El puntaje de Framingham ayudaría en la estratificación del riesgo de pacientes con ergometría positiva y SPECT normal / The Framingham score could help in risk stratification of patients with positive ergometry and normal SPECT

Antecedentes. El valor pronóstico de una ergometría positiva en el contexto de imágenes tomográficas de perfusión miocárdica de estrés y reposo (SPECT) normales no está bien establecido. Objetivos. Documentar la incidencia de infarto, muerte y revascularización coronaria en pacientes con una ergometría positiva de riesgo intermedio e imágenes de perfusión SPECT normales, y explorar el potencial valor del puntaje de riesgo de Framingham en la estratificación pronóstica de estos pacientes. Métodos. Cohorte retrospectiva integrada por pacientes que habían presentado síntomas o hallazgos electrocardiográficos compatibles con enfermedad arterial coronaria durante la prueba de esfuerzo, con criterios de riesgo intermedio en la puntuación de Duke y perfusión miocárdica SPECT normal. Fueron identificados a partir de la base de datos del laboratorio de cardiología nuclear del Instituto de Cardiología y Cirugía Cardiovascular de la ciudad de Posadas, Argentina. Resultados. Fueron elegibles 217 pacientes. El seguimiento fue de 3 1,5 años. La sobrevida libre de eventos (muerte,infarto de miocardio no fatal, angioplastia coronaria o cirugía de bypass de arteria coronaria) a uno, tres y cinco años fue significativamente menor (Log-rank test, p= 0,001) en el grupo con puntaje de Framingham alto o muy alto (77, 71y 59 %, respectivamente) que en el grupo de puntaje bajo o intermedio (89, 87 y 83 %). Tomando como referencia a los pacientes con riesgo bajo en el puntaje de Framingham, luego de ajustar por edad, sexo y puntaje de Duke, los pacientes categorizados en los estratos alto y muy alto riesgo del puntaje de Framingham presentaron una incidencia del evento combinado cercana al triple (hazard ratio [HR] 2,81; intervalo de confianza [IC] del 95 % 0,91 a 8,72; p= 0,07 y HR 3,61;IC 95 % 1,23 a 10,56; p= 0,019 respectivamente). Conclusiones. La estimación de riesgo con el puntaje de Framingham sería de ayuda en la estratificación pronóstica de los pacientes con ergometría positiva y SPECT normal. (AU)

Background. The prognostic value of positive exercise testing with normal SPECT myocardial perfusion imaging is not well established. Objectives. To document the incidence of infarction, death, and coronary revascularization in patients with a positive intermediate-risk exercise test and normal SPECT perfusion images and to explore the potential value of the Framingham Risk Score in the prognostic stratification of these patients. Methods. A retrospective cohort comprised patients who presented symptoms or electrocardiographic findings compatible with coronary artery disease during the stress test, with intermediate risk criteria in the Duke score and normal SPECT myocardial perfusion. They were identified from the database of the nuclear cardiology laboratory of the Instituto de Cardiología y Cirugía Cardiovascular of Posadas, Argentina. Results. 217 patients were eligible. Follow-up was 3 1.5 years. Event-free survival (death, non-fatal myocardial infarction, coronary angioplasty, or coronary artery bypass surgery) at one, three, and five years was significantly lower (Log-ranktest, p: 0.001) in the group with a score of Framingham high or very high (77, 71 and 59 %, respectively) than in the lowor intermediate score group (89, 87 and 83 %). Taking as reference the low-risk patients in the Framingham score, after adjusting for age, sex, and Duke score, the patients categorized in the high-risk and very high-risk strata showed about three times higher incidence of the combined event (hazard ratio [HR] 2.81; 95 % confidence interval [CI] 0.91 to 8.72;p=0.07 and HR 3.61; 95 % CI 1.23 to 10.56; p=0.019 respectively). Conclusions. Risk estimation with the Framingham score would be helpful in the prognostic stratification of patients with positive exercise testing and normal SPECT. (AU)

El dilema clínico frente a los pacientes con ergometría positiva y prueba de perfusión miocárdica con SPECT normal / The clinical dilemma facing patients with positive stress test and normal SPECT myocardial perfusion imaging

La evaluación de la perfusión miocárdica con SPECT combina una prueba de esfuerzo (ergometría o estrés farmacológico) junto a imágenes de perfusión con radioisótopos. Este estudio es útil para establecer el diagnóstico de enfermedad arterial coronaria, estratificar el riesgo de infarto y tomar decisiones terapéuticas. Un resultado normal aporta un alto valor predictivo negativo, es decir, una muy baja probabilidad de que el paciente presente eventos cardiovasculares. El hallazgo de signos de isquemia en la ergometría podría poner en jaque el valor predictivo negativo de una perfusión normal. En presencia de este resultado, el paso siguiente es evaluar los predictores de riesgo en la ergometría, el riesgo propio del paciente en función de los antecedentes clínicos y el puntaje cálcico coronario, cuando este se encuentra disponible. Ante la presencia concomitante de otros marcadores de riesgo se sugiere completar la evaluación con un estudio anatómico.El uso de nuevas tecnologías podría mejorar la precisión en la predicción de eventos. (AU)

Assessment of myocardial perfusion with SPECT combines a stress test (ergometry or pharmacological stress) with radioisotope perfusion imaging. This test is helpful to diagnose coronary artery disease, stratify the risk of heart attack, and make therapeutic decisions. A normal result provides a high negative predictive value; therefore, the probability of cardiovascular events is very low. Signs of ischemia on an ergometry could jeopardize the negative predictive value of normal perfusion. In this clinical setting, the next step is to evaluate the risk predictors in the stress test, the individual risk based on the clinical history, and the coronary calcium score when available. Given the simultaneous presence of other risk markers,completing the evaluation with an anatomical study is suggested. The use of new technologies could improve the accuracy of event prediction. (AU)

Ergometría en el entrenamiento de alto rendimiento cubano / Ergometry in cuban high performance training

