Title: Exercise testing in preventative health populations: Predictors of achieving maximal exercise capacity
Thesis Supervisor: Dr. Robert Boushel
Committee members: Dr. Michael Koehle, Dr. Jasmin Ma
Defence Chair: Dr. Cameron Mitchell
Abstract:
Background: Cardiorespiratory fitness (CRF) testing in preventative health (PH) settings offers healthcare practitioners a feasible tool to stratify chronic disease risk in patients. While this has been established as a powerful tool of assessing mortality risk, it is still not included as part of routine healthcare. Understanding of CRF testing in PH populations could better inform best practices in its implementation.
Objective: This study aimed to provide insight on exercise testing in PH populations exploring the CRF and clinical profiles of patients who underwent a maximal exercise test. Three questions were addressed: 1) What is the proportion of exercise tests in which maximal exercise capacity (MEC) is achieved? 2) Are there pre-test characteristics that affect the proportion of exercise tests in which MEC is achieved? 3) What determines exercise test termination in PH populations?
Methods: A retrospective chart review was conducted for all patients completing an exercise test between 2022-2024. 619 patient charts were included. The frequency of achieving MEC in a PH population was determined. Exercise mode, test protocol, and pre-test demographics were explored as predictors of achieving MEC. As well, reasons for exercise test termination were discussed.
Results:
77% of individuals in this PH population achieved MEC. Older age had the most widespread effect on achievement of MEC. Patients over the age of 70 were less likely to reach MEC in both males (p<.001) and females (p=.033), individuals who are active (p=.088), sedentary (p=.010), unknown physical activity behaviour (p=.012), those with elevated CVD risk (p<.001), those using treadmills (p<.001), and those following the Bruce-ramp protocol (p<.001). The most common reason for termination an exercise test was fatigue or dyspnea (81%).
Conclusion: When working with older adults, exercise clinicians should take extra care in understanding their experience with exercise, as well as their CVD risk factors and impact on exercise, and select the exercise test mode and protocol best suited to their patient. Further understanding and assessment of the CRF profiles of PH patients will contribute to the methodological rigour required in the evaluation of exercise programming and support future explorations of meaningful impacts on health outcomes.