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Researchers Develop Exercise Chart for Women to
Prevent Heart Problems
Oldest women in groundbreaking study with poor
exercise capacity were most likely to die
Aug. 5, 2005 - Women who score less than 85 percent
of their age predicted exercise capacity on an exercise stress test have
a two
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Nomogram for
Women
Exercise capacity can be estimated by
performing a symptom-limited stress test based on the speed and
grade of a treadmill. It is defined as the maximal oxygen uptake
for a given workload and can be expressed in metabolic
equivalents (MET). MET is the amount of oxygen used by an
average seated person and increases with the intensity of
exercise.
To establish the percentage of predicted
exercise capacity for age requires the woman's age and exercise
capacity achieved in MET on the stress test. Drawing a straight
line between the age and exercise capacity will allow the
determination of the percentage of predicted exercise capacity
for age; a value of 100 percent is the mean for any given age.
Any result greater than 100 percent indicates
better-than-average performance. Any result lower than 100
percent indicates some degree of functional impairment for age.
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times greater risk for serious heart problems and
death, say researchers, who have also designed a simple chart (nomogram)
women can use to interpret their exercise capacity, based on normal
values for their age. The women in the study over 70 years of age with
poor exercise capacity had an especially high mortality. Interestingly,
the other high mortality group were the youngest those under 55.
In a groundbreaking first of its kind study,
researchers studied over 5,700 women's fitness levels relative to age
and lifestyle. The goal of the study was to produce the chart for women
to use. The study was published in the August 4 issue of the New England
Journal of Medicine.
"The current American College of Cardiology
(ACC)/American Heart Association (AHA) exercise guidelines and standards
are based on exclusively male data" says Dr. Martha Gulati, study author
and preventive cardiologist at Rush University Medical Center, Chicago.
"This is the first study of its kind in women," said Dr. Gulati.
"Despite extensive research on the role of exercise stress testing and
exercise capacity, there has been a lack of data on what is normal or
expected for healthy women. Until now, they have been evaluated using
the men's nomogram, which does not provide an accurate assessment for
women."
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"From the study we see a woman and man of the same
age, that exercise the same amount, have a different age-predicted
exercise capacity. This study provides women and clinicians a simple
chart that is able to predict with adjusted levels factoring in age,
lifestyle and exercise capacity," she said.
The author explains the 5,721 normal women studied
came from The St. James Women Take Heart Project.
"The women came from a call for volunteers in 1992
from the Chicago metropolitan area which resulted in a cohort of
asymptomatic women. They were 35 years or older, had no active
cardiovascular disease and had to be able to walk on a treadmill.
Another cohort of 4,471 symptomatic women in the study were from the
Economics of Noninvasive Diagnosis (END) study group, from six medical
centers, and referred for stress test for evaluation of suspected
coronary disease. This cohort was used to validate the model," reports
Gulati
All women underwent an exercise treadmill test,
using the Bruce Protocol. Gulati said she and her colleagues measured
the level of fitness in units of metabolic equivalents (MET) achieved on
a treadmill stress test.
A MET unit it equal to what you are doing when
lying at rest, and any activity greater than that is an increment of one
MET. The researchers then calculated the percent exercise capacity as a
number.
Gulati says that to chart a woman's
percent-predicated exercise capacity, one draws a line between age and
fitness (measured in METs). The line will intersect a diagonal line,
which is the percent-predicted exercise capacity. She gives the example
that a 30-year-old woman and a 60-year-old woman who each achieved at 7
METs would achieved a different percent predicted for age.
The 30-year-old would have only reached a 65
percent fitness level, while the 60-year old women would have reached
100 percent of her age predicted fitness level.
The researchers found that normal, healthy women
who were not able to achieve 85 percent of the predicated exercise
capacity were twice as likely to die than those who achieve greater than
or equal to 85 percent. The results were confirmed in the symptomatic
group. Gulati says this is particularly important in younger women,
because younger women are at an increased risk of cardiac death the
further they are deviated from their age-predicted fitness level.
These findings contrast with what has been
previously reported in males and set the standards for both males and
females.
"In general, women's fitness levels seem to be
lower regardless of her age than for men," said Gulati.
Fitness declines with age for both men and women
but the difference between men and women becomes greater with age. The
study found women lose about 1 percent of their exercise capacity each
year.
"Given that we live longer, it just emphasizes the
importance of fitness for women," said Gulati, who along with a fellow
researcher has a patent pending for the fitness guidelines.
A 50-year-old male must achieve 9.2 percent METs to
achieve 100 percent age-predicted exercise capacity. For a 50
year-old-woman, her 100 percent age-predicted exercise capacity would
only be 8.2 METs. "This does not mean that women should exercise less
than men, but rather that women and men have age-predicted fitness
goals," says Gulati.
Gulati says these findings provide women specific
normative values and will likely be incorporated within the ACC/AHA
guidelines.
"Most exercise stress testing systems automatically
calculate the exercise capacity/METs achieved. Minimal additional
programming would be needed to calculate the percent-predicted exercise
capacity achieved for age and gender to further assist clinicians with
risk assessment," she says.
About this study
Author's note/Gulati: This paper is dedicated to
the late Dr. Arfan J. Al-Hani who designed the St. James Women Take
Heart Project. Dr. Gulati is now on the faculty of Northwestern Medical
School, Chicago.
Researchers: Dr. Henry R. Black, Rush University
Medical Center; Leslee J. Shaw Ph.D. and Dr.C. Noel Bairey Merz,
Cedars-Sinai Medical Center, Los Angeles; Ronald A.Thisted, Ph.D., and
Dr. Morton F. Arnsdorf, University of Chicago; Dr. Michael S. Lauer,
Cleveland Clinic Foundation; Dr. Thomas H. Marwick, Princess Alexandra
Hospital, Brisbane, Australia; Dilip K. Pandey Ph.D., University of
Illinois, Chicago; Roxanne H. Wicklund RN, and Dr. Arfan J. Al-Hani, St.
James Hospital and Health Centers, Chicago Heights, IL.
New England Journal of Medicine:
http://www.nejm.org
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