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Mazzuco A, Souza AS, Medeiros WM, Sperandio PA, Alencar MCN, Arbex FF, Neder JA, Borghi-Silva A. Effects of high- and moderate-intensity exercise on central hemodynamic and oxygen uptake recovery kinetics in CHF-COPD overlap. ACTA ACUST UNITED AC 2020; 53:e9391. [PMID: 32077467 PMCID: PMC7025454 DOI: 10.1590/1414-431x20199391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022]
Abstract
The oxygen uptake (V˙O2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The V˙O2, heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (P<0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (P<0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (P<0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (P<0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P>0.05 in group vs load analysis). The ventilatory efficiency was related to MRT of V˙O2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.
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Neder JA, O'Donnell DE, Berton DC. Practical challenges of diagnosing obstruction in the presence of restriction. ACTA ACUST UNITED AC 2019; 45:e20190318. [PMID: 31851216 PMCID: PMC7247758 DOI: 10.1590/1806-3713/e20190318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Neder JA, Berton DC, O'Donnell DE. Why we should never ignore an "isolated" low lung diffusing capacity. ACTA ACUST UNITED AC 2019; 45:e20190241. [PMID: 31508675 PMCID: PMC6733732 DOI: 10.1590/1806-3713/e20190241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Neder JA, Berton DC, O'Donnell DE. Uncovering the beneficial effects of inhaled bronchodilator in COPD: beyond forced spirometry. J Bras Pneumol 2019; 45:e20190168. [PMID: 31271606 PMCID: PMC6715040 DOI: 10.1590/1806-3713/e20190168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Reis HV, Sperandio PA, Correa CL, Guizilini S, Neder JA, Borghi-Silva A, Reis MS. Association of Oscillatory Ventilation during Cardiopulmonary Test to Clinical and Functional Variables of Chronic Heart Failure Patients. Braz J Cardiovasc Surg 2019; 33:176-182. [PMID: 29898148 PMCID: PMC5985845 DOI: 10.21470/1678-9741-2017-0158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/27/2017] [Indexed: 01/05/2023] Open
Abstract
Objective The aim of this study is to characterize the presence of exercise oscillatory
ventilation (EOV) and to relate it with other cardiopulmonary exercise test
(CET) responses and clinical variables. Methods Forty-six male patients (age: 53.1±13.6 years old; left ventricular
ejection fraction [LVEF]: 30±8%) with heart failure were recruited to
perform a maximal CET and to correlate the CET responses with clinical
variables. The EOV was obtained according to Leite et al. criteria and
VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min
were used to assess patients' severity. Results The EOV was observed in 16 of 24 patients who performed the CET, as well as
VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min in
14 and 10 patients, respectively. There was no difference in clinical and
CET variables of the patients who presented EOV in CET when compared to
non-EOV patients. Also, there was no difference in CET and clinical
variables when comparing patients who presented EOV and had a
VE/VCO2 slope > 34 to patients who just had one of these
responses either. Conclusion The present study showed that there was an incidence of patients with EOV and
lower peak VO2 and higher VE/VCO2 slope values, but
they showed no difference on other prognostic variables. As well, there was
no influence of the presence of EOV on other parameters of CET in this
population, suggesting that this variable may be an independent marker of
worst prognosis in HF patients.
