Pulmonary gas exchange and acid-base balance during exercise

The pulmonary physiology of exercise

The pulmonary system is the first and last "line of defense" in terms of maintaining blood gas homeostasis during exercise. Our review provides the reader with an overview of how the pulmonary system responds to acute exercise. We undertook this endeavor to provide a companion article to "Cardiovascular Response to Exercise," which was published in Advances in Physiological Education. Together, these articles provide the readers with a solid foundation of the cardiopulmonary response to acute exercise in healthy individuals. The intended audience of this review is level undergraduate or graduate students and/or instructors for such classes. By intention, we intend this to be used as an educational resource and seek to provide illustrative examples to reinforce topics as well as highlight uncertainty to encourage the reader to think "beyond the textbook." Our treatment of the topic presents "classic" concepts along with new information on the pulmonary physiology of healthy aging.NEW & NOTEWORTHY Our narrative review is written with the student of the pulmonary physiology of exercise in mind, be it a senior undergraduate or graduate student or those simply refreshing their knowledge. We also aim to provide examples where the reader can incorporate real scenarios.

Erythrocyte metabolism

Our aim is to present an updated overview of the erythrocyte metabolism highlighting its richness and complexity. We have manually collected and connected the available biochemical pathways and integrated them into a functional metabolic map. The focus of this map is on the main biochemical pathways consisting of glycolysis, the pentose phosphate pathway, redox metabolism, oxygen metabolism, purine/nucleoside metabolism, and membrane transport. Other recently emerging pathways are also curated, like the methionine salvage pathway, the glyoxalase system, carnitine metabolism, and the lands cycle, as well as remnants of the carboxylic acid metabolism. An additional goal of this review is to present the dynamics of erythrocyte metabolism, providing key numbers used to perform basic quantitative analyses. By synthesizing experimental and computational data, we conclude that glycolysis, pentose phosphate pathway, and redox metabolism are the foundations of erythrocyte metabolism. Additionally, the erythrocyte can sense oxygen levels and oxidative stress adjusting its mechanics, metabolism, and function. In conclusion, fine-tuning of erythrocyte metabolism controls one of the most important biological processes, that is, oxygen loading, transport, and delivery.

A century of exercise physiology: effects of muscle contraction and exercise on skeletal muscle Na+,K+-ATPase, Na+ and K+ ions, and on plasma K+ concentration-historical developments

This historical review traces key discoveries regarding K+ and Na+ ions in skeletal muscle at rest and with exercise, including contents and concentrations, Na+,K+-ATPase (NKA) and exercise effects on plasma [K+] in humans. Following initial measures in 1896 of muscle contents in various species, including humans, electrical stimulation of animal muscle showed K+ loss and gains in Na+, Cl- and H20, then subsequently bidirectional muscle K+ and Na+ fluxes. After NKA discovery in 1957, methods were developed to quantify muscle NKA activity via rates of ATP hydrolysis, Na+/K+ radioisotope fluxes, [3H]-ouabain binding and phosphatase activity. Since then, it became clear that NKA plays a central role in Na+/K+ homeostasis and that NKA content and activity are regulated by muscle contractions and numerous hormones. During intense exercise in humans, muscle intracellular [K+] falls by 21 mM (range - 13 to - 39 mM), interstitial [K+] increases to 12-13 mM, and plasma [K+] rises to 6-8 mM, whilst post-exercise plasma [K+] falls rapidly, reflecting increased muscle NKA activity. Contractions were shown to increase NKA activity in proportion to activation frequency in animal intact muscle preparations. In human muscle, [3H]-ouabain-binding content fully quantifies NKA content, whilst the method mainly detects α2 isoforms in rats. Acute or chronic exercise affects human muscle K+, NKA content, activity, isoforms and phospholemman (FXYD1). Numerous hormones, pharmacological and dietary interventions, altered acid-base or redox states, exercise training and physical inactivity modulate plasma [K+] during exercise. Finally, historical research approaches largely excluded female participants and typically used very small sample sizes.

Prolonged exercise shifts ventilatory parameters at the moderate-to-heavy intensity transition

PURPOSE

To quantify the effects of prolonged cycling on the rate of ventilation ([Formula: see text]), frequency of respiration (FR), and tidal volume (VT) associated with the moderate-to-heavy intensity transition.

METHODS

Fourteen endurance-trained cyclists and triathletes (one female) completed an assessment of the moderate-to-heavy intensity transition, determined as the first ventilatory threshold (VT1), before (PRE) and after (POST) two hours of moderate-intensity cycling. The power output, [Formula: see text], FR, and VT associated with VT1 were determined PRE and POST.

RESULTS

As previously reported, power output at VT1 significantly decreased by ~ 10% from PRE to POST. The [Formula: see text] associated with VT1 was unchanged from PRE to POST (72 ± 12 vs. 69 ± 13 L.min-1, ∆ - 3 ± 5 L.min-1, ∆ - 4 ± 8%, P = 0.075), and relatively consistent (within-subject coefficient of variation, 5.4% [3.7, 8.0%]). The [Formula: see text] associated with VT1 was produced with increased FR (27.6 ± 5.8 vs. 31.9 ± 6.5 breaths.min-1, ∆ 4.3 ± 3.1 breaths.min-1, ∆ 16 ± 11%, P = 0.0002) and decreased VT (2.62 ± 0.43 vs. 2.19 ± 0.36 L.breath-1, ∆ - 0.44 ± 0.22 L.breath-1, ∆ - 16 ± 7%, P = 0.0002) in POST.

CONCLUSION

These data suggest prolonged exercise shifts ventilatory parameters at the moderate-to-heavy intensity transition, but [Formula: see text] remains stable. Real-time monitoring of [Formula: see text] may be a useful means of assessing proximity to the moderate-to-heavy intensity transition during prolonged exercise and is worthy of further research.

A critical assessment of the cellular defences of the avian respiratory system: are birds in general and poultry in particular relatively more susceptible to pulmonary infections/afflictions?

In commercial poultry farming, respiratory diseases cause high morbidities and mortalities, begetting colossal economic losses. Without empirical evidence, early observations led to the supposition that birds in general, and poultry in particular, have weak innate and adaptive pulmonary defences and are therefore highly susceptible to injury by pathogens. Recent findings have, however, shown that birds possess notably efficient pulmonary defences that include: (i) a structurally complex three-tiered airway arrangement with aerodynamically intricate air-flow dynamics that provide efficient filtration of inhaled air; (ii) a specialised airway mucosal lining that comprises air-filtering (ciliated) cells and various resident phagocytic cells such as surface and tissue macrophages, dendritic cells and lymphocytes; (iii) an exceptionally efficient mucociliary escalator system that efficiently removes trapped foreign agents; (iv) phagocytotic atrial and infundibular epithelial cells; (v) phagocytically competent surface macrophages that destroy pathogens and injurious particulates; (vi) pulmonary intravascular macrophages that protect the lung from the vascular side; and (vii) proficiently phagocytic pulmonary extravasated erythrocytes. Additionally, the avian respiratory system rapidly translocates phagocytic cells onto the respiratory surface, ostensibly from the subepithelial space and the circulatory system: the mobilised cells complement the surface macrophages in destroying foreign agents. Further studies are needed to determine whether the posited weak defence of the avian respiratory system is a global avian feature or is exclusive to poultry. This review argues that any inadequacies of pulmonary defences in poultry may have derived from exacting genetic manipulation(s) for traits such as rapid weight gain from efficient conversion of food into meat and eggs and the harsh environmental conditions and severe husbandry operations in modern poultry farming. To reduce pulmonary diseases and their severity, greater effort must be directed at establishment of optimal poultry housing conditions and use of more humane husbandry practices.

Epithelial Transport in Disease: An Overview of Pathophysiology and Treatment

Epithelial transport is a multifaceted process crucial for maintaining normal physiological functions in the human body. This comprehensive review delves into the pathophysiological mechanisms underlying epithelial transport and its significance in disease pathogenesis. Beginning with an introduction to epithelial transport, it covers various forms, including ion, water, and nutrient transfer, followed by an exploration of the processes governing ion transport and hormonal regulation. The review then addresses genetic disorders, like cystic fibrosis and Bartter syndrome, that affect epithelial transport. Furthermore, it investigates the involvement of epithelial transport in the pathophysiology of conditions such as diarrhea, hypertension, and edema. Finally, the review analyzes the impact of renal disease on epithelial transport and highlights the potential for future research to uncover novel therapeutic interventions for conditions like cystic fibrosis, hypertension, and renal failure.