Introducción: El Centro de Investigaciones del Deporte Cubano, en estrecha relación con el Instituto de Medicina Deportiva, ha realizado en el Área de control cardiorrespiratorio numerosas pruebas funcionales a los deportistas de alto rendimiento. Como parte del control médico a los deportistas, se han ejecutado pruebas ergométricas cardiopulmonares en el laboratorio, con la novedad de ajustarse los protocolos a las necesidades especiales del atleta en función de su modalidad deportiva. Objetivos: Fundamentar la importancia de la ergometría cardiovascular para el entrenamiento deportivo y rediseñar protocolos de ergometría deportiva acordes a las especificidades de la modalidad atlética. Métodos: Se realizó un estudio descriptivo, longitudinal, en el periodo entre noviembre de 2019 y febrero de 2020. Muestra selectiva intencional, todos los deportistas de los equipos nacionales en cada modalidad: judo, boxeo y luchas (libre y grecorromana). Resultados: Se rediseñaron los protocolos de ergometría sobre la base de los convencionales estandarizados en medicina deportiva, para judo, boxeo y lucha. Se obtuvieron parámetros óptimos (frecuencia cardíaca, volumen máximo de oxígeno y equivalente metabólico) para cada modalidad deportiva. Conclusiones: Las pruebas ergoespirométricas constituyen una herramienta científica útil en la medicina deportiva. Rediseñar protocolos ergométricos permite una mejor valoración funcional del atleta y proporciona un adecuado soporte científico al entrenamiento individual. La ergometría cardiopulmonar es un instrumento disponible para evaluar, recuperar y mejorar las capacidades funcionales y deportivas de los atletas de alto rendimiento, especialmente en la etapa pos-COVID-19(AU)

Introduction: The Cuban Sports Research Center, in close relationship with the Institute of Sports Medicine, has carried out numerous functional tests on high-performance athletes for cardiorespiratory monitoring. As part of the medical control of athletes, cardiopulmonary ergometric tests have been carried out in the laboratory, with the novelty of adjusting the protocols to the special needs of the athlete depending on their sports modality. Objectives: To demonstrate the importance of cardiovascular exercise testing for sports training and to redesign sports exercise testing protocols according to the specificities of the athletic modality. Methods: A descriptive, longitudinal study was carried out from November 2019 to February 2020. Intentional selective sample, all the athletes of the national teams in each modality such as judo, boxing and wrestling. Results: The ergometry protocols were redesigned based on the conventional standardized in sports medicine, for judo, boxing and wrestling. Optimal parameters, as heart rate, maximum oxygen volume and metabolic equivalent, were obtained for each sports modality. Conclusions: Ergospirometric tests are a useful scientific tool in sports medicine. Redesigning ergometric protocols allows better functional assessment of the athletes and provides adequate scientific support for individual training. Cardiopulmonary ergometry is an instrument available to evaluate, recover and improve the functional and sports capacities of high-performance athletes, especially in the post-COVID-19 stage(AU)

Ergometría cardiovascular en la cultura física y el deporte / Cardiovascular ergometry in sports and physical culture

Introducción: La cultura física y el deporte tienen una gran importancia en el fortalecimiento de la salud humana y en la prevención de los procesos de enfermedad y envejecimiento. Dentro de las herramientas científico-tecnológicas utilizadas desde las ciencias aplicadas, la ergometría es uno de los instrumentos fundamentales en el campo médico deportivo. Puede ser empleada en la planificación del entrenamiento deportivo e igualmente, en el diagnóstico y la recuperación de la salud en los individuos enfermos, así como en el mantenimiento del bienestar físico en la persona sana, de cualquier grupo de edad. Objetivo: Fundamentar la importancia de la ergometría cardiovascular en apoyo a la cultura física y el deporte. Métodos: Se realizó una revisión de literatura científica y trabajos investigativos relacionados con los temas de cultura física y deporte en relación con la ergometría. Se revisaron los trabajos publicados actualmente en Medline con la interfaz PubMed. Desarrollo: La ergometría cardiovascular permite valorar indicadores fiables antes de iniciar toda práctica deportiva. Esto garantiza la implementación de planes de entrenamiento dirigidos sobre bases científicas y evidencia la elevación del rendimiento deportivo, de la calidad de vida y la salud. Conclusiones: La ergometría es una herramienta científico-tecnológica que permite avalar un inicio y mantenimiento eficaz del entrenamiento deportivo individualizado. Es necesaria para la implementación de un correcto programa de ejercicios físicos, que tiene como objetivos promover salud y mejorar los componentes de la aptitud física relacionados con la salud y la rehabilitación(AU)

Introduction: Physical culture and sports are of great importance in strengthening human health and in preventing disease and aging processes. Within the scientific-technological tools used by applied sciences, ergometry is one of the fundamental instruments in the sports medical field. It can be used in the planning of sports training and also in the diagnosis and recovery of health in sick individuals, as well as in the maintenance of physical well-being in the healthy person, of any age group. Objective: To prove the importance of cardiovascular ergometry in support of physical culture and sports. Methods: A review of scientific literature and research works related to the topics of physical culture and sports as to exercise testing was carried out. Articles currently published in Medline with the PubMed interface were reviewed. Findings: Cardiovascular ergometry allows to assess reliable indicators before starting any sports practice. This guarantees the implementation of specific training plans founded on scientific bases, which evidences the rise of sports performance, quality of life and health. Conclusions: Ergometry is a scientific-technological tool that allows to guarantee an effective start and maintenance of individualized sports training. It is necessary for the implementation of correct physical exercise programs, which aims to promote health and improve the components of physical fitness related to health and rehabilitation(AU)

Consideraciones médicas entorno a la reincorporación deportiva después de la COVID-19 / Medical considerations around sports resuming after COVID-19

RESUMEN Introducción: El 11 de marzo de 2020 se declaró por la Organización Mundial de la Salud (OMS) a la enfermedad causada por el coronavirus SARS-COV-2, la COVID-19, como pandemia global. Tanto en Cuba como en el mundo los gobiernos han dictado medidas para proteger la salud de sus habitantes. La alta capacidad de transmisión del germen y su elevada morbi-mortalidad ha tenido como consecuencia profundas afectaciones en todos los ámbitos de la sociedad, y el deporte no ha escapado de esta realidad. Objetivos: Definir los niveles de riesgo de contagio según deporte; elaborar recomendaciones generales de prevención respecto a la reincorporación deportiva en la etapa post COVID-19 y establecer las medidas para la realización de las pruebas ergométricas cardiovasculares a los deportistas. Métodos: Se realizó una revisión de literatura científica y trabajos investigativos relacionados con los temas de la ergometría en el contexto deportivo y la reincorporación de los atletas en la etapa después del COVID-19. Desarrollo: Se elaboraron las medidas en cuanto a acciones a seguir para evitar, tras la reanudación de la práctica deportiva, los contagios entre deportistas y personal que le acompaña, tanto en entrenamiento como en pruebas funcionales cardiorrespiratorias. Conclusiones: La reincorporación al entrenamiento deportivo y la realización de las pruebas cardiopulmonares deben cumplir con las recomendaciones entorno a la reanudación de la actividad atlética, donde será la prioridad minimizar los contagios por virus SARS-COV-2 y reducir la incidencia de las lesiones en los deportistas sometidos a un largo período de aislamiento.