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Berton DC, Neder JA. Measuring slow vital capacity to detect airflow limitation in a woman with dyspnea and a preserved FEV1/FVC ratio. J Bras Pneumol 2019; 45:e20190084. [PMID: 31038657 PMCID: PMC6733748 DOI: 10.1590/1806-3713/e20190084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Barroco AC, Sperandio PA, Reis M, Almeida DR, Neder JA. A practical approach to assess leg muscle oxygenation during ramp-incremental cycle ergometry in heart failure. ACTA ACUST UNITED AC 2017; 50:e6327. [PMID: 28977120 PMCID: PMC5625546 DOI: 10.1590/1414-431x20176327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/24/2017] [Indexed: 12/05/2022]
Abstract
Heart failure is characterized by the inability of the cardiovascular system to maintain oxygen (O2) delivery (i.e., muscle blood flow in non-hypoxemic patients) to meet O2 demands. The resulting increase in fractional O2 extraction can be non-invasively tracked by deoxygenated hemoglobin concentration (deoxi-Hb) as measured by near-infrared spectroscopy (NIRS). We aimed to establish a simplified approach to extract deoxi-Hb-based indices of impaired muscle O2 delivery during rapidly-incrementing exercise in heart failure. We continuously probed the right vastus lateralis muscle with continuous-wave NIRS during a ramp-incremental cardiopulmonary exercise test in 10 patients (left ventricular ejection fraction <35%) and 10 age-matched healthy males. Deoxi-Hb is reported as % of total response (onset to peak exercise) in relation to work rate. Patients showed lower maximum exercise capacity and O2 uptake-work rate than controls (P<0.05). The deoxi-Hb response profile as a function of work rate was S-shaped in all subjects, i.e., it presented three distinct phases. Increased muscle deoxygenation in patients compared to controls was demonstrated by: i) a steeper mid-exercise deoxi-Hb-work rate slope (2.2±1.3 vs 1.0±0.3% peak/W, respectively; P<0.05), and ii) late-exercise increase in deoxi-Hb, which contrasted with stable or decreasing deoxi-Hb in all controls. Steeper deoxi-Hb-work rate slope was associated with lower peak work rate in patients (r=–0.73; P=0.01). This simplified approach to deoxi-Hb interpretation might prove useful in clinical settings to quantify impairments in O2 delivery by NIRS during ramp-incremental exercise in individual heart failure patients.
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Mazzuco A, Medeiros WM, Souza ASD, Alencar MCN, Neder JA, Borghi-Silva A. Are heart rate dynamics in the transition from rest to submaximal exercise related to maximal cardiorespiratory responses in COPD? Braz J Phys Ther 2017; 21:251-258. [PMID: 28558953 PMCID: PMC5537469 DOI: 10.1016/j.bjpt.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 07/27/2016] [Accepted: 09/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Poor exercise capacity is an important negative prognostic marker in patients with chronic obstructive pulmonary disease (COPD). Heart rate variability (HRV) responses can indicate alterations in cardiac autonomic control. Nevertheless, it remains unclear whether these abnormalities are related to cardiorespiratory responses to exercise in these patients. OBJECTIVE To evaluate whether HRV at rest and submaximal exercise are related to impaired cardiopulmonary responses to exercise in COPD patients. METHODS Fifteen men (66.2±8.7 years) with COPD (FEV1: 55.1±19.2%) were assessed. The R-R interval (RRi) data collection was performed at rest (stand position) and during the six-minute walk test (6MWT). All patients performed a symptom-limited cardiopulmonary exercise test on a cycle ergometer. The HRV changes from rest to submaximal exercise (Δ rest-6MWT) were calculated. RESULTS We found significant correlations between low frequency (LF) and high frequency (HF) Δ rest-6MWT with Δ oxyhemoglobin saturation by pulse oximetry (r=-0.64 and r=0.65, respectively; p<0.05), minute ventilation/carbon dioxide output relationship from beginning to peak exercise (r=-0.52 and r=0.53, p<0.05), and exercise ventilatory power (r=0.52 and r=-0.53, p<0.05). Interestingly, there was a strong positive correlation (r=0.82, p<0.05) between six-minute walk distance (6MWD) and Δ LF/HF from rest to exercise. CONCLUSION HRV analysis in the transition from rest to submaximal exercise is associated with exercise ventilatory and hemodynamic abnormalities in COPD patients. Rehabilitative strategies to improve HRV responses may provide an important tool to clinical practice in these patients.
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Souza ASD, Sperandio PA, Mazzuco A, Alencar MC, Arbex FF, Oliveira MFD, O'Donnell DE, Neder JA. Influence of heart failure on resting lung volumes in patients with COPD. J Bras Pneumol 2017; 42:273-278. [PMID: 27832235 PMCID: PMC5063444 DOI: 10.1590/s1806-37562015000000290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/09/2016] [Indexed: 01/04/2023] Open
Abstract
Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC)]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p < 0.05). There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in FRC and TLC in the two groups; therefore, IC was also comparable. Consequently, the inspiratory fraction was higher in the COPD+CHF group than in the COPD group (0.42 ± 0.10 vs. 0.36 ± 0.10; p < 0.05). Although the tidal volume/IC ratio was higher in the COPD+CHF group, the relative inspiratory reserve was remarkably similar between the two groups (0.35 ± 0.09 vs. 0.44 ± 0.14; p < 0.05). Conclusions: Despite the restrictive effects of CHF, patients with COPD+CHF have relatively higher inspiratory limits (a greater inspiratory fraction). However, those patients use only a part of those limits, probably in order to avoid critical reductions in inspiratory reserve and increases in elastic recoil.
