Differential ventilatory control during constant work rate and incremental exercise

Ventilation and perceived exertion are sensitive to changes in exercise tolerance: arm+leg cycling vs. leg cycling

Purpose: Growing evidence suggests that respiratory frequency (f R) is a marker of physical effort and a variable sensitive to changes in exercise tolerance. The comparison between arm+leg cycling (Arm+leg) and leg cycling (Leg) has the potential to further test this notion because a greater exercise tolerance is expected in the Arm+leg modality. We systematically compared Arm+leg vs. Leg using different performance tests. Methods: Twelve males underwent six performance tests in separate, randomized visits. Three tests were performed in each of the two exercise modalities, i.e. an incremental test and two time-to-exhaustion (TTE) tests performed at 90% or 75% of the peak power output reached in the Leg incremental test (PPOLeg). Exercise tolerance, perceived exertion, and cardiorespiratory variables were recorded during all the tests. Results: A greater exercise tolerance (p < 0.001) was found for Arm+leg in the incremental test (337 ± 32 W vs. 292 ± 28 W), in the TTE test at 90% of PPOLeg (638 ± 154 s vs. 307 ± 67 s), and in the TTE test at 75% of PPOLeg (1,675 ± 525 s vs. 880 ± 363 s). Unlike V ˙ O2 and heart rate, both f R and minute ventilation were lower (p < 0.003) at isotime in all the Arm+leg tests vs. Leg tests. Furthermore, a lower perceived exertion was observed in the Arm+leg tests, especially during the TTE tests (p < 0.001). Conclusion: Minute ventilation, f R and perceived exertion are sensitive to the improvements in exercise tolerance observed when comparing Arm+leg vs. Leg, unlike V ˙ O2 and heart rate.

Differential control of respiratory frequency and tidal volume during exercise

The lack of a testable model explaining how ventilation is regulated in different exercise conditions has been repeatedly acknowledged in the field of exercise physiology. Yet, this issue contrasts with the abundance of insightful findings produced over the last century and calls for the adoption of new integrative perspectives. In this review, we provide a methodological approach supporting the importance of producing a set of evidence by evaluating different studies together-especially those conducted in 'real' exercise conditions-instead of single studies separately. We show how the collective assessment of findings from three domains and three levels of observation support the development of a simple model of ventilatory control which proves to be effective in different exercise protocols, populations and experimental interventions. The main feature of the model is the differential control of respiratory frequency (f_R) and tidal volume (V_T); f_R is primarily modulated by central command (especially during high-intensity exercise) and muscle afferent feedback (especially during moderate exercise) whereas V_T by metabolic inputs. Furthermore, V_T appears to be fine-tuned based on f_R levels to match alveolar ventilation with metabolic requirements in different intensity domains, and even at a breath-by-breath level. This model reconciles the classical neuro-humoral theory with apparently contrasting findings by leveraging on the emerging control properties of the behavioural (i.e. f_R) and metabolic (i.e. V_T) components of minute ventilation. The integrative approach presented is expected to help in the design and interpretation of future studies on the control of f_R and V_T during exercise.

Differential control of respiratory frequency and tidal volume during high-intensity interval training

