RESUMEN
Background: The cardiopulmonary exercise test (CPET) is considered a gold standard in assessing cardiorespiratory fitness (CRF) but has limited accessibility due to competency requirements and cost. Incorporating portable sensor devices into a simple bedside test of CRF could improve diagnostic and prognostic value. Objectives: The authors sought to evaluate the association of an augmented 6-minute incremental step test (6MIST) with standard CPET. Methods: We enrolled patients undergoing clinically indicated supine cycle ergometry CPET with invasive hemodynamics (iCPET) for the same-day 6MIST. CRF-related variables were simultaneously recorded using a signal morphology-based impedance cardiograph (PhysioFlow Enduro) and a portable metabolic analyzer (VO2 Master Pro) during incremental pace stationary stepping. The correlation between CPET and hemodynamic parameters from both tests was assessed using the intraclass correlation coefficient (ICC). Results: Fifteen patients (mean age 60 ± 14 years, 40% female, 27% Black) were included. All patients who agreed to undergo 6MIST completed the study without any test-related adverse events. We observed good to excellent correlation between iCPET- and 6MIST-measured CPET parameters: peak heart rate (ICC = 0.60; 95% CI: 0.15-0.85), absolute peak O2 consumption (VO2) (ICC = 0.77; 95% CI: 0.44-0.92), relative peak VO2 (ICC = 0.64; 95% CI: 0.20-0.86), maximum ventilation (ICC = 0.59; 95% CI: 0.13-0.84), O2 pulse (ICC = 0.71; 95% CI: 0.33-0.89), and cardiorespiratory optimal point (ICC = 0.82; 95% CI: 0.52-0.94). No significant correlation was determined between iCPET and 6MIST in measuring cardiac index at rest (ICC = 0.19; 95% CI: -0.34 to 0.63) or at peak exercise (ICC = 0.36; 95% CI: -0.17 to 0.73). Conclusions: We demonstrate the feasibility of a novel augmented 6MIST with wearable devices for simultaneous CPET and hemodynamic assessment. 6MIST-measured CPET parameters were strongly correlated with the iCPET-derived measurements. Additional studies are needed to confirm the validity of the 6MIST compared to standard upright CPET.
RESUMEN
This manuscript reviews the current literature involving clinical anxiety and cardiopulmonary disease, considers the hypothesized physiological mechanisms for anxiety, and discusses the use of exercise as a treatment for both anxiety and cardiopulmonary diseases. The literature summary consists of original investigations, meta-analysis, commentaries, and review publications in order to better understand the biological and psychological mechanisms for using exercise as treatment and to provide details specific to cardiopulmonary disease and anxiety management. A gap in the literature exists concerning the anxiolytic effects of exercise as a psychological and physical treatment in cardiopulmonary populations. The findings from this review support further investigation into the use of exercise to ameliorate the burden of anxiety in cardiopulmonary disease patients. This review evaluates the current literature surrounding cardiopulmonary disease and anxiety. A systematic literature search identified articles discussing the prevalence, association, and risk of anxiety in cardiopulmonary patients. Though depression is often studied in this population, recent investigation supports a need for further research regarding anxiety in cardiopulmonary patients. Treatment to manage patients' psychological profile can reduce exacerbations of known disease, reduce hospital readmission, and improve functional capacity, and overall quality of life.