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Freitas FFMD, Azevedo DPD, Medeiros WM, Neder JA, Chiavegato LD, Amorim CF. Microvascular oxygen extraction during maximal isometric contraction in patients with chronic obstructive pulmonary disease. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.004.ao16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: COPD presents decrease in oxidative metabolism with possible losses of cardiovascular adjustments, suggesting slow kinetics microvascular oxygen during intense exercise. Objective: To test the hypothesis that chronic obstructive pulmonary disease (COPD) patients have lower muscle performance in physical exercise not dependent on central factors, but also greater muscle oxygen extraction, regardless of muscle mass. Methods: Cross-sectional study with 11 COPD patients and nine healthy subjects, male, paired for age. Spirometry and body composition by DEXA were evaluated. Muscular performance was assessed by maximal voluntary isometric contraction (MVIC) in isokinetic dynamometer and muscle oxygen extraction by the NIRS technique. Student t-test and Pearson correlation were applied. A significance level of p<0.05 was adopted. Results: Patients had moderate to severe COPD (FEV1 = 44.5 ± 9.6% predicted; SpO2 = 94.6 ± 1.6%). Lean leg mass was 8.3 ± 0.9 vs. 8.9 ± 1.0 kg (p =0.033), when comparing COPD and control patients, respectively. The decreased muscle oxygen saturation corrected by muscle mass was 53.2% higher (p=0.044) in the COPD group in MVIC-1 and 149.6% higher (p=0.006) in the MVIC-2. Microvascular extraction rate of oxygen corrected by muscle mass and total work was found to be 114.5% higher (p=0.043) in the COPD group in MVIC-1 and 210.5% higher (p=0.015) in the MVIC-2. Conclusion: COPD patients have low muscle performance and high oxygen extraction per muscle mass unit and per unit of work. The high oxygen extraction suggests that quantitative and qualitative mechanisms can be determinants of muscle performance in patients with COPD.
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Ramos RP, Ferreira EVM, Valois FM, Cepeda A, Messina CMS, Oliveira RK, Araújo ATV, Teles CA, Neder JA, Nery LE, Ota-Arakaki JS. Clinical usefulness of end-tidal CO 2 profiles during incremental exercise in patients with chronic thromboembolic pulmonary hypertension. Respir Med 2016; 120:70-77. [PMID: 27817818 DOI: 10.1016/j.rmed.2016.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/28/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Great ventilation to carbon dioxide output (ΔV˙E/ΔV˙CO2) and reduced end-tidal partial pressures for CO2 (PetCO2) during incremental exercise are hallmarks of chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). However, CTEPH is more likely to involve proximal arteries, which may lead to poorer right ventricle-pulmonary vascular coupling and worse gas exchange abnormalities. Therefore, abnormal PetCO2 profiles during exercise may be more prominent in patients with CTEPH and could be helpful to indicate disease severity. METHODS Seventy patients with CTEPH and 34 with IPAH underwent right heart catheterization and cardiopulmonary exercise testing. According to PetCO2 pattern during exercise, patients were classified as having an increase or stabilization in PetCO2 up to the gas exchange threshold (GET), an abrupt decrease in the rest-exercise transition or a progressive and slow decrease throughout exercise. A subgroup of patients with CTEPH underwent a constant work rate exercise test to obtain arterial blood samples during steady-state exercise. RESULTS Multivariate logistic regression analyses showed that progressive decreases in PetCO2 and SpO2 were better discriminative parameters than ΔV˙E/ΔV˙CO2 to distinguish CTEPH from IPAH. This pattern of PetCO2 was associated with worse functional impairment and greater reduction in PaCO2 during exercise. CONCLUSION Compared to patients with IPAH, patients with CTEPH present more impaired gas exchange during exercise, and PetCO2 abnormalities may be used to identify more clinically and hemodynamically severe cases.
