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Gallagher H, Hendrickse PW, Pereira MG, Bowen TS. Skeletal muscle atrophy, regeneration, and dysfunction in heart failure: Impact of exercise training. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:557-567. [PMID: 37040849 PMCID: PMC10466197 DOI: 10.1016/j.jshs.2023.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/30/2022] [Accepted: 02/20/2023] [Indexed: 05/31/2023]
Abstract
This review highlights some established and some more contemporary mechanisms responsible for heart failure (HF)-induced skeletal muscle wasting and weakness. We first describe the effects of HF on the relationship between protein synthesis and degradation rates, which determine muscle mass, the involvement of the satellite cells for continual muscle regeneration, and changes in myofiber calcium homeostasis linked to contractile dysfunction. We then highlight key mechanistic effects of both aerobic and resistance exercise training on skeletal muscle in HF and outline its application as a beneficial treatment. Overall, HF causes multiple impairments related to autophagy, anabolic-catabolic signaling, satellite cell proliferation, and calcium homeostasis, which together promote fiber atrophy, contractile dysfunction, and impaired regeneration. Although both wasting and weakness are partly rescued by aerobic and resistance exercise training in HF, the effects of satellite cell dynamics remain poorly explored.
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Affiliation(s)
- Harrison Gallagher
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Paul W Hendrickse
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Marcelo G Pereira
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - T Scott Bowen
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK.
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2
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Nasser I, Miranda H, Perez RDM, Cabiddu R, Malosa L, Dias I, Brown A, Reis MS. Limited cardiopulmonary capacity in patients with liver cirrhosis when compared to healthy subjects. Rev Assoc Med Bras (1992) 2021; 67:94-100. [PMID: 34161483 DOI: 10.1590/1806-9282.67.01.20200449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/20/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The present study compared cardiorespiratory capacity between cirrhotic patients and healthy subjects. METHODS Nineteen cirrhotic patients and 19 healthy subjects, paired by age and gender, participated in the study. Volunteers performed an incremental cardiopulmonary test with a ramp protocol, a ventilatory and metabolic variables were obtained and analyzed. The recovery was analyzed by calculating the time needed for 50% of oxygen consumption (VO2) recovery to occur as the median between the peak of the exercise and the end of recovery on the VO2 curve (T1/2). The VE/VCO2 slope were performed by the linear regression of ventilation (VE) and carbon dioxide production (VCO2) data. RESULTS During resting condition, cirrhotic patients presented significantly higher levels of VO2 compared to healthy subjects. The VE/ VO2 and VE/ VCO2 values were significantly higher in the control group at the anaerobic threshold and at the peak of the test compared to cirrhotic patients. Time under effort was significantly higher for healthy subjects. CONCLUSIONS Based on these findings, it is possible to conclude that liver cirrhosis can compromise the patients' quality of life, mainly by inducing metabolic alterations which can impair functional capacity and lead to a sedentary lifestyle.