NEW FINDINGS

What is the central question of this study? By manipulating recovery intensity and exercise duration during high-intensity interval training (HIIT), we tested the hypothesis that fast inputs contribute more than metabolic stimuli to respiratory frequency (f_R ) regulation. What is the main finding and its importance? Respiratory frequency, but not tidal volume, responded rapidly and in proportion to changes in workload during HIIT, and was dissociated from some markers of metabolic stimuli in response to both experimental manipulations, suggesting that fast inputs contribute more than metabolic stimuli to f_R regulation. Differentiating between f_R and tidal volume may help to unravel the mechanisms underlying exercise hyperpnoea. Given that respiratory frequency (f_R ) has been proposed as a good marker of physical effort, furthering the understanding of how f_R is regulated during exercise is of great importance. We manipulated recovery intensity and exercise duration during high-intensity interval training (HIIT) to test the hypothesis that fast inputs (including central command) contribute more than metabolic stimuli to f_R regulation. Seven male cyclists performed an incremental test, a 10 and a 20 min continuous time trial (TT) as preliminary tests. Subsequently, recovery intensity and exercise duration were manipulated during HIIT (30 s work and 30 s active recovery) by performing four 10 min and one 20 min trial (recovery intensities of 85, 70, 55 and 30% of the 10 min TT mean workload; and 85% of the 20 min TT mean workload). The work intensity of the HIIT sessions was self-paced by participants to achieve the best performance possible. When manipulating recovery intensity, f_R , but not tidal volume (V_T ), showed a fast response to the alternation of the work and recovery phases, proportional to the extent of workload variations. No association between f_R and gas exchange responses was observed. When manipulating exercise duration, f_R and rating of perceived exertion were dissociated from V_T , carbon dioxide output and oxygen uptake responses. Overall, the rating of perceived exertion was strongly correlated with f_R (r = 0.87; P < 0.001) but not with V_T . These findings may reveal a differential control of f_R and V_T during HIIT, with fast inputs appearing to contribute more than metabolic stimuli to f_R regulation. Differentiating between f_R and V_T may help to unravel the mechanisms underlying exercise hyperpnoea.

Effect of Expiratory Muscle Fatigue on the Respiratory Response during Exercise

[Purpose] The aim of this study was to reveal the effect of expiratory muscle fatigue (EMF) on respiratory response under two different exercise conditions: exercise (EX) with EMF (EMF-EX) and control EX without EMF (CON-EX). [Methods] Nine healthy adult men performed cycle exercise with a ramp load, and a spirometer was used to measure forced vital capacity (FVC), forced expiratory volume in one second, percent of forced expiratory volume, maximal expiratory mouth pressure, and maximal inspiratory mouth pressure (PI_max) to evaluate respiratory functions immediately and at 15 and 30 min after exercise. To assess the respiratory response during exercise, an exhaled gas analyzer was used to measure minute ventilation (V_E), respiratory frequency (f), tidal volume (V_T), oxygen uptake, and carbon dioxide output. In addition, the Borg Scale was used to evaluate dyspnea, while electrocardiography was used to measure heart rate. [Results] The results showed that compared with the CON-EX condition, no change in V_E, an increase in f, or a decrease in V_T was observed under the medium-intensity EMF-EX condition, while high-intensity exercise reduced V_E and f without changing V_T. [Conclusion] These results suggest that during medium-intensity exercise, EMF modulates the respiratory response by inducing shallow and fast breathing to increase ventilation volume.

Effects of Heliox in Stable COPD Patients at Rest and during Exercise

Heliox has been administered to stable chronic obstructive pulmonary disease (COPD) patients at rest and during exercise on the assumption that this low density mixture would have reduced work of breathing, dynamic hyperinflation, and, consequently, dyspnea sensation. Contrary to these expectations, beneficial effects of heliox in these patients at rest have been reported only sporadically, and the majority of the studies performed until now suggests that heliox is not a therapeutic option in spontaneously breathing resting COPD patients. On the other hand, when it is administered to COPD patients exercising at a constant work rate, heliox systematically decreases dyspnea sensation, and, often but not always, increases exercise tolerance. For these reasons, heliox has been evaluated as a non pharmacological tool to power rehabilitation programs. The conflicting results provided by the published trials probably point at a substantial heterogeneity of the COPD patients population in terms of respiratory mechanics and gas exchange. Therefore, further studies, aimed to the identification of mechanisms conditioning the response of exercising COPD patients to heliox, are warranted, before heliox administration, which is costly and cumbersome, can be routinely used in rehabilitation programs.

