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. 2015 May;104(5):366-74.
doi: 10.5935/abc.20150026. Epub 2015 Mar 27.

4-Second Exercise Test: Reference Values for Ages 18-81 Years

[Article in English, Portuguese]
Claudio Gil Araújo  1 , Claudia Lucia Barros de Castro  1 , João Felipe Franca  1 , Plínio Santos Ramos  2
Affiliations

4-Second Exercise Test: Reference Values for Ages 18-81 Years

[Article in English, Portuguese]
Claudio Gil Araújo et al. Arq Bras Cardiol. 2015 May.

Abstract

Background: Physiological reflexes modulated primarily by the vagus nerve allow the heart to decelerate and accelerate rapidly after a deep inspiration followed by rapid movement of the limbs. This is the physiological and pharmacologically validated basis for the 4-s exercise test (4sET) used to assess the vagal modulation of cardiac chronotropism.

Objective: To present reference data for 4sET in healthy adults.

Methods: After applying strict clinical inclusion/exclusion criteria, 1,605 healthy adults (61% men) aged between 18 and 81 years subjected to 4sET were evaluated between 1994 and 2014. Using 4sET, the cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two RR intervals in the electrocardiogram: 1) after a 4-s rapid and deep breath and immediately before pedaling and 2) at the end of a rapid and resistance-free 4-s pedaling exercise.

Results: CVI varied inversely with age (r = -0.33, p < 0.01), and the intercepts and slopes of the linear regressions between CVI and age were similar for men and women (p > 0.05). Considering the heteroscedasticity and the asymmetry of the distribution of the CVI values according to age, we chose to express the reference values in percentiles for eight age groups (years): 18-30, 31-40, 41-45, 46-50, 51-55, 56-60, 61-65, and 66+, obtaining progressively lower median CVI values ranging from 1.63 to 1.24.

Conclusion: The availability of CVI percentiles for different age groups should promote the clinical use of 4sET, which is a simple and safe procedure for the evaluation of vagal modulation of cardiac chronotropism.

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Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Identification and measurement of the length of the RRB and RRC intervals and calculation of CVI (RRB/RRC) in a healthy adult.
Figure 2
Figure 2
ECG tracing (lead CM5) of 4sET with a 35-s duration, allowing visualization and identification of post-pedaling vagal rebound (RRF = 1180 ms) approximately 8 s after the end of the exercise.
Figure 3
Figure 3
Reference data of the 4-s exercise test: percentile curves of the cardiac vagal index for men and women aged between 18 and 81 years (N = 1605).
See this image and copyright information in PMC

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