ABSTRACT Introduction: On March 11, 2020, the disease caused by SARS-COV-2 coronavirus, COVID-19, was declared a global pandemic by the World Health Organization (WHO). Both in Cuba and in the world, governments have issued measures to protect the health of its inhabitants. The high transmission capacity of the germ and its high morbidity and mortality have had profound effects on all areas of society, and sport has not escaped this reality. Objectives: Define the levels of contagion risk according to sport; to develop general prevention recommendations regarding sports reincorporation in the post-COVID-19 stage and to establish measures for performing cardiovascular ergometric tests on athletes. Methods: A review of scientific literature and research papers was carried out on exercise testing in the sports context and the returning of athletes in the post-COVID-19 stage. Findings: Measures were drawn up in terms of actions to follow for avoiding contagion between athletes and accompanying personnel, after resuming sports practice, both in training and in cardiorespiratory functional tests. Conclusions: The return to sports training and the performance of cardiopulmonary tests must comply with the recommendations regarding the resumption of athletic activity, where it will be the priority to minimize infections by SARS-COV-2 virus and to reduce the incidence of injuries in athletes subjected to a long period of distancing.

VO 2 Estimation equation accuracy to young adults / Precisión de la ecuación de estimación del VO2 para adultos jóvenes

Objective: analyze the agreement of the V̇O2max values estimated by American College of Sports Medicine and Foster equations with direct measure gas analyze in young Brazilian males. The maximal oxygen uptake, as a health indicator and mortality predictor, can be assessed in different ways. The gold standard comprises the direct measurement of exhaled gases, which entails high cost. A more conveniently form can be estimation equations. Materials and methods: this study assessed VO2max of 41 young Brazilian males (21.4 ±2.2 years) by cardiopulmonary exercise test in a treadmill ergometer with a ramp protocol. Bland and Altman analysis was performed to verify the agreement between V̇ O2max measured and estimated values by ACSM and Foster equations. Results:the measured VO2max was 52.3 ± 4.9 ml.kg-1.min-1. The difference between the measured V̇O2max and the estimated V̇ O2max by the ACSM equation (9.40±3.67) was approximately 7.5 times greater than the difference between the measured V̇O2max and estimated V̇O2max by Foster's equation (1.25±3.46). Bland Altman graphics shows that only ACSM equation had mean differences that were significantly different from the measured value. Conclusions: the ACSM equation showed not appropriate for during treadmill stress testing young adults in a ramp protocol and Foster equation seems to be a more accurate estimator of V̇O2max for this population, besides showed a bias along the aerobic capacity, trending to overestimates and underestimates V̇O2max of least and most fit people, respectively..(AU)

Objetivo: analizar la concordancia de los valores de VO2max estimados por las ecuaciones del Colegio Americano de Medicina del Deporte y de Foster con el análisis de gases de medida directa en varones brasileños jóvenes. el consumo máximo de oxigeno, como un indicador de salud y predictor de mortalidad, se puede evaluar de diferentes maneras. El estándar de oro comprende la medición directa de los gases exhalados, lo que implica un alto costo. Una forma más conveniente puede ser las ecuaciones de estimación. Materiales y métodos: este estudio evaluó el VO2máx de 41 hombres brasileños jóvenes (21,4 ± 2,2 años) mediante una prueba de ejercicio cardiopulmonar en un ergómetro en cinta ergométrica con un protocolo de rampa. El análisis de Bland y Altman se realizó para verificar la concordancia entre V̇O2max medido y valores estimados por las ecuaciones del ACSM y de Foster. Resultados: el VO2max medido fue de 52,3 ± 4,9 ml.kg-1.min-1. La diferencia entre el V̇O2max medido y el VO2max estimado por la ecuación ACSM (9,40 ± 3,67) fue aproximadamente 7.5 veces mayor que la diferencia entre el VO2max medido y el VO2max estimado por la ecuación de Foster (1,25 ± 3,46). Los gráficos de Bland Altman muestran que solo la ecuación de ACSM tenía diferencias estadísticas del valor medido. Conclusiones: la ecuación ACSM no fue adecuada durante la prueba de ejercicio en cinta de correr en adultos jóvenes en un protocolo de rampa y la ecuación de Foster parece ser un estimador más preciso de VO2max para esta población, además mostró un sesgo a lo largo de la capacidad aeróbica, con tendencia a sobreestimar y subestimar VO2 máx. de personas menos y más en preparadas, respectivamente..(AU)

Rehabilitación cardiovascular en pacientes con infarto agudo de miocardio con elevación del segmento ST e intervencionismo coronario percutáneo / Cardiac rehabilitation in patients with ST-segment elevation acute myocardial infarction and percutaneous coronary intervention

RESUMEN Introducción: La rehabilitación cardiovascular es beneficiosa en múltiples situaciones clínicas. En pacientes que son tratados mediante intervencionismo coronario es necesario seguir profundizando su estudio. Objetivos: Determinar los efectos de la rehabilitación cardiovascular en pacientes con infarto agudo de miocardio con elevación del segmento ST a quienes se les realizó intervencionismo coronario percutáneo. Método: Estudio cuasi-experimental en 30 pacientes con infarto agudo de miocardio con elevación del ST después de ser tratados con angioplastia coronaria y que se atendieron en el Servicio de Rehabilitación Cardiovascular del Hospital Universitario Celestino Hernández Robau, en el período de septiembre de 2016 a marzo de 2018. Se recolectaron datos clínicos y epidemiológicos, y se analizaron variables ergométricas y ecocardiográficas al inicio y luego de 12 semanas de realizar un programa de rehabilitación cardiovascular. Resultados: Existió un efecto positivo en la frecuencia cardíaca en reposo (66±11 vs. 61±11 latidos/minuto; p=0,008), el tiempo de ejercicio (8,3±2,5 vs. 10,2±2,0 minutos; p<0,0001) y del máximo consumo de oxígeno (24,2±5,0 vs. 27,6±4,9 ml/kg/min; p<0,0001). Existió mejoría de la fracción de eyección y reducción del diámetro del ventrículo izquierdo en diástole, pero sin diferencia estadística significativa. Conclusiones: Existió mejoría en los parámetros ergométricos y ecocardiográficos luego del programa de rehabilitación cardiovascular, que fue más beneficioso en pacientes con hipertensión arterial, hábito de fumar e intervencionismo coronario percutáneo de dos arterias.

