Nomogram based on metabolic equivalents and age for assessing aerobic exercise capacity in men

Cardiology Section, Long Beach Veterans Affairs Medical Center, California.

OBJECTIVES. The goal of this study was to create a nomogram, based on maximal exercise capacity (in metabolic equivalents [METs]) and age, for assessing a patient's ability to perform dynamic exercise to quantify the level of physical disability or relative capacity for physical activity. BACKGROUND. Providing an estimation of exercise capacity relative to age is clinically useful. Such an estimate can be derived from measured or estimated maximal oxygen uptake (in METs) from treadmill exercise testing and age. It is an effective means of communicating to patients their cardiopulmonary status, encouraging improvement in exercise capacity and quantifying disability. METHODS. Exercise test results of 1,388 male patients (mean age 57 years, range 21 to 89) free of apparent heart disease who were referred for exercise testing for clinical reasons were retrospectively reviewed. This referral group as well as subgroups of active (n = 346) and sedentary (n = 253) patients were analyzed to determine norms for age and for age by decades for exercise test responses, including METs, maximal heart rate and maximal systolic blood pressure. Regression equations were calculated from this information, and a nomogram for calculating degree of exercise capacity from age and MET level achieved by a patient was created. A similar analysis was performed in a separate group of 244 apparently healthy, normal male volunteers (mean age 45 +/- 14 years, range 18 to 72) who underwent exercise testing with direct measurement of expired gases. RESULTS. Equations for predicted METs for age were derived for the entire clinical referral group (METs = 18.0-0.15[Age]) and for the subgroups of active (METs = 18.7-0.15[Age]) and sedentary (METs = 16.6-0.16[Age]) patients. All results achieved statistical significance, with p values < 0.001. In the volunteer group of normal men who performed exercise testing with ventilatory gas exchange, the decline in maximal heart rate and METs with age was not as steep as in the referral group. Although the normal group confirmed nomograms published previously among similar subjects, the equations derived from the patients differed from those previously reported; in contrast to previous studies using healthy volunteers, the equations and nomograms for the referral group are more appropriate for patients typically referred for testing in a hospital or office-based internal medicine practice. CONCLUSIONS. Norms for METs based on age are presented as well as population-specific nomograms that enable physicians to assess patients' exercise capacity relative to their age group.

This article has been cited by other articles:

				H. Knoester, J. J. Sol, P. Ramsodit, I. M. Kuipers, S.-A. B. Clur, and A. P. Bos Cardiac Function in Pediatric Septic Shock Survivors Arch Pediatr Adolesc Med, December 1, 2008; 162(12): 1164 - 1168. [Abstract] [Full Text] [PDF]

				L. Testa, R. Bhindi, and A. Banning The Hurdles of Translating a Single-Center Observation Into Practice Arch Intern Med, August 11, 2008; 168(15): 1719 - 1720. [Full Text] [PDF]

				P. Kokkinos, J. Myers, J. P. Kokkinos, A. Pittaras, P. Narayan, A. Manolis, P. Karasik, M. Greenberg, V. Papademetriou, and S. Singh Exercise Capacity and Mortality in Black and White Men Circulation, February 5, 2008; 117(5): 614 - 622. [Abstract] [Full Text] [PDF]

				P. N. Peterson, D. J. Magid, C. Ross, P. M. Ho, J. S. Rumsfeld, M. S. Lauer, E. E. Lyons, S. S. Smith, and F. A. Masoudi Association of Exercise Capacity on Treadmill With Future Cardiac Events in Patients Referred for Exercise Testing Arch Intern Med, January 28, 2008; 168(2): 174 - 179. [Abstract] [Full Text] [PDF]

				E. S.H. Kim, H. Ishwaran, E. Blackstone, and M. S. Lauer External Prognostic Validations and Comparisons of Age- and Gender-Adjusted Exercise Capacity Predictions J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1867 - 1875. [Abstract] [Full Text] [PDF]

				P. M. Ribisl, W. Lang, S. A. Jaramillo, J. M. Jakicic, K. J. Stewart, J. Bahnson, R. Bright, J. F. Curtis, R. S. Crow, J. E. Soberman, et al. Exercise Capacity and Cardiovascular/Metabolic Characteristics of Overweight and Obese Individuals With Type 2 Diabetes: The Look AHEAD clinical trial Diabetes Care, October 1, 2007; 30(10): 2679 - 2684. [Abstract] [Full Text] [PDF]

