Effects of functional exercise on maximal metabolic equivalents and peak oxygen pulse in patients with coronary artery disease
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摘要:
目的 探讨30秒坐立(30-s STS)试验、6分钟步行试验(6MWT)与冠心病患者最大代谢当量(METmax)和峰值氧脉搏(peak VO2/HR)之间的相关性,并建立回归方程。 方法 共纳入57例冠心病患者,男43例、女14例,年龄(59.7±8.6)岁。所有患者均接受冠状动脉造影,并在签署知情同意书后的1周内完成心肺运动试验(CPET)、6MWT和30-s STS试验。在自行车测力计上进行CPET,负荷以10~15 W/min递增,记录METmax和peak VO2/HR。遵循美国胸科学会指南进行6MWT,记录6分钟步行距离(6MWD)。使用46 cm高的无扶手硬质座椅靠墙进行30-s STS试验,记录重复次数。30-s STS与6MWT之间设置30 min休息间隔,6MWT与CPET之间间隔72 h。采用Pearson相关分析评估METmax、peak VO2/HR与30-s STS重复次数、6MWD的相关性;分别以METmax、peak VO2/HR为因变量,以30-s STS重复次数、6MWD为自变量,建立线性回归方程。 结果 Pearson相关分析结果表明,METmax与30-s STS重复次数和6MWD均呈正相关(r=0.356,P=0.007;r=0.419,P=0.001),peak VO2/HR与30-s STS重复次数和6MWD均呈正相关(r=0.363,P=0.006;r=0.294,P=0.026)。线性回归方程如下:METmax=1.95+0.08×30-s STS重复次数+0.01×6MWD(R2=0.207,均方根误差=0.723,P=0.002),peak VO2/HR=3.20+0.24×30-s STS重复次数+0.01×6MWD(R2=0.183,均方根误差=2.309,P=0.005),表明30-s STS重复次数与6MWD共同解释了冠心病患者METmax约20.7%的变异以及peak VO2/HR约18.3%的变异。 结论 30-s STS重复次数和6MWD均是冠心病患者METmax和peak VO2/HR的显著影响因素,基于两者建立的回归方程能够定量化地评估其与心肺功能指标之间的关联。 Abstract:Objective To investigate the correlations of the 30-second sit-to-stand (30-s STS) test and the 6-minute walk test (6MWT) with maximal metabolic equivalents (METmax) and peak oxygen pulse (peak VO2/HR) in patients with coronary artery disease (CAD), and to develop corresponding regression equations. Methods A total of 57 patients with CAD, including 43 males and 14 females with a mean age of (59.7±8.6) years, were enrolled. All patients underwent coronary angiography. Within 1 week after signing the informed consent form, they completed a cardiopulmonary exercise test (CPET), 6MWT, and 30-s STS test. CPET was performed on a cycle ergometer with the workload increased by 10-15 W/min. METmax and peak VO2/HR were recorded. The 6MWT was conducted according to the American Thoracic Society guidelines, and the 6MWD was recorded. The 30-s STS test was administered using a chair with a backrest and no armrests, fixed at a height of 46 cm and placed against a wall. The number of repetitions completed in 30 s was recorded. A 30-min interval was maintained between the 6MWT and 30-s STS, and a 72-h interval between the 6MWT and CPET. Pearson correlation analysis was used to assess the relationships of 30-s STS repetitions and 6MWD with METmax and peak VO2/HR. Linear regression models were then developed with METmax and peak VO2/HR as dependent variables and 30-s STS repetitions and 