Busque Vincent, Christle Jeffrey W, Moneghetti Kegan J, Cauwenberghs Nicholas, Kouznetsova Tatiana, Blumberg Yair, Wheeler Matthew T, Ashley Euan, Haddad Francois, Myers Jonathan
Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Clin Obes. 2024 Aug;14(4):e12653. doi: 10.1111/cob.12653. Epub 2024 Mar 12.
The goal of this study is to quantify the assumptions associated with the Wasserman-Hansen (WH) and Fitness Registry and the Importance of Exercise: A National Database (FRIEND) predictive peak oxygen consumption (pVO) equations across body mass index (BMI). Assumptions in pVO for both equations were first determined using a simulation and then evaluated using exercise data from the Stanford Exercise Testing registry. We calculated percent-predicted VO (ppVO) values for both equations and compared them using the Bland-Altman method. Assumptions associated with pVO across BMI categories were quantified by comparing the slopes of age-adjusted VO ratios (pVO/pre-exercise VO) and ppVO values for different BMI categories. The simulation revealed lower predicted fitness among adults with obesity using the FRIEND equation compared to the WH equations. In the clinical cohort, we evaluated 2471 patients (56.9% male, 22% with BMI >30 kg/m, pVO 26.8 mlO/kg/min). The Bland-Altman plot revealed an average relative difference of -1.7% (95% CI: -2.1 to -1.2%) between WH and FRIEND ppVO values with greater differences among those with obesity. Analysis of the VO ratio to ppVO slopes across the BMI spectrum confirmed the assumption of lower fitness in those with obesity, and this trend was more pronounced using the FRIEND equation. Peak VO estimations between the WH and FRIEND equations differed significantly among individuals with obesity. The FRIEND equation resulted in a greater attributable reduction in pVO associated with obesity relative to the WH equations. The outlined relationships between BMI and predicted VO may better inform the clinical interpretation of ppVO values during cardiopulmonary exercise test evaluations.
本研究的目的是量化与瓦瑟曼 - 汉森（WH）方程、健身注册库以及运动的重要性：全国数据库（FRIEND）预测峰值耗氧量（pVO）方程相关的、针对体重指数（BMI）的假设。首先通过模拟确定两个方程在pVO方面的假设，然后使用斯坦福运动测试注册库的运动数据进行评估。我们计算了两个方程的预测VO百分比（ppVO）值，并使用布兰德 - 奥特曼方法进行比较。通过比较不同BMI类别的年龄调整后VO比率（pVO/运动前VO）的斜率和ppVO值，量化了与BMI类别相关的pVO假设。模拟结果显示，与WH方程相比，使用FRIEND方程时肥胖成年人的预测体能较低。在临床队列中，我们评估了2471名患者（男性占56.9%，22%的患者BMI>30 kg/m²，pVO为26.8 mlO₂/kg/min）。布兰德 - 奥特曼图显示，WH和FRIEND的ppVO值之间的平均相对差异为 -1.7%（95%CI：-2.1至 -1.2%），肥胖患者之间的差异更大。对BMI范围内VO比率与ppVO斜率的分析证实了肥胖者体能较低的假设，并且使用FRIEND方程时这种趋势更为明显。WH和FRIEND方程之间的峰值VO估计在肥胖个体中存在显著差异。相对于WH方程，FRIEND方程导致与肥胖相关的pVO归因性降低更大。BMI与预测VO之间概述的关系可能会更好地为心肺运动测试评估期间ppVO值的临床解释提供信息。