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Mazzuco A, Medeiros WM, Sperling MPR, de Souza AS, Alencar MCN, Arbex FF, Neder JA, Arena R, Borghi-Silva A. Relationship between linear and nonlinear dynamics of heart rate and impairment of lung function in COPD patients. Int J Chron Obstruct Pulmon Dis 2015; 10:1651-61. [PMID: 26316739 PMCID: PMC4544724 DOI: 10.2147/copd.s81736] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In chronic obstructive pulmonary disease (COPD), functional and structural impairment of lung function can negatively impact heart rate variability (HRV); however, it is unknown if static lung volumes and lung diffusion capacity negatively impacts HRV responses. We investigated whether impairment of static lung volumes and lung diffusion capacity could be related to HRV indices in patients with moderate to severe COPD. METHODS Sixteen sedentary males with COPD were enrolled in this study. Resting blood gases, static lung volumes, and lung diffusion capacity for carbon monoxide (DLCO) were measured. The RR interval (RRi) was registered in the supine, standing, and seated positions (10 minutes each) and during 4 minutes of a respiratory sinus arrhythmia maneuver (M-RSA). Delta changes (Δsupine-standing and Δsupine-M-RSA) of the standard deviation of normal RRi, low frequency (LF, normalized units [nu]) and high frequency (HF [nu]), SD1, SD2, alpha1, alpha2, and approximate entropy (ApEn) indices were calculated. RESULTS HF, LF, SD1, SD2, and alpha1 deltas significantly correlated with forced expiratory volume in 1 second, DLCO, airway resistance, residual volume, inspiratory capacity/total lung capacity ratio, and residual volume/total lung capacity ratio. Significant and moderate associations were also observed between LF/HF ratio versus total gas volume (%), r=0.53; LF/HF ratio versus residual volume, %, r=0.52; and HF versus total gas volume (%), r=-0.53 (P<0.05). Linear regression analysis revealed that ΔRRi supine-M-RSA was independently related to DLCO (r=-0.77, r (2)=0.43, P<0.05). CONCLUSION Responses of HRV indices were more prominent during M-RSA in moderate to severe COPD. Moreover, greater lung function impairment was related to poorer heart rate dynamics. Finally, impaired lung diffusion capacity was related to an altered parasympathetic response in these patients.
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Terra-Filho M, Bagatin E, Nery LE, Nápolis LM, Neder JA, de Souza Portes Meirelles G, Silva CI, Muller NL. Screening of miners and millers at decreasing levels of asbestos exposure: comparison of chest radiography and thin-section computed tomography. PLoS One 2015; 10:e0118585. [PMID: 25790222 PMCID: PMC4366170 DOI: 10.1371/journal.pone.0118585] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 01/21/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chest radiography (CXR) is inferior to Thin-section computed tomography in the detection of asbestos related interstitial and pleural abnormalities. It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases. METHODS Clinical evaluation, CXR, Thin-section CT and spirometry were obtained in 1418 miners and millers who were exposed to progressively lower airborne concentrations of asbestos. They were separated into four groups according to the type, period and measurements of exposure and/or procedures for controlling exposure: Group I (1940-1966/tremolite and chrysotile, without measurements of exposure and procedures for controlling exposure); Group II (1967-1976/chrysotile only, without measurements of exposure and procedures for controlling exposure); Group III (1977-1980/chrysotile only, initiated measurements of exposure and procedures for controlling exposure) and Group IV (after 1981/chrysotile only, implemented measurements of exposure and a comprehensive procedures for controlling exposure). RESULTS In all groups, CXR suggested more frequently interstitial abnormalities and less frequently pleural plaques than observed on Thin-section CT (p<0.050). The odds for asbestosis in groups of decreasing exposure diminished to greater extent at Thin-section CT than on CXR. Lung function was reduced in subjects who had pleural plaques evident only on Thin-section CT (p<0.050). In a longitudinal evaluation of 301 subjects without interstitial and pleural abnormalities on CXR and Thin-section CT in a previous evaluation, only Thin-section CT indicated that these ARA reduced as exposure decreased. CONCLUSIONS CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure. Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.
