目的：

通过Max试验验证同一个体分别进行上、下肢症状限制性极限运动的心肺运动试验（CPET），分析正常人和慢病患者上、下肢CPET核心指标的异同，探讨上肢作为下肢重要补充，其CPET指导上肢精准运动训练可以显著提高单纯下肢精准运动整体方案的安全性和有效性。

方法：

选取2020年12月到2022年6月在中国医学科学院阜外医院进行下肢和上肢CPET检测的正常人38例和慢性疾病患者59例，经MAX试验验证，最终纳入正常人34例，患者52例，对纳入研究的86受试者CPET核心指标进行计算分析，同一个体上、下肢CPET各项核心指标间采用配对t检验，患者上肢与正常人上肢，下肢与正常人下肢间采用独立样本t检验。

结果:

①正常人和慢病患者的上肢CEPT核心指标峰值摄氧量(PeakO₂)、无氧阈(AT)、峰值氧脉搏(PeakO₂/HR)、摄氧通气效率峰值平台(OUEP)、峰值负荷功率（Peak Work Rate）、峰值心率（Peak HR）均明显低于下肢, 而二氧化碳排出通气效率最低值（Lowest_E/CO₂）及二氧化碳排出通气效率斜率（_E/CO₂ Slope）高于下肢。②慢病患者下肢CPET 峰值摄氧量 （（78.92±16.88）比（87.42±13.76）%pred）和无氧阈（（69.82±16.46）比（82.45±18.39）%pred）显著低于正常人下肢。③慢病患者下肢CPET核心指标峰值氧脉搏低于正常人但无显著差异（P >0.05），其余观察指标存在显著差异；而上肢CPET核心指标无氧阈（L/min）和峰值氧脉搏均低于正常人但无显著差异（P >0.05），其余观察指标存在显著差异。④慢病患者上肢峰值摄氧量和AT占下肢百分比分别约为(80.54±13.54%)和(80.00±13.67%)明显高于正常人的(72.75±13.25%)（P <0.001）和(66.88±14.5%)（P <0.05）。⑤由于个体化差异，正常人和患者中均存在极个别受试者上肢CPET核心指标优于下肢情况。

结论：

正常人组下肢CPET接近正常水平，而患者组明显受限；相较于下肢，患者上肢运动受限程度轻，上肢运动较下肢更加安全；除了极个别情况，不论正常人还是慢病患者，下肢CPET核心指标优于上肢；上肢和下肢非同时交替运动训练可以提高运动整体方案的安全性和有效性。

OBJECTIVE:

The Max test was conducted to verify the cardiopulmonary exercise testing (CPET) of symptom-limited extreme exercise of arm and leg in the same individual respectively, analyzed the similarities and differences of the core indexes of CPET in the arms and legs between normal people and chronic patients, and explored the arms as an important supplement to the legs. The CPET-guided arm precision movement training can significantly improve the safety and effectiveness of the overall program of simple leg precision movement.

METHODS:

   thirty-eight normal people and fifty-nine patients with chronic diseases who underwent arms and legs CPET in Fuwai Hospital of Chinese Academy of Medical Sciences from December 2020 to June 2022 were selected. After MAX test, 34 normal subjects and 52 patients were finally included.  Paired t test was used to compare the core indexes of CPET between the arm and leg of the same individual. Independent sample t test was used to compare the core indexes of CPET between the arm of the patient and the arm of the normal person, and between the leg and the leg of the normal person.

Results:

① The peak oxygen uptake (PeakO₂), anaerobic threshold (AT), PeakO₂/HR, Oxygen uptake efficiency plateau (OUEP), Peak Work Rate and Peak heart rate(Peak HR) were significantly lower in the arm extremity than in the leg extremity CPET in both normal and chronically diseases patients, while the Lowest _E/CO₂  and _E/CO₂ Slope were higher than those of the leg. ② CPET peak oxygen uptake （（78.92±16.88）vs （87.42±13.76）%pred） and anaerobic threshold （（69.82±16.46） vs （82.45±18.39）%pred） of leg in patients with chronic diseases were significantly lower than those in normal. ③The peak oxygen pulse of leg CPET in patients with chronic diseases was lower than that of normal people, but there was no significant difference (P >0.05), the other observation indexes had significant difference. The anaerobic threshold (L/min) and peak oxygen pulse of arm CPET in patients with chronic diseases were lower than those in normal people, but there was no significant difference (P >0.05).④ The percentage of arm peak oxygen uptake in leg of patients with chronic diseases was (80.54±13.54%), and the percentage of arm AT in leg was (80.00±13.67%), which were significantly higher than those of normal people (72.75±13.25%)（P <0.001） and (66.88±14.5%) (P <0.05). ⑤ Due to individual differences, there are very few cases in which the core CPET indexes of the arms are better than the legs in both normal people and patients.

CONCLUSIONS:

The CPET of the leg in the normal group was close to the normal level, while the patient group was significantly limited. Compared with the legs, the arms of patients have less movement limitation, and the arms are safer than the legs. Except in a few very limited cases, the CPET core indexes of legs were better than those of arms in both normal people and patients with chronic diseases. Non-simultaneous alternating exercise training of the arms and legs can improve the safety and effectiveness of the overall exercise program.