title: Comparison of the peak exercise response measured by the ramp and 1-min step cycle exercise protocols in patients with exertional dyspnea.
abstract: OBJECTIVE
  To compare the peak exercise response and determine the limits of agreement between the ramp and the 1-min step cycle protocols in a representative population of patients with exertional breathlessness attending a respiratory outpatient clinic.
  
  
  METHODS
  Crossover with the test order double blinded and randomized.
  
  
  METHODS
  Outpatient exercise physiology laboratory.
  
  
  METHODS
  Twenty-two patients (12 men; mean [SD] age, 59 [8] years; FEV(1), 71% [21%]) with lung disease and/or exertional breathlessness.
  
  
  METHODS
  Symptom-limited, maximum cycle exercise tests using a ramp and a 1-min step work rate (WR) protocols. The two protocols were assigned to subjects in a randomized manner.
  
  
  RESULTS
  Oxygen uptake (O(2)), minute ventilation (E), heart rate (HR), WR, exercise time, and Borg scores were compared at symptom-limited peak exercise. The mean (SD) peak values for the ramp and the step protocols, respectively, were as follows: peak O(2), 1.51 (0.44) L/min and 1.49 (0.43) L/min; peak E, 50.8 (12.9) L/min and 49.9 (14.5) L/min; and peak HR, 133 (24) beats/min and 131 (22) beats/min (p > 0.05). There were no significant differences between breathlessness and perceived exertion at peak exercise. Peak WR (WRpeak) and exercise time were significantly higher using the ramp protocol: 110.5 (37.1) W vs 105.6 (35.6) W, and 8.2 (2.0) min vs. 7.6 (1.9) min, respectively.
  
  
  CONCLUSIONS
  The ramp protocol leads to a higher WRpeak, and this may have implications for exercise prescription. However, there were no significant differences between the two protocols for the peak physiologic responses. The choice of protocol for the measurement of maximal exercise capacity remains one of laboratory preference.
authors.affiliation: Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom.
authors.forename: Sue M
authors.initials: SM
authors.lastname: Revill
authors.forename: Katy E
authors.initials: KE
authors.lastname: Beck
authors.forename: Mike D L
authors.initials: MD
authors.lastname: Morgan
mesh_terms: D000368:Aged; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004417:Dyspnea / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology*
chemical_list: D010100:Oxygen