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Wooten LC, Hasni S, Mikdashi JA, Keyser RE. Cardiorespiratory Insufficiency and Performance Fatigability in Women with Systemic Lupus Erythematosus. Cardiopulm Phys Ther J 2023; 34:51-60. [PMID: 36742346 PMCID: PMC9897569 DOI: 10.1097/cpt.0000000000000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose Patients with systemic lupus erythematosus (SLE) experience excessive, debilitating fatigue with previously reported evidence of etiologically mediated cardiorespiratory impairments. Performance fatigability provides a precise characterization of fatigue as it can be quantified objectively as a function of time, frequency, and/or duration. Nevertheless, little consideration has been given to understanding performance fatigability and its physiological determinants in those with SLE. The purpose of this study was to characterize performance fatigability in patients with SLE, utilizing measures surrounding the anaerobic threshold, with emphasis on cardiorespiratory impairment as a potential mediating factor. Methods This was a case-control study design. 44 physically inactive women, 26 with SLE and 18 controls, completed a treadmill cardiopulmonary exercise test to volitional exhaustion. Results There were no significant differences in age (SLE 34.8(9.0) vs Control 36.9(7.3) yrs; p=0.422) between groups. BMI (SLE 27.1(5.4) vs Control 23.8(5.2) kg/m2; p=0.045) was significantly higher in the SLE vs Control group. Resting heart rate (SLE 68(16) vs Control 78(15) bpm; p=0.040) was significantly lower in the SLE compared to the Control group. The VO2 corresponding to the anaerobic threshold (AT-VO2), used to identify the onset of exercise-induced fatigue, was significantly lower in women with SLE than in controls (SLE 12.4(3.1) vs Control 16.4(2.2) ml/kg/min; p<0.001), as was AT-stage (SLE 2.5(0.90) vs Control 3.4(0.78); p=0.002). Additionally, Fatigue Severity Score (FSS) was highly and inversely correlated with AT-VO2 (rho=-0.615; p<0.001) and FSS was highly correlated with Functional Aerobic Impairment Index (FAI; rho=0.663; p<0.001). Conclusion This study underscores severe performance fatigability in patients with SLE and its link to cardiorespiratory insufficiency. Physiological presentation of performance fatigability was observed during very low intensities of exercise, emphasizing the negative impact it may have on physical function in this population.
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Affiliation(s)
- Liana C Wooten
- Tufts University, Department of Public Health and Community Medicine, Division of Doctorate of Physical Therapy (DPT), Phoenix, Arizona
- Department of Health, Human Function, and Rehabilitation Science, George Washington University, Washington, DC
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Sarfaraz Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD
| | - Jamal A Mikdashi
- Department of Medicine, Division of Rheumatology, University of Maryland School of Medicine, Baltimore, MD
| | - Randall E Keyser
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD
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Moreira-Reis A, Maté-Muñoz JL, Hernández-Lougedo J, García-Fernández P, Heredia-Elvar JR, Pleguezuelos E, Carbonell T, Alva N, Garnacho-Castaño MV. 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. BIOLOGY 2022; 11:biology11111646. [PMID: 36358347 PMCID: PMC9687828 DOI: 10.3390/biology11111646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Alessandra Moreira-Reis
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain
| | - José Luis Maté-Muñoz
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
| | - Juan Hernández-Lougedo
- Department of Physiotherapy, Faculty of Health Sciences, Camilo José Cela University, 28692 Madrid, Spain
| | - Pablo García-Fernández
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan Ramón Heredia-Elvar
- Department of Physical Activity and Sports Science, Alfonso X El Sabio University, 28691 Madrid, Spain
| | - Eulogio Pleguezuelos
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, 08304 Barcelona, Spain
| | - Teresa Carbonell
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain
| | - Norma Alva
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain
| | - Manuel Vicente Garnacho-Castaño
- Campus Docent Sant Joan de Déu, University of Barcelona, 08830 Sant Boi de Llobregat, Spain
- Correspondence: ; Tel.: +34-606-27-5392
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The association of breathing pattern with exercise tolerance and perceived fatigue in women with systemic lupus erythematosus: an exploratory case-control study. Rheumatol Int 2021; 42:2003-2011. [PMID: 34727196 DOI: 10.1007/s00296-021-05005-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/19/2021] [Indexed: 10/19/2022]
Abstract
