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#26 De: Cesar Alonso <cesaralonso@wanadoo.es>
Enviado: Miercoles 16 de Febrero de 2000 08:44
Asunto: Recuperacion tras la ergometria/Recovery after exercise stress testing
Sponsored by: Pfizer
Estimados colegas:
Soy un medico especialista en medicina de la educacion fisica y el deporte que trabaja en un polideportivo municipal realizando reconocimientos medicos a usuarios y deportistas en general. En nuestros protocolos se incluye la realizacion de una prueba de esfuerzo para valorar la adaptacion al ejercicio. He leido con preocupacion en uno de los ultimos New England Journal, que la mala recuperacion al finalizar una ergometria (definiendola como un descenso inferior a 12 latidos en el primer minuto) aparece en un 26% de los pacientes evaluados en el estudio, y lo consideraba un factor de mal pronostico. Mi consulta es la siguiente: Se puede completar el estudio mediante otras tecnicas? (deberia ser reevaluado por un cardiologo?). Mejoraria su situacion mediante entrenamiento aerobico?
Muchas gracias por su atencion.

Dear colleagues:
I am a doctor, specialist on medicine of physical education and sports, who works in a municipal sports center, carrying out medical examinations to users and sportsmen in general. In our protocols, the performance of exercise stress testing is included to assess adjustment to exercise. I have read with concern in one of the last New England Journals, that bad recovery at the end of exercise stress testing (defining it as  a decrease lower than 12 beats in the first minute) appears in a 26% of the patients assessed in the study, and it was considered a bad prognosis factor. My consult is the following: can the study be completed through other techniques? (Should s/he be reassessed by a cardiologist?). Would his/her situation be improved through aerobic training?
Thank you very much for your attention
Dr. Cesar Alonso

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#27 De: Claudio Gil Araujo <cgaraujo@iis.com.br>
Enviado: Jueves 17 de Febrero de 2000 22:59
Asunto: Recuperacion tras la ergometria/Recovery after exercise stress testing
Sponsored by: IntraMed
Estimado colega:
Mientras que del estudio de la Cleveland Clinic surgieron observaciones practicas e interesantes, este tambien tiene sus limitaciones. Debe reconocerse que los sujetos realizaron una recuperacion activa (caminando en cinta deslizante) luego de una ergometria maxima, que aminora considerablemente la disminucion de la frecuencia cardiaca luego del ejercicio. Pero el mensaje real es tanto la maxima frecuencia cardiaca conseguida, como la informacion clinica presente, relevante y no transitoria que deberia utilizarse en conjunto con otros datos del ejercicio y que no sean del ejercicio para hacer una interpretacion final.

Dear colleague:
While the Cleveland Clinic's study brought interesting and practical observations, it has some limitations as well. It must be recognized that the subjects performed an active recovery (walking in the treadmill) after a maximal exercise testing, which slows down considerably the heart rate decrement after exercise. But the real message is both maximal heart rate achieved and the off-transient present relevant clinical information that should be used in conjunction with other exercise and non-exercise data to make a final interpretation.
Dr. Claudio Gil Araujo
Clínica de Medicina do Exercicio - CLINIMEX
Rio de Janeiro - RJ - Brasil

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#28 De: Lourdes Sanchez <lsansal@sv.ftecla.es>
Enviado: Viernes 18 de Febrero de 2000 11:40
Asunto: Recuperacion tras la ergometria/Recovery after exercise stress testing
Sponsored by: IntraMed
Apreciados colegas:
Yo tambien soy especialista en Medicina de la Educacion Fisica y el Deporte. ¿Podria el Dr. Cesar Alonso dar la referencia completa del articulo? Me interesaria mucho consultarla. ¿Se referia a la realizacion de ergometria maxima? ¿Eran individuos sanos o cardiopatas?
Gracias.

Dear colleagues:
I am also a specialist on Medicine of Physical Education and Sports. May Dr. Cesar Alonso provide a complete reference of the article? I am very interested in consulting it. Did he mean performance of maximal exercise stress testing? Were these healthy individuals, or did they suffer heart diseases?
Thanks.
Lourdes Sanchez
Tarragona (España)

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#29 De:  Cesar Alonso <cesaralonso@wanadoo.es>
Enviado: Lunes 21 de Febrero de 2000 00:50
Asunto: Recuperacion tras ergometria/Recovery after exercise stress testing
Sponsored by: Agilent Technologies
Estimados companieros:
En primer lugar, pedir perdon por la falta del dato de la revista. Se trata de un articulo original aparecido en el NEJM n.18 Vol 341 de October 28, 1999.
Trabajan con 2428 sujetos, sanos a los que siguen durante 6 anios y a los que realizan una ergometria maxima y una tomografia de emision de fotones durante el esfuerzo. El 26% (639) tienen valores anormales de recuperacion en el primer minuto, considerando como tal una disminucion menor a 12 latidos por minuto en ese primer minuto.
Creen que puede ser un reflejo de una disminucion en la actividad vagal, pudiendo considerarlo un signo predictivo de mayor mortalidad.
En realidad mi consulta estaba basada en que conozco poca bibliografia que trate del tema de la recuperacion (activa) y el significado que esta tiene. Incluso he visto a algun deportista al que no se le ha querido firmar un certificado de idoneidad para su deporte debido a que (tras realizar una prueba de esfuerzo en tapiz por un cardiologo) presentaba una "mala recuperacion", aunque en este caso, se definia como tal el no recuperar una frecuencia inferior a 100 latidos por minuto pasados 5 minutos de finalizar el test de esfuerzo.
Por otro lado, en el articulo no comentan nada sobre la actividad fisica que realizaron durante los 6 anios en que fueron seguidos los pacientes y por eso era el motivo de mi segunda pregunta.
Gracias.

Dear partners:
First, I apologize because I did not included the information about the journal. It is an original article that was printed in the NEJM n. 18 Vol 341, October 28, 1999.
They worked with 2428 healthy individuals, who were followed for 6 years, and in whom a maximal exercise stress testing and a tomography of photon emission during strain were carried out. A 26% (639) had abnormal values of recovery during the first minute, considering as such a decrease lower than 12 beats per minute in that first minute.
They think it may be a reflection of a decrease in vagal activity, with the possibility of considering it a predictive sign of greater mortality.
In fact, my consult is based in that I know little bibliography that deals with this subject of (active) recovery and its meaning. I have even seen some sportsmen, to whom a certificate of suitability for their sport was denied because (after an exercise stress test in treadmill by a cardiologist) they presented a "bad recovery", although in this case, the former was defined as not recovering a frequency inferior to 100 beats per minute after 5 minutes of ending the exercise stress test.
On the other hand, in the article, nothing is commented about the physical activity that was performed during the 6 years during which the patients were followed, and that was the reason for my second question.
Thanks.

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