Tuner Stephen L, Easton Chris, Wilson John, Byrne Dominique S, Rogers Paul, Kilduff Liam P, Kingsmore David B, Pitsiladis Yannis P
Institute of Diet, Exercise and Lifestyle (IDEAL), Faculty of Biomedical and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
J Vasc Surg. 2008 Jan;47(1):123-30. doi: 10.1016/j.jvs.2007.09.001.
Peripheral arterial disease (PAD) presenting as intermittent claudication (IC) is routinely assessed as the distance or time walked to the onset of pain, which often occurs before significant cardiopulmonary stress and is subject to confounding factors such as increased body mass and altered gait. Thus, where exercise-induced cardiovascular stress is desirable, such as in cardiac stress testing or clinical trials, an alternative modality of exercise is required. Cycling will circumvent several of the associated problems of treadmill walking and may provide an alternative preferable method of exercise, although there is limited information on the physiologic response of patients with PAD to cycling. This study compared the peak cardiorespiratory responses and the repeatability of cycling and treadmill exercise in patients with PAD.
Ten men (mean age, 54 +/- 10 years) with stable IC completed two incremental exercise tests to the limit of tolerance on a treadmill and a cycle ergometer after familiarization with the outcome measures of exercise duration, work performed, respiratory gas exchange variables using continuous breath-by-breath measurement, heart rate, and ratings of perceived pain.
Both methods of exercise assessment revealed high reproducibility in terms of absolute claudication time (treadmill, r = 0.95; cycle, r = 0.91), time to volitional fatigue (treadmill, r = 0.96; cycle, r = 0.91), and cardiopulmonary exercise responses such as the lactate threshold (treadmill, r = 0.95; cycle, r = 0.94), peak heart rate (treadmill, r = 0.94; cycle, r = 0.96), and peak oxygen uptake (treadmill, r = 0.98; cycle, r = 0.87). Cycling induced significantly higher cardiopulmonary responses (peak heart rate, peak carbon dioxide output, peak minute ventilation, and respiratory exchange ratio) than treadmill exercise. There was no difference in time to volitional fatigue or in absolute claudication time between exercise modalities.
These results demonstrate that exercise testing using cycling offers an alternative method of cardiopulmonary testing for patients with IC that is equally reliable and reproducible to treadmill walking. Cycling may be preferable to treadmill exercise because it induces greater cardiopulmonary and metabolic responses and is better tolerated by patients.
表现为间歇性跛行（IC）的外周动脉疾病（PAD）通常通过行走至疼痛发作的距离或时间来评估，疼痛往往在显著的心肺应激之前出现，并且受体重增加和步态改变等混杂因素影响。因此，在需要运动诱发心血管应激的情况下，如心脏应激测试或临床试验中，需要一种替代的运动方式。骑自行车可以规避跑步机行走的一些相关问题，并且可能提供一种更合适的替代运动方法，尽管关于PAD患者对骑自行车的生理反应的信息有限。本研究比较了PAD患者骑自行车和跑步机运动时的心肺反应峰值以及可重复性。
10名患有稳定型IC的男性（平均年龄54±10岁）在熟悉运动持续时间、做功、使用连续逐次呼吸测量的呼吸气体交换变量、心率和疼痛感知评分等运动结果测量指标后，在跑步机和自行车测力计上完成了两次递增运动测试，直至耐受极限。
两种运动评估方法在绝对跛行时间（跑步机，r = 0.95；自行车，r = 0.91）、意志性疲劳时间（跑步机，r = 0.96；自行车，r = 0.91）以及心肺运动反应如乳酸阈值（跑步机，r = 0.95；自行车，r = 0.94）、心率峰值（跑步机，r = 0.94；自行车，r = 0.96）和摄氧量峰值（跑步机，r = 0.98；自行车，r = 0.87）方面均显示出高重现性。与跑步机运动相比，骑自行车诱发的心肺反应（心率峰值、二氧化碳输出峰值、分钟通气量峰值和呼吸交换率）显著更高。运动方式之间在意志性疲劳时间或绝对跛行时间上没有差异。
这些结果表明，对于IC患者，使用骑自行车进行运动测试提供了一种替代的心肺测试方法，其可靠性和可重复性与跑步机行走相当。骑自行车可能比跑步机运动更可取，因为它能诱发更大的心肺和代谢反应，并且患者耐受性更好。