ABSTRACT Introduction: Cardiovascular rehabilitation is beneficial in multiple clinical situations. In patients who are treated through percutaneous coronary intervention it is necessary to continue deepening its study. Objectives: To determine the effects of cardiovascular rehabilitation in patients with ST-segment elevation acute myocardial infarction who underwent percutaneous coronary intervention. Method: Quasi-experimental study in 30 patients with ST-segment elevation acute myocardial infarction after being treated with coronary angioplasty, and who were attended at the Department of Cardiovascular Rehabilitation of the Hospital Universitario Celestino Hernández Robau, in the period from September 2016 to March 2018. Clinical and epidemiological data were collected, and ergometric and echocardiographic variables were analyzed before and after 12 weeks of developing a cardiovascular rehabilitation program. Results: There was a positive effect on heart rate at rest (66±11 vs. 61±11 beats/minute; p=0.008), exercise time (8.3±2.5 vs. 10.2±2.0 minutes; p <0.0001) and maximum oxygen consumption (24.2±5.0 vs. 27.6±4.9 ml/kg/min; p<0.0001). There was improvement of the ejection fraction and reduction of the diameter of the left ventricle in diastole left ventricular end diastolic diameter, but without significant statistical difference. Conclusions: There was improvement in the ergometric and echocardiographic parameters after the cardiovascular rehabilitation program, which was more beneficial in patients with high blood pressure, smoking habit and percutaneous coronary intervention of two arteries.

Relação entre hipertensão arterial sistêmica e doença isquêmica do miocárdio / Relation of systemic arterial hypertension in ischemic myocardial disease

Introdução: A Hipertensão Arterial Sistêmica (HAS) constitui um fator de risco para diversas doenças do aparelho cardiovascular, tendo a sua incidência aumentada nos últimos anos, sobretudo com o envelhecimento da população. Uma das Doenças Cardiovasculares mais graves constitui a Doença Isquêmica do Miocárdio (DIM), que, se não tratada, pode evoluir para sua forma aguda, o Infarto Agudo do Miocárdio. Objetivo: Relacionar a influência da HAS no desenvolvimento da DIM. Métodos: Foram analisados 409 dentre os 440 prontuários obtidos em uma clínica de exames diagnósticos em cardiologia conveniada aos SUS, sendo divididos em quatro grupos de acordo com a presença ou não de HAS e DIM. Foi realizado teste Qui Quadrado para análise nas variáveis. Resultados: 86,79% dos pacientes apresentaram DIM, destes 90,56% possuíam HAS. A idade média dos pacientes que apresentaram DIM e que possuíam HAS foi de 66,15 anos, enquanto os pacientes não HAS com DIM foi de 63,14 anos e composto, em sua maioria, por pacientes do sexo feminino (62,17%). O tamanho da área sob isquemia apresentou associação tanto com a idade dos pacientes quanto pela classificação da HAS. Em pacientes com HAS classe III correspondeu a 35,77% dos pacientes analisados. Destes pacientes, 56,82% apresentaram área de isquemia de grande tamanho. Conclusão: Pode-se concluir que a HAS possui estreita relação com o desenvolvimento da DIM. Visto isso, faz-se necessário alertar a população e realizar campanhas educativas com o intuito de reduzir ou controlar HAS

Introduction: Systemic Arterial Hypertension (SAH) is a risk factor for several diseases of the cardiovascular system, and its incidence has increased in recent years, especially with the aging of the population. One of the most serious Cardiovascular Diseases is Ischemic Myocardial Disease (SID), which, if untreated, can progress to its acute form, Acute Myocardial Infarction. Objective: To relate the influence of SAH in the development of SID. Methods: A total of 409 of the 440 charts obtained at a clinic of diagnostic exams in cardiology agreed to SUS were analyzed, being divided into 4 groups according to the presence or not of SAH and SID. Qui Quadrado test was performed to analyze the variables. Results: 86.79% of the patients presented DIM, of these 90.56% had SAH. The mean age of the patients presenting with SID and having SAH was 66.15 years, whereas the non-SAH patients with SID were 63.14 years and composed mostly of female patients (62.17%). The size of the area under ischemia was associated both with the age of the patients and with the classification of SAH. In patients with Class III hypertension, it corresponded to 35.77% of the patients analyzed. Of these patients, 56.82% presented a large area of ischemia. Conclusion: It can be concluded that hypertension has a close relationship with the development of SID. Given this, it is necessary to alert the population and carry out educational campaigns with the aim of reducing or controlling SAH.

Validation of the ST3x1 Step Test as an estimator of peak VO2 in adults with cardiovascular risk factors / Validación del Test de Escalón ST3x1 como estimador del VO2 pico en adultos con factores de riesgo cardiovascular

Abstract Objective: To validate a tool for assessment and control of functional capacity and peak oxygen uptake. Methods: A transversal, correlational study was conducted in which 111 subjects (49.81 ± 11.16 years) were evaluated, their body mass index (BMI) was 31.42 ± 4.07, classified with moderate and high cardiovascular risk, according to the American Association of Cardiovascular and Pulmonary Rehabilitation. Its peak oxygen uptake was measured directly and also through the Step Test 3x1 (ST3x1). Results: Peak oxygen uptake in ST3x1 corresponded to 28.54 ml•kg-1•min-1 and direct measurement at 28.14 ml•kg-1•min-1, with a "strong positive" Pearson correlation r = 0.81, Student n/s p = 0.14 Conclusion: ST3x1 is a valid alternative to estimate peak oxygen uptake in the group studied, and can be used in mass public health physical activity programs.

Resumen Objetivo: Validar una herramienta de estimación y control de la capacidad funcional y el consumo de oxígeno pico. Materiales y métodos: Se realizó un estudio transversal, correlacional donde se evaluaron a 111 sujetos (49.81 ± 11.16 años), su índice de masa corporal (IMC) fue de 31.42 ± 4.07, clasificados con riesgo cardiovascular mediano y alto, según la American Association of Cardiovascular and Pulmonary Rehabilitation. Se midió su consumo pico de oxígeno en forma directa y también a través del Step Test 3x1 (ST3x1). Resultados: El consumo de oxígeno pico en ST3x1 correspondió a 28.54 mlŸkg -1 Ÿmin -1 y en la medición directa a 28.14 mlŸkg -1 Ÿmin -1, con una correlación de Pearson fuerte positiva r = 0.81, Student n/s p = 0.14. Conclusión: ST3x1 se presenta como alternativa para estimar el consumo de oxígeno pico en el grupo estudiado, pudiendo ser usado en programas masivos de actividad física en salud pública.

