Research method for completing upper limb cardiopulmonary movement test at different power increasing rates

Abstract

The invention discloses a research method for completing upper limb cardiopulmonary exercise tests at different power increasing rates, and relates to the technical field of cardiopulmonary exercise tests. The method specifically comprises the following steps of 1, selecting participants of an upper limb cardiopulmonary exercise test; step 2, CPET quality control and standardized operation; the CPET carries out gas capacity calibration, high, medium and low flow rate calibration, air, oxygen and carbon dioxide gas calibration, metabolism simulator calibration and participant calibration through a Quark PFT Ergo type cardiopulmonary exercise test system, and then test is carried out; and step 3, performing CPET experiment grouping. The invention proves that the CPET of the upper limbs with different power increasing rates obviously changes the power, the movement duration, the oxygen uptake ventilation effectiveness, the carbon dioxide discharge ventilation effectiveness, the unit power oxygen uptake and other core indexes when the peak movement is obviously changed; and the method also has a certain degree of influence on the peak RER and the maximum RER in the recovery period.

Description

Technical Field

[0001] The invention relates to the technical field of cardiopulmonary exercise testing, and in particular to a research method for completing an upper limb cardiopulmonary exercise testing at different power increasing rates. Background Art

[0002] As human society continues to develop, diseases are also evolving and mutating. Chronic diseases such as cardiovascular disease, diabetes, and cancer will become major health problems. Due to the prevalence of unhealthy lifestyles closely related to CVD, such as unhealthy diet, lack of physical activity, and smoking, the population with cardiovascular disease (CVD) risk factors is huge, the aging of the population is accelerating, and the incidence and mortality rates are still rising. There is still a long way to go in the prevention and treatment of CVD, and it is the focus of the present and future.

[0003] Human beings are an indivisible whole, and the heart and lungs are the engines of our body. To maintain the health of the heart and lungs, the touchstone of cardiopulmonary exercise test is indispensable. As a non-invasive, objective, quantitative, continuous and repeatable clinical testing method under the guidance of holism, cardiopulmonary exercise test (CPET) is the only method for testing the overall function of the human body. It has been used in the field of clinical medicine for more than half a century and has broad application prospects and value.

[0004] CPET not only includes the evaluation of exercise tolerance and intolerance and the clarification of the pathophysiological mechanisms of related symptoms occurring under exercise conditions, but also has important clinical value in the differential diagnosis of diseases, the evaluation of patients with cardiovascular diseases (such as heart failure, coronary heart disease, cardiac rehabilitation, transplantation, etc.) and respiratory diseases (such as chronic obstructive pulmonary disease, interstitial lung disease, pulmonary vascular disease, cystic fibrosis, exercise-induced bronchospasm and respiratory disease rehabilitation, etc.), as well as some special clinical applications, such as preoperative risk assessment, prognosis assessment, exercise rehabilitation and exercise prescription formulation.

[0005] Healthy volunteers completed upper limb cardiopulmonary exercise testing (CPET) at different power increment rates. The changes in core indicators were observed and analyzed to explore the effects of different power increment rates on the core indicators of upper limb CPET, and to provide a reference for scientifically selecting the appropriate power increment rate for upper limb cardiopulmonary exercise testing. Summary of the invention

[0006] The purpose of the present invention is to solve the shortcomings of the prior art and to propose a research method for completing an upper limb cardiopulmonary exercise test at different power increment rates.

