Oxygen Uptake to Work Rate Relation Throughout Peak Exercise in Normal Subjects: Relevance for Rate Adaptive Pacemaker Programming
The oxygen uptake to work rate (VO2/WR) relationship observed throughout peak exercise testing is already being applied for rate adaptive pacemaker programming. However, the detailed curve design of VO2/WR with respect to the anaerobic threshold (AT) has not yet been investigated. It was the purpose...
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| Published in | Pacing and clinical electrophysiology Vol. 22; no. 5; pp. 769 - 775 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.05.1999
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| Subjects | |
| Online Access | Get full text |
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| Abstract | The oxygen uptake to work rate (VO2/WR) relationship observed throughout peak exercise testing is already being applied for rate adaptive pacemaker programming. However, the detailed curve design of VO2/WR with respect to the anaerobic threshold (AT) has not yet been investigated. It was the purpose of this study to determine the VO2/WR slope below and above the AT in a healthy control group. Seventy‐eight healthy control subjects (45.9 ± 17.4 years; 34 women: 49.9 ± 18.6 years 44 men: 43.6 ± 16.6 years) were exercised on a treadmill with “breath‐by‐breath” gas exchange monitoring using the symptom limited “ramping incremental treadmill exercise” (RITE) protocol. The slope of the VO2/WR relationship from rest to peak exercise (r‐p), rest to AT (slope A), and AT to peak exercise (slope B) in mL oxygen uptake per watt of external treadmill work was determined by linear regression analysis.
The oxygen uptake to work rate relationship throughout peak exercise in the entire study group generated a significant slope change at the AT (31%, P < 0.0001) with a decreasing slope during higher work load intensities. Female subjects demonstrated a greater percentage of slope change at AT (43%), as compared to men (22%, P < 0.01). When using the oxygen uptake to work rate relationship for the programming of the pacemaker's rate response to exercise, the significant slope change at the AT should be considered to more appropriately pace during higher work intensities supported by anaerobic metabolism. Female pacemaker patients should be programmed to generate a steeper VO2/WR slope below AT with a greater slope change at AT, as compared to men. Abnormally high oxygen uptake to work rate ratios above the AT may be possibly used as an indicator of overpacing. |
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| AbstractList | The oxygen uptake to work rate (VO
2
/WR) relationship observed throughout peak exercise testing is already being applied for rate adaptive pacemaker programming. However, the detailed curve design of VO
2
/WR with respect to the anaerobic threshold (AT) has not yet been investigated. It was the purpose of this study to determine the VO
2
/WR slope below and above the AT in a healthy control group. Seventy‐eight healthy control subjects (45.9 ± 17.4 years; 34 women: 49.9 ± 18.6 years 44 men: 43.6 ± 16.6 years) were exercised on a treadmill with “breath‐by‐breath” gas exchange monitoring using the symptom limited “ramping incremental treadmill exercise” (RITE) protocol. The slope of the VO
2
/WR relationship from rest to peak exercise (r‐p), rest to AT (slope A), and AT to peak exercise (slope B) in mL oxygen uptake per watt of external treadmill work was determined by linear regression analysis.