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Gimenes AC, Bravo DM, Nápolis LM, Mello MT, Oliveira ASB, Neder JA, Nery LE. Effect of L-carnitine on exercise performance in patients with mitochondrial myopathy. ACTA ACUST UNITED AC 2015; 48:354-62. [PMID: 25714882 PMCID: PMC4418367 DOI: 10.1590/1414-431x20143467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/11/2014] [Indexed: 11/22/2022]
Abstract
Exercise intolerance due to impaired oxidative metabolism is a prominent symptom in
patients with mitochondrial myopathy (MM), but it is still uncertain whether
L-carnitine supplementation is beneficial for patients with MM. The aim of our study
was to investigate the effects of L-carnitine on exercise performance in MM. Twelve
MM subjects (mean age±SD=35.4±10.8 years) with chronic progressive external
ophthalmoplegia (CPEO) were first compared to 10 healthy controls (mean age±SD=29±7.8
years) before they were randomly assigned to receive L-carnitine supplementation (3
g/daily) or placebo in a double-blind crossover design. Clinical status, body
composition, respiratory function tests, peripheral muscle strength (isokinetic and
isometric torque) and cardiopulmonary exercise tests (incremental to peak exercise
and at 70% of maximal), constant work rate (CWR) exercise test, to the limit of
tolerance [Tlim]) were assessed after 2 months of L-carnitine/placebo administration.
Patients with MM presented with lower mean height, total body weight, fat-free mass,
and peripheral muscle strength compared to controls in the pre-test evaluation. After
L-carnitine supplementation, the patients with MM significantly improved their Tlim
(14±1.9 vs 11±1.4 min) and oxygen consumption (V˙O2) at CWR exercise, both at isotime (1151±115 vs
1049±104 mL/min) and at Tlim (1223±114 vs 1060±108 mL/min). These
results indicate that L-carnitine supplementation may improve aerobic capacity and
exercise tolerance during high-intensity CWRs in MM patients with CPEO.
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Scuarcialupi MEA, Berton DC, Cordoni PK, Squassoni SD, Fiss E, Neder JA. Can bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation? J Bras Pneumol 2014; 40:111-8. [PMID: 24831394 PMCID: PMC4083636 DOI: 10.1590/s1806-37132014000200003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 12/02/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the modulatory effects that dynamic hyperinflation (DH), defined as a reduction in inspiratory capacity (IC), has on exercise tolerance after bronchodilator in patients with COPD. METHODS An experimental, randomized study involving 30 COPD patients without severe hypoxemia. At baseline, the patients underwent clinical assessment, spirometry, and incremental cardiopulmonary exercise testing (CPET). On two subsequent visits, the patients were randomized to receive a combination of inhaled fenoterol/ipratropium or placebo. All patients then underwent spirometry and submaximal CPET at constant speed up to the limit of tolerance (Tlim). The patients who showed ΔIC(peak-rest) < 0 were considered to present with DH (DH+). RESULTS In this sample, 21 patients (70%) had DH. The DH+ patients had higher airflow obstruction and lower Tlim than did the patients without DH (DH-). Despite equivalent improvement in FEV1 after bronchodilator, the DH- group showed higher ΔIC(bronchodilator-placebo) at rest in relation to the DH+ group (p < 0.05). However, this was not found in relation to ΔIC at peak exercise between DH+ and DH- groups (0.19 ± 0.17 L vs. 0.17 ± 0.15 L, p > 0.05). In addition, both groups showed similar improvements in Tlim after bronchodilator (median [interquartile range]: 22% [3-60%] vs. 10% [3-53%]; p > 0.05). CONCLUSIONS Improvement in TLim was associated with an increase in IC at rest after bronchodilator in HD- patients with COPD. However, even without that improvement, COPD patients can present with greater exercise tolerance after bronchodilator provided that they develop DH during exercise.