6MWD as independent variables. Results Pearson correlation analysis revealed that METmax was significantly positively correlated with 30-s STS repetitions (r=0.356, P=0.007) and 6MWD (r=0.419, P=0.001), and peak VO2/HR was significantly positively correlated with 30-s STS repetitions (r=0.363, P=0.006) and 6MWD (r=0.294, P=0.026). Linear regression analysis yielded the following equations: METmax=1.95+0.08×30-s STS repetitions+ 0.01×6MWD (R2=0.207, RMSE=0.723, P=0.002); peak VO2/HR=3.20+0.24×30-s STS repetitions+0.01×6MWD (R2=0.183, RMSE=2.309, P=0.005). The regression equations demonstrated that the combination of the 30-s STS repetitions and 6MWD collectively explained approximately 20.7% of the variance in METmax and 18.3% in peak VO2/HR among patients with CAD. Conclusion Both 30-s STS repetitions and 6MWD are significant predictors of METmax and peak VO2/HR in patients with CAD. Regression models established based on these 2 variables can quantitatively assess their associations with cardiopulmonary function indicators. -
心肺适能(cardiorespiratory fitness,CRF)是冠心病患者全因死亡的重要预测指标[1-2]。多项前瞻性队列研究证实,较高水平的CRF与较低的心血管疾病风险相关[1, 3]。心肺运动试验(cardiopulmonary exercise test,CPET)是目前公认的评估CRF的金标准方法,通过该试验可获得最大代谢当量(maximal metabolic equivalent,METmax)及峰值氧脉搏(peak oxygen pulse,peak VO2/HR)等关键参数,以客观反映个体的心肺功能状态[4]。代谢当量(metabolic equivalent,MET)是衡量人体活动时代谢强度的通用单位,研究表明,CRF每提高1 MET,人群全因死亡率可降低约10%~25%,心血管疾病风险下降13%,总体死亡率减少15%[5-6]。peak VO2/HR是峰值摄氧量与心率的比值,反映了人体在最大运动负荷下心脏每次搏动输出的血液的氧摄取能力,是评估心肺效率的重要指标[7]。尽管CPET在CRF评估中具有重要价值,但其在临床实践中的应用仍面临诸多限制。该试验不仅依赖昂贵的设备,还需专业人员操作,因此在资源匮乏地区难以普及[8]。此外,对于心功能严重受损或活动能力显著下降的晚期冠心病患者,完成CPET也存在困难[8-9]。这些现实因素促使人们探索更为简便、经济且可行的CRF评估手段。
在替代性评估工具中,6分钟步行试验(6-minute walk test,6MWT)已被广泛用于冠心病患者CRF的客观评估,其操作简便,且能较好地反映患者日常活动能力[8, 10]。另一项常用试验为30秒坐立(30-second sit-to-stand,30-s STS)试验,Wang等[11]研究指出,该试验能有效区分冠心病患者的心血管风险水平,具备良好的临床判别能力。然而,上述功能性运动试验与CPET核心指标(如METmax与peak VO2/HR)之间的定量关系尚待明确,两者在解释CRF变异中的共同作用有待研究。本研究旨在探讨6MWT与30-s STS试验这2项低成本、易操作的试验方法与冠心病患者METmax和peak VO2/HR之间的定量关联,并建立线性回归方程以明确其影响程度,为临床评估冠心病患者CRF提供简便、客观的参考依据。
1 对象和方法
1.1 研究对象
本研究方案经上海交通大学医学院附属新华医院伦理委员会批准(XHEC-C-2020-078-1),所有患者均在数据收集前签署书面知情同意书。于2020年1月至2021年6月期间,在上海交通大学医学院附属新华医院心内科招募受试者。纳入标准:(1)病情稳定的冠心病患者;(2)年龄40~80岁;(3)自愿参与本研究,并签署知情同意书;(4)母语为中文。排除标准:(1)心肌梗死急性期(6个月内);(2)合并其他严重影响运动能力的疾病(如脑血管疾病,严重肺、肝、肾疾病);(3)存在影响肢体活动的肌肉骨骼系统疾病(如骨折、严重软组织损伤、膝关节损伤史或无法完成坐立动作);(4)患有精神障碍、认知功能障碍或拒绝配合完成试验;(5)近3个月内曾参与其他临床研究。
1.2 运动试验
参与者在签署知情同意书后1周内完成6MWT、30-s STS试验及CPET。每项试验仅执行1次,不设预试验。为控制顺序效应,试验顺序采用随机信封法分配:将不同试验顺序写在卡片上并密封入信封,由受试者随机抽取并依序执行。6MWT和30-s STS试验之间设置30 min休息间隔,6MWT与CPET之间间隔72 h。
