Department of Sport and Exercise Science, Faculty of Science, University of Portsmouth , Portsmouth , United Kingdom.
Cystic Fibrosis Unit, University Hospital Southampton National Health Service Foundation Trust , Southampton , United Kingdom.
J Appl Physiol (1985). 2018 Oct 1;125(4):1277-1283. doi: 10.1152/japplphysiol.00454.2018. Epub 2018 Aug 2.
The validity and safety of using supramaximal verification (S) to confirm a maximal effort during cardiopulmonary exercise testing (CPET) in people with cystic fibrosis (CF) and/or those with severe disease has been questioned. Therefore, this study aimed to investigate these concerns in children, adolescents, and adults with mild-to-severe CF lung disease. Retrospective analysis of 17 pediatric and 28 adult participants with CF [age range: 9.2-62.9 y; forced expiratory volume in 1 s: 66.7% (range: 29.9%-102.3%); 30 men] who completed a routine ramp-incremental cycling test to determine peak oxygen uptake (V̇o) was studied. Maximal oxygen uptake (V̇o) was subsequently confirmed by S at 110% of peak power output. All participants satisfied the criteria to verify a maximal effort during CPET. However, S-V̇o exceeded ramp-V̇o in 3/14 (21.4%) of pediatric and 6/28 (21.4%) adult exercise tests. A valid measurement of V̇o was attained in 85.7% of pediatric and 96.4% of adult exercise tests, as S-V̇o did not exceed ramp-V̇o by >9%. Adults ( n = 9) experienced a ≥5% reduction in arterial O saturation during CPET, 4 during both the ramp and S, 3 during only the ramp, and 2 during only S. S did not significantly worsen perceived breathing effort, chest tightness, throat narrowing, or exertion compared with ramp-incremental testing. Given the clinical importance of aerobic fitness in people with CF, incorporating S is recommended to provide a safe and valid measure of V̇o in children, adolescents, and adults who span the spectrum of CF disease severity. NEW & NOTEWORTHY Incorporating supramaximal verification into cardiopulmonary exercise testing protocols did not increase the frequency of adverse events or perceived discomfort versus a single-phase incremental exercise test in people with mild-to-severe cystic fibrosis. Furthermore, a valid measure of maximal oxygen uptake (V̇o) was obtained from 85.7% of pediatric and 96.4% of adult exercise tests, whereas peak oxygen uptake underestimated aerobic fitness in comparison with V̇o in 21.4% of cases (by up to 24.4%).
使用超最大验证 (S) 来确认囊性纤维化 (CF) 患者或患有严重疾病患者心肺运动测试 (CPET) 中的最大努力的有效性和安全性一直受到质疑。因此，本研究旨在调查这些在患有轻度至重度 CF 肺部疾病的儿童、青少年和成年人中的担忧。对 17 名儿科和 28 名成年 CF 参与者（年龄范围：9.2-62.9 岁；1 秒用力呼气量：66.7%（范围：29.9%-102.3%）；30 名男性）进行了回顾性分析，这些参与者完成了常规斜坡递增式踏车测试以确定峰值摄氧量 (V̇o)。随后通过 S 将最大摄氧量 (V̇o) 确认为峰值功率输出的 110%。所有参与者均符合 CPET 中进行最大努力验证的标准。然而，在 3/14（21.4%）名儿科和 6/28（21.4%）名成年运动测试中，S-V̇o 超过了斜坡-V̇o。在 85.7%的儿科和 96.4%的成年运动测试中，V̇o 获得了有效的测量，因为 S-V̇o 没有超过>9%的斜坡-V̇o。9 名成年人（n=9）在 CPET 期间经历了动脉血氧饱和度降低≥5%，4 名在斜坡和 S 期间，3 名仅在斜坡期间，2 名仅在 S 期间。与斜坡递增式测试相比，S 并没有显著增加呼吸努力、胸部紧绷、喉咙变窄或用力的感觉。鉴于有氧健身在 CF 患者中的重要临床意义，建议在儿童、青少年和成年 CF 患者中纳入 S，以提供安全且有效的 V̇o 测量值，涵盖 CF 疾病严重程度的范围。本研究的新发现及意义在轻度至重度囊性纤维化患者中，与单相递增式运动测试相比，将超最大验证纳入心肺运动测试方案并不会增加不良事件或感知不适的频率。此外，在 85.7%的儿科和 96.4%的成年运动测试中获得了最大摄氧量 (V̇o) 的有效测量值，而与 V̇o 相比，峰值摄氧量在 21.4%的情况下低估了有氧健身（最多低 24.4%）。
