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A non-ischemic forearm exercise test for the screening of patients with exercise intolerance

From the Institut de Myologie, unité INSERM 523 (Drs. Hogrel, Laforêt, Yaou, Eymard, and Lombès); and Laboratoire de Biochimie B (Dr. Chevrot), Groupe Hospitalier Pitié-Salpêtrière, Paris, France.

Address correspondence reprint requests to Dr. Jean-Yves Hogrel, Institut de Myologie, Groupe Hospitalier Pitié-Salpêtrière, 75651 Paris Cedex 13, France; e-mail: jy.hogrel{at}myologie.chups.jussieu.fr

BACKGROUND: The forearm exercise test is a common investigation that allows detection of some metabolic myopathies. It is not completely standardized and, when performed in ischemic conditions, may induce rhabdomyolysis in patients with glycogenosis.

OBJECTIVE: To develop a standardized non-ischemic exercise test for a safe screening of patients with exercise intolerance.

METHODS: Twenty-six healthy subjects and 32 patients with exercise intolerance performed an isometric exercise at 70% of the maximal voluntary contraction during 30 seconds in non-ischemic conditions. Blood concentrations of creatine kinase, lactate, and ammonia were analyzed.

RESULTS: A nearly fourfold lactate rise was induced by exercise in healthy subjects. All patients with normal muscle biopsy showed values similar to those of healthy subjects. No significant lactate increase was observed in six patients with a myophosphorylase defect and one with a debrancher defect. Disparate lactate responses were observed in 14 patients with a mitochondrial myopathy. The blood lactate level at rest was abnormally high in four of these patients. The lactate surface normalized by the mechanical energy production was above the normal range in eight patients.

CONCLUSIONS: The authors propose a standardized non-ischemic grip test that overcomes the main drawbacks of the classic ischemic forearm exercise test. It provides a specific, efficient, and safe screening test for patients with exercise intolerance. Its sensitivity was very good for patients with a glycogenolysis defect but remains partial in patients with a mitochondrial disorder.