30-s STS试验在一把固定高度为46 cm的无扶手硬质座椅上进行,椅腿配有橡胶防滑垫,试验时椅子紧靠墙面[11]。试验要求受试者双臂交叉于胸前,双手置于对侧肩部,从坐姿开始,双脚平放,踝关节保持中立位,在30 s内尽可能多地完成从坐到立的动作。完整的坐立动作定义为:站立时膝关节完全伸直,坐下时臀部完全接触椅面。试验过程中不给予任何口头鼓励。若受试者需要辅助或无法完成动作,则终止试验。最终记录30 s内完成动作的重复次数。
6MWT参照美国胸科学会指南[10, 12]执行。试验在一条长30 m以上、平坦、无障碍的笔直走廊上进行。走廊起点设标志线,30 m处放置交通锥作为折返点。为保障安全,走廊旁备有休息椅及应急吸氧站。试验前,由心脏康复物理治疗师测量患者的基线脉率、血压及主观用力感觉评分(rating of perceived exertion,RPE),并进行标准化指导。试验过程中,允许给予标准化的语言鼓励。试验结束时,记录脉率、血压及RPE用于安全性评估,记录6分钟步行距离(6-minute walk distance,6MWD)用于后续分析。
CPET依照现行指南[4, 13-14]在自行车测力计上进行。试验前,对质量流量传感器及气体分析仪进行校准,确保其准确性、再现性与响应时间均符合标准。试验方案如下:受试者先静息2 min,随后在0 W负荷下无阻力热身3 min,接着开始标准递增运动,负荷以10~15 W/min的速率线性增加,直至其达到耐受极限。整个试验过程持续监测心率、12导联心电图和脉搏血氧饱和度(pulse oxygen saturation,SpO2);每2 min记录1次血压。运动的终止指征包括受试者自觉力竭,或出现心肌缺血、复杂性室性心律失常、Ⅱ/Ⅲ度房室传导阻滞、血压骤降>20 mmHg(1 mmHg = 0.133 kPa)、血压极度升高(收缩压>220 mmHg或舒张压>120 mmHg)、SpO2<80%、意识模糊或严重头晕等症状。记录静息收缩压、舒张压、心率以及峰值收缩压、舒张压、心率用于安全性评估,记录METmax和peak VO2/HR用于后续分析。
1.3 临床资料收集
收集患者的社会人口学资料,包括性别、年龄和BMI。同时收集病史资料,以及空腹血糖(fasting blood glucose,FBG)、血清总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、左心室射血分数(left ventricular ejection fraction,LVEF)和左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)等临床指标。
所有患者均接受冠状动脉造影检查,采用Gensini评分评估冠心病的严重程度[15]。由2名专家独立分析冠状动脉造影结果,取其平均值评估狭窄程度。该评分系统通过2个维度进行量化:首先,根据管腔直径狭窄程度赋值,1%~49%为1分,50%~74%为2分,75%~99%为3分,100%为4分。其次,根据病变所在冠状动脉节段的生理重要性赋予相应的权重系数,左主干为5,左前降支近段为2.5、中间段为1.5、远段为1,第一对角支为1,第二对角支为0.5,左回旋支近段为2.5、远段为1,钝缘支与后降支均为1,左心室后支为0.5,右冠状动脉近、中、远段及后降支均为1。每个病变的最终得分为狭窄程度得分与位置权重系数的乘积。将各病变得分相加,即得到Gensini评分。
1.4 统计学处理
采用SPSS 25.0软件进行统计学分析。符合正态分布的连续变量以x±s表示,分类变量以频数与百分数描述。采用Pearson相关分析探讨年龄、BMI、6-MWD、30-s STS重复次数、LVEF、LVEDD、Gensini评分与METmax、peak VO2/HR之间的相关性。分别以METmax和peak VO2/HR作为因变量,以6-MWD和30-s STS重复次数作为自变量,建立线性回归方程。检验水准(α)为0.05。
2 结果
2.1 受试者特征
本研究共纳入57例冠心病患者,年龄(59.7±8.6)岁,男43例(75.4%)、女14例(24.6%),合并高血压和糖尿病的患者比例分别为66.7%(38/57)和26.3%(15/57),冠心病严重程度Gensini评分为(54.5±29.8)分。患者的人口统计学特征以及30-s STS试验、6MWT和CPET结果见表 1。
表 1 冠心病患者人口学特征及30-s STS试验、6MWT、CPET结果Table 1 Demographics characteristics and 30-s STS test, 6MWT, CPET results of patients with coronary artery diseaseN = 57 Characteristic Data Age/year, x±s 59.7±8.6 Gender, n (%) Male 43 (75.4) Female 14 (24.6) BMI/(kg·m-2), x±s 24.41±3.56 CAD-PCI, n (%) 28 (49.1) OMI, n (%) 29 (50.9) Hypertension, n (%) 38 (66.7) Diabetes, n (%) 15 (26.3) Smoking, n (%) 17 (29.8) FBG/(mmol·L-1), x±s 5.81±1.54 TC/(mmol·L-1), x±s 3.77±0.91 TG/(mmol·L-1), x±s 1.61±1.30 HDL-C/(mmol·L-1), x±s 1.05±0.27 LDL-C/(mmol·L-1), x±s 2.05±0.75 NT-proBNP/(ng·L-1), x±s 331.1±158.2 LVEF/%, x±s 