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Reinecke NL, Cunha TM, Heilberg IP, Higa EMS, Nishiura JL, Neder JA, Almeida WS, Schor N. Exercise Capacity in Polycystic Kidney Disease. Am J Kidney Dis 2014; 64:239-46. [DOI: 10.1053/j.ajkd.2014.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/18/2014] [Indexed: 11/11/2022]
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Takara LS, Cunha TM, Barbosa P, Rodrigues MK, Oliveira MF, Nery LE, Neder JA. Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease. ACTA ACUST UNITED AC 2012; 45:1276-83. [PMID: 23250012 PMCID: PMC3854210 DOI: 10.1590/s0100-879x2012007500162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/27/2012] [Indexed: 11/22/2022]
Abstract
This study evaluated the dynamic behavior of total and compartmental chest wall volumes [(V CW) = rib cage (V RC) + abdomen (V AB)] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III) underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim) at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyperinflation was considered to be present when end-expiratory (EE) V CW increased in relation to resting values. There was a noticeable heterogeneity in the patterns of V CW regulation as EEV CW increased non-linearly in 17/30 "hyperinflators" and decreased in 13/30 "non-hyperinflators" (P < 0.05). EEV AB decreased slightly in 8 of the "hyperinflators", thereby reducing and slowing the rate of increase in end-inspiratory (EI) V CW (P < 0.05). In contrast, decreases in EEV CW in the "non-hyperinflators" were due to the combination of stable EEV RC with marked reductions in EEV AB. These patients showed lower EIV CW and end-exercise dyspnea scores but longer Tlim than their counterparts (P < 0.05). Dyspnea increased and Tlim decreased non-linearly with a faster rate of increase in EIV CW regardless of the presence or absence of dynamic hyperinflation (P < 0.001). However, no significant between-group differences were observed in metabolic, pulmonary gas exchange and cardiovascular responses to exercise. Chest wall volumes are continuously regulated during exercise in order to postpone (or even avoid) their migration to higher operating volumes in patients with COPD, a dynamic process that is strongly dependent on the behavior of the abdominal compartment.
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Cordoni PK, Berton DC, Squassoni SD, Scuarcialupi MEA, Neder JA, Fiss E. Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave. J Bras Pneumol 2012; 38:13-23. [DOI: 10.1590/s1806-37132012000100004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/05/2011] [Indexed: 01/17/2023] Open
Abstract
OBJETIVO: Caracterizar a presença, extensão e padrões de hiperinsuflação dinâmica (HD) durante teste em esteira rolante em pacientes com DPOC moderada a grave. Métodos: Estudo transversal com 30 pacientes não hipoxêmicos (VEF1= 43 ± 14% do previsto) submetidos a teste cardiopulmonar de exercício em esteira rolante em velocidade constante (70-80% da velocidade máxima) até o limite da tolerância (Tlim). Manobras seriadas de capacidade inspiratória (CI) foram utilizadas para avaliação da HD. RESULTADOS: Dos 30 pacientes estudados, 19 (63,3%) apresentaram HD (grupo HD+), que apresentaram maior comprometimento funcional em repouso do que os pacientes sem HD (grupo HD-). Nenhuma das variáveis obtidas relacionou-se com a tolerância ao exercício no grupo HD-, enquanto Tlim, CI e percepção de dispneia ao esforço foram significativamente correlacionados no grupo HD+ (p < 0,05). No grupo HD+, 7 e 12 pacientes, respectivamente, apresentaram padrão progressivo e estável de HD (ΔCI Tlim,2min = -0,28 ± 0,11 L e 0,04 ± 0,10 L; p < 0,01). Pacientes com padrão progressivo de HD apresentaram maior relação percepção de dispneia/Tlim e menor tolerância ao exercício do que aqueles com padrão estável (354 ± 118 s e 465 ± 178 s, respectivamente; p < 0,05). CONCLUSÕES: A HD não é um fenômeno universal durante a caminhada em pacientes com DPOC, mesmo que apresentem obstrução ao fluxo aéreo de graus moderado a acentuado. Nos pacientes que apresentaram HD, um padrão progressivo de HD teve maior repercussão na tolerância ao exercício do que um padrão estável de HD.