Alterations in step frequency and muscle activities using body weight support influence the ventilatory response to sinusoidal walking in humans

The use of body weight support (BWS) can reveal important insights into the relationship between lower-limb muscle activities and the ventilatory response during sinusoidal walking. Here, healthy participants (n = 15) walked on a treadmill while 0%, 30%, and 50% of their body weight was supported with BWS. The walking speed was varied sinusoidally between 3 and 6 km h-1, and three different frequencies, and periods ranging from 2 to 10 min were used. Breath-by-breath ventilation ([Formula: see text]) and CO2 output ([Formula: see text]) were measured. The tibialis anterior (TA) muscle activity was measured by electromyography throughout the walking. The amplitude (Amp), normalized Amp [Amp ratio (%)], and phase shift (PS) of the sinusoidal variations in measurement variables were calculated using a Fourier analysis. The results revealed that the Amp ratio in [Formula: see text] increased with the increase in BWS. A steeper slope of the [Formula: see text]-[Formula: see text] relationship and greater [Formula: see text]/[Formula: see text] values were observed under reduced body weight conditions. The Amp ratio in TA muscle was significantly positively associated with the Amp ratio in the [Formula: see text] (p < 0.001). These findings indicate that the greater amplitude in the TA muscle under BWS may have been a potent stimulus for the greater response of ventilation during sinusoidal walking.

EXERCISE-INDUCED ARTERIAL HYPOXEMIA IN FEMALE MASTERS ATHTLETES

The purpose of the study was to characterize exercise induced arterial hypoxemia (EIAH) in female masters athletes (FMA). We hypothesized that FMA would experience EIAH during treadmill running. Eight FMA (48-57 years) completed pulmonary function testing and an incremental exercise test until exhaustion (V̇O₂max=45.7±6.5, range:35-54ml/kg/min). On a separate day, the participants were instrumented with a radial arterial catheter and an esophageal temperature probe. Participants performed three to four constant load exercise tests at 60-70, 75, 90, 95, and 100% of maximal oxygen uptake while sampling arterial blood and recording esophageal temperature. We found that FMA decrease their partial pressure of oxygen (86.0±7.6, range:73-108mmHg), arterial saturation (96.2±1.2, range:93-98%), and widen their alveolar to arterial oxygen difference (23.2±8.8, range:5-42mmHg) during all exercise intensities however, with variability in terms of severity and pattern. Our findings suggest that FMA experience EIAH however aerobic fitness appears unrelated to occurrence or severity (r=0.13, p=0.756).

Effects of short bout small-sided game training on acid-based balance markers in youth male soccer players

This study aimed to compare the effects of 1 × 1 small-sided games (SSGs) with different bout durations on external (ETL) and internal training loads (ITL) in youth soccer players. Twenty U18 players were divided into two groups performing six 1 × 1 SSGs with 30 and 45 s bout durations on a playing field of 10 by 15 m. ITL indices, including the percentage of maximum heart rate (HR), blood lactate (BLa) level, pH, bicarbonate (HCO₃^-) level, and base excess (BE) level, were measured at rest, after each SSG bout, and 15 and 30 min after the entire exercise protocol. ETL (Global Positioning System metrics) was recorded during all six SSG bouts. The analysis showed that the 45 s SSGs had a greater volume (large effect) but a lower training intensity (small to large effect) than the 30 s SSGs. A significant time effect (p < 0.05) was observed in all ITL indices and a significant group effect (F_{1, 18} = 8.84, p = 0.0082, ƞ² = 0.33) in the HCO₃^- level only. Finally, the changes in the HR and HCO₃^- level were smaller in the 45 s SSGs than in the 30 s SSGs. In conclusion, 30-s games, characterized by a higher intensity of training effort, are more physiologically demanding than 45-s games. Secondly during short-bout SSG training the HR and BLa level have limited diagnostic value for ITL. Extending ITL monitoring using other indicators, such as the HCO₃^- and BE levels, appears reasonable.

Similar Slow Component of Oxygen Uptake and Ventilatory Efficiency between an Aerobic Dance Session on an Air Dissipation Platform and a Constant-Load Treadmill Test in Healthy Women

There is a lack of evidence about the slow component of oxygen consumption (V.O2sc) and ventilatory efficiency (slope VE·VCO2−1) during an aerobic dance (AD) session on an air dissipation platform (ADP) despite the key role played in endurance exercises. This research was designed to assess V.O2sc, ventilatory efficiency, and blood lactate concentration by comparing two exercise modes: AD session on an ADP versus treadmill test at a constant-load intensity of the first ventilatory threshold (VT1). In the first session, an incremental treadmill test was completed. In sessions 2 and 3, the participants were randomly assigned to the AD session on an ADP or to a treadmill constant-load test at VT1 intensity to determine their cardioventilatory responses. In addition, their blood lactate levels and ratings of perceived exertion (RPE, CR-10) were evaluated. No significant differences were found between the constant-load treadmill test and AD session on an ADP with respect to V.O2sc, VE VCO2−1 slope, and RPE (p > 0.05). Higher blood lactate concentrations were observed in an AD session on an ADP than in a constant-load treadmill test at 10 min (p = 0.003) and 20 min (p < 0.001). The two different exercise modalities showed similar V.O2sc and VE·VCO2−1 slope, even though the blood lactate concentrations were different.

Physicochemical Analysis of Mixed Venous and Arterial Blood Acid-Base State in Horses at Core Temperature during and after Moderate-Intensity Exercise

The present study determined the independent contributions of temperature, strong ion difference ([SID]), total weak acid concentration ([Atot]) and PCO2 to changes in arterial and mixed venous [H+] and total carbon dioxide concentration ([TCO2]) during 37 min of moderate intensity exercise (~50% of heart rate max) and the first 60 min of recovery. Six horses were fitted with indwelling carotid and pulmonary artery (PA) catheters, had PA temperature measured, and had blood samples withdrawn for immediate analysis of plasma ion and gas concentrations. The increase in core temperature during exercise (+4.5 °C; p < 0.001) significantly (p < 0.05) increased PO2, PCO2, and [H+], but without a significant effect on [TCO2] (p > 0.01). The physicochemical acid-base approach was used to determine contributions of independent variables (except temperature) to the changes in [H+] and [TCO2]. In both arterial and venous blood, there was no acidosis during exercise and recovery despite significant (p < 0.05) increases in [lactate] and in venous PCO2. In arterial blood plasma, a mild alkalosis with exercise was due to primarily to a decrease in PCO2 (p < 0.05) and an increase in [SID] (p < 0.1). In venous blood plasma, a near absence of change in [H+] was due to the acidifying effects of increased PCO2 (p < 0.01) being offset by the alkalizing effects of increased [SID] (p < 0.05). The effect of temperature on PO2 (p < 0.001) resulted in an increased arterio-venous PO2 difference (p < 0.001) that would facilitate O2 transfer to contracting muscle. The simultaneous changes in the PCO2 and the concentrations of the other independent acid-base variables (contributions from individual strong and weak ions as manifest in [SID] and [Atot]) show complex, multilevel control of acid-base states in horses performing even moderate intensity exercise. Correction of acid-base variables to core body temperature presents a markedly different physiological response to exercise than that provided by variables measured and presented at an instrument temperature of 37 °C.

Using Cardiopulmonary Exercise Testing to Understand Dyspnea and Exercise Intolerance in Respiratory Disease

A cardiopulmonary exercise test (CPET) is ideally suited to quantify exercise tolerance and evaluate the pathophysiological mechanism(s) of dyspnea and exercise limitation in people with chronic respiratory disease. Although there are several statements on CPET and many outstanding resources detailing the cardiorespiratory and perceptual responses to exercise, limited information is available to support the health care provider in conducting a practical CPET evaluation. This article provides the health care provider with practical and timely information on how to use CPET data to understand dyspnea and exercise intolerance in people with chronic respiratory diseases. Information on CPET protocol, as well as how to evaluate maximal patient effort, peak rate of oxygen consumption, ventilatory demand, pulmonary gas exchange, ventilatory reserve, operating lung volumes, and exertional dyspnea, is presented. Two case examples are also described to highlight how these parameters are evaluated to provide a clinical interpretation of CPET data.

Chronic Supplementation of 2S-Hesperidin Improves Acid-Base Status and Decreases Lactate at FatMax, at Ventilatory Threshold 1 and 2 and after an Incremental Test in Amateur Cyclists

Simple Summary

Currently, hesperidin is a molecule found mainly in citrus fruits and is being widely researched in the area of chronic disease, but also in the field of sports nutrition. Some studies have shown its antioxidant, anti-inflammatory, lipid and carbohydrate metabolism modulating effects, including the enhancement of nitric oxide synthesis. However, few human studies have demonstrated a positive effect of hesperidin intake, in particular 2S-hesperidin, on sports performance, particularly in anaerobic and aerobic tests. However, the biochemical mechanisms that may be responsible for this enhanced performance have not yet been described. Therefore, one of the aims of this study was to assess whether an eight-week intake of 2S-hesperidin can improve acid-base status and metabolic status (lactate and glucose) in an incremental test in amateur cyclists. The results showed that amateur cyclists chronically supplemented with 2S-hesperidin improved acid-base status and lactate at FatMax, ventilatory thresholds 1 and 2, and in the acute phase of recovery after maximal effort.

