| Part I Effect of different power increasing rate on the overall function evaluation of cardiopulmonary exercise testObjective: The quality of cardiopulmonary exercise test(CPET)is an important basis for its wide application in the clinical field.We found that the choice of the rate of power increase during clinical CPET operation is more arbitrary.Sometimes,operator choose a faster or slower incremental rate scheme,so that the subject completes the power increase rate process earlier or later.The clinical operator will select a specific peak respiratory exchange rate(RER)as the index to judge CPET as extreme exercise,stop CPET or to ensure the safety of the subject.Compared with the moderate power increment rate scheme,whether the lower or higher power increment rate scheme will affect the CPET results and the specific peak RER value is used as a criterion to judge CPET reaches extreme sports,stops CPET,or guarantees the safety of the subject lack of relevant research.In the first part of this study,starting from the quality control of CPET,the effect of low and high power increasing rate on CPET results was observed compared with the moderate power increasing rate CPET of healthy people.By comparing whether the peak RER values of symptom limiting limit CPET completed at different power increasing rates are the same,we can judge whether it is appropriate to use a specific peak RER value as a standard to evaluate CPET as extreme exercise,stop CPET and ensure the safety of subjects.Methods: Twenty healthy volunteers were randomly selected to complete the symptom-limiting limits of CPET,power increment rates of 30 and 10,and 60W/min,respectively,for moderate and relatively low and relatively high power increment rates in different working days within a week.The main indicators of CPET data: Peak V.O2,Peak V.CO2,anaerobic threshold(AT),peak Oxygen pulse(O2P),peak work rate(WR),peak respiratory exchange rate(RER),peak breathe frequency(Bf),peak tidal volume(V.T),peak ventilation(V.E),peak heart rate(HR),peak blood pressure(BP),excercise time and Oxygen uptake per unit power(△V.O2/△WR)and ventilation effectiveness index were analyzed using standard methods.Paired T test was performed on the difference of each index in the three groups of different power increasing rates.Results: Compared with the moderate power increment rate group,the peak power of the low power increment rate group and the high power increment rate group decreased and increased significantly(167.3±30.2 vs 139.0±25.6 vs 198.5±36.8)W/min(all P < 0.001);the exercise time was significantly prolonged and shortened(353.5±57.1 vs 849.0±153.1 vs 214.0±36.6)s(all P < 0.001);the peak RER was significantly decreased and increased(1.32±0.07 vs 1.22±0.05 vs 1.39±0.09)(all P < 0.001);the △V.O2/△WR was significantly increased and decreased(8.7±0.6 vs 10.3±0.7 vs 7.2±0.7)ml/min/W(all P < 0.001);the oxygen uptake efficiency plateau(OUEP)decreased significantly(43.7±7.0 vs 42.0±6.0 vs 41.3±4.2)(all P < 0.05).Conclusion: Relatively low or high power increasing rate CPET significantly changed the peak WR,peak RER,exercise time and △V.O2/△ WR,and reduced the ventilation efficiency during exercise.The standardized operation of CPET should choose a moderate power increasing rate scheme which is individualized and suitable for the subjects,so that the results obtained are more objective and reliable and can more truly reflect the functional state of the subjects.Moreover,a fixed RER value can not be used as a standard to judge the subjects to reach extreme sports,stop CPET or ensure the safety of the subjects.Part II Effect of individualized precise exercise therapy on pulse waveform in patients with chronic diseaseObjective: The pulse waveform contains rich cardiovascular physiological and pathological information.This part of the study observed the difference of pulse waveform between patients with chronic disease and normal people at rest,and the changes of pulse waveform in patients with chronic disease after individual exercise.To explore the effect of individualized exercise therapy on pulse waveform in patients with chronic disease,and intends to find out the waveform evidence of individualized exercise in the effective treatment of chronic disease from the change of pulse waveform.Methods: 16 patients with chronic diseases(hypertension,diabetes,dyslipidemia)and 16 normal subjects were selected for cardiopulmonary exercise test(CPET).Within one week after CPET,a single individualized exercise therapy with △50% power intensity of 30 min exercise was completed by power bicycle.The pulse wave data of 50 s in patient group and normal group were measured and recorded at different time points before and after exercise.The characteristics of pulse waveform before exercise and the changes of 50 s pulse waveform at each time point of 10 min,20min and 30 min after exercise were qualitatively and quantitatively analyzed.Results:(1)The proportion of obvious peak dicrotic wave in patient group before exercise was significantly lower than that in normal people(28.6% vs 94.5%)(P < 0.001).The amplitude of main wave(YP1),amplitude of dicrotic wave peak point(YP2),peak-to-valley slope(S2),amplitude of dicrotic wave(YP2-YPL)and time difference between Peak-to-valley(TP2)in patient group were significantly lower than those in normal group,while the amplitude of trough relative to main wave(YPL/YP1)in patient group was significantly higher than that in normal group(all P < 0 05).Dicrotic wave amplitude as a percentage of main wave amplitude(YPL/YP1)was significantly larger than that of the normal group(P < 0.05).(2)The proportion of dicrotic wave with obvious peak in patients with 10 min(65.7% vs.28.6%),20 min(77.1% vs.28.6%)and 30 min(73.7% vs.28.6%)after exercise was significantly higher than that before exercise(all P < 0.001).(3)In the patient group,the amplitude of the starting point of pulse wave(YB1)at different time after exercise was significantly lower than that before exercise,and the amplitude of main wave(YP1)was significantly higher than that before exercise(all P < 0.05).In the normal group,the amplitude of the starting point of pulse wave at different time after exercise(YB1)was higher than that before exercise,and the amplitude of main wave(YP1)was lower than that before exercise,but the difference was not statistically significant(all P > 0.05).(4)The amplitude of dicrotic wave peak point(YP2)and amplitude of dicrotic wave valley point(YPL)at different times after exercise in the patient group and the normal group were significantly lower than those before exercise;while peak-to-valley slope(S2),amplitude of dicrotic wave(YP2-YPL)and the time difference between the peak and trough of repulse wave(TP2)were significantly increased compared with those before exercise(all P < 0 05),and the peak amplitude of repulse wave(YP2-YPL)and time difference between Peak-to-valley(TP2)were significantly higher than those before exercise(all P < 0 05).Conclusion: Under the continuous dynamic pulse wave recording,(1)the pulse waveform of the patients with chronic disease before exercise was significantly different from that of the normal subjects,which was mainly manifested as the decrease of main wave amplitude,the low proportion of dicrotic wave with obvious peak,the decrease of the amplitude of dicrotic wave,the short TP2 and so on,which can be used as the waveform evidence of poor cardiovascular function in patients with chronic disease.(2)The pulse waveform of the patients changed significantly after individualized exercise therapy,and could be maintained for a certain period of time,which was mainly manifested as the increased proportion of obvious peak dicrotic wave,the decrease of the position of dicrotic wave,the increase of dicrotic wave amplitude,△TP2 became longer and so on.The waveform of dicrotic wave in patients after exercise tends to that of normal people,suggesting that the change of wave form of dicrotic wave can be used as a reference for individual exercise in the effective treatment of chronic diseases. |
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