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Gimenes AC, Neder JA, Dal Corso S, Nogueira CR, Nápolis L, Mello MT, Bulle AS, Nery LE. Relationship between work rate and oxygen uptake in mitochondrial myopathy during ramp-incremental exercise. BRAZILIAN JOURNAL OF MEDICAL AND BIOLOGICAL RESEARCH = REVISTA BRASILEIRA DE PESQUISAS MEDICAS E BIOLOGICAS 2011; 44:354-60. [PMID: 21487644 DOI: 10.1590/s0100-879x2011007500023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 02/16/2011] [Indexed: 11/22/2022]
Abstract
We determined the response characteristics and functional correlates of the dynamic relationship between the rate (Δ) of oxygen consumption (VO(2)) and the applied power output (work rate = WR) during ramp-incremental exercise in patients with mitochondrial myopathy (MM). Fourteen patients (7 males, age 35.4 ± 10.8 years) with biopsy-proven MM and 10 sedentary controls (6 males, age 29.0 ± 7.8 years) took a ramp-incremental cycle ergometer test for the determination of the VO(2) on-exercise mean response time (MRT) and the gas exchange threshold (GET). The ΔVO(2)/ΔWR slope was calculated up to GET (S(1)), above GET (S(2)) and over the entire linear portion of the response (S(T)). Knee muscle endurance was measured by isokinetic dynamometry. As expected, peak VO(2) and muscle performance were lower in patients than controls (P < 0.05). Patients had significantly lower ΔVO(2)/ΔWR than controls, especially the S(2) component (6.8 ± 1.5 vs 10.3 ± 0.6 mL·min(-1)·W(-1), respectively; P < 0.001). There were significant relationships between ΔVO(2)/ΔWR (S(T)) and muscle endurance, MRT-VO(2), GET and peak VO(2) in MM patients (P < 0.05). In fact, all patients with ΔVO(2)/ΔWR below 8 mL·min(-1)·W(-1) had severely reduced peak VO(2) values (<60% predicted). Moreover, patients with higher cardiopulmonary stresses during exercise (e.g., higher Δ ventilation/carbon dioxide output and Δ heart rate/ΔVO(2)) had lower ΔVO(2)/ΔWR (P < 0.05). In conclusion, a readily available, effort-independent index of aerobic dysfunction during dynamic exercise (ΔVO(2)/ΔWR) is typically reduced in patients with MM, being related to increased functional impairment and higher cardiopulmonary stress.
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Neder JA. Teste da caminhada de seis minutos na doença respiratória crônica: simples de realizar, nem sempre fácil de interpretar. J Bras Pneumol 2011; 37:1-3. [DOI: 10.1590/s1806-37132011000100001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Nápolis LM, Dal Corso S, Neder JA, Malaguti C, Gimenes ACO, Nery LE. Neuromuscular electrical stimulation improves exercise tolerance in chronic obstructive pulmonary disease patients with better preserved fat-free mass. Clinics (Sao Paulo) 2011; 66:401-6. [PMID: 21552662 PMCID: PMC3071998 DOI: 10.1590/s1807-59322011000300006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 10/07/2010] [Accepted: 11/17/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND High-frequency neuromuscular electrical stimulation increases exercise tolerance in patients with advanced chronic obstructive pulmonary disease (COPD patients). However, it is conceivable that its benefits are more prominent in patients with better-preserved peripheral muscle function and structure. OBJECTIVE To investigate the effects of high-frequency neuromuscular electrical stimulation in COPD patients with better-preserved peripheral muscle function. DESIGN Prospective and cross-over study. METHODS Thirty COPD patients were randomly assigned to either home-based, high-frequency neuromuscular electrical stimulation or sham stimulation for six weeks. The training intensity was adjusted according to each subject's tolerance. Fat-free mass, isometric strength, six-minute walking distance and time to exercise intolerance (Tlim) were assessed. RESULTS Thirteen (46.4%) patients responded to high-frequency neuromuscular electrical stimulation; that is, they had a post/pre Δ Tlim >10% after stimulation (unimproved after sham stimulation). Responders had a higher baseline fat-free mass and six-minute walking distance than their seventeen (53.6%) non-responding counterparts. Responders trained at higher stimulation intensities; their mean amplitude of stimulation during training was significantly related to their fat-free mass (r = 0.65; p<0.01). Logistic regression revealed that fat-free mass was the single independent predictor of Tlim improvement (odds ratio [95% CI] = 1.15 [1.04-1.26]; p<0.05). CONCLUSIONS We conclude that high-frequency neuromuscular electrical stimulation improved the exercise capacity of COPD patients with better-preserved fat-free mass because they tolerated higher training stimulus levels. These data suggest that early training with high-frequency neuromuscular electrical stimulation before tissue wasting begins might enhance exercise tolerance in patients with less advanced COPD.