Evaluación del nivel de eficiencia física a estudiantes de Medicina / Evaluation of the level of physical efficiency in medical students

Introducción: La calidad del proceso enseñanza-aprendizaje en las clases de Educación Física, depende del desarrollo adecuado de habilidades y capacidades físicas, esto implica la búsqueda de vías más factibles para poder determinar con mayor acierto las deficiencias de nuestros estudiantes. Objetivo: Evaluar el nivel de eficiencia física a estudiantes de Medicina. Material y Métodos: Se realizó un estudio explicativo con diseño experimental, en la Filial de Ciencias Médicas Gabriela Arias del municipio de Cárdenas, en el curso escolar 2015-2016. El universo estuvo constituido por 54 estudiantes de Medicina de primer año quienes cumplieron con los criterios de inclusión; seleccionaron una muestra de 20, que se distribuyeron aleatoriamente en dos grupos, al grupo control se les aplicó las pruebas de aptitud físicas integradoras del programa de la signatura Educación Física y al grupo estudio las pruebas funcionales de terreno. Resultados: Las pruebas de aptitud físicas integradoras establecidas por el programa, no poseen ninguna prueba que determine la capacidad aeróbica y, por ende, los P1 no cuentan con la calidad científica requerida. Las pruebas funcionales de terreno permiten realizar una correcta planificación de las cargas de entrenamiento y lograr cumplir con los objetivos de la preparación, conociendo las características funcionales de los estudiantes y sus respuestas a las cargas de entrenamiento. Conclusiones: La aplicación de las pruebas funcionales de terreno permite una mayor integralidad en el proceso de evaluación de los diferentes sistemas energéticos, aeróbicos y anaeróbicos(AU)

Introduction: The quality of the teaching-learning process in Physical Education, depends on the appropriate development of abilities and physical capacities, which implies the search of more appropriate ways of determining the deficiencies of our students in a more successful way. Objective: To evaluate the level of physical efficiency in medical students. Material and Methods: An explanatory study with experiment design was conducted in the Subsidiary of Medical Sciences Gabriela Arias in Cárdenas municipality during the 2015-2016 academic year. The universe was composed of 54 first year medical students that fulfilled the inclusion criteria; a sample of 20 students was selected, who were randomly distributed in two groups. Tests of physical integrated behavior corresponding to the Physical Education syllabus were applied to the control group; and field tests of functional performance were applied to the experimental group. Results: The tests of physical integrated behavior conceived in the syllabus, do not demonstrate any evidence that determines the aerobic capacity; therefore, the lesson plans do not have the required scientific quality. The field tests of functional performance allow to carry out a correct planning of the training loads to be able to fulfill the objectives of the preparation, knowing the functional characteristics of the students and their responses to the training loads. Conclusions: The application of the field tests of functional performance provides a greater comprehensiveness in the evaluation process of the different energetic, aerobic, and anaerobic systems(AU)

Sex-Specific Equations to Estimate Maximum Oxygen Uptake in Cycle Ergometry / Equações Específicas por Sexo para Estimativa do Consumo Máximo de Oxigênio em Cicloergometria

AbstractBackground:Aerobic fitness, assessed by measuring VO2max in maximum cardiopulmonary exercise testing (CPX) or by estimating VO2max through the use of equations in exercise testing, is a predictor of mortality. However, the error resulting from this estimate in a given individual can be high, affecting clinical decisions.Objective:To determine the error of estimate of VO2max in cycle ergometry in a population attending clinical exercise testing laboratories, and to propose sex-specific equations to minimize that error.Methods:This study assessed 1715 adults (18 to 91 years, 68% men) undertaking maximum CPX in a lower limbs cycle ergometer (LLCE) with ramp protocol. The percentage error (E%) between measured VO2max and that estimated from the modified ACSM equation (Lang et al. MSSE, 1992) was calculated. Then, estimation equations were developed: 1) for all the population tested (C-GENERAL); and 2) separately by sex (C-MEN and C-WOMEN).Results:Measured VO2max was higher in men than in WOMEN: -29.4 ± 10.5 and 24.2 ± 9.2 mL.(kg.min)-1 (p < 0.01). The equations for estimating VO2max [in mL.(kg.min)-1] were: C-GENERAL = [final workload (W)/body weight (kg)] x 10.483 + 7; C-MEN = [final workload (W)/body weight (kg)] x 10.791 + 7; and C-WOMEN = [final workload (W)/body weight (kg)] x 9.820 + 7. The E% for MEN was: -3.4 ± 13.4% (modified ACSM); 1.2 ± 13.2% (C-GENERAL); and -0.9 ± 13.4% (C-MEN) (p < 0.01). For WOMEN: -14.7 ± 17.4% (modified ACSM); -6.3 ± 16.5% (C-GENERAL); and -1.7 ± 16.2% (C-WOMEN) (p < 0.01).Conclusion:The error of estimate of VO2max by use of sex-specific equations was reduced, but not eliminated, in exercise tests on LLCE.

ResumoFundamento:A condição aeróbica, avaliada pela medida do VO2máx no teste cardiopulmonar de exercício máximo (TCPE) ou estimada por equações no teste de exercício, é preditora de mortalidade. Porém, o erro obtido pela estimativa em um dado indivíduo pode ser alto, afetando decisões clínicas.Objetivo:Determinar o erro de estimativa do VO2máx em cicloergometria em população atendida nos serviços de ergometria e propor equações específicas por sexo para minimizar o erro na estimativa do VO2máx.Métodos:Foram avaliados 1715 adultos (18 a 91 anos) (68% homens) submetidos a TCPE máximo em cicloergômetro de membros inferiores (CMI) com protocolo de rampa. Calculou-se o erro percentual (E%) entre o VO2máx medido e o estimado pela equação ACSM modificada (Lang e col. MSSE, 1992). A seguir, foram desenvolvidas equações de estimativa: 1) para toda a amostra testada (C-GERAL) e 2) separadamente por sexo (C-HOMENS e C-MULHERES).Resultados:O VO2máx medido foi maior em homens do que em mulheres - 29,4 ± 10,5 e 24,2 ± 9,2 mL.(kg.min)-1 (p < 0,01) -. As equações de estimativa do VO2máx foram mL.(kg.min)-1: C-GERAL = [carga final (W)/peso (kg)] x 10,483 + 7; C‑HOMENS = [carga final (W)/peso (kg)] x 10,791 + 7; e C-MULHERES = [carga final (W)/peso (kg)] x 9,820 + 7. Os E% em homens foram -3,4 ± 13,4% (ACSM modificada), 1,2 ± 13,2% (C-GERAL) e -0,9 ± 13,4% (C-HOMENS) (p < 0,01). Em mulheres, obtivemos: -14,7 ± 17,4% (ACSM modificada), -6,3 ± 16,5% (C-GERAL) e -1,7 ± 16,2% (C-MULHERES) (p < 0,01).Conclusão:O erro de estimativa do VO2máx através de equações específicas por sexo foi reduzido, porém não eliminado, nos testes de exercício em CMI.