[0007] In order to achieve the above object, the present invention adopts the following technical solutions:

[0008] A research method for completing an upper limb cardiopulmonary exercise test at different power increment rates comprises the following steps:

[0009] Step 1: Select participants for upper limb cardiopulmonary exercise test; 14 healthy volunteers without disease diagnosis were selected as participants, including 5 males and 9 females;

[0010] Step 2: CPET quality control and standardized operation; CPET was calibrated with gas volume, high, medium and low flow rate, air, oxygen and carbon dioxide gas, and metabolic simulator using the Quark PFT Ergo cardiopulmonary exercise test system. After all the calibrations were passed, the test was conducted; participants were asked to complete one symptom-limited lower limb CPET and four upper limb CPETs with different power increment rates of 15W using a continuously increasing power program;

[0011] Step 3: CPET experiment grouping: According to the power increment rate of the upper limb CPET completed by the same healthy subject, the experiment was divided into 4 groups: 5W / min group, 20W / min group, 35W / min group and 50W / min group;

[0012] Step 4: Standardized processing and analysis of CPET data: Based on the standardized principles of FDA clinical trial CPET data analysis and interpretation, the raw data derived from each breath segment is segmented every second, and the 10-second average of all indicators is calculated for graphic interpretation and data analysis;

[0013] Step 5: Statistical analysis: The measured data that conform to normal distribution are expressed as mean ± standard deviation. SPSS statistical software was used for statistical analysis and Origin was used for graphics.

[0014] As a preferred embodiment of the present invention, the basic data of the participants include age, height, weight and physical fitness data.

[0015] As a preferred embodiment of the present invention, the CPET includes 4 stages, including resting for 3 minutes, warming up for 3 minutes, and then exercising at a power increasing rate of 5W / min, 20W / min, 35W / min or 50W / min to the maximum limit of symptom limitation, followed by recovery for 5 minutes.

[0016] As a preferred embodiment of the present invention, the CPET process requires continuous measurement of a 12-lead electrocardiogram, measurement of airflow at 100 Hz, collection of gas samples for continuous oxygen and carbon dioxide measurement, and calculation of data for each breath.

[0017] As a preferred embodiment of the present invention: in step 4, CPET data of every 10 seconds is used, with VO2 as the horizontal coordinate and VCO2 as the vertical coordinate, and the VCO2-vs-VO2 data is used to illustrate the anaerobic threshold, and the anaerobic threshold is measured using the Beaver's V slope method; 10 seconds of data is used to perform data analysis and calculation of indicators such as resting, warm-up, peak, and recovery.

[0018] As a preferred embodiment of the present invention: in the step 5, ANOVA statistical analysis is performed on each index of the four groups with different power increasing rates, and further a paired t-test is performed between the groups.

[0019] The beneficial effects of the present invention are:

[0020] A research method for completing upper limb cardiopulmonary exercise test with different power increment rates proved that upper limb CPET with different power increment rates significantly changed the power at peak exercise, exercise duration, and core indicators such as oxygen uptake and ventilation effectiveness, carbon dioxide removal and ventilation effectiveness, and oxygen uptake per unit power; it also had a certain degree of impact on the peak RER and the maximum RER in the recovery period. BRIEF DESCRIPTION OF THE DRAWINGS

[0021] Figure 1 This is a summary table of general information of the subjects of the present invention;

[0022] Figure 2 A summary table of the CPET core parameters and the proportions of each subject of the leg ergometer of the present invention;

[0023] Figure 3 The four different incremental working rates of the present invention are Comparative summary table of core indexes of lower arm ergometer CPET peak exercise;

[0024] Figure 4 The present invention operates at four increments of speed The following is a summary table comparing the RERs of CPET at different stages;

[0025] Figure 5 It is a schematic diagram of the process structure of the research method of the present invention.

[0026] Figure 2 Chinese: Peak HR: Peak heart rate (peak heart rate); Peak BF: Peak respiratory rate (peak respiratory rate); Peak V T :Peak tidal volume(peak tidal volume);Peak Peak minute ventilation (peak minute ventilation); EX-time: Exercise time (exercise time); Peak Work Rate: Peak load power (peak load power); Peak Peak oxygen uptake (peak oxygen uptake); AT: Anaerobic threshold (anaerobic threshold); Peak / HR: Peak oxygen pulse; OUEP: Peak oxygen uptake ventilation efficiency platform; Lowest The minimum value of carbon dioxide emission ventilation efficiency (the minimum value of carbon dioxide emission ventilation efficiency); Slope: Ventilation carbondioxide emission efficiency; %pred: Percentage of actualmeasured value to expected value;

