Hamilton A L, Killian K J, Summers E, Jones N L
Department of Medicine, McMaster University Medical Centre, Hamilton, Ontario, Canada.
Chest. 1996 Nov;110(5):1255-63. doi: 10.1378/chest.110.5.1255.
The aim of the study was to compare (1) the intensity of leg effort and dyspnea during exercise and (2) subjective limitations to performance in normal subjects, patients receiving medication for cardiac disorders, patients with pulmonary impairment, patients with pulmonary impairment who were also receiving cardiac medications, patients experiencing chest pain during exercise, and patients who had a reduced exercise capacity but did not have pulmonary impairment and were not receiving cardiac medication. Five hundred seventy-eight subjects rated the intensity of leg effort, discomfort with breathing (dyspnea), and chest pain every minute (Borg scale) during an incremental exercise task (100 kpm/min each minute) to maximum work capacity on a cycle ergometer and following exercise indicated their subjective limitation by completing a simple questionnaire. Leg effort and dyspnea increased systematically with power output in a positively accelerating manner in all groups; both symptoms were significantly more intense in the impaired groups compared with the normal group at submaximal power outputs. In all groups, there was a significant relationship between symptom intensity at submaximal power outputs and the maximal power output achieved. Leg discomfort in combination with breathing discomfort was the predominant subjective limitation in all groups; chest pain in combination with leg and breathing discomfort was the major subjective limitation in individuals with angina. Activation of the sensory systems during exercise is accompanied by a perception of discomfort associated with the peripheral exercising muscles and discomfort with breathing; both discomfort associated with the exercising muscles and discomfort associated with breathing contribute to exercise limitation to a large degree in normal subjects and patients with cardiorespiratory diseases.
（1）运动期间腿部用力强度和呼吸困难程度；（2）正常受试者、接受心脏疾病药物治疗的患者、肺功能受损患者、同时接受心脏药物治疗的肺功能受损患者、运动期间经历胸痛的患者以及运动能力下降但无肺功能受损且未接受心脏药物治疗的患者在运动表现方面的主观限制。578名受试者在递增运动任务（每分钟100千帕米）中，在自行车测力计上达到最大工作能力的过程中，每分钟（采用Borg量表）对腿部用力强度、呼吸不适（呼吸困难）和胸痛进行评分，并在运动后通过填写一份简单问卷表明其主观限制。在所有组中，腿部用力和呼吸困难均随着功率输出以正加速方式系统性增加；在次最大输出功率时，与正常组相比，所有受损组的这两种症状均明显更强烈。在所有组中，次最大输出功率时的症状强度与达到的最大输出功率之间均存在显著关系。腿部不适与呼吸不适相结合是所有组中的主要主观限制；胸痛与腿部及呼吸不适相结合是心绞痛患者的主要主观限制。运动期间感觉系统的激活伴随着与外周运动肌肉相关的不适感知以及呼吸不适；在正常受试者和心肺疾病患者中，与运动肌肉相关的不适和与呼吸相关的不适在很大程度上均导致运动受限。