58.7±8.8 LVEDD/mm, x±s 50.9±5.6 Gensini score, x±s 54.5±29.8 30-s STS repetition, x±s 13.8±2.8 6MWD/m, x±s 454.6±58.1 METmax, x±s 5.0±0.9 peak VO2/HR/(mL per beat), x±s 10.2±2.1 30-s STS: 30-second sit-to-stand; 6MWT: 6-minute walk test; CPET: Cardiopulmonary exercise test; BMI: Body mass index; CAD-PCI: Coronary artery disease underwent percutaneous coronary intervention; OMI: Old myocardial infraction; FBG: Fasting blood glucose; TC: Total cholesterol; TG: Triglyceride; HDL-C: High density lipoprotein-cholesterol; LDL-C: Low density lipoprotein-cholesterol; NT-proBNP: N-terminal pro-brain natriuretic peptide; LVEF: Left ventricular ejection fraction; LVEDD: Left ventricular end-diastolic diameter; 6MWD: 6-minute walk distance; METmax: Maximal metabolic equivalent; peak VO2/HR: Peak oxygen pulse. 2.2 METmax和peak VO2/HR与其他指标的相关性
Pearson相关分析结果显示,患者年龄与METmax和peak VO2/HR均无明显相关性(均P>0.05),BMI与METmax和peak VO2/HR均呈负相关(均P<0.05),30-s STS重复次数与METmax和peak VO2/HR均呈正相关(均P<0.01),6MWD与METmax和peak VO2/HR均呈正相关(均P<0.05),LVEF、LVEDD与METmax和peak VO2/HR均无明显相关性(均P>0.05),Gensini评分与peak VO2/HR呈负相关(P<0.05)、与METmax无明显相关性(P>0.05)。见表 2。
表 2 METmax和peak VO2/HR与其他指标的Pearson相关分析结果Table 2 Pearson correlation analysis of METmax, peak VO2/HR and other indicatorsIndex METmax peak VO2/HR r P value r P value Age -0.245 0.066 -0.208 0.121 BMI -0.288 0.030 -0.520 <0.001 30-s STS repetition 0.356 0.007 0.363 0.006 6MWD 0.419 0.001 0.294 0.026 LVEF 0.019 0.909 0.060 0.714 LVEDD -0.302 0.058 -0.014 0.485 Gensini score -0.309 0.052 -0.395 0.012 METmax: Maximal metabolic equivalent; peak VO2/HR: Peak oxygen pulse; BMI: Body mass index; 30-s STS: 30-second sit-to-stand; 6MWD: 6-minute walk distance; LVEF: Left ventricular ejection fraction; LVEDD: Left ventricular end-diastolic diameter. 2.3 METmax和peak VO2/HR与30-s STS重复次数、6MWD的线性回归分析
为探讨30-s STS与6MWD对冠心病患者METmax和peak VO2/HR的影响,分别建立了一系列线性回归方程,线性回归分析结果见表 3。其中,联合方程(方程3和方程6)在解释因变量变异方面表现最佳,其决定系数(coefficient of determination,R2)最高,同时均方根误差(root mean square error,RMSE)与平均绝对误差(mean absolute error,MAE)均为同类方程中最低。方程3解释了METmax约20.7%的变异(R2 = 0.207),而方程6解释了peak VO2/HR约18.3%的变异(R2 = 0.183)。该结果表明,30-s STS重复次数与6MWD均是影响冠心病患者心肺功能的关键因素,两者共同纳入方程时比单一指标能够更有效地反映心肺功能的整体状态。