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Affiliation(s)
- Igor Nasser
- Universidade Federal do Rio de Janeiro, Escola de Educação Física e Desportos - Rio de Janeiro (RJ), Brasil.,Universidade Federal do Rio de Janeiro, Laboratório de Desempenho, Treinamento e Exercício Físico - Rio de Janeiro (RJ), Brasil.,Universidade Federal do Rio de Janeiro, Grupo de Pesquisa em Avaliação e Reabilitação Cardiorrespiratória - Rio de Janeiro (RJ), Brasil
| | - Humberto Miranda
- Universidade Federal do Rio de Janeiro, Escola de Educação Física e Desportos - Rio de Janeiro (RJ), Brasil.,Universidade Federal do Rio de Janeiro, Laboratório de Desempenho, Treinamento e Exercício Físico - Rio de Janeiro (RJ), Brasil
| | - Renata de Mello Perez
- Universidade Federal do Rio de Janeiro, Serviço de Hepatologia - Rio de Janeiro (RJ), Brasil.,Instituto D'Or de Ensino e Pesquisa - Rio de Janeiro (RJ), Brasil
| | - Ramona Cabiddu
- Universidade Federal de São Carlos, Laboratório de Fisioterapia Cardiopulmonar - São Carlos (SP), Brasil
| | - Luciana Malosa
- Universidade Nove de Julho, Pós-graduação Stricto Sensu em Ciências da Reabilitação - São Paulo (SP), Brasil
| | - Ingrid Dias
- Universidade Federal do Rio de Janeiro, Escola de Educação Física e Desportos - Rio de Janeiro (RJ), Brasil
| | - Amanda Brown
- Universidade Federal do Rio de Janeiro, Escola de Educação Física e Desportos - Rio de Janeiro (RJ), Brasil
| | - Michel Silva Reis
- Universidade Federal do Rio de Janeiro, Escola de Educação Física e Desportos - Rio de Janeiro (RJ), Brasil.,Universidade Federal do Rio de Janeiro, Serviço de Hepatologia - Rio de Janeiro (RJ), Brasil
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3
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Borghi-Silva A, Goulart CDL, Carrascosa CR, Oliveira CC, Berton DC, de Almeida DR, Nery LE, Arena R, Neder JA. Proportional Assist Ventilation Improves Leg Muscle Reoxygenation After Exercise in Heart Failure With Reduced Ejection Fraction. Front Physiol 2021; 12:685274. [PMID: 34234692 PMCID: PMC8255967 DOI: 10.3389/fphys.2021.685274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/21/2021] [Indexed: 12/31/2022] Open
Abstract
Background Respiratory muscle unloading through proportional assist ventilation (PAV) may enhance leg oxygen delivery, thereby speeding off-exercise oxygen uptake ( V . O 2 ) kinetics in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Methods Ten male patients (HFrEF = 26 ± 9%, age 50 ± 13 years, and body mass index 25 ± 3 kg m2) underwent two constant work rate tests at 80% peak of maximal cardiopulmonary exercise test to tolerance under PAV and sham ventilation. Post-exercise kinetics of V . O 2 , vastus lateralis deoxyhemoglobin ([deoxy-Hb + Mb]) by near-infrared spectroscopy, and cardiac output (Q T ) by impedance cardiography were assessed. Results PAV prolonged exercise tolerance compared with sham (587 ± 390 s vs. 444 ± 296 s, respectively; p = 0.01). PAV significantly accelerated V . O 2 recovery (τ = 56 ± 22 s vs. 77 ± 42 s; p < 0.05), being associated with a faster decline in Δ[deoxy-Hb + Mb] and Q T compared with sham (τ = 31 ± 19 s vs. 42 ± 22 s and 39 ± 22 s vs. 78 ± 46 s, p < 0.05). Faster off-exercise decrease in Q T with PAV was related to longer exercise duration (r = -0.76; p < 0.05). Conclusion PAV accelerates the recovery of central hemodynamics and muscle oxygenation in HFrEF. These beneficial effects might prove useful to improve the tolerance to repeated exercise during cardiac rehabilitation.
