The Prognostic Value of a Nomogram for Exercise Capacity in Women
Martha Gulati, M.D., Henry R. Black, M.D., Leslee J. Shaw, Ph.D., Morton F. Arnsdorf, M.D., C. Noel Bairey Merz, M.D., Michael S. Lauer, M.D., Thomas H. Marwick, M.D., Ph.D., Dilip K. Pandey, Ph.D., Roxanne H. Wicklund, R.N., and Ronald A. Thisted, Ph.D.
Background Recent studies have demonstrated that exercise capacityis an independent predictor of mortality in women. Normativevalues of exercise capacity for age in women have not been wellestablished. Our objectives were to construct a nomogram topermit determination of predicted exercise capacity for agein women and to assess the predictive value of the nomogramwith respect to survival.
Methods A total of 5721 asymptomatic women underwent a symptom-limited,maximal stress test. Exercise capacity was measured in metabolicequivalents (MET). Linear regression was used to estimate themean MET achieved for age. A nomogram was established to allowthe percentage of predicted exercise capacity to be estimatedon the basis of age and the exercise capacity achieved. Thenomogram was then used to determine the percentage of predictedexercise capacity for both the original cohort and a referralpopulation of 4471 women with cardiovascular symptoms who underwenta symptom-limited stress test. Survival data were obtained forboth cohorts, and Cox survival analysis was used to estimatethe rates of death from any cause and from cardiac causes ineach group.
Results The linear regression equation for predicted exercisecapacity (in MET) on the basis of age in the cohort of asymptomaticwomen was as follows: predicted MET = 14.7 – (0.13 x age).The risk of death among asymptomatic women whose exercise capacitywas less than 85 percent of the predicted value for age wastwice that among women whose exercise capacity was at least85 percent of the age-predicted value (P<0.001). Resultswere similar in the cohort of symptomatic women.
Conclusions We have established a nomogram for predicted exercisecapacity on the basis of age that is predictive of survivalamong both asymptomatic and symptomatic women. These findingscould be incorporated into the interpretation of exercise stresstests, providing additional prognostic information for riskstratification.
Source Information
From the Department of Preventive Medicine, Rush University Medical Center, Chicago (M.G., H.R.B.); the Division of Cardiology, Department of Medicine, Cedars–Sinai Research Institute, Cedars–Sinai Medical Center, Los Angeles (L.J.S., C.N.B.M.); the Departments of Medicine (M.F.A.) and Health Studies (R.A.T.), University of Chicago, Chicago; the Department of Cardiology, Cleveland Clinic Foundation, Cleveland (M.S.L.); the Department of Medicine, Princess Alexandra Hospital, Brisbane, Australia (T.H.M.); the Department of Neurology, University of Illinois, Chicago (D.K.P.); and the Division of Cardiology, St. James Hospital and Health Centers, Chicago Heights, Ill. (R.H.W.).
Address reprint requests to Dr. Gulati at Northwestern University, Bluhm Cardiovascular Institute, 201 E. Huron St., Chicago, IL 60611, or at mgulati{at}nmff.org.
Nomogram for Exercise Capacity in Women
Hossack K. F., Haas F., Byrne N. M., Rey M., Pletcher M. J., McCulloch C., Gulati M., Shaw L. J., Arnsdorf M. F.
Extract |
Full Text |
PDF
N Engl J Med 2005;
353:2301-2303, Nov 24, 2005.
Correspondence
This article has been cited by other articles:
Ruiz, J. R, Sui, X., Lobelo, F., Morrow, J. R Jr, Jackson, A. W, Sjostrom, M., Blair, S. N
(2008). Association between muscular strength and mortality in men: prospective cohort study. BMJ
337: a439-a439
[Abstract][Full Text]
Testa, L., Bhindi, R., Banning, A.
(2008). The Hurdles of Translating a Single-Center Observation Into Practice. Arch Intern Med
168: 1719-1720
[Full Text]
Peterson, P. N., Magid, D. J., Ross, C., Ho, P. M., Rumsfeld, J. S., Lauer, M. S., Lyons, E. E., Smith, S. S., Masoudi, F. A.
(2008). Association of Exercise Capacity on Treadmill With Future Cardiac Events in Patients Referred for Exercise Testing. Arch Intern Med
168: 174-179
[Abstract][Full Text]
Lauer, M. S., Pothier, C. E., Magid, D. J., Smith, S. S., Kattan, M. W.
(2007). An Externally Validated Model for Predicting Long-Term Survival after Exercise Treadmill Testing in Patients with Suspected Coronary Artery Disease and a Normal Electrocardiogram. ANN INTERN MED
147: 821-828
[Abstract][Full Text]
Kim, E. S.H., Ishwaran, H., Blackstone, E., Lauer, M. S.