The aims of the study were to (1) to characterize the breathing pattern and work of breathing during peak exercise in patients with SLE; (2) to examine the extent to which the breathing pattern and work of breathing impact the exercise capacity and fatigue. Forty-one women participated in the study (SLE: n = 23, median = 35, range = 21-57 years, control: n = 18, median = 38, range = 22-45 years). Each subject performed a treadmill cardiopulmonary exercise test (a modified Bruce treadmill protocol) ending with volitional exhaustion. Breathing mechanic was characterized by measures of expired minute volume (VE), tidal volume (Vt), respiratory rate (f), work of breathing, and cardiorespiratory fitness was quantified by measures of peak oxygen consumption (VO2) and time to exhaustion. Data presented as median and interquartile range (IQR). Women with SLE had lower Vt {1221 [488.8] mL/min vs. 1716 [453.1] mL; p = .006}, VE {58.9 [18.9] L/min vs 70 [28.1] L/min, p = 0.04} and increased breathing frequency {51.5 [10.8] vs 43.6 [37.8] bpm, p = 0.01} compared to the control group. The time to exhaustion and peak VO2 during the CPET were significantly reduced in those with SLE compared to controls {13.3 [10.2] vs 16.1 [2.2] min; p = 0.004}, {20 [6.1] mL/kg/min vs 26.6 [7] mL/kg/min p < 0.001}, respectively. Differences remained when the analyses were controlled for the observed differences in peak VO2. When the regression model adjusted for the peak VO2, it had been shown that Vt, WOB and f were explained variances in the fatigue severity by 64% [p < 0.001]. The decline in VE and Vt coupled with a decreased peak VO2, and work of breathing may have contributed to low cardiorespiratory fitness and fatigue in patients with systemic lupus erythematosus.
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Wooten LC, Neville BT, Keyser RE. Measures of excess [Formula: see text]CO 2 and recovery [Formula: see text]CO 2 as indices of performance fatigability during exercise: a pilot study. Pilot Feasibility Stud 2021; 7:131. [PMID: 34162443 PMCID: PMC8220798 DOI: 10.1186/s40814-021-00840-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The severity of performance fatigability and the capacity to recover from activity are profoundly influenced by skeletal muscle energetics, specifically the ability to buffer fatigue-inducing ions produced from anaerobic metabolism. Mechanisms responsible for buffering these ions result in the production of excess carbon dioxide (CO2) that can be measured as expired CO2 ([Formula: see text]CO2) during cardiopulmonary exercise testing (CPET). The primary objective of this study was to assess the feasibility of select assessment procedures for use in planning and carrying out interventional studies, which are larger interventional studies investigating the relationships between CO2 expiration, measured during and after both CPET and submaximal exercise testing, and performance fatigability. METHODS Cross-sectional, pilot study design. Seven healthy subjects (30.7±5.1 years; 5 females) completed a peak CPET and constant work-rate test (CWRT) on separate days, each followed by a 10-min recovery then 10-min walk test. Oxygen consumption ([Formula: see text]O2) and [Formula: see text]CO2 on- and off-kinetics (transition constant and oxidative response index), excess-[Formula: see text]CO2, and performance fatigability severity scores (PFSS) were measured. Data were analyzed using regression analyses. RESULTS All subjects that met the inclusion/exclusion criteria and consented to participate in the study completed all exercise testing sessions with no adverse events. All testing procedures were carried out successfully and outcome measures were obtained, as intended, without adverse events. Excess-[Formula: see text]CO2 accounted for 61% of the variability in performance fatigability as measured by [Formula: see text]O2 on-kinetic ORI (ml/s) (R2=0.614; y = 8.474x - 4.379, 95% CI [0.748, 16.200]) and 62% of the variability as measured by PFSS (R2=0.619; y = - 0.096x + 1.267, 95% CI [-0.183, -0.009]). During CPET, [Formula: see text]CO2 -off ORI accounted for 70% (R2=0.695; y = 1.390x - 11.984, 95% CI [0.331, 2.449]) and [Formula: see text]CO2 -off Kt for 73% of the variability in performance fatigability measured by [Formula: see text]O2 on-kinetic ORI (ml/s) (R2=0.730; y = 1.818x - 13.639, 95% CI [0.548, 3.087]). CONCLUSION The findings of this study suggest that utilizing [Formula: see text]CO2 measures may be a viable and useful addition or alternative to [Formula: see text]O2 measures, warranting further study. While the current protocol appeared to be satisfactory, for obtaining select cardiopulmonary and performance fatigability measures as intended, modifications to the current protocol to consider in subsequent, larger studies may include use of an alternate mode or measure to enable control of work rate constancy during performance fatigability testing following initial CPET.