The oxygen uptake to work rate relationship throughout peak exercise in the entire study group generated a significant slope change at the AT (31%, P < 0.0001) with a decreasing slope during higher work load intensities. Female subjects demonstrated a greater percentage of slope change at AT (43%), as compared to men (22%, P < 0.01). When using the oxygen uptake to work rate relationship for the programming of the pacemaker's rate response to exercise, the significant slope change at the AT should be considered to more appropriately pace during higher work intensities supported by anaerobic metabolism. Female pacemaker patients should be programmed to generate a steeper VO
2
/WR slope below AT with a greater slope change at AT, as compared to men. Abnormally high oxygen uptake to work rate ratios above the AT may be possibly used as an indicator of overpacing. The oxygen uptake to work rate (VO2/WR) relationship observed throughout peak exercise testing is already being applied for rate adaptive pacemaker programming. However, the detailed curve design of VO2/WR with respect to the anaerobic threshold (AT) has not yet been investigated. It was the purpose of this study to determine the VO2/WR slope below and above the AT in a healthy control group. Seventy-eight healthy control subjects (45.9 +/- 17.4 years; 34 women: 49.9 +/- 18.6 years 44 men: 43.6 +/- 16.6 years) were exercised on a treadmill with "breath-by-breath" gas exchange monitoring using the symptom limited "ramping incremental treadmill exercise" (RITE) protocol. The slope of the VO2/WR relationship from rest to peak exercise (r-p), rest to AT (slope A), and AT to peak exercise (slope B) in mL oxygen uptake per watt of external treadmill work was determined by linear regression analysis. [table: see text] The oxygen uptake to work rate relationship throughout peak exercise in the entire study group generated a significant slope change at the AT (31%, P < 0.0001) with a decreasing slope during higher work load intensities. Female subjects demonstrated a greater percentage of slope change at AT (43%), as compared to men (22%, P < 0.01). When using the oxygen uptake to work rate relationship for the programming of the pacemaker's rate response to exercise, the significant slope change at the AT should be considered to more appropriately pace during higher work intensities supported by anaerobic metabolism. Female pacemaker patients should be programmed to generate a steeper VO2/WR slope below AT with a greater slope change at AT, as compared to men. Abnormally high oxygen uptake to work rate ratios above the AT may be possibly used as an indicator of overpacing.The oxygen uptake to work rate (VO2/WR) relationship observed throughout peak exercise testing is already being applied for rate adaptive pacemaker programming. However, the detailed curve design of VO2/WR with respect to the anaerobic threshold (AT) has not yet been investigated. It was the purpose of this study to determine the VO2/WR slope below and above the AT in a healthy control group. Seventy-eight healthy control subjects (45.9 +/- 17.4 years; 34 women: 49.9 +/- 18.6 years 44 men: 43.6 +/- 16.6 years) were exercised on a treadmill with "breath-by-breath" gas exchange monitoring using the symptom limited "ramping incremental treadmill exercise" (RITE) protocol. The slope of the VO2/WR relationship from rest to peak exercise (r-p), rest to AT (slope A), and AT to peak exercise (slope B) in mL oxygen uptake per watt of external treadmill work was determined by linear regression analysis. [table: see text] The oxygen uptake to work rate relationship throughout peak exercise in the entire study group generated a significant slope change at the AT (31%, P < 0.0001) with a decreasing slope during higher work load intensities. Female subjects demonstrated a greater percentage of slope change at AT (43%), as compared to men (22%, P < 0.01). When using the oxygen uptake to work rate relationship for the programming of the pacemaker's rate response to exercise, the significant slope change at the AT should be considered to more appropriately pace during higher work intensities supported by anaerobic metabolism. Female pacemaker patients should be programmed to generate a steeper VO2/WR slope below AT with a greater slope change at AT, as compared to men. Abnormally high oxygen uptake to work rate ratios above the AT may be possibly used as an indicator of overpacing. The oxygen uptake to work rate (VO2/WR) relationship observed throughout peak exercise testing is already being applied for rate adaptive pacemaker programming. However, the detailed curve design of VO2/WR with respect to the anaerobic threshold (AT) has not yet been investigated. It was the purpose of this study to determine the VO2/WR slope below and above the AT in a healthy control group. Seventy‐eight healthy control subjects (45.9 ± 17.4 years; 34 women: 49.9 ± 18.6 