表 3 METmax、peak VO2/HR与30-s STS重复次数、6MWD的线性回归分析Table 3 Linear regression analysis for METmax and peak VO2/HR based on 30-s STS repetitions and 6MWDNo. Regression equation R2 RMSE MAE P value 1 METmax = 2.73+0.09×30-s STS repetition 0.164 0.784 0.623 0.009 2 METmax = 2.05+0.01×6MWD 0.182 0.754 0.593 0.001 3 METmax = 1.95+0.08×30-s STS repetition+0.01×6MWD 0.207 0.723 0.570 0.002 4 peak VO2/HR = 6.36+0.28×30-s STS repetition 0.139 2.357 1.892 0.008 5 peak VO2/HR = 5.27+0.01×6MWD 0.090 2.409 1.921 0.028 6 peak VO2/HR = 3.20+0.24×30-s STS repetition+0.01×6MWD 0.183 2.309 1.847 0.005 METmax: Maximal metabolic equivalent; peak VO2/HR: Peak oxygen pulse; 30-s STS: 30-second sit-to-stand; 6MWD: 6-minute walk distance; R2: Coefficient of determination; RMSE: Root mean square error; MAE: Mean absolute error. 3 讨论
本研究首次探讨了30-s STS试验和6MWT这2项简易功能性运动试验结果与冠心病患者METmax及peak VO2/HR之间的定量关系。结果显示,30-s STS重复次数和6MWD均是METmax和peak VO2/HR的显著影响因素,两者共同构成的回归方程能更全面地反映冠心病患者的心肺功能状态。
Pearson相关分析结果表明,METmax与30-s STS重复次数和6MWD均呈正相关(r = 0.356,P = 0.007;r = 0.419,P = 0.001),peak VO2/HR与30-s STS重复次数和6MWD均呈正相关(r = 0.363,P = 0.006;r = 0.294,P = 0.026)。既往研究支持坐立试验作为评估不同人群身体功能的替代方法的有效性。例如,Nakamura等[16]报道老年2型糖尿病患者的增量坐立试验与CPET测得的峰值摄氧量之间存在强相关性(r = 0.89,P<0.01)。本研究中30-s STS重复次数与CPET测得的peak VO2/HR呈正相关,提示30-s STS试验可用于评估冠心病患者的心肺功能。本研究中6MWD与peak VO2/HR的相关性与既往meta分析结果(r = 0.37~0.78)[17]基本一致,不同研究之间的差异可能源于CPET方案及指标选择的不同[14, 18]。目前,尚无研究专门探讨冠心病患者中6MWD、坐立试验与METmax之间的关系,但已有研究报道功能性试验与CPET所测最大摄氧量(maximal oxygen uptake,VO2 max)之间呈线性关系[19-21]。Pereira De Sousa等[22]发现使用永久性心脏起搏器患者的6MWD与估计VO2 max存在线性关联。Gurses等[23]研究显示,健康年轻人的周能量消耗与不同时长坐立试验及6MWT呈中度相关,提示坐立试验可作为快速评估身体功能和下肢肌力的有效工具。
本研究建立的回归方程表明,30-s STS重复次数与6MWD共同解释了METmax约20.7%以及peak VO2/HR约18.3%的变异。30-s STS试验主要评估下肢肌力与功率[11],而6MWT则侧重于评估有氧耐力与整体功能容量[10]。两者分别从不同维度衡量身体功能,其联合应用能够综合捕捉到影响心肺功能的多方面因素,因此在线性回归方程中表现出比单一指标更强的解释能力。
从临床实践角度看,本研究建立的回归方程具有重要的参考价值。peak VO2/HR和METmax是评估个体CRF的重要指标。低水平CRF已被确立为临床生命体征之一,也是冠心病的危险因素及运动康复的有效预后指标[24]。因此,临床工作者应重视对患者进行定期CRF评估,并制定包括规律身体活动在内的结构化运动处方。然而,作为评估金标准的CPET因设备昂贵、操作复杂,在临床普及中受限[9]。本研究提供的基于简易功能性运动试验的回归方程为资源受限场景下的临床评估提供了重要的替代思路。临床工作者可以基于30-s STS试验和6MWT的结果,利用回归方程对患者的心肺功能水平进行初步估算,从而为制定个体化的运动处方和社区康复干预提供客观参考。
本研究存在以下局限性:首先,样本量相对较小且为单中心设计,其结果外推性受限,未来需在不同人群与文化背景下进行验证;其次,本研究仅对患者进行了30-s STS试验,其他时长的坐立试验可能也有应用价值,有待进一步研究。
综上所述,本研究结果表明30-s STS重复次数和6MWD均是冠心病患者METmax和peak VO2/HR的显著影响因素,基于两者建立的回归方程能够定量化地评估其与心肺功能指标之间的关联,为不具备CPET条件的临床及社区环境提供了一个简便、客观的评估工具。
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表 1 冠心病患者人口学特征及30-s STS试验、6MWT、CPET结果
Table 1 Demographics characteristics and 30-s STS test, 6MWT, CPET results of patients with coronary artery disease