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Affiliation(s)
- Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos (UFSCar), São Paulo, Brazil.,Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Cassia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos (UFSCar), São Paulo, Brazil
| | - Cláudia R Carrascosa
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | | | - Danilo C Berton
- Pulmonary Physiology Unit, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Dirceu Rodrigues de Almeida
- Division of Cardiology, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Luiz Eduardo Nery
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - J Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil.,Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen's University, Kingston, ON, Canada
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4
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Noninvasive Ventilation Accelerates Oxygen Uptake Recovery Kinetics in Patients With Combined Heart Failure and Chronic Obstructive Pulmonary Disease. J Cardiopulm Rehabil Prev 2020; 40:414-420. [PMID: 33074848 DOI: 10.1097/hcr.0000000000000499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Oxygen uptake (V˙o2) recovery kinetics appears to have considerable value in the assessment of functional capacity in both heart failure (HF) and chronic obstructive pulmonary disease (COPD). Noninvasive positive pressure ventilation (NIPPV) may benefit cardiopulmonary interactions during exercise. However, assessment during the exercise recovery phase is unclear. The purpose of this investigation was to explore the effects of NIPPV on V˙o2, heart rate, and cardiac output recovery kinetics from high-intensity constant-load exercise (CLE) in patients with coexisting HF and COPD. METHODS Nineteen males (10 HF/9 age- and left ventricular ejection fraction-matched HF-COPD) underwent 2 high-intensity CLE tests at 80% of peak work rate to the limit of tolerance (Tlim), receiving either sham ventilation or NIPPV. RESULTS Despite greater V˙o2 recovery kinetics on sham, HF-COPD patients presented with a faster exponential time constant τ (76.4 ± 14.0 sec vs 62.8 ± 15.2 sec, P < .05) and mean response time (MRT) (86.1 ± 19.1 sec vs 68.8 ± 12.0 sec, P < .05) with NIPPV and greater ΔNIPPV-sham (τ: 5.6 ± 19.5 vs -25.2 ± 22.4, P < .05; MRT: 4.1 ± 32.2 vs -26.0 ± 19.2, P < .05) compared with HF. There was no difference regarding Tlim between sham and NIPPV in both groups (P < .05). CONCLUSION Our results suggest that NIPPV accelerated the V˙o2 recovery kinetics following high-intensity CLE to a greater extent in patients with coexisting HF and COPD compared with HF alone. NIPPV should be considered when the objective is to apply high-intensity interval exercise training as an adjunct intervention during a cardiopulmonary rehabilitation program.
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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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Affiliation(s)
- A Mazzuco
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - A S Souza
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - W M Medeiros
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - P A Sperandio
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - M C N Alencar
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - F F Arbex
- Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - J A Neder
- Laboratory of Clinical Exercise Physiology, Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - A Borghi-Silva
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
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6
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High intensity interval training after cardiac resynchronization therapy: An explorative randomized controlled trial. Int J Cardiol 2020; 299:169-174. [DOI: 10.1016/j.ijcard.2019.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
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7
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Predicting oxygen uptake responses during cycling at varied intensities using an artificial neural network. BIOMEDICAL HUMAN KINETICS 2019. [DOI: 10.2478/bhk-2019-0008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Summary
Study aim: Oxygen Uptake (VO2) is avaluable metric for the prescription of exercise intensity and the monitoring of training progress. However, VO2 is difficult to assess in anon-laboratory setting. Recently, an artificial neural network (ANN) was used to predict VO2 responses during aset walking protocol on the treadmill [9]. The purpose of the present study was to test the ability of an ANN to predict VO2 responses during cycling at self-selected intensities using Heart Rate (HR), time derivative of HR, power output, cadence, and body mass data.
Material and methods: 12 moderately-active adult males (age: 21.1 ± 2.5 years) performed a50-minute bout of cycling at a variety of exercise intensities. VO2, HR, power output, and cadence were recorded throughout the test. An ANN was trained, validated and tested using the following inputs: HR, time derivative of HR, power output, cadence, and body mass. A twelve-fold hold-out cross validation was conducted to determine the accuracy of the model.
Results: The ANN accurately predicted the experimental VO2 values throughout the test (R2 = 0.91 ± 0.04, SEE = 3.34 ± 1.07 mL/kg/min).
Discussion: This preliminary study demonstrates the potential for using an ANN to predict VO2 responses during cycling at varied intensities using easily accessible inputs. The predictive accuracy is promising, especially considering the large range of intensities and long duration of exercise. Expansion of these methods could allow ageneral algorithm to be developed for a more diverse population, improving the feasibility of oxygen uptake assessment.