[0027] Figure 3 Middle: Peak Peak oxygen uptake (Peak oxygen uptake); Peak Peak carbondioxide emissions (peak carbon dioxide emissions); Peak HR: Peak heart rate (peak heart rate); Peak Peak minute ventilation (Peak minute ventilation); Peak V T :Peak tidal volume (peak tidal volume); Peak BF:Peak respiratory rate (peak respiratory rate); Peak / HR: Peak oxygen pulse; Peak Work Rate: Peak load power; EX-time: Exercise time; OUEP: peak platform of oxygen uptake effectiveness; OUE-AT: O2 / E at anaerobic threshold; Lowest minimum value of average ventilation equivalent of carbon dioxide in 90s @AT: carbon dioxide ventilation equivalent at anaerobic threshold Slope(<VCP): the slope of carbon dioxide ventilation equivalent before the ventilation compensation point; Intercept of carbon dioxide ventilation equivalent intercept before ventilation compensation point

[0028] / ΔWR (all exercise): the oxygen uptake per unit power during the whole process of incremental exercise

[0029] **P < 0.01 20W / min group vs 5W / min group; ##P < 0.01 50W / min group vs 5W / min group; &&P < 0.01 35W / min group vs 5W / min group

[0030] △P<0.0150W / min group vs 20W / min group; P<0.0535W / min group vs 20W / min group; P<0.0550W / min group vs 35W / min group. DETAILED DESCRIPTION

[0031] The technical solution of the present invention is further described in detail below in conjunction with specific implementation methods.

[0032] Embodiments of the present invention are described in detail below, examples of which are shown in the accompanying drawings, wherein the same or similar reference numerals throughout represent the same or similar elements or elements having the same or similar functions. The embodiments described below with reference to the accompanying drawings are exemplary and are only used to explain the present invention, and cannot be understood as limiting the present invention.

[0033] A research method for completing upper limb cardiopulmonary exercise test with different power increment rates, such as Figures 1 to 5 As shown, the following steps are included:

[0034] Step 1: Select participants for upper limb cardiopulmonary exercise test; 14 healthy volunteers who studied and worked in Fuwai Hospital of Chinese Academy of Medical Sciences and had no disease diagnosis were selected as participants, including 5 males and 9 females; the basic data of the participants included age (years), height (m), weight (kg), body mass data (kg per square meter), BIM (kg / m 2 ); the participants were aged (34.36±7.65) years, tall (1.67±0.06) m, weighed (65.93±11.03) kg, and had a body mass index of (23.66±3.20) kg / m 2 .

[0035] For basic information of all participants, please see Figure 1 , the core index parameters of lower limb CPET are detailed in Figure 2 .

[0036] Step 2: CPET quality control and standardized operation; CPET is conducted using the Quark PFT Ergo cardiopulmonary exercise testing system from COSMED SRL, Italy. Participants undergo gas volume calibration, high, medium and low flow rate calibration, air, oxygen and carbon dioxide gas calibration, and metabolic simulator calibration before each test. After all calibrations are passed, testing is performed.

[0037] According to the standards of the Harbor-UCLA Center Cardiopulmonary Exercise Laboratory, resting pulmonary function tests were first performed, and then a symptom-limited maximum upper limb CPET was performed using a continuous incremental power program.

[0038] After all participants signed informed consent, they were randomly assigned to complete one symptom-limited lower limb CPET and four upper limb CPETs with different power increment rates of 15W each on different days within one month under the supervision of a doctor, according to the standards of the Harbor-UCLA Medical Center, using a continuously increasing power protocol.

[0039] The CPET includes 4 stages, including resting for 3 minutes, warming up for 3 minutes, and then exercising at a power increasing rate of 5W / min, 20W / min, 35W / min or 50W / min to the symptom-limited maximum limit exercise (increasing the load by 2W, 20W, 35W, 50W per minute until exhaustion), followed by recovery for more than 5 minutes.