(2007). External Prognostic Validations and Comparisons of Age- and Gender-Adjusted Exercise Capacity Predictions. J Am Coll Cardiol
50: 1867-1875
[Abstract][Full Text]
Harris, G. D., White, R. D.
(2007). Exercise Stress Testing in Patients With Type 2 Diabetes: When Are Asymptomatic Patients Screened?. Clin. Diabetes
25: 126-130
[Abstract][Full Text]
Ribisl, P. M., Lang, W., Jaramillo, S. A., Jakicic, J. M., Stewart, K. J., Bahnson, J., Bright, R., Curtis, J. F., Crow, R. S., Soberman, J. E., on behalf of the Look AHEAD Research Group,
(2007). Exercise Capacity and Cardiovascular/Metabolic Characteristics of Overweight and Obese Individuals With Type 2 Diabetes: The Look AHEAD clinical trial. Diabetes Care
30: 2679-2684
[Abstract][Full Text]
Harris, G. D.
(2007). A 52-Year-Old Woman With Hypertension and Diabetes Who Presents With Chest Pain. Clin. Diabetes
25: 115-118
[Full Text]
Lee, I-M.
(2007). Dose-Response Relation Between Physical Activity and Fitness: Even a Little Is Good; More Is Better. JAMA
297: 2137-2139
[Full Text]
Novak, V., Hu, K., Vyas, M., Lipsitz, L. A.
(2007). Cardiolocomotor Coupling in Young and Elderly People. J. Gerontol. A Biol. Sci. Med. Sci.
62: 86-92
[Abstract][Full Text]
Tice, J. A., Kanaya, A., Hue, T., Rubin, S., Buist, D. S. M., LaCroix, A., Lacey, J. V. Jr, Cauley, J. A., Litwack, S., Brinton, L. A., Bauer, D. C.
(2006). Risk Factors for Mortality in Middle-aged Women. Arch Intern Med
166: 2469-2477
[Abstract][Full Text]
Kligfield, P., Lauer, M. S.
(2006). Exercise Electrocardiogram Testing: Beyond the ST Segment. Circulation
114: 2070-2082
[Full Text]
Ades, P. A., Savage, P. D., Brawner, C. A., Lyon, C. E., Ehrman, J. K., Bunn, J. Y., Keteyian, S. J.
(2006). Aerobic Capacity in Patients Entering Cardiac Rehabilitation. Circulation
113: 2706-2712
[Abstract][Full Text]
Dolan, S. E., Frontera, W., Librizzi, J., Ljungquist, K., Juan, S., Dorman, R., Cole, M. E., Kanter, J. R., Grinspoon, S.
(2006). Effects of a supervised home-based aerobic and progressive resistance training regimen in women infected with human immunodeficiency virus: a randomized trial.. Arch Intern Med
166: 1225-1231
[Abstract][Full Text]
Newman, A. B., Simonsick, E. M., Naydeck, B. L., Boudreau, R. M., Kritchevsky, S. B., Nevitt, M. C., Pahor, M., Satterfield, S., Brach, J. S., Studenski, S. A., Harris, T. B.
(2006). Association of Long-Distance Corridor Walk Performance With Mortality, Cardiovascular Disease, Mobility Limitation, and Disability. JAMA
295: 2018-2026
[Abstract][Full Text]
(2006). Additional articles abstracted in ACP Journal Club. Evid. Based Med.
11: 30-30
[Full Text]
Carnethon, M. R., Gulati, M., Greenland, P.
(2005). Prevalence and Cardiovascular Disease Correlates of Low Cardiorespiratory Fitness in Adolescents and Adults. JAMA
294: 2981-2988
[Abstract][Full Text]
Hossack, K. F., Haas, F., Byrne, N. M., Rey, M., Pletcher, M. J., McCulloch, C., Gulati, M., Shaw, L. J., Arnsdorf, M. F.
(2005). Nomogram for exercise capacity in women.. NEJM
353: 2301-2303
[Full Text]
(2005). From the Library. Br. J. Ophthalmol.
89: 1546-1546
[Full Text]
(2005). Exercise Capacity Norms Predict Mortality in Women. JWatch Women's Health
2005: 7-7
[Full Text]
(2005). An Exercise Nomogram for Women. Journal Watch Cardiology
2005: 2-2
[Full Text]
Martyn, C.
(2005). What's new in the other general journals. BMJ
331: 369-370
[Full Text]
Kraus, W. E., Douglas, P. S.
(2005). Where Does Fitness Fit In?. NEJM
353: 517-519
[Full Text]
Previous