Effect of Regular Exercise on Cardiopulmonary Fitness in Males With Spinal Cord Injury

OBJECTIVE: To evaluate the cardiopulmonary endurance of subjects with spinal cord injury by measuring the maximal oxygen consumption with varying degrees of spinal cord injury level, age, and regular exercise. METHODS: We instructed the subjects to perform exercises using arm ergometer on healthy adults at 20 years of age or older with spinal cord injury, and their maximal oxygen consumption (VO2max) was measured with a metabolic measurement system. The exercise proceeded stepwise according to the exercise protocol and was stopped when the subject was exhausted or when VO2 reached an equilibriu RESULTS: Among the 40 subjects, there were 10 subjects with cervical cord injury, 27 with thoracic cord injury, and 3 with lumbar cord injury. Twenty-five subjects who were exercised regularly showed statistically higher results of VO2max than those who did not exercise regularly. Subjects with cervical injury showed statistically lower VO2max than the subjects with thoracic or lumbar injury out of the 40 subjects with neurologic injury. In addition, higher age showed a statistically lower VO2max. Lastly, the regularly exercising paraplegic group showed higher VO2max than the non-exercising paraplegic group. CONCLUSION: There are differences in VO2max of subjects with spinal cord injury according to the degree of neurologic injury, age, and whether the subject participates in regular exercise. We found that regular exercise increased the VO2max in individuals with spinal cord injury.

Tempo de Exercicio como Indicador de Controle de Qualidade em Servicos de Ergometria / Time of Exercise as Indicator of Quality Control in Ergometry Services

Fundamento: A busca pela qualidade exige ferramentas de avaliação nas diversas subdivisões de um complexo de saúde. Na medicina diagnóstica eles são escassos e em ergometria não foram encontradas sugestões de indicadores. Objetivo: Estabelecer indicador para controle de qualidade em ergometria baseado nas III Diretrizes da Sociedade Brasileira de Cardiologia Sobre Teste Ergométrico; verificar o percentual dos testes que apresentaram o indicador dentro da conformidade em dois serviços de uma mesma instituição, antes e após a publicação do documento. Métodos: Foi realizada análise crítica das diretrizes em busca de indicador que apresentasse: exatidão, confiabilidade, simplicidade, validade, sensibilidade e capacidade de medir quantitativamente as variações no comportamento dos critérios de qualidade e que fosse aplicável a todos os testes. O indicador foi aplicado nos testes de 2010, anterior à publicação e 2011, depois que ele foi adotado, por dois serviços de uma mesma instituição. Resultados: O indicador que preencheu os critérios foi o de percentual de exames ergométricos com duração do exercício entre 8 e 12 minutos. Nos anos 2010 e 2011, respectivamente, os percentuais de testes ergométricos dentro da conformidade foram 85,5% e 86,1% (p = 0,068) no Hospital Geral, e 81,5% e 85,7% (p < 0,001) no Serviço de Avaliação Periódica de Saúde. Conclusão: O tempo do exercício entre 8 e 12 minutos pode ser utilizado como critério de qualidade em ergometria e nos serviços onde ele foi aplicado, pelo menos 80% dos testes ergométricos estiveram conformes. .

Background: The search for quality requires assessment tools in the various subdivisions of a health complex. In diagnostic medicine, they are scarce and in ergometry suggestions of indicators were not found. Objective: To establish indicator for quality control on ergometry based on III Guidelines of the Brazilian Cardiology Society About Ergometric Test; to verify the percentage of tests that have presented the indicator within the compliance in two services of the same institution before and after the publication of the document. Methods: A critical analysis of the guidelines in the search for indicator that would present: accuracy, reliability, simplicity, validity, sensitivity and ability to quantitatively measure the variations in the behavior of quality criteria and that would be applicable to all tests. The indicator was applied in tests of 2010 and 2011 prior to the publication, and after it was adopted by two services of the same institution. Results: The indicator that has met the criteria was the percentage of ergometric tests with exercise duration between 8 and 12 minutes. In the years 2010 and 2011, respectively, the percentage of ergometric tests within compliance were 85.5% and 86.1% (p = 0.068) at the General Hospital, and 81.5% and 85.7% (p <0.001) the Service of Periodic Health Assessment. Conclusion: The exercise time between 8 and 12 minutes can be used as a quality criterion in ergometric and services where it was applied, at least 80% of the ergometric tests were compliant. .

Valor del score de Atenas en el diagnóstico de cardiopatía isquémica

Antecedentes: la aparición de ángor y/o infradesnivel del segmento ST durante la prueba ergométrica graduada (PEG) permite hacer el diagnóstico presuntivo de cardiopatía isquémica (CI). Otros cambios electrocardiográficos podrían ser de utilidad. Uno de ellos es el score de Atenas (SDA), que relaciona los cambios de amplitud del complejo QRS en reposo y en el posesfuerzo inmediato (PEI). El propósito de nuestro estudio es determinar la validez del SDA en el diagnóstico de CI; secundariamente, evaluar su correlación con la clase funcional (CF) del paciente y el incremento del doble producto (DP) durante la PEG. Material y método: se realizó un análisis retrospectivo en 75 pacientes remitidos a estudio de perfusión miocárdica (EPM) sensibilizados con PEG. En 25 pacientes se diagnosticó isquemia por la presencia de defectos reversibles de grado moderado a severo. Resultados: en los valores medios del SDA no se hallaron diferencias estadísticamente significativas entre los grupos. En EPM (+) fue -0,16 mm (DS±4,39) y en EPM (-) 1,88 mm (±4,3) (p=0,062). En cambio, existen diferencias significativas en los pacientes con CF I (>7 MET) o un DP>2,5 veces el basal. En los primeros, el SDA fue -3,73 mm (±6,83) en los EPM (+) y 5,2 mm (±4,34) en los EPM (-) (p<0,02). En aquellos con incremento del DP >2,5 veces, el SDA fue -1,57 mm (±6,99) en los EPM (+) y 3,64 mm (±4,72) en los EPM (-) (p<0,03). Conclusiones: el SDA tiene utilidad para predecir isquemia moderada a severa en el EPM en aquellos pacientes en CF I o que incrementen dos veces y media el DP en la PEG.

