Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.
Anaesthesia. 2021 Jan;76(1):72-81. doi: 10.1111/anae.15162. Epub 2020 Jun 27.
Cardiopulmonary exercise testing is performed increasingly for cardiorespiratory fitness assessment and pre-operative risk stratification. Lower limb osteoarthritis is a common comorbidity in surgical patients, meaning traditional cycle ergometry-based cardiopulmonary exercise testing is difficult. The purpose of this study was to compare cardiopulmonary exercise testing variables and subjective responses in four different exercise modalities. In this crossover study, 15 patients with osteoarthritis scheduled for total hip or knee arthroplasty (mean (SD) age 68 (7) years; body mass index 31.4 (4.1) kg.m ) completed cardiopulmonary exercise testing on a treadmill, elliptical cross-trainer, cycle and arm ergometer. Mean (SD) peak oxygen consumption was 20-30% greater on the lower limb modalities (treadmill 21.5 (4.6) (p < 0.001); elliptical cross-trainer (21.2 (4.1) (p < 0.001); and cycle ergometer (19.4 (4.2) ml.min .kg (p = 0.001), respectively) than on the arm ergometer (15.7 (3.7) ml.min .kg ). Anaerobic threshold was 25-50% greater on the lower limb modalities (treadmill 13.5 (3.1) (p < 0.001); elliptical cross-trainer 14.6 (3.0) (p < 0.001); and cycle ergometer 10.7 (2.9) (p = 0.003)) compared with the arm ergometer (8.4 (1.7) ml.min .kg ). The median (95%CI) difference between pre-exercise and peak-exercise pain scores was greater for tests on the treadmill (2.0 (0.0-5.0) (p = 0.001); elliptical cross-trainer (3.0 (2.0-4.0) (p = 0.001); and cycle ergometer (3.0 (1.0-5.0) (p = 0.001)), compared with the arm ergometer (0.0 (0.0-1.0) (p = 0.406)). Despite greater peak exercise pain, cardiopulmonary exercise testing modalities utilising the lower limbs affected by osteoarthritis elicited higher peak oxygen consumption and anaerobic threshold values compared with arm ergometry.
心肺运动测试越来越多地用于评估心肺适应性和术前风险分层。下肢骨关节炎是手术患者的常见合并症，这意味着传统的基于脚踏车的心肺运动测试较为困难。本研究的目的是比较四种不同运动方式的心肺运动测试变量和主观反应。在这项交叉研究中，15 名计划接受全髋关节或全膝关节置换术的骨关节炎患者（平均（标准差）年龄 68（7）岁；体重指数 31.4（4.1）kg.m ）在跑步机、椭圆交叉训练器、脚踏车和手臂测力计上完成心肺运动测试。下肢运动方式的峰值摄氧量平均（标准差）增加 20-30%（跑步机 21.5（4.6）（p<0.001）；椭圆交叉训练器 21.2（4.1）（p<0.001）；和脚踏车 19.4（4.2）ml.min.kg（p=0.001）），而手臂测力计的峰值摄氧量为 15.7（3.7）ml.min.kg。下肢运动方式的无氧阈增加 25-50%（跑步机 13.5（3.1）（p<0.001）；椭圆交叉训练器 14.6（3.0）（p<0.001）；脚踏车 10.7（2.9）（p=0.003）），而手臂测力计为 8.4（1.7）ml.min.kg。与手臂测力计相比，跑步机（2.0（0.0-5.0）（p=0.001）；椭圆交叉训练器（3.0（2.0-4.0）（p=0.001）；脚踏车（3.0（1.0-5.0）（p=0.001）））的运动测试中，运动前和峰值运动疼痛评分之间的中位数（95%CI）差值更大，而手臂测力计为 0.0（0.0-1.0）（p=0.406））。尽管峰值运动疼痛更大，但下肢运动方式的心肺运动测试比手臂测力计产生更高的峰值摄氧量和无氧阈值。
