Direct versus indirect methods of determining the exercise intensity in cardiovascular rehabilitation

Czech version

Authors: L. Mífková ^1,2; F. Várnay ¹; P. Homolka ^1,3; J. Jančík ¹; R. Panovský ^3,4; P. Dobšák ^1,2,3; J. Siegelová ^1,2; L. Špinarová ^3,4
Authors‘ workplace: Klinika tělovýchovného lékařství a rehabilitace LF MU a FN u sv. Anny v Brně ¹; Katedra fyzioterapie a rehabilitace, LF MU, Brno ²; Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně ³; I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ⁴
Published in: Kardiol Rev Int Med 2015, 17(2): 141-148
Category: Cardiology Review

Overview

Objective:
Determination of both ventilatory anaerobic thresholds (VT1 and VT2) using spiroergometry testing and the assessment of the applicability of indirect methods of determining the training parameters in cardiac patients before the initiation of a cardiovascular rehabilitation programme.

Methods:
Of 107 ramp spiroergometric tests carried out in cardiac patients before cardiac rehabilitation programme initiation, 57 tests were selected (43 men – mean age 61.3 ± 10.3 years, and 14 women – mean age 63.4 ± 10.9 years), where VT1 and VT2 were detectable and the test completed with adequate metabolic load (RER_peak ≥ 1.10). To assess the applicability of indirect methods the oxygen uptake reserve (VO₂R) and heart rate reserve (heart rate reserve – HRR) were also calculated from results of the spiroergometric testing.

Results:
Absolute values of VO_2VT1 were lower in women compared to men. However, VT1 was higher in women (59% VO_2peak) than in men (53% VO_2peak). VT1 (expressed as % of VO₂R and % of HRR) in men was at 43% of VO₂R and at 44% of HRR – the difference between these values was not statistically significant. In women, the VT1 was at 45% of VO₂R and at 47% of HRR (also in this case the difference was not statistically significant). The correlation between %HRR and %VO₂R was statistically significant both in men (p<0.001) and women (p<0.01), but with low coefficient of determination (R² in men = 0.32; R² in women = 0.44) suggesting a low power of linear dependence. In case of noticeable variance of values, the equal values of %HRR may correspond significantly to different values of %VO₂R. In 39% of patients, chronotropic incompetence (CTI) was present and the achieved maximum heart rate (HR_peak) was lower than the 80% HR_max value corresponding to age. It should be pointed out that the training HR calculated by indirect methods very often differs substantially from the correct values set by spiroergometry.

Conclusion:
The only correct and accurate method to determine the training intensity is the spiroergometric testing. Indirect methods have their importance for a healthy population, but from the point of view of cardiovascular rehabilitation they are unreliable and thus their use cannot be recommended.

Keywords:
excercise training – spiroergometry – ventilatory thresholds – cardiovascular rehabilitation – oxygen uptake – heart rate

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