PubMed · 6544149
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1984. Symposium on clinical exercise testing.. https://pubmed.ncbi.nlm.nih.gov/6544149/
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OBJECTIVE: To identify the components of exercise rehabilitation programs that were most effective in improving claudication pain symptoms in patients with peripheral arterial disease. DATA SOURCES: English-language articles were identified by a computer search using Index Medicus and MEDLINE, followed by an extensive bibliography review. STUDY SELECTION: Studies were included if they provided the mean or individual walking distances or times to the onset of claudication pain and to maximal pain during a treadmill test before and after rehabilitation. DATA EXTRACTION: Walking distances and times and characteristics of the exercise programs were independently abstracted by two observers. DATA SYNTHESIS: Thirty-three English-language studies were identified, of which 21 met the inclusion criteria. Overall, following a program of exercise rehabilitation, the distance (mean +/- SD) to onset of claudication pain increased 179% from 125.9 +/- 57.3 m to 351.2 +/- 188.7 m (P < .001), and the distance to maximal claudication pain increased 122% from 325.8 +/- 148.1 m to 723.3 +/- 591.5 m (P < .001). The greatest improvement in pain distances occurred with the following exercise program: duration greater than 30 minutes per session, frequency of at least three sessions per week, walking used as the mode of exercise, use of near-maximal pain during training as claudication pain end point, and program length of greater than 6 months. However, the claudication pain end point, program length, and mode of exercise were the only independent predictors (P < .001) for improvement in distances. CONCLUSIONS: The optimal exercise program for improving claudication pain distances in patients with peripheral arterial disease uses intermittent walking to near-maximal pain during a program of at least 6 months. Such a program should be part of the standard medical care for patients with intermittent claudication.
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Mixed venous oxygen saturation (SvO2) is a physiologic parameter reflecting cardiac output (CO) and tissue oxygen utilization. An implantable oxygen sensor incorporated in a right ventricular pacing lead has been developed to assess the feasibility of ambulatory monitoring of SvO2 to predict cardiorespiratory parameters. Eight patients with a mean age of 62 +/- 2 years and sinoatrial disease received an SvO2-driven dual-chamber rate-adaptive pacemaker capable of continuous SvO2 measurement. During graded maximal exercise with measurement of oxygen consumption (Vo2), arterial oxygen saturation (SaO2), and telemetered derived SvO2 data, CO was assessed using the Fick principle. The accuracy of the derived CO was compared with CO measured directly by continuous-wave Doppler assessment of the ascending aortic flow. The maximum changes in SvO2 and SaO2 during exercise were 25 +/- 5 and 3 +/- 1%, respectively. SvO2 was significantly correlated with Vo2 (r = 0.9 +/- 0.1, p < 0.001), work done (r = 0.8 +/- 0.1, p < 0.05), and minute ventilation (r = 0.9 +/- 0.1, p < 0.05). Doppler-derived CO was significantly correlated with CO estimated from SvO2 measured (r = 0.8 +/- 0.1, p < 0.05) and is expressed as 46x derived CO +300. Although continuous SvO2 sensing was originally developed to increase pacing rate during exercise, its use can be extended for monitoring cardiopulmonary performance on an ambulatory basis. This may be useful as a direct assessment of cardiopulmonary status in diseased states and also as an objective means to evaluate cardiac response to medical therapy in patients with heart failure.