Locomotor muscle fatigue increases cardiorespiratory responses and reduces performance during intense cycling exercise independently from metabolic stress

Locomotor muscle fatigue, defined as an exercise-induced reduction in maximal voluntary force, occurs during prolonged exercise, but its effects on cardiorespiratory responses and exercise performance are unknown. In this investigation, a significant reduction in locomotor muscle force (−18%, P < 0.05) was isolated from the metabolic stress usually associated with fatiguing exercise using a 100-drop-jumps protocol consisting of one jump every 20 s from a 40-cm-high platform. The effect of this treatment on time to exhaustion during high-intensity constant-power cycling was measured in study 1 ( n = 10). In study 2 ( n = 14), test duration (871 ± 280 s) was matched between fatigue and control condition (rest). In study 1, locomotor muscle fatigue caused a significant curtailment in time to exhaustion (636 ± 278 s) compared with control (750 ± 281 s) ( P = 0.003) and increased cardiac output. Breathing frequency was significantly higher in the fatigue condition in both studies despite similar oxygen consumption and blood lactate accumulation. In study 2, high-intensity cycling did not induce further fatigue to eccentrically-fatigued locomotor muscles. In both studies, there was a significant increase in heart rate in the fatigue condition, and perceived exertion was significantly increased in study 2 compared with control. These results suggest that locomotor muscle fatigue has a significant influence on cardiorespiratory responses and exercise performance during high-intensity cycling independently from metabolic stress. These effects seem to be mediated by the increased central motor command and perception of effort required to exercise with weaker locomotor muscles.

The repeatability of submaximal endurance exercise testing in cystic fibrosis

Submaximal endurance cycle ergometer exercise tests are used to measure the efficacy of an exercise intervention, but the repeatability of these tests in patients with cystic fibrosis (CF) has not been established. The purpose of this study was to examine the repeatability of submaximal endurance testing in stable CF. Fifteen adults with CF underwent two submaximal endurance tests carried out over a 7-day period. A subset of six subjects returned 28 days later for a third submaximal endurance test. Workload was set at 80% of maximum workload and exercise was performed to exhaustion. Oxygen consumption, minute ventilation, tidal volume, carbon dioxide output, respiratory rate, heart rate, and oxygen saturation were measured at rest, at end exercise and at four matched times during the submaximal endurance tests (20, 40, 60, and 80% of exercise duration calculated from the first endurance test). Submaximal endurance test time was highly repeatable with no significant learning effect identified on multiple testing. Submaximal endurance exercise time demonstrated a variability of 5.7% which is consistent with high levels of repeatability. Metabolic, ventilatory and cardiac variables were all also highly reproducible between test days. Submaximal endurance testing is repeatable in stable CF, confirming that submaximal endurance tests are a reliable tool for assessment of therapeutic benefit in patients with CF.

Influence of diaphragm and rib cage muscle fatigue on breathing during endurance exercise

Inspiratory muscle fatigue (IMF) can develop during exhaustive exercise and cause tachypnea or rapid shallow breathing. We assessed the effects of rib cage muscle (RCM-F) and diaphragm fatigue (DIA-F) on breathing pattern and respiratory mechanics during high-intensity endurance exercise. Twelve healthy subjects performed a constant-load (85% maximal power) cycling test to exhaustion with prior IMF and a cycling test of similar intensity and duration without prior IMF (control). IMF was induced by resistive breathing and assessed by oesophageal and gastric twitch pressure measurements during cervical magnetic stimulation. Both RCM-F and DIA-F increased RCM and abdominal muscle force production during exercise compared to control. With RCM-F, tidal volume decreased while it increased with DIA-F. RCM-F was associated with a smaller increase in end-expiratory oesophageal pressure (i.e. decrease in lung volume) than DIA-F. These results suggest that RCM-F and not DIA-F is associated with rapid shallow breathing and that lowering the operating lung volume with DIA-F may help to preserve diaphragmatic function.