Abstract

Chronic supplementation with 2S-hesperidin improves performance; however, the mechanisms underlying this effect have not yet been explored. Therefore, the aim of this study was to assess whether changes in acid-base status may be associated with improved performance after 2S-hesperidin supplementation compared to microcellulose (placebo). Forty amateur cyclists (n = 20 per group) underwent a rectangular test where capillary blood samples were taken at baseline, FatMax1, VT1, VT2, P_MAX, FatMax2 and EPOC to measure acid-base parameters. After eight weeks of 2S-hesperidin supplementation (500 mg/d) increased HCO₃⁻, SBC, ABE (p ≤ 0.05) and decreased Lac were found at FatMax1, VT1, FatMax2 and EPOC (p ≤ 0.05), while decreased Lac at VT2 was found with a large effect size (ES = 1.15) compared to placebo. Significant group differences in the area under the curve were observed when comparing pre-post-intervention pH changes (p = 0.02) between groups. Chronic supplementation with 2S-hesperidin improved acid-base status and Lac, both at low-moderate and submaximal intensities, improving recovery after exercise-to-exhaustion in amateur cyclists.

Sex, gender and the pulmonary physiology of exercise

In this review, we detail how the pulmonary system's response to exercise is impacted by both sex and gender in healthy humans across the lifespan. First, the rationale for why sex and gender differences should be considered is explored, and then anatomical differences are highlighted, namely that females typically have smaller lungs and airways than males. Thereafter, we describe how these anatomical differences can impact functional aspects such as respiratory muscle energetics and activation, mechanical ventilatory constraints, diaphragm fatigue, and pulmonary gas exchange in healthy adults and children. Finally, we detail how gender can impact the pulmonary response to exercise.

Biological sex can influence the pulmonary response to exercise in healthy individuals across the lifespanhttps://bit.ly/3ejMDrv

Acid-Base Balance, Blood Gases Saturation, and Technical Tactical Skills in Kickboxing Bouts According to K1 Rules

Simple Summary

The aim of our study was to analyze the changes in ABB after a three-round kickboxing fight and the level of technical and tactical skills presented during the fight. Fighting in kickboxing under K1 rules takes place with a high presence of anaerobic metabolism. Kickboxing athletes must have a good tolerance for metabolic acidosis and the ability to conduct an effective duel despite ABB disorders. Properly developed post-workout regeneration also plays an extremely important role.

Abstract

Background: Acid–base balance (ABB) is a major component of homeostasis, which is determined by the efficient functioning of many organs, including the lungs, kidneys, and liver, and the proper water and electrolyte exchange between these components. The efforts made during competitions by combat sports athletes such as kickboxers require a very good anaerobic capacity, which, as research has shown, can be improved by administering sodium bicarbonate. Combat sports are also characterized by an open task structure, which means that cognitive and executive functions must be maintained at an appropriate level during a fight. The aim of our study was to analyze the changes in ABB in capillary blood, measuring levels of H⁺, pCO₂, pO₂, HCO₃⁻, BE and total molar CO₂ concentration (TCO₂), which were recorded 3 and 20 min after a three-round kickboxing bout, and the level of technical and tactical skills presented during the fight. Methods: The study involved 14 kickboxers with the highest skill level (champion level). Statistical comparison of mentioned variables recorded prior to and after a bout was done with the use of Friedman’s ANOVA. Results: 3 min after a bout, H⁺ and pO₂ were higher by 41% and 11.9%, respectively, while pCO₂, HCO₃⁻, BE and TO₂ were lower by 14.5%, 39.4%, 45.4% and 34.4%, respectively. Furthermore, 20 min after the bout all variables tended to normalization and they did not differ significantly compared to the baseline values. Scores in activeness of the attack significantly correlated (r = 0.64) with pre–post changes in TCO₂. Conclusions: The disturbances in ABB and changes in blood oxygen and carbon dioxide saturation observed immediately after a bout indicate that anaerobic metabolism plays a large part in kickboxing fights. Anaerobic training should be included in strength and conditioning programs for kickboxers to prepare the athletes for the physiological requirements of sports combat.

Total Carbon Dioxide in Adult Standardbred and Thoroughbred Horses

The TCO2 (total carbon dioxide) test is performed on the blood of racehorses as a means of combatting the practice of administering alkalizing agents for the purpose of enhancing performance. The purposes of this review are to present an overview of the factors contributing to TCO2 and to review the literature regarding TCO2 in adult Standardbred and Thoroughbred horses to demonstrate the range of variability of TCO2 in horses. Most of the research published on the topic of TCO2 or bicarbonate measurement in racehorses was accessed and reviewed. PubMed and Google Scholar were the primary search engines used to source the relevant literature. The main physicochemical factors that contribute to changes in TCO2 in horses at rest are changes in strong ions concentration, followed by changes in weak acid (i.e. plasma albumin) concentrations. There is a wide normal distribution of TCO2 in horses ranging from 23 mmol/L to 38 mmol/L. Independent of administration of alkalizing agents, blood TCO2 is affected mainly by feeding, time of day (diurnal variation), season and exercise. There are few studies that have reported hour-by-hour changes in TCO2. Racehorse population studies suffer from lack of validation regarding whether or not a horse was administered an alkalizing agent. It is concluded that the normal range of TCO2 in non-alkalized Standardbred and Thoroughbred horses is significantly wider than has been appreciated, that periods of elevated TCO2 appear to be normal for many horses at rest, and that a TCO2 test alone is not definitive for the purposes of determining of an alkalizing agent has been administered to a horse.

Effect of Silymarin Supplementation in Lung and Liver Histological Modifications during Exercise Training in a Rodent Model

BACKGROUND

Exercise training induces adaptive physiological and morphological modifications in the entire organism; however, excessive loads of training may increase damage in tissues. The purpose of this study was to evaluate the effect of silymarin in lung and liver histological changes in rats subjected to exercise training (ET).

METHODS

Male Wistar rats were subjected to an 8-week ET treadmill program 5 days per week, 60 min/session, and were previously administered 100 mg ascorbic acid or 100 mg of silymarin.

RESULTS

Silymarin increased alveolar and bronchial muscle size, improve vascularization, and reduced tissue inflammation. In liver, silymarin promoted the reduction of lipid content.

CONCLUSION

Silymarin supplementation may improve inflammation in pulmonary tissue after 8 weeks of the ET treadmill program, improve cell recovery, and reduce intrahepatic lipid content.

Pre-loading large volume oral electrolytes: tracing fluid and ion fluxes in horses during rest, exercise and recovery

KEY POINTS

Exercise results in rapid and large extracellular to intracellular fluid shifts, as well as significant sweating losses of water and ions. It is unknown whether ions within oral electrolyte supplements are taken up by muscle (and other soft tissues) and whether oral supplementation can effectively offset sweating losses. Pre-loading with 8 L of a balanced hypotonic electrolyte supplement attenuated extracellular fluid losses, increased exercise duration and increased sweating fluid and ion losses during submaximal exercise. Supplemented electrolytes appear in skeletal muscle within 1 h after administration. Electrolyte supplementation increased exercise performance, improved maintenance of extracellular fluid volumes, and attenuated body fluid losses while maintaining sweating rates.

ABSTRACT

This study used radioactive sodium (24 Na) and potassium (42 K) in a balanced, hypotonic electrolyte supplement to trace their appearance in skeletal muscle, and also quantified extracellular and whole-body fluid and ion changes during electrolyte supplementation, exercise and recovery. In a randomized crossover design, 1 h after administration of 1 to 3 L of water or electrolyte supplement with 24 Na, horses were exercised at 35% VO2max to voluntary fatigue or, after administration of 8 L of water or electrolyte supplement with 42 K were exercised at 50% peak VO2 for 45 min (n = 4 in each trial). Pre-exercise electrolyte supplementation was associated with decreased loss of fluid and electrolytes from the extracellular fluid compartments during exercise and recovery compared with water alone. The improved fluid and ion balance during prolonged exercise was associated with increased exercise duration, despite continuing sweating losses of fluid and ions. Nasogastric administration of radiotracer 24 Na+ and 42 K+ showed rapid absorption into the blood with plasma levels peaking 45 min after administration, followed by distribution into the extracellular space and intracellular fluid of muscle within 1 h. Following exercise, virtually all Na+ remained within the extracellular compartment, while the majority of K+ underwent intracellular uptake by 2 h of recovery. It is concluded that pre-loading with a large volume, balanced electrolyte supplement helps maintain whole-body fluid and ion balance and support muscle function during periods of prolonged sweat ion losses.