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Reboredo MDM, Pinheiro BDV, Neder JA, Ávila MPW, Ribeiro MLDBAE, Mendonça AFD, Mello MVD, Bainha ACC, Dondici Filho J, Paula RBD. Efeito do exercício aeróbico durante as sessões de hemodiálise na variabilidade da frequência cardíaca e na função ventricular esquerda em pacientes com doença renal crônica. J Bras Nefrol 2010. [DOI: 10.1590/s0101-28002010000400006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Reboredo MDM, Pinheiro BDV, Neder JA, Ávila MPW, Araujo E Ribeiro MLDB, de Mendonça AF, de Mello MV, Bainha ACC, Dondici Filho J, de Paula RB. Effects of aerobic training during hemodialysis on heart rate variability and left ventricular function in end-stage renal disease patients. J Bras Nefrol 2010; 32:367-373. [PMID: 21541451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/22/2010] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION Decreased heart rate variability (HRV) in patients with end stage renal disease (ESRD) undergoing hemodialysis is predictive of cardiac death, especially due to sudden death. OBJECTIVE To evaluate the effects of aerobic training during hemodialysis on HRV and left ventricular function in ESRD patients. METHODS Twenty two patients were randomized into two groups: exercise (n = 11; 49.6 ± 10.6 years; 4 men) and control (n = 11; 43.5 ± 12.8; 4 men). Patients assigned to the exercise group were submitted to aerobic training, performed during the first two hours of hemodialysis, three times weekly, for 12 weeks. HRV and left ventricular function were assessed by 24 hours Holter monitoring and echocardiography, respectively. RESULTS After 12 weeks of protocol, no significant differences were observed in time and frequency domains measures of HRV in both groups. The ejection fraction improved non-significantly in exercise group (67.5 ± 12.6% vs. 70.4 ± 12%) and decreased non-significantly in control group (73.6 ± 8.4% vs. 71.4 ± 7.6%). CONCLUSION A 12-week aerobic training program performed during hemodialysis did not modify HRV and did not significantly improve the left ventricular function.
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Santana VTS, Squassoni SD, Neder JA, Fiss E. [Influence of current smoking on adherence and responses to pulmonary rehabilitation in patients with COPD]. REVISTA BRASILEIRA DE FISIOTERAPIA (SAO CARLOS (SAO PAULO, BRAZIL)) 2010; 14:16-23. [PMID: 20414557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 05/26/2009] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate the modulating effects of current smoking on adherence and responses to pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). METHODS In a prospective study, 18 ex-smokers and 23 current smokers (GOLD stages II-III) were enrolled in a 12-week multidisciplinary, supervised PR program. The patients were assessed clinically and as to subjective variables (dyspnea and health-related quality of life) and objective variables (body composition, pulmonary function and 6-min walking distance). The degree of nicotine dependence in current smokers was assessed by the Fagerström test. Program completion defined PR 'adherence'. RESULTS There was a significant association between current smoking and non-adherence to PR with 30.4% vs. 11.1% and odds ratio=2.9 (1.6-4.1; p<0.01). However, the current smokers who completed the program (n=16) had a similar absentee rate to the ex-smokers, as well as similar gains in the subjective (quality of life) and objective (walked distance) items. Additionally, there was a significant reduction in daily cigarette consumption and in the degree of nicotine dependence in current smokers (p<0.05). CONCLUSIONS Although current smoking is negatively related to PR adherence, COPD smokers who complete the PR can have similar gains in functionality and quality of life compared to ex-smokers. Moreover, PR may be related to decreased nicotine dependence, even without a formal smoking withdrawal program.
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Najas CS, Pissulin FDM, Pacagnelli FL, Betônico GN, Almeida IC, Neder JA. Segurança e eficácia do treinamento físico na insuficiência renal crônica. REV BRAS MED ESPORTE 2009. [DOI: 10.1590/s1517-86922009000600013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A doença renal crônica acarreta alterações em todos os sistemas corporais. Os pacientes cursam com marcada redução do condicionamento cardiorrespiratório, alterações musculares, reduzida performance física e pior qualidade de vida. A atividade física tem sido cada vez mais utilizada como forma de tratamento para essa população. Programas de treinamento físico aeróbio e/ou resistidos de moderada ou baixa intensidade no período interdialítico e durante a hemodiálise têm sido utilizados. Entretanto, os benefícios dessas intervenções no doente renal crônico, a escolha mais apropriada do tipo de treinamento e a segurança da aplicabilidade de atividades específicas não estão bem esclarecidos. Esta revisão tem como objetivo abordar os aspectos relacionados com o tipo de treinamento, período em que este é realizado, assim como os possíveis benefícios que o treinamento físico pode induzir nessa população.
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