"Value" of improved treadmill exercise capacity: lessons from a study of rate responsive pacing.
OBJECTIVE
To compare the value of a series of cardiovascular measurements in patients with symptomatic disease receiving an effective treatment (rate responsive pacing).


METHODS
12 pacemaker dependent patients with VVIR units.


METHODS
Single blind crossover between VVI and VVIR.


METHODS
Exercise capacity was assessed by treadmill tests (modified Bruce protocol and a fixed workload protocol) with respiratory gas analysis. Self paced corridor walk tests were also undertaken. Quality of life (QOL) was assessed by questionnaire. Daily activity was measured in the patients' homes using shoe and belt pedometers.


RESULTS
Treadmill tests and QOL questionnaires correctly identified the clinical benefit associated with VVIR. The modified Bruce protocol was superior to the fixed workload protocol as it was better tailored to the fairly well preserved exercise capacity of the patients. Symptom scores, but not walking times, were improved with VVIR during corridor walk tests. VVIR did not improve daily activity measured using either the belt or shoe pedometers.


CONCLUSIONS
VVIR pacing improved some but not all measures of exercise capacity. This finding illustrates the difficulty of selecting an instrument to measure symptomatic improvement in clinical research; and raises the question, what is the best way of measuring exercise capacity?
Staniforth
A D
AD
Department of Cardiovascular Medicine, Queen's Medical Centre, University of Nottingham, UK.
Andrews
R
R
Harrison
M
M
Perry
A
A
Cowley
A J
AJ
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006327:Heart Block / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016037:Single-Blind Method; D018709:Statistics, Nonparametric