A CROSSOVER COMPARISON OF 3 MODALITIES OF CARDIOPULMONARY STRESS-TESTING IN THE ELDERLY

Objectives To compare arm and leg ergometry with treadmiil exercise te sting in elderly patients with ischaemic heart disease. Methods A cros sover comparison of graded exercise tests using a treadmill (modified Bruce protocol), leg ergometry (20 W per 2 min stage) and arm ergometr y (10 W per 2 min stages) was made in 16 patients aged 65 years and ol der. Cardiorespiratory data were collected at peak exercise time and a t the ischaemic threshold. Continuous variables were subjected to anal ysis by of variance and corrected by the Bonferroni method to allow fo r multiple comparisons. Categorical data were analysed by Friedman's t est. Results An 81% concordance in endpoints between the tests was fou nd for 13 patients. Peak oxygen consumption was significantly greater during treadmill testing [18.0 ml/min/kg, 95% confidence interval (CI) 16.6-19.4] than during leg ergometry (13.7 ml/min/kg, 95% CI 12.3-15. 1) or arm ergometry (12.8 ml/min/kg, 95% CI 11.4-14.2). Six patients h ad a corresponding positive ischaemic ST segment response. Oxygen cons umption was significantly greater at the ischaemic threshold during ar m ergometry (10.6 ml/min/kg, 95% CI 8.6-12.7) than during treadmill te sting (6.2 ml/min/kg, 95% CI 4.2-8.2) or leg ergometry (5.8 ml/min/kg, 95% CI 3.8-7.8). No significant difference in perception of work invo lved during the three types of tests was found but there was a non-sig nificant preference in favour of the treadmill test. Conclusions Arm a nd leg ergometry provide useful information and should be considered f or people unable to use a treadmill for various reasons. However arm e rgometry performed at 10 W per 2 min stage may constitute a test of en durance rather than aerobic capacity, and may be influenced by the war m-up phenomenon; a more sensitive procedure should be developed for th is method of testing. (C) Rapid Science Publishers.