Physiologic Responses to Incremental and Self-Paced Exercise in COPD

OBJECTIVES

To investigate cardiorespiratory and dyspnea responses to incremental and self-paced exercise tests in patients with COPD.

DESIGN

A prospective within-subject design was used.

PATIENTS

Twenty stable subjects (15 men), with a mean (+/- SD) age of 64.0 +/- 7.5 years and moderate-to-severe COPD (ie, mean FEV(1), 0.8 +/- 0.3 L and 28.9 +/- 7.9% predicted) were studied.

METHODS

Each subject completed a 6-min walk test (6MWT), an incremental shuttle walking test (ISWT), and a cycle ergometer test (CET), within a 2-week period. The tests were performed at least 24 h apart. Standardized encouragement was utilized in each test with the aim of maximizing performance. Heart rate (HR) and dyspnea were measured each minute throughout the tests, and pulse oximetric saturation (Spo(2)) was measured before and immediately after each test. The distances walked in the 6MWT and ISWT were compared to peak oxygen uptake (Vo(2)) values from the CET.

RESULTS

HR increased linearly with increasing workload during the CET and ISWT, but increased alinearly with a disproportionate increase early in the 6MWT. In contrast, dyspnea scores increased linearly during the 6MWT, but increased alinearly with a disproportionate increase late during the CET and ISWT. Peak HR and dyspnea were not significantly different between tests. Spo(2) was significantly lower at the end of both walking tests compared to that at the end of the CET (p < 0.001). The distance walked in both the ISWT and 6MWT were related to peak Vo(2) values on the CET (for both tests, r = 0.73; p < 0.001).

CONCLUSIONS

The patterns of response in HR and dyspnea seen during the 6MWT suggest that patients with COPD titrate exertion against dyspnea to achieve a peak tolerable intensity. This strategy is not possible in an externally paced ISWT or CET. However, it is a limited strategy, with performance converging at higher workloads. Similar peak exercise responses were achieved in the 6MWT, ISWT, and CET. Greater oxygen desaturation was observed during the field walking tests, suggesting that both the ISWT and 6MWT are more sensitive than the CET in detecting exercise-induced hypoxemia and in assessing ambulatory oxygen therapy needs.

Respiratory-related activation of human abdominal muscles during exercise

We tested the hypothesis that abdominal muscles are active during the expiratory phase of the respiratory cycle during exercise. Electromyographic (EMG) activities of external oblique and rectus abdominis muscles were recorded during incremental exercise to exhaustion and during 30 min of constant work rate exercise at an intensity of 85 % of the peak oxygen consumption rate (V(O(2))). High amplitude intramuscular EMG activities of both abdominal muscles could be evoked with postural manoeuvres in all subjects. During cycling, respiratory-related activity of the external obliques was evoked in four of seven subjects, whereas rectus abdominis activity was observed in six of the seven subjects. We measured only the activity that was confined exclusively to the expiratory phase of the respiratory cycle. Expiratory activity of both muscles increased with exercise intensity, although peak values averaged only 10-20 or 20-40 % of the peak activity (obtained during maximal, voluntary expiratory efforts) for the external oblique and rectus abdominis muscles, respectively. To estimate how much of the recorded abdominal muscle activity was supporting leg movements during exercise, we compared the activity at the very end of incremental exercise to that recorded during the first five respiratory cycles after the abrupt cessation of exercise, when ventilation was still very high. Although external oblique activity was reduced after exercise stopped, clear expiratory activity remained. Rectus abdominis activity remained high after exercise cessation, showing a gradual decline that approximated the decline in ventilation. During constant work rate exercise, EMG activities increased to 40-50 and 5-10 % of peak in rectus and external oblique muscles, respectively, and then plateaued for the remainder of the bout in spite of a continual upward drift in (V(O(2))) and pulmonary ventilation. Linear regression analysis showed that the rise in respiratory-related expiratory muscle activity during progressive intensity exercise was significantly correlated with ventilation, although weakly. In constant work rate exercise, expiratory EMG activities increased, but the changes were highly variable and did not change as a function of exercise time, even though ventilation drifted significantly with time. These experiments suggest that abdominal muscles play a role in regulating the ventilatory response to progressive intensity bicycle exercise, although some of the observed activity may support postural adjustments or limb movements. The contribution of abdominal muscles to ventilation during constant work rate exercise is variable, and expiratory activity does not 'drift' significantly with time.

