpm increased from 60 to 70, the rise in HR and RPP may have occurred in response to factors other than the total-body oxygen demand.     

Maximal response of wheelchair-confined subjects to four types of arm exercise

Maximal work capacity and aerobic fitness of wheelchair-confined subjects generally have been determined by one of three modes of exercise: wheelchair ergometry, wheelchair exercise on a treadmill (TM), and arm crank ergometry. In the present study, two new types of arm ergometers, the Cybex Upper Body Exercise ergometer (CUBE) and the Schwinn Air-Dyne ergometer (SAE), have been evaluated and compared with older methods for determining aerobic capacities of wheelchair-confined subjects. Seven persons with paraplegia with lesions ranging from T-3 to L-1 and one bilateral amputee each performed four exercise tests to volitional exhaustion, on separate days, utilizing four modes of exercise. These included wheelchair exercise on a treadmill and arm exercise using a Monark arm ergometer (MAE), a CUBE, or an SAE. Peak values for oxygen consumption, heart rate, and blood lactate were similar during each type of exercise. Significant (p less than 0.05) differences were observed only in the peak values for minute ventilation (CUBE greater than MAE, SAE greater than MAE). The similarity of the maximal responses observed in this study indicates that the CUBE and SAE are comparable to TM exercise and to the MAE in assessing the aerobic capacity of wheelchair-confined subjects.     

Cardiovascular responses and anaerobic threshold for bicycle and arm ergometer exercise

Cardiovascular responses occurring at the anaerobic threshold (AT) were compared during intermittent bicycle and arm ergometry in eight healthy college students. Arm and bicycle tests used time-matched, discontinuous protocols (three-minute work stages alternated with three-minute rest intervals). Anaerobic threshold was determined by plotting expired minute volume (Ve) on oxygen consumption (VO2) and expressed as the percentage of the respective peak VO2 at which the deflection occurred. Analysis of variance revealed AT was similar for arm and bicycle tests. Absolute VO2 at AT was higher for bicycle than for arm ergometer exercise (p less than .05). Heart rate (HR) and rate pressure product (RPP) were higher for bicycle than for arm ergometry at AT (p less than .05). Moreover, a similarity in percent maximum RPP and percent maximum VO2 was observed at AT for arm ergometry, whereas percent maximum RPP was higher than percent maximum VO2 at AT for bicycle ergometry. Because AT has been suggested as an appropriate intensity of exercise for conditioning, it was concluded that a sufficient level of exercise intensity can be elicited at a lower percentage of the cardiovascular reserve for arm than for bicycle ergometer exercise.     

Development of an exercise testing protocol for patients with a lower limb amputation: results of a pilot study

Due to a decrease in physical activity, lower limb amputees experience a decline in physical fitness. This causes problems in walking with a prosthesis because energy expenditure in walking with a prosthesis is much higher than in walking with two sound legs. Exercise training may therefore increase the functional walking ability of these patients. To generate a safe and effective aerobic training program, exercise testing of amputees is recommended. The objectives of this study were to develop a maximal exercise testing protocol for lower limb amputees and to compare two different testing methods: combined arm-leg ergometry and arm ergometry. The protocols were tested in five amputee patients. Combined ergometry elicited a higher oxygen uptake and heart rate than arm ergometry. Electrocardiography during combined ergometry was easier to read. Combined ergometry was judged most comfortable by the amputees. The exercise testing protocol was useful in lower limb amputees to determine their maximal aerobic capacity and their main exercise limitation. Future exercise training programs may be based on this testing protocol. Combined arm-leg ergometry is appropriate for unilateral amputees without significant claudication of the remaining leg. Continuous arm ergometry is suitable for unilateral amputees with significant claudication of the remaining limb or bilateral amputees.     

Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations

OBJECTIVES: To examine 12-month reamputation and mortality rates as well as acute and postacute medical care costs among a large cohort of persons with dysvascular amputations. DESIGN: Retrospective cohort study. SETTING: General community. PARTICIPANTS: Medicare beneficiaries identified from the Centers for Medicare and Medicaid Services data as undergoing a lower-limb amputation secondary to vascular disease in 1996. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Twelve-month reamputation and mortality rates, and acute and postacute medical care costs, by initial amputation level and presence or absence of diabetes. RESULTS: A total of 3565 persons, corresponding to 71,300 Medicare beneficiaries nationwide, were identified from the claims data as undergoing lower-limb amputations in 1996. Twenty-six percent of them required subsequent amputation procedures within 12 months, and more than one third died within 1 year of their index amputation. Acute and postacute medical care costs associated with caring for beneficiaries with a dysvascular amputation exceeded $4.3 billion yearly. There were marked differences in patient characteristics, progression of amputation to higher levels, service use, and mortality among dysvascular amputees with and without a comorbidity of diabetes. Diabetic amputees were younger than those without diabetes; they were also more likely to be men, to have more comorbidities, and to have undergone their first amputation at an earlier age than persons with dysvascular amputations who did not have diabetes. Although diabetic amputees were less likely to die within 12 months of the index amputation, they died at a significantly younger age than their nondiabetic counterparts. Progression to a higher level of limb loss occurred most frequently (34.5%) among persons with an initial foot or ankle amputation. Diabetic amputees were more likely than nondiabetic amputees to experience progression to a higher amputation level for all initial amputation levels. CONCLUSIONS: This study provides information that can be used by physicians when counseling patients about expected outcomes of dysvascular amputations at different levels.     

The difference in blood pressure between upper arm and finger during physical exercise

Summary. A new apparatus which measures the blood pressure in the finger continuously and yet not invasively was tested for its usefulness during exercise. It was compared with upper arm measurements in 23 volunteers during prolonged bicycle ergometry. Simultaneously, a pulse plethysmogram was recorded from another finger of the same arm, whereas in six additional volunteers Doppler measurements were carried out on the radial artery. The results show that finger systolic pressure ceased to rise at about 40% of maximal exercise; the difference with the continuously rising systolic pressure in the upper arm becoming significant at 140 W. At the same time the amplitude of the finger plethysmogram became significantly higher than its initial value, indicating distinct cutaneous vasodilation, whereas the volunteers also became hot and started to perspire. However, the radial artery ‘flow’, deduced from the Doppler measurements, did not change significantly during exercise. It increased sharply and markedly in the cooling down period. Simultaneously with this increase in flow, HR and both systolic blood pressures fell drastically whereas the plethysmography amplitude remained about stable at its raised level. The results fit in with the idea that a compromise is achieved between the need for muscle activity and the need for temperature regulation. It is concluded that the Finapres functions well during exercise, but that the systolic pressure in the finger is not representative for its more central counterpart during cutaneous vasodilation. It is argued that opening up of AVAs may contribute to this pressure effect.     

Plasma nitroglycerin levels, blood pressure and apical heart rate variations to site of application of nitroglycerin ointment

The purpose of this study was to observe changes in plasma nitroglycerin levels, systolic and diastolic blood pressure, and apical heart rate after the administration of nitroglycerin ointment to selected sites. The sample consisted of 15 subjects with a diagnosis of coronary artery disease. The four application sites used were the fifth intercostal space of the left anterior chest, medial aspect of the left upper arm, medial aspect of the left thigh, and medial aspect of the left lower leg. There was no statistically significant difference in plasma nitroglycerin levels and diastolic blood pressure to site of application. Mean systolic blood pressure was significantly lower (p less than 0.05) for the upper arm and anterior chest sites than for the thigh and ankle at both 75 and 90 minutes. Mean heart rate was significantly higher (p less than 0.05) for the anterior chest than for the ankle at 45 and 60 minutes.     

Dysvascular amputee rehabilitation. The role of continuous noninvasive cardiovascular monitoring during physical therapy

Recognition of cardiac problems and their impact on the treatment of dysvascular amputees is important during rehabilitation because the energy demands and cardiac work loads of functional activities are substantially greater when performed by persons with amputation than when performed by control subjects. For this reason, monitoring the cardiovascular response to therapeutic exercise might be expected to enhance the medical and rehabilitative management of dysvascular amputees. In the present study, 31 amputees with peripheral vascular disease underwent continuous noninvasive dynamic cardiovascular monitoring during an initial physical therapy session. The sample had a mean age of 65 yr. There were 20 females. Twenty patients had unilateral below knee amputation. Fifty-two percent had a preamputation history of cardiac disease and six experienced major cardiovascular complications during rehabilitation. After a mean acute hospitalization of 20 days and a mean rehabilitation stay of 36 days, 11 patients were walking independently and 25 were discharged to home. During the monitored physical therapy session, patients achieved a mean maximum heart rate of 113 beats/min, mean maximum blood pressure of 159/81, mean maximum rate-pressure product of 14,546, and mean percent of age-predicted maximal heart rate of 73%. Seventeen (55%) patients demonstrated abnormalities during the monitored session, four of whom had no prior history of heart disease. These changes consisted predominantly of ST-T segment abnormalities, but also included exercise-induced arrhythmias and decreases in blood pressure. Patients with a history of heart disease demonstrated significantly more abnormalities during the monitored session than did those without a history of heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cycling program effects on one rheumatoid arthritic

