medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»medalphabet-625Research ArticleКОЛОНКА ГЛАВНОГО РЕДАКТОРАИндивидуальный «рэмп»-протокол и модифицированный протокол Брюса в оценке толерантности к физической нагрузке у пациентов 70 лет и старшеThe individualized ramp protocol and the modified Bruce protocol in the assessment of exercise capacity in patients aged 70 years and olderКозловС. Г.KozlovS. G.noemail@neicon.ruЧерноваО. В.ChernovaO. V.noemail@neicon.ruМатвееваМ. А.MatveevaM. A.noemail@neicon.ruАлексееваИ. А.AlekseevaI. A.noemail@neicon.ruФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава РоссииРоссияNational Medical Research Centre of CardiologyRussian Federation201807052018114Современная функциональная диагностика2733Copyright © Козлов С.Г., Чернова О.В., Матвеева М.А., Алексеева И.А., 20182018Козлов С.Г., Чернова О.В., Матвеева М.А., Алексеева И.А.Kozlov S.G., Chernova O.V., Matveeva M.A., Alekseeva I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/625

Цель исследования. Выбор оптимального протокола пробы с физической нагрузкой на тредмиле для оценки толерантности к физической нагрузке у пациентов 70 лет и старше. Материалы и методы. Проведено сопоставление результатов проб с дозированной физической нагрузкой на тредмиле у 40 пациентов обоего пола в возрасте 70 лет и старше, не имеющих ИБС или сердечной недостаточности. Каждому из пациентов с интервалом в один день были проведены две пробы - одна с использованием модифицированного протокола Брюса, другая - с использованием индивидуально подобранного «рэмп»-протокола. Субъективную переносимость нагрузки оценивали по 10-балльной шкале Борга. Результаты. Продолжительность нагрузки при использовании модифицированного протокола Брюса у мужчин и женщин равнялась в среднем 2,7 [2,0; 3,0] и 2,0 [1,5; 2,9] мин., величина выполненной нагрузки - 3,7 [3,5; 4,2] и 3,5 [2,7; 3,6] МЕТ, соответственно. По 10-балльной шкале Борга 5 (13 %) пациентов считали нагрузку средней тяжести, 35 (87 %) больных - тяжёлой. Продолжительность нагрузки при использовании индивидуального «рэмп»-протокола у мужчин и женщин равнялась в среднем 11 [8,7; 12,0] и 8,2 [6,0; 8,6] мин., величина выполненной нагрузки - 6,3 [6,0; 7,5] МЕТ и 5,5 [5,0; 6,0] МЕТ, соответственно, что было достоверно больше (в обоих случаях p<0,001), чем при использовании модифицированного протокола Брюса. При использовании «рэмп»-протокола 18 (45 %) пациентов считали нагрузку легкой, 22 (55 %) больных - средней тяжести. Заключение. Использование у пациентов в возрасте 70 лет и старше индивидуального «рэмп»-протокола при проведении пробы с физической нагрузкой на тредмиле для оценки толерантности к физической нагрузке позволяет чаще, чем при использовании модифицированного протокола Брюса, достигнуть расчетной для этого возраста величины нагрузки при ее оптимальной продолжительности, а выполнение нагрузки более комфортно для пациентов.

Objective. To identify optimal protocol of exercise treadmill testing for exercise capacity assessment in patients aged 70 years and older. Materials and methods. The study comprised 40 patients of both genders, aged 70 years and older, who did not have a baseline history of established CAD or heart failure. All patients underwent treadmill stress testing on 2 consecutive days. Stress testing was carried out using a modified Bruce protocol and individualized ramp protocols. The Borg 10-point category ratio scale was used to assess perceived exertion. Results. Significant differences between the protocols were the longer exercise duration (10,4±1,5 vs. 2,4±1,4 min in men, P<0,001; and 10±1,9 vs. 2,2±1,7 min in women, P<0,001) and the greater achieved workload (6,2±2,3 vs. 3,7±1,5 MET in men, P<0,001; and 5,8±1,1 vs. 3,3±1,2 MET in women, P<0,001) resulting from the individualized ramp protocols. The mean maximum heart rates, systolic blood pressures and diastolic blood pressures did not differ significantly. The rating of perceived exertion from the revised Borg scale (0 to 10) in men and women was 5±2 for the ramp protocol and 8±1 for the modified Bruce protocol (P <0.01), indicating that the subjects found the ramp protocol easier. Conclusion. In patients aged 70 years and older individualized ramp treadmill protocol more often allows to achieve of optimal test duration with higher degrees of workload and greater patient comfort during the test than the modified Bruce protocol.

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The authors declare that there are no conflicts of interest present.