Determinants of VO(2) kinetics at high power outputs during a ramp exercise protocol

PURPOSE

To determine the relationship between the additional, nonlinear increase in oxygen uptake (Delta VO(2)) that occurs at high power outputs during a ramp cycle ergometer test, on one hand; and possible explanatory mechanisms of the phenomenon, such as cardiorespiratory work, blood lactate, fitness level, or muscle fiber distribution, on the other.

METHODS

Ten healthy, sedentary young adults (age (mean +/- SEM), 22 +/- 1 yr) were chosen as subjects. A muscle biopsy specimen was taken from the vastus lateralis of the right leg to determine fiber type distribution by immunohistochemical identification of myosin heavy chain (MHC) isoforms. During the ramp tests (power output increases of 5 W every 15-s interval), the ventilatory threshold (VT) and lactate threshold (LT) were measured. We defined Delta VO(2) as the difference between "true" VO(2) values observed at the maximal power output (VO(2)obs) and those expected (VO(2)exp) from the previous linear VO2:power output relationship below the VT.

RESULTS

A nonlinear increase was observed in VO2 (Delta VO(2) = 239 +/- 79 mL x min(-1), P < 0.05 for VO(2)obs vs VO(2)exp), which was significantly correlated with the percentage of type IIX fibers (r = 0.80, P < 0.05). No other correlations were found between Delta VO(2) and possible explanatory mechanisms.

CONCLUSION

A greater percentage of type IIX fibers is associated with a higher excess VO(2) at high power outputs (above VT).

Effects of endurance training on the breathing pattern of professional cyclists

The aim of this longitudinal study was to clarify the changes induced by endurance training on the breathing pattern of 13 professional cyclists (age+/-SD: 24+/-2 years; VO(2 max) approximately 75 ml x kg(-1) x min(-1)) during the three periods (rest, precompetition, and competition) of a sports season. Both the volume and the intensity of training were quantified during these periods. In each session (corresponding to each of the three periods) all subjects performed (1) a pulmonary function test (to measure forced vital capacity [FVC], peak expiratory flow [PEF], and maximal voluntary ventilation [MVV]), and (2) a ramp test until exhaustion on a cycle ergometer (workload increases of 25 W x min(-1)). The following variables were recorded every 100 W until the end of the tests: pulmonary ventilation (VE, in l x min(-1) BTPS), tidal volume (VT, inl BTPS), breathing frequency (f(b), in breaths x min(-1)), ventilatory equivalents for oxygen (VE x VO(2)(-1)) and carbon dioxide (VE x VCO(2)(-1)), inspiratory (TI) and expiratory (TE) times (s), ratio of TI to total respiratory duration or inspiratory "duty cycle" (TI/TTOT, and mean inspiratory flow rate (VT)/TI), in l x s(-1)). The results showed no changes in any of these variables (p>0.05) between the three periods of study, despite significant changes in training loads (i.e., increases in the volume and/or intensity of training throughout the season). These findings suggest that endurance conditioning does not alter the breathing pattern of professional cyclists during an incremental exercise test.

Comparison of pulmonary gas exchange measurements between incremental and constant work exercise above the anaerobic threshold

STUDY OBJECTIVES

To compare arterial blood gas (ABG) and pulmonary gas exchange variables (alveolar-arterial oxygen pressure difference [P(A-a)O2] and physiologic dead space to tidal volume ratio [VD/VT]) measured during incremental exercise test (IET) and constant work (CW) exercise at a matched oxygen uptake (VO2).