[0040] The CPET process requires continuous measurement of a 12-lead electrocardiogram, measurement of airflow at 100 Hz, collection of gas samples for continuous oxygen and carbon dioxide measurement, and calculation of data for each breath.

[0041] Step 3: CPET experiment grouping; according to the power increment rate of the upper limb CPET completed by the same healthy subject, the experiment was divided into 4 groups: named 5W / min group, 20W / min group, 35W / min group and 50W / min group.

[0042] Step 4: Standardized processing and analysis of CPET data: Based on the standardized principles of CPET data analysis and interpretation of FDA clinical trials at Harbor-UCLA Medical Center, the raw data derived from breath-by-breath separations were segmented second-by-second, and the 10-second average values ​​of all indicators were calculated for graphical interpretation and data analysis.

[0043] The anaerobic threshold was graphically plotted using the CPET data of every 10 seconds, with VO2 as the horizontal axis and VCO2 as the vertical axis. The anaerobic threshold was measured using the Beaver's V slope method. The 10-second data was used to analyze and calculate indicators such as resting (after 120 seconds), warm-up (after 30 seconds), peak (after 30 seconds), and recovery (10 seconds).

[0044] Step 5: Statistical analysis: The measured data that conform to normal distribution are expressed as mean ± standard deviation. SPSS statistical software was used for statistical analysis and Origin for drawing. ANOVA statistical analysis was performed on each index under different power increasing rates in the four groups, and further paired t-tests were performed between groups.

[0045] The results are as follows:

[0046] 1. Changes in oxygen uptake, carbon dioxide output, and respiratory exchange rate during upper limb CPET

[0047] by Figure 1 The dynamic changes of oxygen uptake, carbon dioxide emissions, RER and power are demonstrated by taking healthy young male subjects as an example.

[0048] During the resting stage, oxygen uptake, carbon dioxide excretion, and RER change steadily, which is no different from the lower limbs.

[0049] After the warm-up phase begins, oxygen uptake and carbon dioxide emissions both increase, but RER does not change much.

[0050] After the power starts to increase, oxygen uptake and carbon dioxide emissions both increase, RER decreases slightly, and RER continues to rise after the anaerobic threshold.

[0051] When reaching peak exercise, oxygen uptake and carbon dioxide emissions reach maximum values, but peak RER is not maximum.

[0052] During the recovery period, oxygen uptake and carbon dioxide emissions both decrease, while RER rises rapidly, reaching a maximum value in about 1 minute and then decreases.

[0053] The overall trend of dynamic changes was the same as that of lower limb CPET. The 20W / min power increment rate group was able to complete the power increment process in an appropriate time (about 4 to 6 minutes), which prolonged and shortened the power increment time respectively compared with the low and high power increment rate groups.

[0054] 2. Comparison of core parameters of upper limb CPET at different power increment rates

[0055] Reference Figure 3 , Figure 4 The results of symptom-limited upper limb CPET peak oxygen uptake, peak carbon dioxide output, peak oxygen pulse, peak heart rate, peak respiratory rate, peak tidal volume, peak ventilation volume, end-tidal oxygen partial pressure, end-tidal carbon dioxide partial pressure, and carbon dioxide ventilation equivalent slope completed at different power increment rates in the four groups were not significantly different, and there was no statistically significant difference among the groups (P>0.05).

[0056] With the increase of the power increment rate, the peak power at the end of exercise under higher load power was significantly increased {(58.04±11.44vs 80.39±18.25vs

[0057] 95.00±22.43vs 109.64±22.23)W / min}, and the differences between the two groups were statistically significant (P<0.01).

[0058] The exercise time was significantly shortened with the increase of power increment rate {(11.61±2.29vs4.02±0.91vs 2.71±0.64vs 2.19±0.44)min}, and the comparison among the 5W / min, 20W / min and 35W / min groups was statistically significant (P<0.05). Compared with the 35W / min group, the exercise time of the 50W / min group was reduced, but the difference was small and not statistically significant (P>0.05).