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Affiliation(s)
- Liana C. Wooten
- Department of Health, Human Function, and Rehabilitation Science, George Washington University, Washington, DC USA
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA USA
| | - Brian T. Neville
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA USA
| | - Randall E. Keyser
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA USA
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD USA
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Wooten LC, Neville BT, Guccione AA, Chin LM, Keyser RE. Carbon Dioxide Expiration and Performance Fatigability Following Aerobic Exercise Training: A Longitudinal, Observational, Pilot Study. Cardiopulm Phys Ther J 2021; 32:3-10. [PMID: 37614414 PMCID: PMC10445408 DOI: 10.1097/cpt.0000000000000162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose This study examined the influence of aerobic exercise training (AET) on components of carbon dioxide expiration (VCO2), cardiorespiratory function, and fatigability. Methods Twenty healthy adults completed peak cardiopulmonary exercise (CPX) and submaximal tests before and after a vigorous, 4-week AET regimen. Each test was followed by a 10-min recovery and endurance test at 70% of peak wattage attained during CPX. Fatigability was assessed using testing durations and power output. Respiratory buffering (excess VCO2) and non-buffering (metabolic VCO2) were calculated. Data were analyzed for significance (p<0.05) using regressions and paired t-tests. Results Significant improvements in all measures of fatigability were observed after AET. A significant increase in excess VCO2 was observed, though not in metabolic VCO2. Excess VCO2 was strongly predictive of fatigability measures. Conclusion Significant decreases in fatigability are often observed in clinical populations such as obstructive or restrictive lung disease or pulmonary hypertension following AET, even when peak cardiorespiratory function does not appear to adapt. Decreases in fatigability appear to predict longevity with no yet identified mechanism. These results suggest that respiratory buffering and metabolic components of VCO2 may adapt independently to AET, introducing foundational plausibility for an influence of respiratory buffering adaptation to AET on fatigability status.
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Affiliation(s)
- Liana C. Wooten
- Department of Health, Human Function, and Rehabilitation Science, School of Medicine, George Washington University, Washington, D.C
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Brian T. Neville
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Andrew A. Guccione
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Lisa M.K. Chin
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD
| | - Randall E. Keyser
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD
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Wooten LC, Neville BT, Guccione AA, Chin LM, Keyser RE. Role of Respiratory Buffering in the Relationship Between Recovery and Performance Fatigability Following Aerobic Exercise Training: A Longitudinal, Observational, Pilot Study. Cardiopulm Phys Ther J 2021; 32:11-19. [PMID: 37583789 PMCID: PMC10425857 DOI: 10.1097/cpt.0000000000000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose:
This study characterized the influence of excess expired carbon dioxide (excess V̇co
2) in the relationship between recovery and fatigability.
Methods:
Twenty healthy adults completed peak cardiopulmonary exercise tests (CPXs) and constant work rate tests before and after a vigorous, 4-week aerobic exercise training (AET) regimen. Each test was followed by 10 minutes of recovery and an endurance test at 70% of peak watts attained during CPX. Fatigability was assessed by measures of time to exhaustion and power output. Metabolic and recovery capacity indices were obtained. Data were analyzed using correlations and regressions and compared pre/post AET using paired t tests.
Results:
Significant improvements in recovery and fatigability were observed after AET, along with significant increases in total and excess V̇co
2. Relationships between measures of recovery and fatigability were observed, although strengths of the relationships were diminished after controlling analyses for the effect of excess V̇co
2.