Impact of wearing a surgical and cloth mask during cycle exercise

We sought to determine the impact of wearing cloth or surgical masks on the cardiopulmonary responses to moderate-intensity exercise. Twelve subjects (n = 5 females) completed three, 8-min cycling trials while breathing through a non-rebreathing valve (laboratory control), cloth, or surgical mask. Heart rate (HR), oxyhemoglobin saturation (SpO₂), breathing frequency, mouth pressure, partial pressure of end-tidal carbon dioxide (P_etCO₂) and oxygen (P_etO₂), dyspnea were measured throughout exercise. A subset of n = 6 subjects completed an additional exercise bout without a mask (ecological control). There were no differences in breathing frequency, HR or SpO₂ across conditions (all p > 0.05). Compared with the laboratory control (4.7 ± 0.9 cmH₂O [mean ± SD]), mouth pressure swings were smaller with the surgical mask (0.9 ± 0.7; p < 0.0001), but similar with the cloth mask (3.6 ± 4.8 cmH₂O; p = 0.66). Wearing a cloth mask decreased P_etO₂ (-3.5 ± 3.7 mm Hg) and increased P_etCO₂ (+2.0 ± 1.3 mm Hg) relative to the ecological control (both p < 0.05). There were no differences in end-tidal gases between mask conditions and laboratory control (both p > 0.05). Dyspnea was similar between the control conditions and the surgical mask (p > 0.05) but was greater with the cloth mask compared with laboratory (+0.9 ± 1.2) and ecological (+1.5 ± 1.3) control conditions (both p < 0.05). Wearing a mask during short-term moderate-intensity exercise may increase dyspnea but has minimal impact on the cardiopulmonary response. Novelty: Wearing surgical or cloth masks during exercise has no impact on breathing frequency, tidal volume, oxygenation, and heart rate However, there are some changes in inspired and expired gas fractions that are physiologically irrelevant. In young healthy individuals, wearing surgical or cloth masks during submaximal exercise has few physiological consequences.

The Oxygen Cascade During Exercise in Health and Disease

The oxygen transport cascade describes the physiological steps that bring atmospheric oxygen into the body where it is delivered and consumed by metabolically active tissue. As such, the oxygen cascade is fundamental to our understanding of exercise in health and disease. Our narrative review will highlight each step of the oxygen transport cascade from inspiration of atmospheric oxygen down to mitochondrial consumption in both healthy active males and females along with clinical conditions. We will focus on how different steps interact along with principles of homeostasis, physiological redundancies, and adaptation. In particular, we highlight some of the parallels between elite athletes and clinical conditions in terms of the oxygen cascade.

The Relationship between Resistance Exercise Performance and Ventilatory Efficiency after Beetroot Juice Intake in Well-Trained Athletes

The assessment of ventilatory efficiency is critical to understanding the matching of ventilation (VE) and perfusion in the lungs during exercise. This study aimed to establish a causal physiological relationship between ventilatory efficiency and resistance exercise performance after beetroot juice (BJ) intake. Eleven well-trained males performed a resistance exercise test after drinking 140 mL of BJ (~12.8 mmol NO₃^-) or a placebo (PL). Ventilatory efficiency was assessed by the VE•VCO₂^-1 slope, the oxygen uptake efficiency slope and the partial pressure of end-tidal carbon dioxide (PetCO₂). The two experimental conditions were controlled using a randomized, double-blind crossover design. The resistance exercise test involved repeating the same routine twice, which consisted of wall ball shots plus a full squat (FS) with a 3 min rest or without a rest between the two exercises. A higher weight lifted was detected in the FS exercise after BJ intake compared with the PL during the first routine (p = 0.004). BJ improved the VE•VCO₂^-1 slope and the PetCO₂ during the FS exercise in the first routine and at rest (p < 0.05). BJ intake improved the VE•VCO₂^-1 slope and the PetCO₂ coinciding with the resistance exercise performance. The ergogenic effect of BJ could be induced under aerobic conditions at rest.

Face Masks and the Cardiorespiratory Response to Physical Activity in Health and Disease

To minimize transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus responsible for coronavirus disease (COVID-19), the U.S. Centers for Disease Control and Prevention and the World Health Organization recommend wearing face masks in public. Some have expressed concern that these may affect the cardiopulmonary system by increasing the work of breathing, altering pulmonary gas exchange and increasing dyspnea, especially during physical activity. These concerns have been derived largely from studies evaluating devices intentionally designed to severely affect respiratory mechanics and gas exchange. We review the literature on the effects of various face masks and respirators on the respiratory system during physical activity using data from several models: cloth face coverings and surgical masks, N95 respirators, industrial respirators, and applied highly resistive or high-dead space respiratory loads. Overall, the available data suggest that although dyspnea may be increased and alter perceived effort with activity, the effects on work of breathing, blood gases, and other physiological parameters imposed by face masks during physical activity are small, often too small to be detected, even during very heavy exercise. There is no current evidence to support sex-based or age-based differences in the physiological responses to exercise while wearing a face mask. Although the available data suggest that negative effects of using cloth or surgical face masks during physical activity in healthy individuals are negligible and unlikely to impact exercise tolerance significantly, for some individuals with severe cardiopulmonary disease, any added resistance and/or minor changes in blood gases may evoke considerably more dyspnea and, thus, affect exercise capacity.

Role of Regular Physical Exercise in Tumor Vasculature: Favorable Modulator of Tumor Milieu

The tumor vessel network has been investigated as a precursor of an inhospitable tumor microenvironment, including its repercussions in tumor perfusion, oxygenation, interstitial fluid pressure, pH, and immune response. Dysfunctional tumor vasculature leads to the extravasation of blood to the interstitial space, hindering proper perfusion and causing interstitial hypertension. Consequently, the inadequate delivery of oxygen and clearance of by-products of metabolism promote the development of intratumoral hypoxia and acidification, hampering the action of immune cells and resulting in more aggressive tumors. Thus, pharmacological strategies targeting tumor vasculature were developed, but the overall outcome was not satisfactory due to its transient nature and the higher risk of hypoxia and metastasis. Therefore, physical exercise emerged as a potential favorable modulator of tumor vasculature, improving intratumoral vascularization and perfusion. Indeed, it seems that regular exercise practice is associated with lasting tumor vascular maturity, reduced vascular resistance, and increased vascular conductance. Higher vascular conductance reduces intratumoral hypoxia and increases the accessibility of circulating immune cells to the tumor milieu, inhibiting tumor development and improving cancer treatment. The present paper describes the implications of abnormal vasculature on the tumor microenvironment and the underlying mechanisms promoted by regular physical exercise for the re-establishment of more physiological tumor vasculature.

Dyspnea, effort and muscle pain during exercise in lung transplant recipients: an analysis of their association with cardiopulmonary function parameters using machine learning

Background

Despite improvement in lung function, most lung transplant (LTx) recipients show an unexpectedly reduced exercise capacity that could be explained by persisting peripheral muscle dysfunction of multifactorial origin. We analyzed the course of symptoms, including dyspnea, muscle effort and muscle pain and its relation with cardiac and pulmonary function parameters during an incremental exercise testing.

Methods

Twenty-four bilateral LTx recipients were evaluated in an observational cross-sectional study. Recruited patients underwent incremental cardio-pulmonary exercise testing (CPET). Arterial blood gases at rest and peak exercise were measured. Dyspnea, muscle effort and muscle pain were scored according to the Borg modified scale. Potential associations between the severity of symptoms and exercise testing parameters were analyzed using a Forest-Tree Machine Learning approach, which accomplishes for a ratio between number of observations and number of screened variables less than unit.

Results

Dyspnea score was significantly associated with maximum power output (WR, watts), and minute ventilation (VE, L/min) at peak exercise. In a controlled subgroup analysis, dyspnea score was a limiting symptom only in LTx recipients who reached the higher levels of WR (≥ 101 watts) and V_E (≥ 53 L/min). Muscle effort score was significantly associated with breathing reserve as percent of maximal voluntary ventilation (BR%MVV). The lower the BR%MVV at peak exercise (< 32) the higher the muscle effort perception. Muscle pain score was significantly associated with VO₂ peak, arterial [HCO₃⁻] at rest, and V_E/VCO₂ slope. In a subgroup analysis, muscle pain was the limiting symptom in LTx recipients with a lower VO₂ peak (< 15 mL/Kg/min) and a higher V_E/VCO₂ slope (≥ 32).

Conclusions

The majority of our LTx recipients reported peripheral limitation as the prevalent reason for exercise termination. Muscle pain at peak exercise was strictly associated with basal and exercise-induced metabolic altered pathways. The onset of dyspnea (breathing effort) was associated with the intensity of ventilatory response to meet metabolic demands for increasing WR. Our study suggests that only an accurate assessment of symptoms combined with cardio-pulmonary parameters allows a correct interpretation of exercise limitation and a tailored exercise prescription. The role and mechanisms of muscle pain during exercise in LTx recipients requires further investigations.