[0059] The OUEP of the 50W / min group with a higher power increment rate was significantly lower (37.84±4.03 vs 36.91±6.85 vs 36.69±7.43 vs 36.21±5.9), which was statistically different from the 5W / min group (P<0.05).

[0060] V E / VCO2 was lower (29.45±3.33vs 30.67±7.05vs 30.27±4.23vs30.2±4.24).

[0061] The oxygen uptake per unit power decreased significantly with the increase of power increment rate {(17.10±2.40vs 13.16±2.46vs10.76±1.97vs 8.37±3.02)ml / (min·kg)}, and there was a statistically significant difference between the groups (P<0.05).

[0062] The oxygen uptake per unit power before the anaerobic threshold decreased significantly with the increase in power increment rate {(13.72±3.12 vs 12.29±3.79 vs 8.87±3.24 vs 6.64±2.28) ml / (min·kg)}, and the difference between the groups was statistically significant (P<0.05).

[0063] The oxygen uptake per unit power after the anaerobic threshold also decreased with the increase of the power increment rate {(19.48±4.00vs12.38±4.31vs 10.16±3.65vs 8.25±4.65)ml / (min·kg)}, and the difference between the groups was statistically significant (P<0.05).

[0064] 3. Comparison of RER at different stages of upper limb CPET performed at different power increment rates

[0065] The RER during resting period in different power increment rate groups was around 0.85 (0.85±0.07 vs 0.86±0.09 vs 0.85±0.11 vs 0.87±0.08).

[0066] The RER during the warm-up period was slightly higher than that during the resting period (0.89±0.07 vs 0.90±0.08 vs 0.92±0.10 vs 0.95±0.08).

[0067] At the anaerobic threshold, the RER value in the 20W / min power increment rate group was the lowest (0.93±0.07vs 0.90±0.07vs0.95±0.12vs 0.92±0.11).

[0068] When the exercise reached the peak, the RER of the group with a relatively low power increment rate of 5 W / min was the lowest (1.08±0.07 vs 1.17±0.12 vs 1.20±0.12 vs 1.21±0.14), which was statistically significant compared with the other three groups (P<0.05).

[0069] The peak RER increased slightly in the 20W / min, 35W / min, and 50W / min power increasing rate groups, and there was no statistical significance in the pairwise comparisons between the groups (P>0.05).

[0070] After entering the recovery period, the RER of the four power-increasing rate groups continued to rise. 2 minutes into the recovery period, the RER of the 50 W / min power-increasing rate group was still the highest (1.26±0.15 vs 1.27±0.23 vs 1.34±0.14 vs 1.39±0.19).

[0071] Among the four groups with different power increment rates, the maximum RER time of the 5W / min group was longer (1.58±0.41 vs 0.93±0.39 vs 1.31±0.46 vs 1.26±0.53), which was around 1min50s, and there was a statistical difference (P<0.05).

[0072] The higher the power increment rate, the greater the maximum RER in the recovery period (1.36±0.13vs.

[0073] The maximum RER in the 5 W / min power increment rate group during the recovery period was significantly lower than that in the 35 W / min and 50 W / min groups (P < 0.05), but there was no significant difference between the 5 W / min and 20 W / min groups (P > 0.05).

[0074] There was no significant difference in the maximum RER during the recovery period among the 20W / min group, 35W / min group and 50W / min group (P>0.05).

[0075] In summary, the power increment rate can affect the peak exercise indexes of upper limb cardiopulmonary exercise test - exercise time, peak power, and peak RER; there is no significant difference in the RER of the symptom-limited upper limb CPET completed at different power increment rates during rest and warm-up periods; as the intensity of exercise increases during the exercise phase, lactate buffering helps The output of the upper limb CPET makes the numerator increase at a faster rate than the denominator; the upper limb CPET power increment rate is more reasonable in time between 5-8 minutes. Completing the upper limb CPET in a moderate time will not cause excessive physical fatigue to the participants.