These researchers investigated the effects of a progressive resistive, cycle ergometric exercise program on cardio-vascular endurance in one rheumatoid arthritic. The 46 yr. old, male subject exercised three days/week for 14 weeks. Workouts included interval-type training using 5 minute intervals for a total of 20-30 minutes (work rate set at 50-75 watts for each interval), not including 3-minute warm-up and cool-down periods (work rate set at zero resistance). Maximal exercise stress testing on the cycle ergometer was completed and blood samples collected before and after the exercise program. Also, psychological and physical health and lifestyle data were gathered before, during and after completion of the program. The conditioning program produced a training effect (greater than 75% of the HR max after the second exercise session) and blood values improved (10-28%) from the beginning to the end of the program. Finally, the program appeared to have a positive influence on various physical and psychological parameters as perceived by the subject and his wife.     

Angina and ST-segment depression during treadmill and arm ergometer testing in patients with coronary artery disease

The clinical use of exercise rehabilitation programs has increased for patients with coronary artery disease. Exercise testing in these programs typically is conducted on a treadmill or cycle ergometer, although many patients' vocations require upper extremity activities and some patients cannot perform lower extremity exercises. To compare the hemodynamic responses and the incidence of angina and ST-segment depression during upper and lower extremity exercise in patients with coronary artery disease, we administered symptom-limited arm ergometer and submaximal or maximal symptom-limited treadmill tests to 95 cardiac rehabilitation patients who had completed an eight-week exercise training program. Treadmill testing resulted in significantly higher heart rates, systolic blood pressures, and double products than arm ergometer testing. The incidence of ST-segment depression was significantly greater with treadmill testing than with arm ergometer testing, but the incidence of angina was not different between tests. Ten patients had ST-segment depression during both arm ergometer and treadmill testing, and the double products at the onset of ST-segment depression were not different. Our data suggest that arm ergometer testing is less likely to result in ST-segment depression than treadmill testing in patients with coronary artery disease, possibly because of the lower hemodynamic responses during arm ergometer testing.     

Comparison of different exercise tests in assessing outcomes of pulmonary rehabilitation

INTRODUCTION: Common modalities of clinical exercise testing for outcome measurement after pulmonary rehabilitation (PR) include walk tests, progressive cycle ergometry, and cycle endurance testing. We hypothesized that patients' responses to PR, as measured by those 3 tests, are differentially correlated, and we designed a study to investigate the tests' capacity to detect changes after PR. METHODS: We prospectively tested 37 male patients with stable chronic obstructive pulmonary disease who completed a comprehensive 6-week PR program that included supervised exercise training that emphasized steady-state lower-limb aerobic exercise. Before and after the PR program the patients underwent 6-minute walk test, progressive cycle ergometry, and cycle endurance testing (at 80% of the peak work rate achieved during progressive cycle ergometry). The exercise performance indices of interest were the peak oxygen uptake (VO2max) and maximum work-rate (Wmax) during progressive cycle ergometry, the cycling endurance time, and the 6-minute walk distance (6MWD). RESULTS: After PR there were statistically significant improvements in 6MWD (16%, p <0.001), VO2max (53%, p=0.004), Wmax (30%, p=0.001), and cycling endurance time (144%, p <0.001). The changes in VO2max and Wmax were significantly correlated (r=0.362, p=0.027), as were the changes in endurance time and Wmax (r=0.406, p=0.013). There was no significant correlation between changes in any other exercise index. CONCLUSIONS: Among the frequently used exercise tests in PR, the most responsive index is the endurance time. The correlation between the post-PR changes in the various exercise indices is poor.     