years 44 men: 43.6 ± 16.6 years) were exercised on a treadmill with “breath‐by‐breath” gas exchange monitoring using the symptom limited “ramping incremental treadmill exercise” (RITE) protocol. The slope of the VO2/WR relationship from rest to peak exercise (r‐p), rest to AT (slope A), and AT to peak exercise (slope B) in mL oxygen uptake per watt of external treadmill work was determined by linear regression analysis. The oxygen uptake to work rate relationship throughout peak exercise in the entire study group generated a significant slope change at the AT (31%, P < 0.0001) with a decreasing slope during higher work load intensities. Female subjects demonstrated a greater percentage of slope change at AT (43%), as compared to men (22%, P < 0.01). When using the oxygen uptake to work rate relationship for the programming of the pacemaker's rate response to exercise, the significant slope change at the AT should be considered to more appropriately pace during higher work intensities supported by anaerobic metabolism. Female pacemaker patients should be programmed to generate a steeper VO2/WR slope below AT with a greater slope change at AT, as compared to men. Abnormally high oxygen uptake to work rate ratios above the AT may be possibly used as an indicator of overpacing. The oxygen uptake to work rate (VO2/WR) relationship observed throughout peak exercise testing is already being applied for rate adaptive pacemaker programming. However, the detailed curve design of VO2/WR with respect to the anaerobic threshold (AT) has not yet been investigated. It was the purpose of this study to determine the VO2/WR slope below and above the AT in a healthy control group. Seventy-eight healthy control subjects (45.9 +/- 17.4 years; 34 women: 49.9 +/- 18.6 years 44 men: 43.6 +/- 16.6 years) were exercised on a treadmill with "breath-by-breath" gas exchange monitoring using the symptom limited "ramping incremental treadmill exercise" (RITE) protocol. The slope of the VO2/WR relationship from rest to peak exercise (r-p), rest to AT (slope A), and AT to peak exercise (slope B) in mL oxygen uptake per watt of external treadmill work was determined by linear regression analysis. [table: see text] The oxygen uptake to work rate relationship throughout peak exercise in the entire study group generated a significant slope change at the AT (31%, P < 0.0001) with a decreasing slope during higher work load intensities. Female subjects demonstrated a greater percentage of slope change at AT (43%), as compared to men (22%, P < 0.01). When using the oxygen uptake to work rate relationship for the programming of the pacemaker's rate response to exercise, the significant slope change at the AT should be considered to more appropriately pace during higher work intensities supported by anaerobic metabolism. Female pacemaker patients should be programmed to generate a steeper VO2/WR slope below AT with a greater slope change at AT, as compared to men. Abnormally high oxygen uptake to work rate ratios above the AT may be possibly used as an indicator of overpacing. |
| Author | MACCARTER, DEAN RICKLI, HANS SCHWARTZE, PETER SCHIMPF, RAINER CANDINAS, RETO JUNG, WERNER SCHUMACHER, BURGHARD LÜDERITZ, BERNDT LEWALTER, THORSTEN |
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| References | Soucie LP, Carey C, Woodend AK et al. Correlation of the heart rate-minute ventilation relationship with clinical data: Relevance to rate adaptive pacing. PACE 1997; 20:1913-1918. Weber KT, Janicki JS. Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. Am J Cardiol 1985; 55:22A-31A. Lewalter T, Jung W, MacCarter D, et al. Heart rate during exercise: What is the optimal goal of pacemaker therapy Am Heart J 1994; 127:1026-1030. Treese N, MacCarter D, Akbukut O, et al. Ventilation and heart rate response during exercise in normals: Relevance for rate variable pacing. PACE 1993; 16:1693-1700. Wilkoff BL, Corey J, Blackburn G. Analytic techniques in the assessment of chronotropic response to exercise. (abstract) PACE 1988; II:530. Payne G, Spinelli J, Garratt CJ, et al. The optimal pacing rate: An unpredictable parameter. PACE 1997; 20:866-873. Kay GN. Quantitation of chronotropic response: Comparison of methods for rate-modulating permanent pacemakers. J Am Coll Cardiol 1992; 20:1533-1541. Higginbotham MB, Morris KG, Coleman E et al. Sex-related differences in the normal cardiac response to upright exercise. Circulation 1984; 70:357-366. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting the anaerobic threshold by gas exchange. J Appl Physiol 1986; 60:2020-2027. McElroy PA, Janicki JS, Weber KT. Physiologic correlates of the heart rate response to upright isotonic exercise: Relevance to rate responsive pacemakers. J Am Coll Cardiol 1988; 11:94-99. Rickli H, MacCarter D, Maire R, et al. Age and sex related changes in heart rate to ventilation coupling: Implications for rate adaptive pacemaker algorithms. PACE 1997; 20:104-111. Wasserman K, Hansen JE, Sue DY, et al. Principles of exercise testing and interpretation. Philadelphia , PA , Lea & Febiger, 1987, pp. 3-26. Kay GN, Bubien RS, Epstein AE, et al. Rate-modulated cardiac pacing based on transthoracic impedance measurements of minute-ventilation: Correlation with exercise gas exchange. J Am Coll Cardiol 1989; 14:1283-1289. Lewalter T, MacCarter D, Jung W, et al. Heart rate to work rate relation throughout peak exercise in normal subjects as a guideline for rate-adaptive pacemaker programming. Am J Cardiol 1995; 76:812-816. Wilkoff BL, Corey J, Blackburn G. A mathematical model of the cardiac chronotropic response to exercise. J Electrophysiol 1989; 3:176-180. Hansen JE, Sue DY, Oren A, et al. Relation of oxygen uptake to work rate in normal men and men with circulatory disorders. Am J Cardiol 1987; 59:669-674. 1989; 3 1994; 127 1986; 60 1984; 70 1993; 16 1997; 20 1995; 76 1987 1988; II 1988; 11 1972 1992; 20 1985; 55 1989; 14 1987; 59 Wilkoff BL (e_1_2_1_9_2) 1988 e_1_2_1_6_2 e_1_2_1_7_2 e_1_2_1_4_2 e_1_2_1_5_2 e_1_2_1_2_2 e_1_2_1_11_2 e_1_2_1_3_2 e_1_2_1_12_2 e_1_2_1_10_2 e_1_2_1_15_2 e_1_2_1_16_2 e_1_2_1_13_2 e_1_2_1_14_2 Wasserman K (e_1_2_1_18_2) 1987 e_1_2_1_8_2 e_1_2_1_17_2 |
| References_xml | – reference: Soucie LP, Carey C, Woodend AK et al. Correlation of the heart rate-minute ventilation relationship with clinical data: Relevance to rate adaptive pacing. PACE 1997; 20:1913-1918. – reference: Hansen JE, Sue DY, Oren A, et al. Relation of oxygen uptake to work rate in normal men and men with circulatory disorders. Am J Cardiol 1987; 59:669-674. – reference: Rickli H, MacCarter D, Maire R, et al. Age and sex related changes in heart rate to ventilation coupling: Implications for rate adaptive pacemaker algorithms. PACE 1997; 20:104-111. – reference: Wilkoff BL, Corey J, Blackburn G. Analytic techniques in the assessment of chronotropic response to exercise. (abstract) PACE 1988; II:530. – reference: Lewalter T, Jung W, MacCarter D, et al. Heart rate during exercise: What is the optimal goal of pacemaker therapy Am Heart J 1994; 127:1026-1030. – reference: Beaver WL, Wasserman K, Whipp BJ. A new method for detecting the anaerobic threshold by gas exchange. J Appl Physiol 1986; 60:2020-2027. – reference: Higginbotham MB, Morris KG, Coleman E et al. Sex-related differences in the normal cardiac response to upright exercise. Circulation 1984; 70:357-366. – reference: Kay GN, Bubien RS, Epstein AE, et al. Rate-modulated cardiac pacing based on transthoracic impedance measurements of minute-ventilation: Correlation with exercise gas exchange. J Am Coll Cardiol 1989; 14:1283-1289. – reference: Lewalter T, MacCarter D, Jung W, et al. Heart rate to work rate relation throughout peak exercise in normal subjects as a guideline for rate-adaptive pacemaker programming. Am J Cardiol 1995; 76:812-816. – reference: Kay GN. Quantitation of chronotropic response: Comparison of methods for rate-modulating permanent pacemakers. J Am Coll Cardiol 1992; 20:1533-1541. – reference: Wasserman K, Hansen JE, Sue DY, et al. Principles of exercise testing and interpretation. Philadelphia , PA , Lea & Febiger, 1987, pp. 3-26. – reference: Payne G, Spinelli J, Garratt CJ, et al. The optimal pacing rate: An unpredictable parameter. PACE 1997; 20:866-873. – reference: Weber KT, Janicki JS. Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. Am J Cardiol 1985; 55:22A-31A. – reference: Wilkoff BL, Corey J, Blackburn G. A mathematical model of the cardiac chronotropic response to exercise. J Electrophysiol 1989; 3:176-180. – reference: McElroy PA, Janicki JS, Weber KT. Physiologic correlates of the heart rate response to upright isotonic exercise: Relevance to rate responsive pacemakers. J Am Coll Cardiol 1988; 11:94-99. – reference: Treese N, MacCarter D, Akbukut O, et al. Ventilation and heart rate response during exercise in normals: Relevance for rate variable pacing. 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| Snippet | The oxygen uptake to work rate (VO2/WR) relationship observed throughout peak exercise testing is already being applied for rate adaptive pacemaker... The oxygen uptake to work rate (VO 2 /WR) relationship observed throughout peak exercise testing is already being applied for rate adaptive pacemaker... |
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| SubjectTerms | Adult Anaerobic Threshold - physiology Electrocardiography, Ambulatory exercise Exercise - physiology Exercise Test Female Heart Rate - physiology Humans Male Middle Aged oxygen uptake to work rate relation Pacemaker, Artificial - standards rate adaptive pacemaker Reference Values Respiratory Function Tests |
| Title | Oxygen Uptake to Work Rate Relation Throughout Peak Exercise in Normal Subjects: Relevance for Rate Adaptive Pacemaker Programming |
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