N = 57 Characteristic Data Age/year, x±s 59.7±8.6 Gender, n (%) Male 43 (75.4) Female 14 (24.6) BMI/(kg·m-2), x±s 24.41±3.56 CAD-PCI, n (%) 28 (49.1) OMI, n (%) 29 (50.9) Hypertension, n (%) 38 (66.7) Diabetes, n (%) 15 (26.3) Smoking, n (%) 17 (29.8) FBG/(mmol·L-1), x±s 5.81±1.54 TC/(mmol·L-1), x±s 3.77±0.91 TG/(mmol·L-1), x±s 1.61±1.30 HDL-C/(mmol·L-1), x±s 1.05±0.27 LDL-C/(mmol·L-1), x±s 2.05±0.75 NT-proBNP/(ng·L-1), x±s 331.1±158.2 LVEF/%, x±s 58.7±8.8 LVEDD/mm, x±s 50.9±5.6 Gensini score, x±s 54.5±29.8 30-s STS repetition, x±s 13.8±2.8 6MWD/m, x±s 454.6±58.1 METmax, x±s 5.0±0.9 peak VO2/HR/(mL per beat), x±s 10.2±2.1 30-s STS: 30-second sit-to-stand; 6MWT: 6-minute walk test; CPET: Cardiopulmonary exercise test; BMI: Body mass index; CAD-PCI: Coronary artery disease underwent percutaneous coronary intervention; OMI: Old myocardial infraction; FBG: Fasting blood glucose; TC: Total cholesterol; TG: Triglyceride; HDL-C: High density lipoprotein-cholesterol; LDL-C: Low density lipoprotein-cholesterol; NT-proBNP: N-terminal pro-brain natriuretic peptide; LVEF: Left ventricular ejection fraction; LVEDD: Left ventricular end-diastolic diameter; 6MWD: 6-minute walk distance; METmax: Maximal metabolic equivalent; peak VO2/HR: Peak oxygen pulse. 表 2 METmax和peak VO2/HR与其他指标的Pearson相关分析结果
Table 2 Pearson correlation analysis of METmax, peak VO2/HR and other indicators
Index METmax peak VO2/HR r P value r P value Age -0.245 0.066 -0.208 0.121 BMI -0.288 0.030 -0.520 <0.001 30-s STS repetition 0.356 0.007 0.363 0.006 6MWD 0.419 0.001 0.294 0.026 LVEF 0.019 0.909 0.060 0.714 LVEDD -0.302 0.058 -0.014 0.485 Gensini score -0.309 0.052 -0.395 0.012 METmax: Maximal metabolic equivalent; peak VO2/HR: Peak oxygen pulse; BMI: Body mass index; 30-s STS: 30-second sit-to-stand; 6MWD: 6-minute walk distance; LVEF: Left ventricular ejection fraction; LVEDD: Left ventricular end-diastolic diameter. 表 3 METmax、peak VO2/HR与30-s STS重复次数、6MWD的线性回归分析
Table 3 Linear regression analysis for METmax and peak VO2/HR based on 30-s STS repetitions and 6MWD
No. Regression equation R2 RMSE MAE P value 1 METmax = 2.73+0.09×30-s STS repetition 0.164 0.784 0.623 0.009 2 METmax = 2.05+0.01×6MWD 0.182 0.754 0.593 0.001 3 METmax = 1.95+0.08×30-s STS repetition+0.01×6MWD 0.207 0.723 0.570 0.002 4 peak VO2/HR = 6.36+0.28×30-s STS repetition 0.139 2.357 1.892 0.008 5 peak VO2/HR = 5.27+0.01×6MWD 0.090 2.409 1.921 0.028 6 peak VO2/HR = 3.20+0.24×30-s STS repetition+0.01×6MWD 0.183 2.309 1.847 0.005 METmax: Maximal metabolic equivalent; peak VO2/HR: Peak oxygen pulse; 30-s STS: 30-second sit-to-stand; 6MWD: 6-minute walk distance; R2: Coefficient of determination; RMSE: Root mean square error; MAE: Mean absolute error. -
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