Cardiac Stress Testing In Claudicants: Use Of A Stationary Bicycle In Place Of A Treadmill Is An Acceptable Alternative

Main Category: Cardiovascular / Cardiology
Also Included In: Heart Disease
Article Date: 25 Nov 2008 - 5:00 PDT

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Peripheral artery disease (PAD) presenting with intermittent claudication (IC) is the local manifestation of a systemic disease with consequently poor life expectancies of 70 to 80% at 5 years, due largely to latent coronary artery disease.

Cardiac stress testing using treadmill walking protocols is often used to diagnose the presence and extent of cardiac disease. However the ability of walking protocols to sufficiently stress the heart may be limited in patients with PAD by the pain of claudication and gait abnormalities.

Cycling would circumvent several of the associated problems of treadmill walking, but there is limited information on the physiologic response of patients with PAD to cycling. A study undertaken by David Kingsmore, M.D., FRCS (Ed), M.B. Ch.B, BMedBiol, University of Glasgow and Consultant Surgeon at Gartnavel General Hospital, Glasgow, Scotland, and his team compared the peak cardiopulmonary responses and reproducibility of cycling and treadmill exercise in patients with PAD.

Both methods of exercise assessment revealed high reproducibility of absolute claudication time to volitional fatigue, and cardiopulmonary responses such as lactate threshold, peak heart rate, and peak oxygen uptake. Cycling induced significantly higher cardiopulmonary responses (peak heart rate, peak carbon dioxide output, peak minute ventilation, and respiratory exchange ratio) than the treadmill.

Absolute claudication time and time to volitional fatigue were not significantly different between exercise modalities. Dr. Kingsmore concluded that exercise testing using cycling may offer equally reproducible data to treadmill exercise with intermittent claudication, but more important importantly incurs significantly higher cardiorespiratory responses. Further, eight out of ten patients preferred the cycle exercise test to that with the treadmill.

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Source
Pauline T. Mayer
www.ptmhcm.com