Standardizing Submaximal Exercise Intensities for Use of Supine Push-pull Exercise during Cardiovascular Magnetic Resonance

Jarno Steenhorst, Alexander Hirsch, Linda van den Berg, Lieke Kamphuis, Daphne Merkus, Eric Boersma, W.A. Helbing*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BackgroundCardiovascular magnetic resonance (CMR) imaging during supine exercise at (sub)maximal oxygen consumption (VO2) offers unique diagnostic insights. However, maximal VO2 is not achievable in the supine position and standardizing submaximal exercise intensities remains challenging. Using heart rate or workload could be a viable option to translate VO2-based submaximal exercise intensities. Aim

To translate submaximal exercise intensities upright cycling exercise (UCE) to supine push–pull exercise (SPPE), by comparing heart rate or workload determined during UCE, with heart rate and workload during SPPE at similar exercise intensities.

Methods and Results

Sixteen healthy young adults (20.4 ± 2.2 years; 8 female) underwent cardiopulmonary UCE and SPPE testing [mean ± standard deviation maximal VO2: 3.2 ± 0.6 vs. 5 ± 0.3 L min−1, p < 0.001 and median (interquartile range) of the maximum workload: 310 (244, 361) vs. 98 (98, 100), p < 0.001, respectively]. Heart rate at 40% and 60% of maximal VO2, as determined by UCE, showed low bias (−3 and 0 bpm, respectively) and wide limits of agreement (±26 and ±28 bpm, respectively), in Bland–Altman analysis. VO2/Workload relation was exponential and less efficient during SPPE compared to UCE. Generalized estimated equation analysis predicted model-based mean workload during SPPE, with acceptable 95% confidence interval.


Heart rate during UCE at submaximal exercise intensities can reasonably well be used to for SPPE in healthy subjects. Using workload, an ergometer specific, model-based mean can be used to determine exercise intensities during SPPE. Individual variations in response to posture and movement change are high. During clinical interpretation of exercise CMR, individual exercise intensity has to be considered.

Original languageEnglish
Pages (from-to)10-19
Number of pages10
JournalClinical Physiology and Functional Imaging
Issue number1
Publication statusE-pub ahead of print - 29 Aug 2022

Bibliographical note

Funding Information:
The authors thank Frans Mertens and Bert Bannink for their excellent support during the implementation of the study. Erasmus MC Thorax Foundation, project number 22109.

Publisher Copyright:
© 2022 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.


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