Guidelines suggest that individualized ramp protocols with treadmill times targeted between 8 and 12 minutes are most suitable to estimate exercise capacity. However, previous methods to determine ...individualized ramp rates and comparisons between ramp and standardized protocols have been limited to clinically referred populations.
Forty-three healthy volunteers median (interquartile range), age 36 (30-41) years; 10 women performed an individualized ramp and a Bruce treadmill exercise protocol in random order. The Veterans Specific Activity Questionnaire VSAQ, resulting in metabolic equivalents (METs)VSAQ combined with a modified variant of the VSAQ nomogram (resulting in METs(NOMOGRAM)) was used to individualize the ramp protocol. Exercise capacity estimated from speed and grade of the treadmill (METs(ESTIMATED)) and that derived from directly measured peak oxygen uptake (VO2) METs(MEASURED) were compared with the pretest estimates of exercise capacity.
Median values for METs(VSAQ), METs(NOMOGRAM), METs(ESTIMATED), and METs(MEASURED) for the ramp protocol were 12.0 (10-12), 15.0 (14-16.5), 16.7 (15.9-17.8), and 15.2 (13.5-16.7), respectively. For the ramp protocol, all 43 participants achieved a treadmill time between 8 and 12 minutes, whereas with the Bruce protocol only 6 (14%) participants fell within this range (P < .0001). Peak VO2 ramp: 53.1 (47.4-58.3) versus Bruce: 53.5 (48.7-58.3) mL/kg/min; P = .008 was slightly lower using the ramp protocol.
The modified variant of the VSAQ nomogram is a useful tool to estimate an individual's exercise capacity and to select a treadmill ramp protocol to yield the recommended exercise duration for moderately to highly fit, healthy individuals. The individualized ramp and the Bruce protocols are similar with regard to directly measured peak VO2 achieved.
Rupture of the aortic arch and laceration of the diaphragm after blunt trauma are two serious lesions that are difficult to manage. (1,2) We repaired both lesions in a patient with an anterior ...approach (i.e., a median sternotomy and a superior median laparotomy). The repair, carried out during extracorporeal circulation, turned out to be relatively easy to perform. The potential dangers associated with the use of cardiopulmonary bypass after blunt trauma must be acknowledged. In selected cases, however, when no strong contraindications to the administration of anticoagulation exist, the anterior approach and the use of cardiopulmonary bypass offer an excellent exposure for the repair of both lesions.