Marathoners' Breathing Pattern Protects Against Lung Injury by Mechanical Ventilation: An Ex Vivo Study Using Rabbit Lungs

Background

Breathing during a marathon is often empirically conducted in a so-called "2:2 breathing rhythm," which is based on a four-phase cycle, consisting of the 1st and 2nd inspiratory and the 1st and 2nd expiratory phases. We developed a prototype ventilator that can perform intermittent positive pressure ventilation, mimicking the breathing cycle of the 2:2 breathing rhythm. This mode of ventilation was named the marathoners' breathing rhythm ventilation (MBV). We hypothesized that MBV may have a lung protective effect.

Methods

We examined the effects of the MBV on the pulmonary pre-edema model in isolated perfused rabbit lungs. The pulmonary pre-edema state was induced using bloodless perfusate with low colloid osmotic pressure. The 14 isolated rabbit lung preparations were randomly divided into the conventional mechanical ventilation (CMV) group and MBV group, (both had an inspiratory/expiratory ratio of 1/1). In the CMV group, seven rabbit lungs were ventilated using the Harvard Ventilator 683 with a tidal volume (TV) of 8 mL/kg, a respiratory rate (RR) of 30 cycles/min, and a positive end-expiratory pressure (PEEP) of 2 cmH₂O for 60 min. In the MBV group, seven rabbit lungs were ventilated using the prototype ventilator with a TV of 6 mL/kg, an RR of 30 cycles/min, and a PEEP of 4 cmH₂O (first step) and 2 cmH₂O (second step) for 60 min. The time allocation of the MBV for one cycle was 0.3 s for each of the 1st and 2nd inspiratory and expiratory phases with 0.2 s of intermittent resting between each phase.

Results

Peak airway pressure and lung wet-to-dry ratio after 60 min of ventilation were lower in the MBV group than in the CMV group.

Conclusion

MBV was considered to have a lung-protective effect compared to CMV.

Peripheral chemoresponsiveness during exercise in male athletes with exercise-induced arterial hypoxaemia

NEW FINDINGS

What is the central question of this study? Do highly trained male endurance athletes who develop exercise-induced arterial hypoxaemia (EIAH) demonstrate reduced peripheral chemoresponsiveness during exercise? What is the main finding and its importance? Those with the lowest arterial saturation during exercise have a smaller ventilatory response to hypercapnia during exercise. There was no significant relationship between the hyperoxic ventilatory response and EIAH. The findings suggest that peripheral chemoresponsiveness to hypercapnia during exercise could play a role in the development of EIAH. The findings improve our understanding of the mechanisms that contribute to EIAH.

ABSTRACT

Exercise-induced arterial hypoxaemia (EIAH) is characterized by a decrease in arterial oxygen tension and/or saturation during whole-body exercise, which may in part result from inadequate alveolar ventilation. However, the role of peripheral chemoresponsiveness in the development of EIAH is not well established. We hypothesized that those with the most severe EIAH would have an attenuated ventilatory response to hyperoxia and hypercapnia during exercise. To evaluate this, on separate days, we measured ventilatory sensitivity to hyperoxia and separately hypercapnia at rest and during three different exercise intensities (25, 50% of V ̇ O 2 max and ventilatory threshold (∼67% of V ̇ O 2 max )) in 12 males cyclists ( V ̇ O 2 max  = 66.6 ± 4.7 ml kg^-1  min^-1 ). Subjects were divided into two groups based on their end-exercise arterial oxygen saturation (ear oximetry, S p O 2 ): a normal oxyhaemoglobin saturation group (NOS, S p O 2  = 93.4 ± 0.4%, n = 5) and a low oxyhaemoglobin saturation group (LOS, S p O 2  = 89.9 ± 0.9%, n = 7). There was no difference in V ̇ O 2 max (66.4 ± 2.9 vs. 66.8 ± 6.0 ml kg^-1  min^-1 , respectively, P = 0.9), peak ventilation during maximal exercise (182 ± 15 vs. 197 ± 32 l min^-1 , respectively, P = 0.36) or ventilatory response to hyperoxia (P = 0.98) at any exercise intensity between NOS and LOS groups. However, those in the LOS group had a significantly lower ventilatory response to hypercapnia (P = 0.004, (η²  = 0.18). There was also a significant relationship between the mean hypercapnic response and end-exercise S p O 2 (r = 0.75, P = 0.009) but not between the mean hyperoxic response and end-exercise S p O 2 (r = 0.21, P = 0.51). A blunted hypercapnic ventilatory response may contribute to EIAH in highly trained men due to a failure to increase ventilation sufficiently to offset exercise-induced gas exchange impairments.

Ventilation/Perfusion Relationships and Gas Exchange: Measurement Approaches

Ventilation-perfusion ( V ˙ A / Q ˙ ) matching, the regional matching of the flow of fresh gas to flow of deoxygenated capillary blood, is the most important mechanism affecting the efficiency of pulmonary gas exchange. This article discusses the measurement of V ˙ A / Q ˙ matching with three broad classes of techniques: (i) those based in gas exchange, such as the multiple inert gas elimination technique (MIGET); (ii) those derived from imaging techniques such as single-photon emission computed tomography (SPECT), positron emission tomography (PET), magnetic resonance imaging (MRI), computed tomography (CT), and electrical impedance tomography (EIT); and (iii) fluorescent and radiolabeled microspheres. The focus is on the physiological basis of these techniques that provide quantitative information for research purposes rather than qualitative measurements that are used clinically. The fundamental equations of pulmonary gas exchange are first reviewed to lay the foundation for the gas exchange techniques and some of the imaging applications. The physiological considerations for each of the techniques along with advantages and disadvantages are briefly discussed. © 2020 American Physiological Society. Compr Physiol 10:1155-1205, 2020.

Validation of a Noninvasive Assessment of Pulmonary Gas Exchange During Exercise in Hypoxia

BACKGROUND

Pulmonary gas exchange efficiency, determined by the alveolar-to-arterial Po₂ difference (A-aDo₂), progressively worsens during exercise at sea-level; this response is further elevated during exercise in hypoxia. Traditionally, pulmonary gas exchange efficiency is assessed through measurements of ventilation and end-tidal gases paired with direct arterial blood gas (ABG) sampling. Because these measures have a number of caveats, particularly invasive blood sampling, the development of new approaches for the noninvasive assessment of pulmonary gas exchange is needed.

RESEARCH QUESTION

Is a noninvasive method of assessing pulmonary gas exchange valid during rest and exercise in acute hypoxia?

STUDY DESIGN AND METHODS

Twenty-five healthy participants (10 female) completed a staged maximal exercise test on a cycle ergometer in a hypoxic chamber (Fio₂ = 0.11). Simultaneous ABGs via a radial arterial catheter and noninvasive gas-exchange measurements (AGM100) were obtained in 2-minute intervals. Noninvasive gas exchange, termed the O₂ deficit, was calculated from the difference between the end-tidal and the calculated Pao₂ (via pulse oximetry and corrected for the Bohr effect by using the end-tidal Pco₂). Noninvasive O₂ deficit was compared with the traditional alveolar to arterial oxygen difference (A-aDo₂), using the traditional Riley analysis.

RESULTS

Under conditions of rest at room air, hypoxic rest, and hypoxic exercise, strong correlations between the calculated gPao₂ and directly measured Pao₂ (R² = 0.97; P < .001; mean bias = 1.70 mm Hg) were observed. At hypoxic rest and exercise, strong relationships between the estimated and directly measured Pao₂ (R² = 0.68; P < .001; mean bias = 1.01 mm Hg) and O₂ deficit with the traditional A-aDo₂ (R² = 0.70; P < .001; mean bias = 5.24 mm Hg) remained.

INTERPRETATIONS

Our findings support the use of a noninvasive measure of gas exchange during acute hypoxic exercise in heathy humans. Further studies are required to determine whether this approach can be used clinically as a tool during normoxic exercise in patients with preexisting impairments in gas exchange efficiency.

