Hagberg J M
University of Pittsburgh Medical School, PA 15213.
Baillieres Clin Rheumatol. 1994 Feb;8(1):29-52. doi: 10.1016/s0950-3579(05)80223-7.
Exercise testing is now widely used as both a diagnostic tool in the elderly and as a means of generating the information necessary to provide them with a valid exercise training prescription. An appropriate medical history and physical examination prior to exercise testing will allow for the adequate assessment of an individual's risk of undergoing an exercise test. Appropriate screening of the individual, assessment of risk prior to exercise, and appropriate monitoring during and following the exercise test have contributed to the relative safety of maximal exercise testing, with statistics indicating roughly one death occurs in every 10,000 clinical maximal exercise tests. When designing an exercise test protocol for use in the elderly, their reduced exercise capacities, increased prevalence of CV disease, and the reason for doing the test must be taken into consideration. The Bruce treadmill protocol is the most widely used exercise test in populations of all ages; however, because of its relatively high VO2 demands in the initial minutes of exercise, it may not be the optimal protocol for the elderly. Other alternative protocols including the Naughton and Balke tests may be more appropriate, especially when attempting to generate a valid exercise prescription. However, the modified Balke protocol, with a constant speed of 2 miles/h and starting on the level, is probably the best protocol for exercise testing in the elderly for the purposes of generating an exercise prescription. If individuals are unable to undergo exercise tests on a treadmill, cycle and arm ergometer tests provide alternative test modalities, but these have a number of inherent problems that must be considered prior to exercise testing. The interpretation of an elderly individual's ECG responses during a maximal exercise test is intimately related to their risk of having CV disease prior to the exercise test, though fewer false-positive tests will be evident because of the increased prevalence of CV disease in the elderly.
运动测试如今被广泛用作老年人的诊断工具，也是生成必要信息以给他们提供有效运动训练处方的一种手段。在进行运动测试之前进行适当的病史询问和体格检查，将有助于充分评估个体进行运动测试的风险。对个体进行适当筛查、运动前风险评估以及运动测试期间和之后的适当监测，都有助于最大运动测试的相对安全性，统计数据表明，每10000次临床最大运动测试中大约发生1例死亡。在设计用于老年人的运动测试方案时，必须考虑到他们降低的运动能力、心血管疾病患病率的增加以及进行测试的原因。布鲁斯跑步机方案是所有年龄段人群中使用最广泛的运动测试；然而，由于其在运动开始几分钟内对摄氧量的要求相对较高，它可能不是老年人的最佳方案。其他替代方案，包括诺顿和巴尔克测试，可能更合适，特别是在试图生成有效运动处方时。然而，修改后的巴尔克方案，恒定速度为每小时2英里且从平路开始，可能是为老年人进行运动测试以生成运动处方的最佳方案。如果个体无法在跑步机上进行运动测试，自行车和手臂测力计测试提供了替代测试方式，但在进行运动测试之前必须考虑这些方式存在的一些固有问题。在最大运动测试期间对老年人心电图反应的解读与他们在运动测试前患心血管疾病的风险密切相关，尽管由于老年人心血管疾病患病率增加，假阳性测试会更少。
