The Ventilatory Threshold and Maximal Steady-State Exercise in Patients with Coronary Artery Disease
Melvin, William Stacy
MetadataShow full item record
BACKGROUND: Previous research has shown that the ventilatory threshold (VT) correlates highly with onset of lactate accumulation and maximal steady-state exercise (MSS) level. Also, studies have shown the VT is useful in prescribing exercise for cardiac patients in that it gives an exercise intensity at which the patient is metabolically stable. METHODS: The purpose of this study was to determine if a MSS response could be achieved at an exercise intensity corresponding to the VT for patients with CAD. A group of 31 patients with CAD performed a maximal effort treadmill exercise test in which respiratory gas exchange was measured. The VT was determined using the V-slope method of computer regression analysis of the plot of carbon dioxide production versus oxygen consumption. Subjects then performed a constant load treadmill test a speed and grade that corresponded to the VT. Heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) evaluated for steady-state responses. If subjects showed a steady-state response in two of these three parameters they were scored as having achieved a maximal steady-state (MSS+) response; those not meeting this standard were scored as failing to achieve maximal steady-state (MSS-) response. Subjects were analyzed as an entire group (N=31), as well as analyzed in subsets according to history of myocardial infarction (MI+, N=20; MI-, N=11) and administration of beta-blocker medications (BB+, N=16; BB-, N=15). RESULTS: Overall, subjects demonstrated significantly more MSS+ responses than MSS- responses (80% Vs 20%, P<0.05). Analysis of the subgroup data showed that it was the patient s with a history of MI (MI+ =85%, P<0.05) and those not receiving beta-blocker medications (BB- = 93%, P<0.05) who had significantly greater proportions of subject achieving MSS+ responses in the fixed load exercise condition. Conversely patient in the MI- (73 %, P < 0.05) and BB (69% P < 0.05) groups showed no significant differences in the number of MSS+ and MSS- responses. CONCLUSIONS: The VT, as measured during ramp exercise testing on the treadmill, provided a basis for establishing a maximal steady-state load in terms of cardiovascular and perceptual variables for 80% of the patients in the CAD study group. The measurements of HR, SBP, and RPE are easily obtained in a clinical setting and thus enable the VT to be used in bringing about a more efficacious exercise prescription. The validity of this method may be questioned, however, for patient with out a history of MI and for those receiving beta-blocker medications.
- Masters Theses