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8
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Mankowski RT, Niemeijer VM, Jansen JP, Spraakman L, Stam HJ, Praet SFE. Oxygen delivery is not a limiting factor during post-exercise recovery in healthy young adults. J Exerc Sci Fit 2018. [PMID: 29541131 PMCID: PMC5812842 DOI: 10.1016/j.jesf.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose It is still equivocal whether oxygen uptake recovery kinetics are limited by oxygen delivery and can be improved by supplementary oxygen. The present study aimed to investigate whether measurements of muscle and pulmonary oxygen uptake kinetics can be used to assess oxygen delivery limitations in healthy subjects. Methods Sixteen healthy young adults performed three sub-maximal exercise tests (6 min at 40% Wmax) under hypoxic (14%O2), normoxic (21%O2) and hyperoxic (35%O2) conditions on separate days in randomized order. Both Pulmonary VO2 and near infra red spectroscopy (NIRS) based Tissue Saturation Index (TSI) offset kinetics were calculated using mono-exponential curve fitting models. Results Time constant τ of VO2 offset kinetics under hypoxic (44.9 ± 7.3s) conditions were significantly larger than τ of the offset kinetics under normoxia (37.9 ± 8.2s, p = 0.02) and hyperoxia (37±6s, p = 0.04). TSI mean response time (MRT) of the offset kinetics under hypoxic conditions (25.5 ± 13s) was significantly slower than under normoxic (15 ± 7.7, p = 0.007) and hyperoxic (13 ± 7.3, p = 0.008) conditions. Conclusion The present study shows that there was no improvement in the oxygen uptake and muscle oxygenation recovery kinetics in healthy subjects under hyperoxic conditions. Slower TSI and VO2 recovery kinetics under hypoxic conditions indicate that both NIRS and spiro-ergometry are appropriate non-invasive measurement tools to assess the physiological response of a healthy individual to hypoxic exercise.
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Affiliation(s)
- Robert T Mankowski
- Subdivision MOVEFIT-Sports Medicine, Dept. of Rehabilitation Medicine, Erasmus University Medical Center, Wytemaweg 80, 3000 CA Rotterdam, The Netherlands.,Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Victor M Niemeijer
- Department of Cardiology, Máxima Medical Centre, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands
| | - Jasper P Jansen
- Department of Cardiology, Máxima Medical Centre, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Lotte Spraakman
- Subdivision MOVEFIT-Sports Medicine, Dept. of Rehabilitation Medicine, Erasmus University Medical Center, Wytemaweg 80, 3000 CA Rotterdam, The Netherlands
| | - Henk J Stam
- Subdivision MOVEFIT-Sports Medicine, Dept. of Rehabilitation Medicine, Erasmus University Medical Center, Wytemaweg 80, 3000 CA Rotterdam, The Netherlands
| | - Stephan F E Praet
- Subdivision MOVEFIT-Sports Medicine, Dept. of Rehabilitation Medicine, Erasmus University Medical Center, Wytemaweg 80, 3000 CA Rotterdam, The Netherlands.,Department of Sports Medicine, Australian Institute of Sport, Canberra, Australia
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9
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van Gestel AJ, Baty F, Rausch-Osthof AK, Brutsche MH. Cardiopulmonary and Gas-Exchange Responses during the Six-Minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease. Respiration 2014; 88:307-14. [DOI: 10.1159/000365997] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/18/2014] [Indexed: 11/19/2022] Open
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10
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Papaioannou AI, Orfanos SE. ‘Every Breath You Take I'll Be Watching You': Measuring Exercise Kinetics during 6-Min Walking Test in COPD. Respiration 2014; 88:449-50. [DOI: 10.1159/000368372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Muscular exercise requires transitions to and from metabolic rates often exceeding an order of magnitude above resting and places prodigious demands on the oxidative machinery and O2-transport pathway. The science of kinetics seeks to characterize the dynamic profiles of the respiratory, cardiovascular, and muscular systems and their integration to resolve the essential control mechanisms of muscle energetics and oxidative function: a goal not feasible using the steady-state response. Essential features of the O2 uptake (VO2) kinetics response are highly conserved across the animal kingdom. For a given metabolic demand, fast VO2 kinetics mandates a smaller O2 deficit, less substrate-level phosphorylation and high exercise tolerance. By the same token, slow VO2 kinetics incurs a high O2 deficit, presents a greater challenge to homeostasis and presages poor exercise tolerance. Compelling evidence supports that, in healthy individuals walking, running, or cycling upright, VO2 kinetics control resides within the exercising muscle(s) and is therefore not dependent upon, or limited by, upstream O2-transport systems. However, disease, aging, and other imposed constraints may redistribute VO2 kinetics control more proximally within the O2-transport system. Greater understanding of VO2 kinetics control and, in particular, its relation to the plasticity of the O2-transport/utilization system is considered important for improving the human condition, not just in athletic populations, but crucially for patients suffering from pathologically slowed VO2 kinetics as well as the burgeoning elderly population.