[0076] Upper limb CPET with different power increment rates significantly changes the power at peak exercise, exercise duration, and core indicators such as oxygen uptake and ventilation effectiveness, carbon dioxide removal and oxygen uptake per unit power; it also has a certain degree of impact on peak RER and maximum RER during recovery. The selection of power increment rate for standardized operation of upper limb CPET cannot be arbitrary. It is necessary to select a power increment rate that is individualized and suitable for the subjects, so that the core indicators of upper limb CPET can best reflect the actual functional status of the participants.

[0077] The above description is only a preferred specific implementation manner of the present invention, but the protection scope of the present invention is not limited thereto. Any technician familiar with the technical field can make equivalent replacements or changes according to the technical scheme and inventive concept of the present invention within the technical scope disclosed by the present invention, which should be covered by the protection scope of the present invention.

Claims

1. A research method for completing upper limb cardiopulmonary exercise test with different power increment rates, characterized in that: The following steps are involved: Step 1: Select participants for upper limb cardiopulmonary exercise test; 14 healthy volunteers without disease diagnosis were selected as participants, including 5 males and 9 females; Step 2: CPET quality control and standardized operation; CPET was calibrated with gas volume, high, medium and low flow rate, air, oxygen and carbon dioxide gas, and metabolic simulator using the Quark PFT Ergo cardiopulmonary exercise test system. After all the calibrations were passed, the test was conducted; participants were asked to complete one symptom-limited lower limb CPET and four upper limb CPETs with different power increment rates of 15W using a continuously increasing power program; Step 3: CPET experiment grouping: According to the power increment rate of the upper limb CPET completed by the same healthy subject, the experiment was divided into 4 groups: 5W / min group, 20W / min group, 35W / min group and 50W / min group; Step 4: Standardized processing and analysis of CPET data: Based on the standardized principles of FDA clinical trial CPET data analysis and interpretation, the raw data derived from each breath segment is segmented every second, and the 10-second average of all indicators is calculated for graphic interpretation and data analysis; Step 5: Statistical processing: The measured data that conformed to the normal distribution were expressed as mean ± standard deviation (X ± s), and SPSS statistical software was used for statistical analysis and Origin for drawing.

2. The method for completing upper limb cardiopulmonary exercise test at different power increment rates according to claim 1, characterized in that: The basic data of the participants include age, height, weight, and physical fitness data.

3. The method for completing upper limb cardiopulmonary exercise test at different power increment rates according to claim 1, characterized in that: The CPET includes 4 stages, including resting for 3 minutes, warming up for 3 minutes, and then exercising at a power increasing rate of 5 W / min, 20 W / min, 35 W / min or 50 W / min to the maximum limit of symptom limitation, followed by recovery for 5 minutes.

4. The method for completing upper limb cardiopulmonary exercise test at different power increment rates according to claim 1, characterized in that: The CPET process requires continuous measurement of a 12-lead electrocardiogram, measurement of airflow at 100 Hz, collection of gas samples for continuous oxygen and carbon dioxide measurement, and calculation of data for each breath.

5. The method for completing upper limb cardiopulmonary exercise test at different power increment rates according to claim 1, characterized in that: In step 4, the CPET data of every 10 seconds is used, with VO2 as the horizontal axis and VCO2 as the vertical axis, and the VCO2-vs-VO2 data is used to illustrate the anaerobic threshold, and the anaerobic threshold is measured using the Beaver's V slope method; the 10-second data is used to perform data analysis and calculation of indicators such as rest, warm-up, peak, and recovery.

6. The method for completing upper limb cardiopulmonary exercise test at different power increment rates according to claim 1, characterized in that: In the step 5, ANOVA statistical analysis was performed on each index under the four groups with different power increasing rates, and further a paired t-test was performed between the groups.

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