The supine position improves but does not normalize the blunted pulmonary capillary blood volume response to exercise in mild COPD

Patients with mild chronic obstructive pulmonary disease (COPD) demonstrate resting pulmonary vascular dysfunction as well as a blunted pulmonary diffusing capacity (DLCO) and pulmonary capillary blood volume (V_C) response to exercise. The transition from the upright to supine position increases central blood volume and perfusion pressure, which may overcome microvascular dysfunction in an otherwise intact alveolar-capillary interface. The present study examined whether the supine position normalized DLCO and V_C responses to exercise in mild COPD. Sixteen mild COPD participants and 13 age-, gender-, and height-matched controls completed DLCO maneuvers at rest and during exercise in the upright and supine position. The multiple FIO2-DLCO method was used to determine DLCO, V_C, and membrane diffusion capacity (D_M). All three variables were adjusted for alveolar volume (DLCOAdj, V_CAdj, and D_MAdj). The supine position reduced alveolar volume similarly in both groups, but oxygen consumption and cardiac output were unaffected. DLCOAdj, D_MAdj, and V_CAdj were all lower in COPD. These same variables all increased with upright and supine exercise in both groups. DLCOAdj was unaffected by the supine position. V_CAdj increased in the supine position similarly in both groups. D_MAdj was reduced in the supine position in both groups. While the supine position increased exercise V_CAdj in COPD, the increase was of similar magnitude to healthy controls; therefore, exercise V_C remained blunted in COPD. The persistent reduction in exercise DLCO and V_C when supine suggests that pulmonary vascular destruction is a contributing factor to the blunted DLCO and V_C response to exercise in mild COPD.NEW & NOTEWORTHY Patients with mild chronic obstructive pulmonary disease demonstrate a combination of reversible pulmonary microvascular dysfunction and irreversible pulmonary microvascular destruction.

Influence of high affinity haemoglobin on the response to normoxic and hypoxic exercise

KEY POINTS

Theoretical models suggest there is no benefit of high affinity haemoglobin to preserve maximal oxygen uptake in acute hypoxia but the comparative biology literature has many examples of species that are evolutionarily adapted to hypoxia and have high affinity haemoglobin. We studied humans with high affinity haemoglobin and compensatory polycythaemia. These subjects performed maximal exercise tests in normoxia and hypoxia to determine how their altered haemoglobin affinity impacts hypoxic exercise tolerance. The high affinity haemoglobin participants demonstrated an attenuated decline in maximal aerobic capacity in acute hypoxia. Those with high affinity haemoglobin had no worsening of pulmonary gas exchange during hypoxic exercise but had greater lactate and lower pH than controls for all exercise bouts. High affinity haemoglobin and compensatory polycythaemia mitigated the decline in exercise performance in acute hypoxia through a higher arterial oxygen content and an unchanged pulmonary gas exchange.

ABSTRACT

The longstanding dogma is that humans exhibit an acute reduction in haemoglobin (Hb) binding affinity for oxygen that facilitates adaptation to moderate hypoxia. However, many animals have adapted to high altitude through enhanced Hb binding affinity for oxygen. The objective of the study was to determine whether high affinity haemoglobin (HAH) affects maximal and submaximal exercise capacity. To accomplish this, we recruited individuals (n = 11, n = 8 females) with HAH (P₅₀  = 16 ± 1 mmHg), had them perform normoxic and acute hypoxic (15% inspired oxygen) maximal exercise tests, and then compared their results to matched controls (P₅₀  = 26 ± 1, n = 14, n = 8 females). Cardiorespiratory and arterial blood gases were collected throughout both exercise tests. Despite no difference in end-exercise arterial oxygen tension in hypoxia (59 ± 6 vs. 59 ± 9 mmHg for controls and HAH, respectively), the HAH subjects' oxyhaemoglobin saturation ( S a , O 2 ) was ∼7% higher. Those with HAH had an attenuated decline in maximal oxygen uptake ( V ̇ O 2 max ) (4 ± 5% vs. 12 ± %, p < 0.001) in hypoxia and the change in V ̇ O 2 max between trials was related to the change in S a O 2 (r = -0.75, p < 0.0001). Compared to normoxia, the controls' alveolar-to-arterial oxygen gradient significantly increased during hypoxic exercise, whereas pulmonary gas exchange in HAH subjects was unchanged between the two exercise trials. However, arterial lactate was significantly higher and arterial pH significantly lower in the HAH subjects for both exercise trials. We conclude that HAH attenuates the decline in maximal aerobic capacity and preserves pulmonary gas exchange during acute hypoxic exercise. Our data support the comparative biology literature indicating that HAH is a positive adaptation to acute hypoxia.

The effect of dopamine on pulmonary diffusing capacity and capillary blood volume responses to exercise in young healthy humans

NEW FINDINGS

What is the Central question? Does dopamine, a pulmonary vascular vasodilator, contribute to the regulation of pulmonary diffusing capacity and capillary blood volume responses to exercise and exercise tolerance? What are the main findings and their importance? Dopamine appears not to be important for regulating pulmonary diffusing capacity or pulmonary capillary blood volume during exercise in healthy participants. Dopamine blockade trials demonstrated that endogenous dopamine is important for maintaining exercise tolerance; however, exogenous dopamine does not improve exercise tolerance.

ABSTRACT

Pulmonary capillary blood volume (V_c ) and diffusing membrane capacity (D_m ) expansion are important contributors to the increased pulmonary diffusing capacity (DL_CO ) observed during upright exercise. Dopamine is a pulmonary vascular vasodilator, and recent studies suggest that it may play a role in V_c regulation through changes in pulmonary vascular tone. The purpose of this study was to examine the effect of exogenous dopamine and dopamine receptor-2 (D₂ -receptor) blockade on DL_CO , V_c and D_m at baseline and during cycle exercise, as well as time-to-exhaustion at 85% of V ̇ O 2 peak . We hypothesized that dopamine would increase DL_CO , V_c , D_m and time-to-exhaustion, while D₂ -receptor blockade would have the opposite effect. We recruited 14 young, healthy, recreationally active subjects ( V ̇ O 2 peak 45.8 ± 6.6 ml kg^-1  min^-1 ). DL_CO , V_c and D_m were determined at baseline and during exercise at 60% and 85% of V ̇ O 2 peak under the following randomly assigned and double blinded conditions: (1) intravenous saline and placebo pill, (2) intravenous dopamine (2 µg kg^-1  min^-1 ) and placebo pill, and (3) intravenous saline and D₂ -receptor antagonist (20 mg oral metoclopramide). Exogenous dopamine and dopamine blockade had no effect on DL_CO , V_c and D_m responses at baseline or during exercise. Dopamine blockade reduced time-to-exhaustion by 47% (P = 0.04), but intravenous dopamine did not improve time-to-exhaustion. While dopamine modulation did not affect DL_CO , V_c or D_m , the reduction in time-to-exhaustion with D₂ -receptor blockade suggests that endogenous dopamine is important for exercise tolerance.

Precapillary pulmonary gas exchange is similar for oxygen and inert gases

KEY POINTS

Precapillary gas exchange for oxygen has been documented in both humans and animals. It has been suggested that, if precapillary gas exchange occurs to a greater extent for inert gases than for oxygen, shunt and its effects on arterial oxygenation may be underestimated by the multiple inert gas elimination technique (MIGET). We evaluated fractional precapillary gas exchange in canines for O2 and two inert gases, sulphur hexafluoride and ethane, by measuring these gases in the proximal pulmonary artery, distal pulmonary artery (1 cm proximal to the wedge position) and systemic artery. Some 12-19% of pulmonary gas exchange occurred within small (1.7 mm in diameter or larger) pulmonary arteries and this was quantitatively similar for oxygen, sulphur hexafluoride and ethane. Under these experimental conditions, this suggests only minor effects of precapillary gas exchange on the magnitude of calculated shunt and the associated effect on pulmonary gas exchange estimated by MIGET.

ABSTRACT

Some pulmonary gas exchange is known to occur proximal to the pulmonary capillary, although the magnitude of this gas exchange is uncertain, and it is unclear whether oxygen and inert gases are similarly affected. This has implications for measuring shunt and associated gas exchange consequences. By measuring respiratory and inert gas levels in the proximal pulmonary artery (P), a distal pulmonary artery 1 cm proximal to the wedge position (using a 5-F catheter) (D) and a systemic artery (A), we evaluated precapillary gas exchange in 27 paired samples from seven anaesthetized, ventilated canines. Fractional precapillary gas exchange (F) was quantified for each gas as F = (P - D)/(P - A). The lowest solubility inert gases, sulphur hexafluoride (SF6 ) and ethane were used because, with higher solubility gases, the P-A difference is sufficiently small that experimental error prevents accurate assessment of F. Distal samples (n = 12) with oxygen (O2 ) saturation values that were (within experimental error) equal to or above systemic arterial values, suggestive of retrograde capillary blood aspiration, were discarded, leaving 15 for analysis. D was significantly lower than P for SF6 (D/P = 88.6 ± 18.1%; P = 0.03) and ethane (D/P = 90.6 ± 16.0%; P = 0.04), indicating partial excretion of inert gas across small pulmonary arteries. Distal pulmonary arterial O2 saturation was significantly higher than proximal (74.1 ± 6.8% vs. 69.0 ± 4.9%; P = 0.03). Fractional precapillary gas exchange was similar for SF6 , ethane and O2 (0.12 ± 0.19, 0.12 ± 0.20 and 0.19 ± 0.26, respectively; P = 0.54). Under these experimental conditions, 12-19% of pulmonary gas exchange occurs within the small pulmonary arteries and the extent is similar between oxygen and inert gases.