Background: the onset of angina and/or ST segment displacement during exercise testing (ET) is useful in the diagnosis of ischemic heart disease (IHD). Other changes in the electrocardiogram also may be of diagnostic value. One of them is the QRS or Athens Score (SDA) based in changes in the amplitude of the QRS complex recorded at rest and immediately post-stress. The purpose of this study is to determine the validity of the SDA in the diagnosis of IHD, secondarily, to evaluate SDA results according the functional class (CF) and the increment in the double product (DP) during the ET. Material and method: we conducted a retrospective study in 75 patients referred to perform myocardial perfusion imaging (EPM) with ET. The diagnosis of ischemia was done in 25 patients with moderate to severe reversible defects. Results: the SDA mean value expressed in mm (±SD) was -0,16 ± 4,39 for EPM (+) and 1,88 ± 4,3 for EPM (-), the difference was non-significant (p=0.062). However, there were significant differences in patients with CF I (> 7 MET) or a DP >2,5 times the baseline. In the first, the SDA was -3,73 ± 6,83 in EPM (+) and 5,2 ± 4,34 in the EPM (-) (p< 0,02). In those with DP increased >2.5 times, the SDA was -1,57 ± 6,99 in the EPM (+) and 3,64 ± 4,72 EPM (-) (p<0,03). Conclusion:the SDA have diagnostic utility for predicting moderate to severe ischemia in the EPM in those patients with CF I or an increment of the DP >2,5 in the ET.

Avaliação da capacidade aeróbia determinada por respostas sanguíneas e ventilatórias em quatro diferentes ergômetros / Assessment of aerobic capacity through blood and ventilatory responses in four different ergometers

O objetivo do presente estudo foi comparar as intensidades do ponto de compensação respiratório (PCR), limiar anaeróbio de concentração fixa (OBLA3,5) e limiar anaeróbio de lactato de aumento abrupto lactacidêmico (LAnLAC) determinadas em diferentes ergômetros. Para isso, onze mesatenistas (19±1 anos) realizaram testes incrementais máximos no cicloergômetro, ergômetro de braço, esteira e em teste específico para o tênis de mesa. Durante esses esforços, foram mensuradas as repostas lactacidêmica e respiratória. Na análise intraergômetro, não foram encontradas diferenças significativas entre o PCR, LAnLAC e OBLA3,5 no ergômetro de braço (63,4±4,8W, 66,9±4,5W e 64,5±6,1W, respectivamente), esteira (11,4±0,4km.h-1, 11,3±0,3km.h-1 e 11,1±0,3km.h-1, respectivamente) e teste específico (40,5±1,8bolas.min-1, 42,6±3,6bolas.min-1 e 42,8±5,6bolas.min-1, respectivamente); apenas no cicloergômetro foi verificado menor valor de OBLA3,5 (131,9±6,6W) em relação ao PCR (149,3±4,9W) e o LAnLAC (149,3±4,7W). No entanto, fortes e significativas correlações foram verificadas no teste específico entre todos esses métodos (r entre 0,83 a 0,95), entre o PCR e OBLA3,5 no ergômetro de braço (r=0,78) e entre OBLA3,5 e LAnLAC na esteira (r=0,76). Desse modo, podemos concluir que o PCR, OBLA3,5 e LAnLAC parecem corresponder ao mesmo fenômeno fisiológico, principalmente, no teste específico para o tênis de mesa.

The objective of the study was to compare intensities of respiratory compensation point (RCP), anaerobic threshold at onset blood lactate accumulation (OBLA3,5), and anaerobic threshold at lactate abrupt increase (AnT LAC) determined in four different ergometers. Hence, eleven table tennis players (19±1 years) performed graded exercise tests on cycle ergometer, arm cranking ergometer, treadmill and specific table tennis test. The respiratory response and lactatemia were measured during the tests. We did not find significant differences among RCP, AnT LAC and OBLA3,5 in arm cranking ergometer (63.4±4.8W, 66.9±4.5W and 64.5±6.1W, respectively), treadmill (11.4±0.4km.h-1, 11.3±0.3km.h-1 and 11.1±0.3km.h-1, respectively), and specific table tennis test (40.5±1.8bolas.min-1, 42.6±3.6bolas.min-1 and 42.8±5.6bolas.min-1, respectively). However, the OBLA3,5 (131.9±6.6W) was significantly lower than RCP (149.3±4.9W) and AnT LAC (149.3±4.7W) in the cycle ergometer. Strong and significant correlation coefficients were found in the specific test for all methods (r range 0.83 to 0.95), in arm cranking ergometer between RCP and OBLA3,5 (r=0.78), and on treadmill running between OBLA3,5 and AnT LAC (r=0.76). Therefore, we conclude that RCP, OBLA3,5 and AnT LAC seem to correspond to the same physiological phenomenon, mostly during specific table tennis test.

Consumo de oxigênio de pico em idosas: comparação entre valores medidos e previstos / Peak oxygen uptake in older women: comparison between measured and predicted values

O objetivo deste estudo foi comparar o consumo de oxigênio de pico (VO2pico) mensurado por meio de teste de esforço e os obtidos por equações preditivas. Participaram deste estudo 116 idosas (66,7 ± 5,8 anos), que realizaram teste ergoespirométrico em esteira. Os valores de VO2pico também foram estimados pela equação do Colégio Americano de Medicina do Esporte (ACSM) e equação de Foster. As comparações foram realizadas por meio da ANOVA para medidas repetidas. A relação entre valores da esteira e equações foi examinada pelo coeficiente de Pearson e método de Bland e Altman. As equações do ACSM e Foster superestimaram significantemente o VO2pico medido (p<0,001; diferença média de 6,9 e 2,7 ml.kg-1.min-1, respectivamente), sendo que a equação ACSM gerou valores superiores aos de Foster (p<0,05). Houve correlação positiva entre o valor do teste e o das equações (r=0,70; p<0,01), mas uma correlação negativa entre idade e VO2pico (r=-0,31; p=0,001). Os achados demonstram que para idosas, equações ergométricas comumente usadas superestimam o VO2pico em relação aos mensurados pela ergoespirometria, apontando para cautela quando da classificação da aptidão cardiorrespiratória por testes ergométricos.

The purpose of this study was to compare the peak oxygen uptake (VO2peak) measured through stress testing and those obtained by predictive equations. A total of 116 elderly women (mean age 66.7 ± 5.8 years) were submitted to a cardiopulmonary exercise test in treadmill (ramp protocol). In addition, VO2peak values were estimated through the American College of Sports Medicine (ACSM) and Foster equations. Measured and estimated values were compared using repeated measures ANOVA. Correlation between methods was examined using Pearson coefficient and agreement using Bland and Altman plot. Both ACSM and Foster equations significantly overestimated measured VO2peak (p<0.001; mean of 6.9 and 2.7 ml.kg-1.min-1, respectively). The ACSM equation generated greater values than the Foster equation. Positive and significant correlation was observed between measured and estimated values (r = 0.70; p<0.01), while age was negatively correlated with measured VO2peak (r = -0.31; p=0.001). Findings show that for the elderly, equations commonly used overestimate VO2peak measured by cardiopulmonary exercise test, pointing to caution during classification of cardiorespiratory fitness.

