Evaluation of exercise tolerance and cardiac function on symptom limited tredmill exercise test in chronic hemodialysis patients, and exercise trainin
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1 Evaluation of exercise tolerance and cardiac function on symptom limited tredmill exercise test in chronic hemodialysis patients, and exercise training HIROKI BASE, RYOICHI NAKAMURA 3rd Department of Internal Medicine, School of Medicine, Toho University, Tokyo, Japan (Director : Prof. K. Seki) KUNIO EBINE Cardiovascular section of Ohashi Hospital, School of Medicine, Toho University, Tokyo, Japan MAKOTO AKAIKE, MASAYUKI NOMURA and KWANGCHOL CHANG Odawara Cardiovascular Hospital, Odawara, Japan Key words: chronic hemodialysis patient, treadmill exercise test, exercise tolerance, cardiac function, exercise training The purpose of this study is evaluated the characteristics of tolerance and cardiac function in chronic hemodialysis patients (HD patients). Symptom limited treadmill exercise test was carried out in 33 HD patients and the results were compared with them in normal subjects and in ischemic heart disease patients (IHD patients). The following results were obtained that 18.2% of the HD patients indicated positive findings on treadmill exercise test. But 69.7% of the cases had to stop the test by their leg fatigue. In comparison with normal subjects, exercise time, maximum heart rate, maximum V02 and maximum pressure-rate products were reduced to the same degree both in HD patients (negative findings on treadmill exercise test) and in IHD patients. Based on these findings, it was recommended to conduct exercise training as part of a cardiac rehabilitation program on HD patients. Generally in considering an exercise training program, a target heart rate is used as an index of the proper exercise loading factor, which is determined by the % HR max method or the Karvonen method. In determining the target heart rate of HD patients, the Karvonen method was proved to be much better than the % HR max method. In HD patients, a strong positive correlation was observed between Ht and r:aximum V02i but no significant correlation was observed between the BUN level and either serum
2 Cr level or maximum VO2. Thus the cause of the marked reduction both in exercise tolerace and in cardiac function in HD patients was considered to be the complication of coronary artery disease, chronic anemia, and early muscular fatigue due to disorder of aerobic metabolism.
3 Table 1 Patients with chronic hemodialysis. The mean values for each parameter are shown.
4 Table 4 Mean exercies time (min) of normal subjects, IHD patients, and HD patients in negative treadmill exercise test. N. S.: not significant Normal : IHD P<0.001 Normal : HD P<0.01 IHD : HD N.S Table 2 Results of treadmill exercise test in hemodialysis patients. Table 3 The end points in treadmil exercise test. Normal: normal subjects IHD : ischemic heart disease patients HD : chronic hemodialysis patients
5 Table 5 Mean VO2 max. in normal subjects, IHD patients, and HD patients in negative treadmill exercise test. (mi/kg. min) N. S.: not significant Normal : IHD Normal : HD HD : HDN.S P<0.05 P<0.001I Table 6 Mean heart rate max. (/min) in normal subjects, IHD patients, and HD patients in negative treadmill exercise test. N. S.: not significant Normal : IHD P<0.01 Normal : HD P<0.01 IHD : HD N.S Table 7 Mean testing heart rate (/min) in normal subjects, IHD patients, and HD patients in negative treadmill exercise test in each exercise level. level 1: 30<% HR max. 50 level 2: 50<% HR max. 70 level 3: 70<% HR max. 90 level 4: 90<% HR max.
6 Table 8 Mean systolic blood pressure (mmhg) in normal subjects, IHD patients, and HD patients in negative treadmill exercise test in each exercise level. Table 9 Mean pressure-rate products (PRP/100) in normal subjects, IHD patients, and HD patients in negative treadmill exercise test in each exercise level. level 1: 30<% HR max. 50 level 2: 50<% HR max. 70 level 3: 70<% HR max. 90 level 4: 90<% HR max level 1: 30<% HR max. 50 level 2: 50<% HR max. 70 level 3: 70<% HR max. 90 level 4: 90<% HR max. Fig. 1 Values of % VO2 max, and % HR max, calculated by the % HR max method in normal subjects, IHD patients, and HD patients innegative treadmill exercise test. There are significant relations between them in each group. This figure shows that the values of % VO2 max. estimated by % HR max. using the % HR max method are higher than the true % VO2 max.
7 Fig. 2 Values of % VO2 max. and % HR max. calculated by the Karvonen method in normal subjects, IHD patients, and HD patients in negative treadmill exercise test. there are significant relations between them in each group. This figure shows that the values of % VO2 max. estimated by % HR max, using the Karvonen method are close to the true % VO2 max. in comparison with the values using the % HR max methnd Fig. 3 Values of V02 max. and Ht in HD patients in treadmill exercise test. There is significant relation (r=0.762) between them.
8 Fig. 4 Values of VO2 max. and BUN level in HD patients in treadmill exercise test. There is no significant relations in them. Fig. 5 Values of VO2 max. and SCr level in HD patients in negative treadmill exercise test. There is no significant relations in them.
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11 2) Hensel, G., Pundchus, H. D. and Durr, F.: Effect of physical exercion on various hemodynamic values in patients treated regularly by hemodialysis. Medsch Welt. 24: , ) Mallion, J. M., Cordonnier, D., Meftal, H., et al.: Exercise test of hemodialyzed chronic kidney failure patients: method of long-term determination of cardiovascular condition and effect of treatment. J. Urol. Nephrol. 79: , ) Ulmer, H. E., Greiner, H., Schler, H. W., et al.: Cardiovascular impairment and phisical working capacity in children with chronic renal failure. Acta Pediat. Scand. 67: 43, ) Goldberg, A. P., Hagberg, J. A., Delmez, J. A., et al.: Metabolic effects of exercise training in hemodialysis patients. Kidney Int. 18: , ) Zabetakis, P. M., Gleim, G. W., Pasternack, F. L., et al.: Long-duration submaximal exercise conditioning in hemodialysis patients. Clan. Nephrol. 18: 17-22, science an sports, 7: , reinfusion. J. Appl. Physaol. 41: , ) Karvonen, M. J., Kentala, E., Mustala, O., et al.: The effects of training on heart rate. Ann. Med. Exp. Fenn. 35: , ) Parrish, A. E. and Ostapenko, E.: The effect of exercise on blood lactate in azotemic sub jests. Clan. Nephrol. 16: 35-39, ) Barnea, N., Drory, Y., Iaina, A., et al.: Exercise tolerance in patients on chronic hemo dialysis. Israel. J. Med. Sca. 16: 17-21, ) Naughton, J. P., Hellerstein, H. K. and Mohler, I. C.: Exercise testing and exercise training in coronary heart disease. Academic working capacity in children with chronic renal failure. Acta. Paediatr. Scand. 67: 43-48,1978. press , New York, San Francisco, London : pp. 16) Naughton, J. R., Hellerstein, H. K. and Mohler, I. C.: Exercise testing and exercise training in coronary heart disease. Academic press. New York, San Francisco, London : pp , ) Davis, J. A. and Convertiono, V. A.: A comparison of heart rate methods for predicting endurance training intensity. Medicine and 18) Ekblom, B., Goldbarg, A. N. and Gullbring, B.: Response to exercise after blood loss and 19) Ulmer, H. E., Greiner, H., Schuler, H. W., et al.: Cardiovascular impairment and physical
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