Intra-pulmonary arteriovenous anastomoses and pulmonary gas exchange: evaluation by microspheres, contrast echocardiography and inert gas elimination

KEY POINTS

Imaging techniques such as contrast echocardiography suggest that anatomical intra-pulmonary arteriovenous anastomoses (IPAVAs) are present at rest and are recruited to a greater extent in conditions such as exercise. IPAVAs have the potential to act as a shunt, although gas exchange methods have not demonstrated significant shunt in the normal lung. To evaluate this discrepancy, we compared anatomical shunt with 25-µm microspheres to contrast echocardiography, and gas exchange shunt measured by the multiple inert gas elimination technique (MIGET). Intra-pulmonary shunt measured by 25-µm microspheres was not significantly different from gas exchange shunt determined by MIGET, suggesting that MIGET does not underestimate the gas exchange consequences of anatomical shunt. A positive agitated saline contrast echocardiography score was associated with anatomical shunt measured by microspheres. Agitated saline contrast echocardiography had high sensitivity but low specificity to detect a ≥1% anatomical shunt, frequently detecting small shunts inconsequential for gas exchange.

ABSTRACT

The echocardiographic visualization of transpulmonary agitated saline microbubbles suggests that anatomical intra-pulmonary arteriovenous anastomoses are recruited during exercise, in hypoxia, and when cardiac output is increased pharmacologically. However, the multiple inert gas elimination technique (MIGET) shows insignificant right-to-left gas exchange shunt in normal humans and canines. To evaluate this discrepancy, we measured anatomical shunt with 25-µm microspheres and compared the results to contrast echocardiography and MIGET-determined gas exchange shunt in nine anaesthetized, ventilated canines. Data were acquired under the following conditions: (1) at baseline, (2) 2 µg kg-1  min-1 i.v. dopamine, (3) 10 µg kg-1  min-1 i.v. dobutamine, and (4) following creation of an intra-atrial shunt (in four animals). Right to left anatomical shunt was quantified by the number of 25-µm microspheres recovered in systemic arterial blood. Ventilation-perfusion mismatch and gas exchange shunt were quantified by MIGET and cardiac output by direct Fick. Left ventricular contrast scores were assessed by agitated saline bubble counts, and separately by appearance of 25-µm microspheres. Across all conditions, anatomical shunt measured by 25-µm microspheres was not different from gas exchange shunt measured by MIGET (microspheres: 2.3 ± 7.4%; MIGET: 2.6 ± 6.1%, P = 0.64). Saline contrast bubble score was associated with microsphere shunt (ρ = 0.60, P < 0.001). Agitated saline contrast score had high sensitivity (100%) to detect a ≥1% shunt, but low specificity (22-48%). Gas exchange shunt by MIGET does not underestimate anatomical shunt measured using 25-µm microspheres. Contrast echocardiography is extremely sensitive, but not specific, often detecting small anatomical shunts which are inconsequential for gas exchange.

"Train-High Sleep-Low" Dietary Periodization Does Not Alter Ventilatory Strategies During Cycling Exercise

Objective: The purpose of this study was to investigate the effects of "train-high sleep-low" (THSL) dietary periodization on ventilatory strategies during cycling exercise at submaximal and maximal intensities.Method: In a randomized crossover design, 8 trained men [age (mean ± SEM) = 28 ± 1 y; peak oxygen uptake = 56.8 ± 2.4 mL kg^-1 min^-1] completed two glycogen-depleting protocols on a cycle ergometer on separate days, with the cycling followed by a low carbohydrate (CHO) meal and beverages containing either no additional CHO (THSL) or beverages containing 1.2 g kg^-1 CHO [traditional CHO replacement (TRAD)]. The following morning, participants completed 4 minutes of cycling below (Stage 1), at (Stage 2), and above (Stage 3) gas exchange threshold, followed by a 5-km time trial.Results: Timetrial performance was significantly faster in TRAD compared to THSL (8.7 ± 0.3 minutes and 9.0 ± 0.3 minutes, respectively; p = 0.02). No differences in ventilation, tidal volume, or carbon dioxide production occurred between conditions at any exercise intensity (p > 0.05). During Stage 1, oxygen uptake was 37.9 ± 1.5 mL kg^-1 min^-1 in the TRAD condition and 39.6 ± 1.8 mL kg^-1 min^-1 in THSL (p = 0.05). During Stage 2, VO2 was 44.6 ± 1.7 mL kg^-1 min^-1 in the TRAD condition and 47.0 ± 1.9 mL kg^-1 min^-1 in THSL (p = 0.07). No change in operating lung volume was detected between dietary conditions (p > 0.05).Conclusions: THSL impairs performance following the dietary intervention, but this occurs with no alteration of ventilatory measures.

The effect of general duty police ensemble on graded exercise and simulated work performance

This 2-part study examined the impact of general duty police ensemble on selected cardiopulmonary responses during incremental treadmill exercise and on simulated work performance in 25 healthy young male and female participants. Part I comprised randomly ordered treadmill tests in 2 experimental conditions: physical training (PT; undergarments, shorts, t-shirt, and running shoes) and police duty ensemble (PDE; undergarments, body armour, patrol uniform, boots, duty belt with required equipment, radio, and weapons). The PDE added 10.3 kg (SD 0.4) or 14% (SD 2) body mass. Participants walked at 5.6 km·h^-1, starting at 0% grade with 2% increases in grade every 2 min. The 4% stage was 6 min in duration to achieve physiological steady state. Subsequently, the 2-min increments continued to exhaustion. Part II evaluated performance time on a recognized job-related work simulation circuit, in 3 experimental conditions: (i) PT, (ii) weighted belt (WB; PT plus a 7.5 kg weighted belt), and (iii) PDE. In Part I, physiological responses (e.g., oxygen uptake, ventilation, heart rate) were elevated (p < 0.05) with PDE during submaximal exercise but peak values were unchanged. Test duration and peak power output were significantly reduced with PDE. In Part II, circuit completion time was increased in PDE but not WB when compared with PT (p < 0.05). Heart rate and perceived exertion were similar in all conditions and perceived dyspnea was higher in PDE. Novelty Police duty ensemble negatively affected exercise performance more than would be expected due to load mass alone. Specificity must be considered when simulating occupational load carriage.

Exercise-induced arterial hypoxemia; some answers, more questions

Exercise-induced arterial hypoxemia (EIAH) is characterized by the decrease in arterial oxygen tension and oxyhemoglobin saturation during dynamic aerobic exercise. Since the time of the initial observations, our knowledge and understanding of EIAH has grown, but many unknowns remain. The purpose of this review is to provide an update on recent findings, highlight areas of disagreement, and identify where information is lacking. Specifically, this review will place emphasis on (i) the occurrence of EIAH during submaximal exercise, (ii) whether there are sex differences in the development and severity of EIAH, and (iii) unresolved questions and future directions.

Physiological comparison of hemorrhagic shock and V˙ O2max: A conceptual framework for defining the limitation of oxygen delivery

IMPACT STATEMENT

Disturbance of normal homeostasis occurs when oxygen delivery and energy stores to the body's tissues fail to meet the energy requirement of cells. The work submitted in this review is important because it advances the understanding of inadequate oxygen delivery as it relates to early diagnosis and treatment of circulatory shock and its relationship to disturbance of normal functioning of cellular metabolism in life-threatening conditions of hemorrhage. We explored data from the clinical and exercise literature to construct for the first time a conceptual framework for defining the limitation of inadequate delivery of oxygen by comparing the physiology of hemorrhagic shock caused by severe blood loss to maximal oxygen uptake induced by intense physical exercise. We also provide a translational framework in which understanding the fundamental relationship between the body's reserve to compensate for conditions of inadequate oxygen delivery as a limiting factor to V ˙ O2max helps to re-evaluate paradigms of triage for improved monitoring of accurate resuscitation in patients suffering from hemorrhagic shock.

Pulmonary capillary blood volume response to exercise is diminished in mild chronic obstructive pulmonary disease

BACKGROUND

Previous work suggests that mild chronic obstructive pulmonary disease (COPD) patients have greater lung dysfunction than previously appreciated from spirometry alone. There is evidence of pulmonary microvascular dysfunction in mild COPD, which may reduce diffusing capacity (DLCO) and increase ventilatory inefficiency during exercise. The purpose of this study was to determine if DLCO, pulmonary capillary blood volume (Vc), and membrane diffusing capacity (Dm) are diminished during exercise in mild COPD, and whether this is related to ventilatory inefficiency and dyspnea.

METHODS

Seventeen mild COPD patients (FEV₁/FVC: 64 ± 4%, FEV₁ = 94 ± 11%_pred) and 17 age- and sex-matched controls were recruited. Ten moderate COPD patients were also tested for comparison (FEV₁ = 66 ± 7%_pred). DLCO, Vc, and Dm were determined using the multiple-fraction of inspired oxygen (F_IO₂) DLCO method at baseline and during steady-state cycle exercise at 40W, 50%, and 80% of V˙O_2peak. Using expired gas data, ventilatory inefficiency was assessed by V˙_E/V˙CO₂.

