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(Circulation. 2006;113:2706-2712.)
© 2006 American Heart Association, Inc.

Exercise Physiology

Aerobic Capacity in Patients Entering Cardiac Rehabilitation

Philip A. Ades, MD; Patrick D. Savage, MS; Clinton A. Brawner, BS; Caroline E. Lyon, MD; Jonathan K. Ehrman, PhD; Janice Y. Bunn, PhD; Steven J. Keteyian, PhD

From the Divisions of Cardiology (P.A.A., P.D.S., C.E.L.) and Medical Biostatistics (J.Y.B.), University of Vermont College of Medicine, Fletcher-Allen Health Care, Burlington, and Division of Cardiovascular Medicine (C.A.B.), Henry Ford Hospital, Detroit, Mich.

Correspondence to Philip A. Ades, MD, McClure 1, Cardiology, University of Vermont College of Medicine, Burlington, VT 05401. E-mail philip.ades{at}vtmednet.org

Received December 8, 2005; revision received April 3, 2006; accepted April 18, 2006.

Background— Symptom-limited treadmill testing is commonly performed on entry to cardiac rehabilitation (CR) for its prognostic value and to design a safe and effective exercise program. Normative values for this evaluation are not available. The primary goals of this study were to establish normative values for peak aerobic capacity (peak O₂) for patients entering CR and to create nomograms for conversion of peak O₂ to a percentage of predicted exercise capacity, stratified by age, gender, and diagnosis.

Methods and Results— Peak O₂ was measured in 2896 patients entering CR from 1996 to 2004. Peak O₂ was higher in men than in women: 19.3±6.1 mL · kg^–1 · min^–1 (range, 5.2 to 49.7 mL · kg^–1 · min^–1) versus 14.5±3.9 mL · kg^–1 · min^–1 (range, 3.8 to 29.8 mL · kg^–1 · min^–1) (P<0.0001). Peak O₂ decreased steadily with age with a greater rate of decline in men than women (–0.242 versus –0.116 mL · kg^–1 · min^–1 per year) (P<0.01). Factors associated with lower peak O₂ include coronary artery bypass grafting (CABG), angina at stress testing, hypertension, and, in women, ß-blocking medications. Nomograms are presented for individual values to be compared with mean values by age, gender, and cardiac diagnosis. These include a nomogram to convert estimated maximal metabolic equivalents to actual peak O₂ for patients who do not undergo direct measurement of peak O₂.

Conclusions— Values of peak O₂ on entry to CR are extremely low, particularly in women, approaching values seen with severe chronic heart failure. This underscores the importance of CR after a major cardiac event to improve physical function and long-term prognosis.

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