Comparison of Three Methods to Identify the Anaerobic Threshold During Maximal Exercise Testing in Patients with Chronic Heart Failure

Beckers PJ, Possemiers NM, Van Craenenbroeck EM, Van Berendoncks AM, Wuyts K, Vrints CJ, Conraads VM: Comparison of three methods to identify the anaerobic threshold during maximal exercise testing in patients with chronic heart failure. Am J Phys Med Rehabil 2012; 91: 148-155. Objective: Exercise training efficiently improves peak oxygen uptake ((V) over dotO(2)peak) in patients with chronic heart failure. To optimize training-derived benefit, higher exercise intensities are being explored. The correct identification of anaerobic threshold is important to allow safe and effective exercise prescription. Design: During 48 cardiopulmonary exercise tests obtained in patients with chronic heart failure (59.6 +/- 11 yrs; left ventricular ejection fraction, 27.9% +/- 9%), ventilatory gas analysis findings and lactate measurements were collected. Three technicians independently determined the respiratory compensation point (RCP), the heart rate turning point (HRTP) and the second lactate turning point (LTP2). Thereafter, exercise intensity (target heart rate and workload) was calculated and compared between the three methods applied. Results: Patients had significantly reduced maximal exercise capacity (68% +/- 21% of predicted (V) over dotO(2)peak) and chronotropic incompetence (74% +/- 7% of predicted peak heart rate). Heart rate, workload, and (V) over dotO(2) at HRTP and at RCP were not different, but at LTP2, these parameters were significantly (P < 0.0001) higher. Mean target heart rate and target workload calculated using the LTP2 were 5% and 12% higher compared with those calculated using HRTP and RCP, respectively. The calculation of target heart rate based on LTP2 was 5% and 10% higher in 12 of 48 (25%) and 6 of 48 (12.5%) patients, respectively, compared with the other two methods. Conclusions: In patients with chronic heart failure, RCP and HRTP, determined during cardiopulmonary exercise tests, precede the occurrence of LTP2. Target heart rates and workloads used to prescribe tailored exercise training in patients with chronic heart failure based on LTP2 are significantly higher than those derived from HRTP and RCP.