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Affiliation(s)
- David C Poole
- Departments of Kinesiology, Anatomy, and Physiology, Kansas State University, Manhattan, Kansas, USA.
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12
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Gademan MGJ, van der Laarse A, Swenne CA, van der Wall EE. Oxygen uptake in heart failure: how much, how fast? Neth Heart J 2011; 17:224-5. [PMID: 19789683 DOI: 10.1007/bf03086251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- M G J Gademan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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13
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Oxygen uptake kinetics in chronic heart failure: clinical and physiological aspects. Neth Heart J 2011; 17:238-44. [PMID: 19789686 DOI: 10.1007/bf03086254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
One of the hallmark symptoms of patients with chronic heart failure (CHF) is exercise intolerance. Therefore, exercise testing has become an important tool for the evaluation and monitoring of heart failure. Whereas the maximal aerobic capacity (peak VO(2)) is a reliable indicator of the severity and prognosis of heart failure, submaximal exercise parameters may be more closely related to the ability to perform daily activities. As such, oxygen (O(2)) uptake kinetics, describing the rate change of O(2) uptake during onset or recovery of submaximal constant-load exercise (O(2) onset and recovery kinetics, respectively), have been shown to be useful parameters for objectively evaluating the functional capacity of CHF patients. However, their evaluation in this population is not a routine part of daily clinical practice. Possible reasons for this include a lack of standardisation of the assessment methodology and a limited number of studies evaluating the clinical use of O(2) uptake kinetics in CHF patients. In addition, the pathophysiological mechanisms underlying the delay in O(2) uptake kinetics in these patients are not completely understood. This review discusses the current literature on the clinical potency and physiological determinants of O(2) uptake kinetics in CHF patients and provides directions for future research. (Neth Heart J 2009;17:238-44.Neth Heart J 2009;17:238-44.).
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14
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Karsten M, Contini M, Cefalù C, Cattadori G, Palermo P, Apostolo A, Bussotti M, Magrì D, Salvioni E, Farina S, Sciomer S, Catai AM, Agostoni P. Effects of carvedilol on oxygen uptake and heart rate kinetics in patients with chronic heart failure at simulated altitude. Eur J Prev Cardiol 2011; 19:444-51. [DOI: 10.1177/1741826711402736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The response to moderate exercise at altitude in heart failure (HF) is unknown. Methods and results: We evaluated 30 HF patients, (NYHA I-III, 25 M/5 F; 59 ± 10 years; LVEF = 39.6 ± 7.1%), in stable clinical conditions, treated with carvedilol at the maximal tolerated dose. We performed a maximal cardiopulmonary exercise test (CPET) with ramp protocol at sea level to evaluate patients’ performance and two moderate intensity constant workload CPETs (50% of peak workload) at sea level (normoxia) and simulated altitude (hypoxia). Oxygen uptake ([Formula: see text]) and heart rate (HR) on-kinetics at constant workload were assessed calculating the time constant (τ) with a monoexponential equation. [Formula: see text] and HR were higher in hypoxia (0.944 ± 0.233 vs 1.031 ± 0.264 l/min; 100 ± 23 vs 108 ± 22 bpm; p < 0.001). On-kinetics showed a different behavior of τ being [Formula: see text] faster in hypoxia (67.1 ± 23.0 vs. 56.3 ± 19.7 s; p = 0.026) and HR faster in normoxia (49.3 ± 19.4 vs. 62.2 ± 22.5 s; p = 0.018). Ten patients, who lowered oxygen kinetics in hypoxia, had greater HR increase during maximal CPET suggesting lower functional betablockade. The higher τ of [Formula: see text] in hypoxia is likely to be due to a peripheral effect of carvedilol mediated either by β- or α-receptor. Conclusion: HF patients performing moderate exercise at 2000 m simulated altitude have 20% [Formula: see text] increase without trouble at the beginning of exercise when treated with carvedilol.