				J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]

				P. Kligfield and M. S. Lauer Exercise Electrocardiogram Testing: Beyond the ST Segment Circulation, November 7, 2006; 114(19): 2070 - 2082. [Full Text] [PDF]

				P. A. Ades, P. D. Savage, C. A. Brawner, C. E. Lyon, J. K. Ehrman, J. Y. Bunn, and S. J. Keteyian Aerobic Capacity in Patients Entering Cardiac Rehabilitation Circulation, June 13, 2006; 113(23): 2706 - 2712. [Abstract] [Full Text] [PDF]

				M. R. Carnethon, M. Gulati, and P. Greenland Prevalence and Cardiovascular Disease Correlates of Low Cardiorespiratory Fitness in Adolescents and Adults JAMA, December 21, 2005; 294(23): 2981 - 2988. [Abstract] [Full Text] [PDF]

				K. F. Hossack, F. Haas, N. M. Byrne, M. Rey, M. J. Pletcher, C. McCulloch, M. Gulati, L. J. Shaw, and M. F. Arnsdorf Nomogram for exercise capacity in women. N. Engl. J. Med., November 24, 2005; 353(21): 2301 - 2303. [Full Text] [PDF]

				N. M. Byrne, A. P. Hills, G. R. Hunter, R. L. Weinsier, and Y. Schutz Metabolic equivalent: one size does not fit all J Appl Physiol, September 1, 2005; 99(3): 1112 - 1119. [Abstract] [Full Text] [PDF]

				M. Gulati, H. R. Black, L. J. Shaw, M. F. Arnsdorf, C. N. B. Merz, M. S. Lauer, T. H. Marwick, D. K. Pandey, R. H. Wicklund, and R. A. Thisted The Prognostic Value of a Nomogram for Exercise Capacity in Women N. Engl. J. Med., August 4, 2005; 353(5): 468 - 475. [Abstract] [Full Text] [PDF]

				Z. Y. Fang, J. Sharman, J. B. Prins, and T. H. Marwick Determinants of Exercise Capacity in Patients With Type 2 Diabetes Diabetes Care, July 1, 2005; 28(7): 1643 - 1648. [Abstract] [Full Text] [PDF]

				P. M. Mottram, B. Haluska, R. Leano, D. Cowley, M. Stowasser, and T. H. Marwick Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure Circulation, August 3, 2004; 110(5): 558 - 565. [Abstract] [Full Text] [PDF]

				S. J. Skaluba and S. E. Litwin Mechanisms of Exercise Intolerance: Insights From Tissue Doppler Imaging Circulation, March 2, 2004; 109(8): 972 - 977. [Abstract] [Full Text] [PDF]

				J. Myers, M. Prakash, V. Froelicher, D. Do, S. Partington, and J. E. Atwood Exercise Capacity and Mortality among Men Referred for Exercise Testing N. Engl. J. Med., March 14, 2002; 346(11): 793 - 801. [Abstract] [Full Text] [PDF]

				G. F. Fletcher, G. J. Balady, E. A. Amsterdam, B. Chaitman, R. Eckel, J. Fleg, V. F. Froelicher, A. S. Leon, I. L. Pina, R. Rodney, et al. Exercise Standards for Testing and Training: A Statement for Healthcare Professionals From the American Heart Association Circulation, October 2, 2001; 104(14): 1694 - 1740. [Full Text] [PDF]

				W. M. DeCampli, H. Luikart, S. Hunt, and E. B. Stinson Characteristics of patients surviving more than ten years aftercardiac transplantation J. Thorac. Cardiovasc. Surg., June 1, 1995; 109(6): 1103 - 1115. [Abstract] [Full Text]

				G. F. Fletcher, G. Balady, V. F. Froelicher, L. H. Hartley, W. L. Haskell, and M. L. Pollock Exercise Standards : A Statement for Healthcare Professionals From the American Heart Association Circulation, January 15, 1995; 91(2): 580 - 615. [Full Text]