RESULTS

Compared to controls, mild COPD had lower DLCO at baseline and during exercise secondary to diminished Vc (P < 0.05). No difference in Dm was observed between controls and mild COPD at rest or during exercise. Patients with high V˙_E/V˙CO₂ (i.e. ≥34) had lower Vc and greater dyspnea ratings compared to control at 40W. Moderate COPD patients were unable to increase Vc with increasing exercise intensity, suggesting further pulmonary vascular impairment with increased obstruction severity.

CONCLUSION

Despite relatively minor airflow obstruction, mild COPD patients exhibit a diminished DLCO and capillary blood volume response to exercise, which appears to contribute to ventilatory inefficiency and greater dyspnea.

Exercise Testing, Supplemental Oxygen, and Hypoxia

Cardiopulmonary exercise testing (CPET) in hyperoxia and hypoxia has several applications, stemming from characterization of abnormal physiological response profiles associated with exercise intolerance. As altered oxygenation can impact the performance of gas-concentration and flow sensors and pulmonary gas exchange algorithms, integrated CPET system function requires validation under these conditions. Also, as oxygenation status can influence peak [Formula: see text]o₂, care should be taken in the selection of work-rate incrementation rates when CPET performance is to be compared with normobaria at sea level. CPET has been used to evaluate the effects of supplemental O₂ on exercise intolerance in chronic obstructive pulmonary disease, interstitial pulmonary fibrosis, and cystic fibrosis at sea level. However, identification of those CPET indices likely to be predictive of supplemental O₂ outcomes for exercise tolerance at altitude in such patients is lacking. CPET performance with supplemental O₂ in respiratory patients residing at high altitudes is also poorly studied. Finally, CPET has the potential to give physiological and clinical information about acute and chronic mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema. It may also translate high-altitude acclimatization and adaptive processes in healthy individuals into intensive care medical practice.

Lactate metabolism: historical context, prior misinterpretations, and current understanding

Lactate (La^-) has long been at the center of controversy in research, clinical, and athletic settings. Since its discovery in 1780, La^- has often been erroneously viewed as simply a hypoxic waste product with multiple deleterious effects. Not until the 1980s, with the introduction of the cell-to-cell lactate shuttle did a paradigm shift in our understanding of the role of La^- in metabolism begin. The evidence for La^- as a major player in the coordination of whole-body metabolism has since grown rapidly. La^- is a readily combusted fuel that is shuttled throughout the body, and it is a potent signal for angiogenesis irrespective of oxygen tension. Despite this, many fundamental discoveries about La^- are still working their way into mainstream research, clinical care, and practice. The purpose of this review is to synthesize current understanding of La^- metabolism via an appraisal of its robust experimental history, particularly in exercise physiology. That La^- production increases during dysoxia is beyond debate, but this condition is the exception rather than the rule. Fluctuations in blood [La^-] in health and disease are not typically due to low oxygen tension, a principle first demonstrated with exercise and now understood to varying degrees across disciplines. From its role in coordinating whole-body metabolism as a fuel to its role as a signaling molecule in tumors, the study of La^- metabolism continues to expand and holds potential for multiple clinical applications. This review highlights La^-'s central role in metabolism and amplifies our understanding of past research.

Changes in acid-base and ion balance during exercise in normoxia and normobaric hypoxia

Purpose

Both exercise and hypoxia cause complex changes in acid–base homeostasis. The aim of the present study was to investigate whether during intense physical exercise in normoxia and hypoxia, the modified physicochemical approach offers a better understanding of the changes in acid–base homeostasis than the traditional Henderson–Hasselbalch approach.

Methods

In this prospective, randomized, crossover trial, 19 healthy males completed an exercise test until voluntary fatigue on a bicycle ergometer on two different study days, once during normoxia and once during normobaric hypoxia (12% oxygen, equivalent to an altitude of 4500 m). Arterial blood gases were sampled during and after the exercise test and analysed according to the modified physicochemical and Henderson–Hasselbalch approach, respectively.

Results

Peak power output decreased from 287 ± 9 Watts in normoxia to 213 ± 6 Watts in hypoxia (−26%, P < 0.001). Exercise decreased arterial pH to 7.21 ± 0.01 and 7.27 ± 0.02 (P < 0.001) during normoxia and hypoxia, respectively, and increased plasma lactate to 16.8 ± 0.8 and 17.5 ± 0.9 mmol/l (P < 0.001). While the Henderson–Hasselbalch approach identified lactate as main factor responsible for the non-respiratory acidosis, the modified physicochemical approach additionally identified strong ions (i.e. plasma electrolytes, organic acid ions) and non-volatile weak acids (i.e. albumin, phosphate ion species) as important contributors.

Conclusions

The Henderson–Hasselbalch approach might serve as basis for screening acid–base disturbances, but the modified physicochemical approach offers more detailed insights into the complex changes in acid–base status during exercise in normoxia and hypoxia, respectively.

Electronic supplementary material

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Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased oxygen demand; otherwise, a diffusion limitation may occur. The increase in DLCO with exercise is due to increased capillary blood volume (Vc) and membrane diffusing capacity (Dm). Vc and Dm increase secondary to the recruitment and distension of pulmonary capillaries, increasing the surface area for gas exchange and decreasing pulmonary vascular resistance, thereby attenuating the increase in pulmonary arterial pressure. At the same time, the recruitment of intrapulmonary arteriovenous anastomoses (IPAVA) during exercise may contribute to gas exchange impairment and/or prevent large increases in pulmonary artery pressure. We describe two techniques to evaluate pulmonary diffusion and circulation at rest and during exercise. The first technique uses multiple-fraction of inspired oxygen (FIO2) DLCO breath holds to determine Vc and Dm at rest and during exercise. Additionally, echocardiography with intravenous agitated saline contrast is used to assess IPAVAs recruitment. Representative data showed that the DLCO, Vc, and Dm increased with exercise intensity. Echocardiographic data showed no IPAVA recruitment at rest, while contrast bubbles were seen in the left ventricle with exercise, suggesting exercise-induced IPAVA recruitment. The evaluation of pulmonary capillary blood volume, membrane diffusing capacity, and IPAVA recruitment using echocardiographic methods is useful to characterize the ability of the lung vasculature to adapt to the stress of exercise in health as well as in diseased groups, such as those with pulmonary arterial hypertension and chronic obstructive pulmonary disease.

Are there sex differences in the capillary blood volume and diffusing capacity response to exercise?

Previous work suggests that women may exhibit a greater respiratory limitation in exercise compared with height-matched men. Diffusion capacity (Dl_CO) increases with incremental exercise, and the smaller lungs of women may limit membrane diffusing capacity (Dm) and pulmonary capillary blood volume (Vc) in response to the increased oxygen demand. We hypothesized that women would have lower Dl_CO, Dl_CO relative to cardiac output (Dl_CO/Q̇), Dm, Vc, and pulmonary transit time, secondary to lower Vc at peak exercise. Sixteen women (112 ± 12% predicted relative V̇o_2peak) and sixteen men (118 ± 22% predicted relative V̇o_2peak) were matched for height and weight. Hemoglobin-corrected diffusing capacity (Dl_CO), Vc, and Dm were determined via the multiple-[Formula: see text] Dl_CO technique at rest and during incremental exercise up to 90% of V̇o_2peak Both groups increased Dl_CO, Vc, and Dm with exercise intensity, but women had 20% lower Dl_CO (P < 0.001), 18% lower Vc (P = 0.002), and 22% lower Dm (P < 0.001) compared with men across all workloads, and neither group exhibited a plateau in Vc. When expressed relative to alveolar volume (Va), the between-sex difference was eliminated. The drop in Dl_CO/Q̇ was proportionally less in women than men, and mean pulmonary transit time did not drop below 0.3 s in either group. Women demonstrate consistently lower Dl_CO, Vc, and Dm compared with height-matched men during exercise; however, these differences disappear with correction for lung size. These results suggest that after differences in lung volume are accounted for there is no intrinsic sex difference in the Dl_CO, Vc, or Dm response to exercise.NEW & NOTEWORTHY Women demonstrate lower diffusing capacity-to-cardiac output ratio (Dl_CO/Q̇), pulmonary capillary blood volume (Vc), and membrane diffusing capacity (Dm) compared with height-matched men during exercise. However, these differences disappear after correction for lung size. The drop in Dl_CO/Q̇ was proportionally less in women, and pulmonary transit time did not drop below 0.3 s in either group. After differences in lung volume are accounted for, there is no intrinsic sex difference in Dl_CO, Vc, or Dm response to exercise.