Prescriptive arm ergometry to optimize muscular endurance in acutely injured paraplegic patients

This study compared the effect of (1) continuous, (2) intermittent, and (3) graded exercise on the cardiopulmonary responses of 12 acutely injured paraplegic individuals having neurologically complete spinal lesions, between T7 and T12, and seven able-bodied control subjects. Continuous exercise consisted of cranking an arm ergometer at a constant rate of 30W. Intermittent exercise consisted of arm ergometry at 60W for 30-second periods interspersed with 30-second rest periods. In graded exercise, subjects worked for consecutive two-minute periods at rates of 10, 20, 30, 40, and 50W with no rest periods between work periods. Subjects exercised for 10 minutes or until they reached subjective fatigue. Heart rate (HR) and oxygen consumption (VO2) were measured during rest and work. Paraplegic subjects performed 4.93, 4.89, and 4.95 watt-hours of continuous, intermittent, and graded exercise respectively. Comparable figures for control subjects were 4.98, 4.91, and 4.96 watt-hours. There was a high degree of correlation between HR and VO2 in both paraplegic (r = 0.80) and normal (r = 0.85) subjects. Both VO2 and HR were highly correlated with work load in each group. Paraplegic subjects had significantly higher HRs (p less than 0.001), respiratory quotients (p less than 0.05), and ventilatory volumes (p less than 0.05) than control subjects. Graded exercise produced a significantly higher HR than continuous or intermittent exercise (p less than 0.001) during the final data collection period. Oxygen consumption during graded exercise was higher than VO2 for continuous or intermittent exercise (p less than 0.01) during the final data collection period.(ABSTRACT TRUNCATED AT 250 WORDS)     

Exercise-induced hypertension in normotensive patients with NIDDM

The aim of this study was to determine whether blood pressure during mild to moderate exercise is abnormal in patients with non-insulin-dependent diabetes mellitus (NIDDM). The study group consisted of 11 patients with NIDDM and 11 nondiabetic subjects of comparable age and body mass index. All subjects were sedentary and basally normotensive. Bicycle ergometry was used to assess the effect of exercise on blood pressure at a steady state of 70-75 W, with a target duration of 20 min. Blood pressure was measured basally and every 5 min. Greater exercise-induced systolic blood pressure (mean max 208.0 +/- 6.0 vs. 177.0 +/- 3.0 mmHg) occurred in the NIDDM group (P less than 0.001). Neither pulse rate nor diastolic blood pressure differed between the groups before or during exercise. Return to basal pulse and blood pressure was similar. Mild to moderate exercise induces greater systolic blood pressure in sedentary patients with NIDDM. Because exercise is recommended as one therapeutic modality, intraexercise blood pressure should be considered in assessing the safety of this form of treatment.     

Cardiac rehabilitation after coronary artery bypass grafting: effects on exercise performance and risk factors

After coronary artery bypass grafting (CABG), 49 nonselected patients followed a cardiac rehabilitation program that included medical follow-up and physical training, both in outpatient groups and on an individual basis at home. The effect of the program on exercise test variables, coronary risk factors, and medication one year after surgery was compared to a nonexercised control group (n = 98). The study group showed less increase in the rate-pressure product, indicating a favorable effect on myocardial oxygen consumption (0.7 +/- 5.4 vs 2.8 +/- 5.6, p less than .05); a lower frequency of angina at exercise testing (6% vs 18%, p less than .01); a reduction in resting systolic and diastolic blood pressure (9/4mmHg, p less than .01); fewer smokers (6% vs 17%, p less than .05); and fewer patients taking long-acting nitrates (0% vs 10.2%, p less than .05). It is suggested, therefore, that an organized cardiac rehabilitation program may be advantageous after CABG.     

急性脑梗塞患者语言活动前后血压变化观察

目的　观察急性脑梗塞患者语言活动前后血压变化的幅度和持续时间。方法　测量 86例急性脑梗塞患者右侧肱动脉血压 ,语言活动前测量 1次 ,活动后即刻、5、10、15分钟各测量 1次 ,并设正常对照组。结果　活动后与活动前比较 ,急性脑梗塞伴高血压组收缩压 :即刻有非常显著增高 (P <0 .0 0 1) ;5分钟也显著增高 (P <0 .0 5 )。结论　急性脑梗塞患者在生命体征稳定后、血压在 3级以下可进行适当语言活动 ,急性脑梗塞非高血压患者尚可加强之