Abstract

The cause of inability to achieve target heart rate in obese patients with treadmill or bicycle exercise is often multifactorial, including severe deconditioning, physical limitations of the patient, refusal of participation, and fear of exercise equipment. Pharmocalogical stress testing in conjunction with a techniciam-99m perfusion agent is an option but is less desirable because of expense and suboptimal image quality. We investigated the ability to achieve adequate heart rate for the evalutaion of chest pain in the deconditioned obese patient by static walking in place.

We stressed 11 (8 female, 3 male) obese (average weight 415 lb [body mass index 65]) patients by walking in place to achieve adequate heart rate. Each walked in place while pulse, blood pressure, and ECG were monitored. The speed of static walking was increased as needed and at maximal exercise, technitium-99 sestimibi was injected and walking in place continued for an additional 1-2 minutes.

The target heart rate (85% of the age predicted heart rate) was achieved in 6 of 11 patients (55%), 80% of age predicted in 9 of 11 (82%), and 75% of age predicted in 100% of the patients. The systolic blood pressure increased by an average of 42mmHg and all test were ended due to fatigue after an average of 7 minutes and 18 seconds of walking in place.

Static walking in place is an option for achieving adequate heart rate in some obese patients for the evaluation of chest pain. (See Table)

sex/ ageweight (lbs)body mass indexmax hr achieved/ % targetexercise timerest blood pressuremax blood pressure
F / 3549082161 / 87%5m 1s121/79192/94
F / 4044975152 / 84%12m 55s151/90223/98
M / 2654969145 / 75%3m 9s144/100165/103
F / 2846669156 / 81%6m 6s165/113244/140
F / 2548874155 / 80%6m 5s122/70168/98
F / 3641672151 / 82%15m 4s122/75140/70
M / 2848271166 / 87%7m162/80184/90
F / 5228848147 / 88%6m 34s112/72123/60
M / 5339258145 / 87%7m 1s115/92148/80
F / 4527847151 / 86%11m125/88172/96
F / 5727050147 / 90%3m 45s148/96200/100
sex/ ageweight (lbs)body mass indexmax hr achieved/ % targetexercise timerest blood pressuremax blood pressure
F / 3549082161 / 87%5m 1s121/79192/94
F / 4044975152 / 84%12m 55s151/90223/98
M / 2654969145 / 75%3m 9s144/100165/103
F / 2846669156 / 81%6m 6s165/113244/140
F / 2548874155 / 80%6m 5s122/70168/98
F / 3641672151 / 82%15m 4s122/75140/70
M / 2848271166 / 87%7m162/80184/90
F / 5228848147 / 88%6m 34s112/72123/60
M / 5339258145 / 87%7m 1s115/92148/80
F / 4527847151 / 86%11m125/88172/96
F / 5727050147 / 90%3m 45s148/96200/100
sex/ ageweight (lbs)body mass indexmax hr achieved/ % targetexercise timerest blood pressuremax blood pressure
F / 3549082161 / 87%5m 1s121/79192/94
F / 4044975152 / 84%12m 55s151/90223/98
M / 2654969145 / 75%3m 9s144/100165/103
F / 2846669156 / 81%6m 6s165/113244/140
F / 2548874155 / 80%6m 5s122/70168/98
F / 3641672151 / 82%15m 4s122/75140/70
M / 2848271166 / 87%7m162/80184/90
F / 5228848147 / 88%6m 34s112/72123/60
M / 5339258145 / 87%7m 1s115/92148/80
F / 4527847151 / 86%11m125/88172/96
F / 5727050147 / 90%3m 45s148/96200/100
sex/ ageweight (lbs)body mass indexmax hr achieved/ % targetexercise timerest blood pressuremax blood pressure
F / 3549082161 / 87%5m 1s121/79192/94
F / 4044975152 / 84%12m 55s151/90223/98
M / 2654969145 / 75%3m 9s144/100165/103
F / 2846669156 / 81%6m 6s165/113244/140
F / 2548874155 / 80%6m 5s122/70168/98
F / 3641672151 / 82%15m 4s122/75140/70
M / 2848271166 / 87%7m162/80184/90
F / 5228848147 / 88%6m 34s112/72123/60
M / 5339258145 / 87%7m 1s115/92148/80
F / 4527847151 / 86%11m125/88172/96
F / 5727050147 / 90%3m 45s148/96200/100

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