Milani Juliana Goulart Prata Oliveira, Milani Mauricio, Cipriano Graziella França Bernardelli, Hansen Dominique, Cipriano Junior Gerson
Graduate Programme in Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil.
REVAL/BIOMED, Hasselt University, Hasselt, Belgium.
BMJ Open Sport Exerc Med. 2023 Jul 31;9(3):e001601. doi: 10.1136/bmjsem-2023-001601. eCollection 2023.
To compare the elicited exercise responses at ventilatory thresholds (VTs: VT1 and VT2) identified by cardiopulmonary exercise testing (CPET) in patients with cardiovascular disease (CVD) with the guideline-directed exercise intensity domains; to propose equations to predict heart rate (HR) at VTs; and to compare the accuracy of prescription methods.
A cross-sectional study was performed with 972 maximal treadmill CPET on patients with CVD. First, VTs were identified and compared with guideline-directed exercise intensity domains. Second, multivariate linear regression analyses were performed to generate prediction equations for HR at VTs. Finally, the accuracy of prescription methods was assessed by the mean absolute percentage error (MAPE).
Significant dispersions of individual responses were found for VTs, with the same relative intensity of exercise corresponding to different guideline-directed exercise intensity domains. A mathematical error inherent to methods based on percentages of peak effort was identified, which may help to explain the dispersions. Tailored multivariable equations yielded r of 0.726 for VT1 and 0.901 for VT2. MAPE for the novel VT1 equation was 6.0%, lower than that for guideline-based prescription methods (9.5 to 23.8%). MAPE for the novel VT2 equation was 4.3%, lower than guideline-based methods (5.8%-19.3%).
The guideline-based exercise intensity domains for cardiovascular rehabilitation revealed inconsistencies and heterogeneity, which limits the currently used methods. New multivariable equations for patients with CVD were developed and demonstrated better accuracy, indicating that this methodology may be a valid alternative when CPET is unavailable.
比较心血管疾病（CVD）患者通过心肺运动试验（CPET）确定的通气阈值（VTs：VT1和VT2）时的诱发运动反应与指南指导的运动强度范围；提出预测VTs时心率（HR）的方程；并比较处方方法的准确性。
对972例CVD患者进行了最大运动平板CPET的横断面研究。首先，确定VTs并与指南指导的运动强度范围进行比较。其次，进行多变量线性回归分析以生成VTs时HR的预测方程。最后，通过平均绝对百分比误差（MAPE）评估处方方法的准确性。
发现VTs的个体反应存在显著差异，相同的相对运动强度对应于不同的指南指导的运动强度范围。确定了基于峰值努力百分比的方法固有的数学误差，这可能有助于解释这些差异。定制的多变量方程得出VT1的r为0.726，VT2的r为0.901。新型VT1方程的MAPE为6.0%，低于基于指南的处方方法（9.5%至23.8%）。新型VT2方程的MAPE为4.3%，低于基于指南的方法（5.8%-19.3%）。
心血管康复的基于指南的运动强度范围显示出不一致性和异质性，这限制了目前使用的方法。开发了针对CVD患者的新多变量方程并证明了更好的准确性，表明当无法进行CPET时，这种方法可能是一种有效的替代方法。