Frequência cardíaca máxima: influência da experiência desportiva na infância e adolescência / Maximal heart rate: influence of sport practice during childhood and adolescence

FUNDAMENTO: A Frequência Cardíaca (FC) alcançada ao final de um teste de exercício (TE) é denominada FC máxima e possui reconhecida relevância clínica e epidemiológica. Para sua medida correta é necessário que o TE seja verdadeiramente máximo. OBJETIVO: Avaliar a influência do histórico de exercício físico intenso e/ou participação desportiva competitiva na juventude sobre a FC máxima (% da prevista pela idade) em um teste cardiopulmonar de exercício (TCPE) clínico. MÉTODOS: Foram selecionados retrospectivamente 600 indivíduos não atletas (65,8% homens) com idade de 46 ± 13,7 anos, em prevenção primária de doenças cardiovasculares, submetidos a um TCPE máximo. O perfil de exercício físico na infância/adolescência (PEFIA) foi classificado em escores crescentes de 0 a 4, com o valor 2 correspondendo aos níveis esperados para a faixa etária. RESULTADOS: Dentre os 20 indivíduos com valores de FC máxima igual ou maior do que 200 bpm, nenhum deles tinha sido inativo ou pouco ativo na infância/adolescência. Houve uma associação significativa entre escores de PEFIA e a FC máxima (% da prevista pela idade) (p = 0,02), com um valor de 7 bpm mais alto para os escores de PEFIA 3-4 (32,9% da amostra) quando comparados com 0-2. CONCLUSÃO: Duas hipóteses surgem para explicar esses resultados nos indivíduos mais ativos na juventude: a) persistência de adaptações crônicas do treinamento sobre o cronotropismo cardíaco ou b) maior capacidade e/ou motivação para alcançar um TCPE verdadeiramente máximo. Questionar sobre o perfil de exercício físico na infância/adolescência pode contribuir para a interpretação da FC máxima no TE.

BACKGROUND: The heart rate (HR) achieved at the end of an exercise test (ET) is called maximal HR and is known to have clinical and epidemiological relevance. For its correct measurement, it is necessary that the ET be truly maximal. OBJECTIVE: To evaluate the influence of a history of intense physical activity and/or participation in sports competitions during youth on the maximal HR (% of age-predicted HR) on a clinical cardiopulmonary exercise test (CPET). METHODS: A total of 600 non-athlete individuals (65.8% males) with a mean age of 46 ± 13.7 years, under primary prevention of cardiovascular diseases and who underwent maximal CPET, were retrospectively selected. Their physical activity profile during childhood/adolescence (PAPCA) was classified in scores growing from 0 to 4, with value 2 corresponding to their respective age-predicted levels. RESULTS: None of the 20 individuals with maximal HR values equal to or greater than 200 bpm had been inactive or somewhat active during childhood/adolescence. A significant association was observed between PAPCA scores and maximal HR (% of age-predicted HR) (p = 0.02), with a 7-bpm higher value for PAPCA scores 3-4 (32.9% of the sample) in comparison to PAPCA 0-2. CONCLUSION: Two hypotheses exist to explain these results in individuals who had been more active during youth: a) persistence of chronic adaptations to training on the cardiac chronotropism, or b) higher ability and/or motivation to achieve a truly maximal CPET. Information on the physical activity profile during childhood / adolescence may contribute to the interpretation of maximal HR on ET.

Exaggerated Response of Systolic Blood Pressure to Cycle Ergometer

OBJECTIVE: The aim of this study is to exam the effects of exercise modes on the systolic blood pressure and rate-pressure product during a gradually increasing exercise load from low to high intensity. METHODS: Fifteen apparently healthy men aged 19 to 23 performed the graded exercise tests on cycle ergometer (CE) and treadmill (TM). During the low-to-maximal exercises, oxygen uptake (VO2), heart rate (HR), systolic blood pressure (SBP) and rate-pressure product were measured. RESULTS: CE had a significantly lower maximum VO2 than TM (CE vs. TM: 48.51+/-1.30 vs. 55.4+/-1.19 mL/kg/min; p<0.001). However, CE showed a higher maximum SBP (SBPmax) at the all-out exercise load than TM (CE vs. TM: 170+/-2.4 vs. 154+/-1.7 mmHg; p<0.001). During the low-to-maximal intensity increment, the slope of the HR with VO2 was the same as VO2 increased in times of the graded exercise test of CE and TM (CE vs. TM: 2.542+/-0.100 vs. 2.506+/-0.087; p=0.26). The slope of increase on SBP accompanied by VO2 increase was significantly higher in CE than in TM (CE vs. TM: 1.669+/-0.117 vs. 1.179+/-0.063; p<0.001). CONCLUSION: The SBP response is stronger in CE than in TM during the graded exercise test. Therefore, there is a possibility that CE could induce a greater burden on workloads to cardiovascular system in humans than TM.

The Effects of Assisted Ergometer Training With a Functional Electrical Stimulation on Exercise Capacity and Functional Ability in Subacute Stroke Patients

OBJECTIVE: To determine if assistive ergometer training can improve the functional ability and aerobic capacity of subacute stroke patients and if functional electrical stimulation (FES) of the paretic leg during ergometer cycling has additional effects. METHODS: Sixteen subacute stroke patents were randomly assigned to the FES group (n=8) or the control group (n=8). All patients underwent assistive ergometer training for 30 minutes (five times per week for 4 weeks). The electrical stimulation group received FES of the paretic lower limb muscles during assistive ergometer training. The six-minute walk test (6MWT), Berg Balance Scale (BBS), and the Korean version of Modified Barthel Index (K-MBI) were evaluated at the beginning and end of treatment. Peak oxygen consumption (Vo2peak), metabolic equivalent (MET), resting and maximal heart rate, resting and maximal blood pressure, maximal rate pressure product, submaximal rate pressure product, submaximal rate of perceived exertion, exercise duration, respiratory exchange ratio, and estimated anaerobic threshold (AT) were determined with the exercise tolerance test before and after treatment. RESULTS: At 4 weeks after treatment, the FES assistive ergometer training group showed significant improvements in 6MWT (p=0.01), BBS (p=0.01), K-MBI (p=0.01), Vo(2peak) (p=0.02), MET (p=0.02), and estimated AT (p=0.02). The control group showed improvements in only BBS (p=0.01) and K-MBI (p=0.02). However, there was no significant difference in exercise capacity and functional ability between the two groups. CONCLUSION: This study demonstrated that ergometer training for 4 weeks improved the functional ability of subacute stroke patients. In addition, aerobic capacity was improved after assisted ergometer training with a FES only.