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Affiliation(s)
- Marlus Karsten
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Laboratório de Fisioterapia Cardiovascular, Núcleo de Pesquisa em Exercício Físico, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | | | | | | | | | | | - Maurizio Bussotti
- Cardiologia Riabilitativa, Fondazione S Maugeri, IRCCS, Milan, Italy
| | - Damiano Magrì
- U.O. Cardiologia, S. Andrea Hospital, “Sapienza”, Rome University, Rome, Italy
| | | | | | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche e Geriatriche, ‘Sapienza’, Rome University, Rome, Italy
| | - Aparecida Maria Catai
- Laboratório de Fisioterapia Cardiovascular, Núcleo de Pesquisa em Exercício Físico, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Division of Critical Care and Respiratory Medicine, University of Washington, Seattle, USA
- Dipartimento di Scienze Cardiovascolari, Università di Milano, Milan, Italy
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Copp SW, Hirai DM, Ferreira LF, Poole DC, Musch TI. Progressive chronic heart failure slows the recovery of microvascular O2 pressures after contractions in the rat spinotrapezius muscle. Am J Physiol Heart Circ Physiol 2010; 299:H1755-61. [PMID: 20817826 DOI: 10.1152/ajpheart.00590.2010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Chronic heart failure (CHF) induces muscle fiber-type specific alterations in skeletal muscle O(2) delivery and utilization during metabolic transitions. As a result, the recovery of microvascular Po(2) (Pmv(O(2))) is prolonged in slow-twitch skeletal muscle but not fast-twitch skeletal muscle in rats with CHF. We tested the hypothesis that CHF slows Pmv(O(2)) recovery in rat skeletal muscle of a mixed fiber-type analogous to human locomotory muscles and that the degree of slowing correlates with central indexes of heart failure. Healthy control [n = 6, left ventricular end-diastolic pressure (LVEDP): 10 ± 1 mmHg], moderate CHF (n = 6, LVEDP: 18 ± 2 mmHg), and severe CHF (n = 4, LVEDP: 34 ± 2 mmHg) female Sprague-Dawley rats had their right spinotrapezius muscles (41% type I, 7% type IIa, and 52% type IIb and d/x) exposed, and Pmv(O(2)) was measured via phosphorescence quenching during 180 s of recovery from 180 s of electrically induced twitch contractions (1 Hz, 4-6 V). CHF progressively slowed the mean response time (MRT; the time to reach 63% of the overall dynamic response) of Pmv(O(2)) recovery (MRT(off); control: 60.2 ± 6.9, moderate CHF: 72.8 ± 6.6, and severe CHF: 109.8 ± 6.6 s, P < 0.05 for all). MRT(off) correlated positively with central hemodynamic (LVEDP: r = 0.76, P < 0.01) and morphological (right ventricle-to-body weight ratio: r = 0.74, P < 0.01; and lung weight-to-body weight ratio: r = 0.79, P < 0.01) indexes of heart failure. The present investigation suggests that slowed Pmv(O(2)) kinetics during recovery in CHF constitutes a mechanistic link between impaired circulatory and metabolic recovery after contractions in CHF.
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Affiliation(s)
- Steven W Copp
- Department of Kinesiology, Kansas State University, Manhattan, Kansas 66506-5802, USA
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Cardiovascular dynamics in ischemic cardiomyopathy during exercise. Int J Cardiovasc Imaging 2009; 26:161-4. [PMID: 19937127 PMCID: PMC2817072 DOI: 10.1007/s10554-009-9533-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 10/29/2009] [Indexed: 11/30/2022]
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