DESIGN

A comparison of IET and CW variables was accomplished using patient data from clinical referrals for cardiopulmonary exercise testing and control data not reported from a previous study.

SETTINGS

El Paso, Tex, located at an altitude of 1,270 m (barometric pressure, 656 mm Hg).

PARTICIPANTS

Sixteen patients with dyspnea on exertion/exercise intolerance and nine normal subjects were evaluated above the anaerobic threshold (AT); seven patients were also studied below the AT.

INTERVENTIONS

Participants had a maximal IET followed in 1 h by a 5-min CW test. Arterial blood samples were obtained from a radial catheter every other minute during IET and during minute 5 of CW. Cardiopulmonary measurements were obtained using an automated system in a breath-by-breath fashion (60-s averaging).

RESULTS

Above the AT, no differences were observed in normal subjects between IET and CW at a matched VO2 in the following: PaO2 (79 vs 79 mm Hg); arterial oxygen saturation (SaO2) (94% vs 94%); P(A-a)O2 (16 vs 16 mm Hg); and VD/VT (0.09 vs 0.09) (mean values). Similarly, no differences were observed in patients above the AT in PaO2 (69 vs 68), SaO2 (90 vs 90), and VD/VT (0.24 vs 0.23). PaCO2 was 2 mm Hg higher (36 vs 34) in normal subjects and in patients (34 vs 32) during IET. A significant (p<0.05), albeit clinically unimportant, difference was also observed in P(A-a)O2 (28 vs 29) in patients. No statistically significant differences were observed below the AT between IET and CW for any of the variables measured.

CONCLUSIONS

These data demonstrate the reliability of ABG and pulmonary gas exchange variables measured during 1-min IET for clinical use in patients and normal subjects. However, PaCO2 tends to be slightly higher during IET vs CW.

Lack of importance of respiratory muscle load in ventilatory regulation during heavy exercise in humans

1. Seven active subjects (24 +/- 1 years; maximal oxygen uptake (VO2,max), 3.77 +/- 0.2 l min-1; mean +/- S.E.M.) performed constant work rate heavy exercise (CWHE, approximately 80% of maximal incremental work rate) to exhaustion on 2 days, one with (unload) and one without (control) respiratory muscle unloading. 2. With unloading, a special device applied flow-proportional mouth pressure assist (positive with inspiratory (I), negative with expiratory (E) flows) throughout each breath. No pressure assist occurred during control CWHE. To confirm unloading, respiratory muscle pressures (Pmus) were derived (n = 5) from measured pleural pressure and chest wall elastic and resistive pressures. 3. Other than minor differences in early exercise, the temporal course of minute ventilation (VE) was similar in both tests as exercise progressed. The fall in estimated mean alveolar CO2 (PA,CO2) throughout CWHE was identical in both tests. There were no significant differences (ANOVA) in VE, tidal volume, frequency, oxygen consumption rate (VO2), heart rate or PA,CO2, between unload and control CWHE, at matched times (at 50% of control duration and at the end of exercise). Unloading reduced Pmus significantly throughout CWHE; at 50% control duration, peak Pmus,I and Pmus,E fell by 24 and 41%, respectively, with unloading, as did mean Pmus,I and Pmus,E (21 and 44%). 4. The lack of any significant changes in VE, PA,CO2 or breathing pattern, despite a marked reduction in respiratory muscle load throughout CWHE, indicates that the load on the respiratory muscles has only a minor role in the regulation of ventilation during heavy exercise. 5. The absence of improvement in CWHE duration (control, 11.4 +/- 1.2 min; unload, 12.6 +/- 2.1 min, n.s.) with unloading implies that respiratory muscle function does not limit endurance exercise performance during cycling in healthy humans.