Clinical Exercise and Testing (European Respiratory by P. Palange, S. Ward

By P. Palange, S. Ward

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Extra resources for Clinical Exercise and Testing (European Respiratory Monograph)

Sample text

Consequently, if steady states are required, the test must be sufficiently long for each variable of interest to attain its steady state. As the effective time constant of the V9O2 response during moderate exercise in healthy young subjects is y45 s (or less in fitter subjects), 3 min is the minimum time for the variable to attain a steady state (to within y1%). Steady-state measurements of V9O2, therefore, should only begin after 3 min. In patients with heart [125, 126] or lung disease [127, 128] or even older, but sedentary normal subjects [16], this time constant can be appreciably longer, and hence a longer period would be required before the steady state is attained.

Oxygen uptake (V’O2) versus WR or V’E versus V’CO2). Judgements regarding the normalcy, or otherwise, of such outcomes depend on the availability of suitable population-based ‘‘normal’’ values [reviewed in 1]. This chapter considers the physiological basis of standard (and emerging) measurements using incremental and constantload (or, more properly, constant-WR) exercise as frames of reference. Indices of CPET response: incremental exercise A symptom-limited incremental (or ramp) exercise test [2] can provide information both on the extent to which an individual manifests ‘‘exercise intolerance’’ and whether the intolerance is reflective of abnormal physiological system function, from the response profiles of particular variables of interest.

16]. With reference to the former, it is of interest that there are reports of slightly greater DV’O2/DWR values in subjects with a high V’O2,peak [12, 22]. A reduction in gp consequent to a defect at some point(s) within the energy transduction mechanisms linking adenosine triphosphate production to oxygen utilisation, as might be expected for hyperthyroidism, would predispose towards increased DV’O2/DWR values [23]. This has also been reported in patients with a deficiency of muscle succinate dehydrogenase and mitochondrial aconitase [24].

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