Conclusions:
This study suggests that the ionic buffering capacity may moderate the relationship between recovery and fatigability. These results could have implications regarding AET-induced buffering dynamics, and its role in fatigue resistance when performing activities above moderate intensities. This may be of particular importance in patients with cardiopulmonary complications, unable to improve peak aerobic capacity.
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Affiliation(s)
- Liana C. Wooten
- Department of Health, Human Function, and Rehabilitation Science, School of Medicine, George Washington University, Washington, D.C
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Brian T. Neville
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Andrew A. Guccione
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Lisa M.K. Chin
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD
| | - Randall E. Keyser
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD
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Miyamoto ST, Valim V, Carletti L, Ng WF, Perez AJ, Lendrem DW, Trennel M, Giovelli RA, Dias LH, Serrano ÉV, Subtil AM, Abreu VC, Natour J. Supervised walking improves cardiorespiratory fitness, exercise tolerance, and fatigue in women with primary Sjögren's syndrome: a randomized-controlled trial. Rheumatol Int 2019; 39:227-238. [PMID: 30604204 DOI: 10.1007/s00296-018-4213-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/24/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and effectiveness of a supervised walking program in women with primary Sjögren's syndrome (pSS). METHODS Forty-five sedentary women fulfilling the American European Consensus Criteria for pSS were randomized to a training group (TG, n = 23) or control group (CG, n = 22). Patients in the TG were submitted to supervise walking three times a week for 16 weeks. The patients of the CG were instructed to not perform any kind of regular physical exercise. Physical fitness [maximum oxygen uptake (VO2max) and distance], EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), hematological tests, and Medical Outcomes Study 36 (SF-36) were assessed at baseline and week 16. In addition, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-fatigue), and Beck Depression Inventory (BDI) were measured prior to intervention, after 8 and 16 weeks. Patient global assessment of response to therapy was completed at the final assessment. An intent-to-treat analysis was performed. RESULTS After 16 weeks, the mean change of VO2max (ml/kg/min), distance, and FACIT-fatigue were higher in the TG than in the CG (p = 0.016, p = 0.043 and p = 0.030, respectively). Improved cardiorespiratory fitness was associated with improvements in fatigue scores and physical components of quality of life (SF-36). Furthermore, improved fatigue scores were associated with reduced depression and improvements in the physical and mental components of SF-36. Overall, 95.4% of patients in the TG rated themselves as clinically improved versus 62% of the patients in the CG (p = 0.049). There was no flare in disease activity and no serious adverse events with exercise. CONCLUSIONS This supervised walking program was demonstrated to be feasible and safe with improvements in cardiorespiratory fitness, exercise tolerance, fatigue, and patient perception of improvement in pSS patients. TRIAL REGISTRATION Clinical Trials.gov ID, number NCT02370225.
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Affiliation(s)
- Samira Tatiyama Miyamoto
- Department of Integrated Education in Health, Universidade Federal do Espírito Santo, Av. Maruípe, 1468, Vitoria, ES, 29040-090, Brazil
- Department of Rheumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina, Rua Botucatu, 740, São Paulo, SP, 04023-900, Brazil
| | - Valéria Valim
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
- Department of Medical Clinic, Universidade Federal do Espírito Santo, Av. Marechal Campos, 1468, Vitoria, ES, 29040-090, Brazil
| | - Luciana Carletti
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Anselmo José Perez
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Dennis William Lendrem
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Michael Trennel
- MoveLab, Physical Activity and Exercise Research, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Raquel Altoé Giovelli
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
| | - Laiza Hombre Dias
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
| | - Érica Vieira Serrano
- Rheumatology Outpatient Clinic-Hospital Universitário Cassiano Antônio de Moares (HUCAM), Universidade Federal do Espírito Santo, Av. Marechal Campos, 1355, 29043-260, Vitoria, ES, Brazil
| | - Alice Mendonça Subtil
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Vanessa Cândido Abreu
- Exercise Physiology Laboratory (LAFEX), Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitoria, ES, 29075-810, Brazil
| | - Jamil Natour
- Department of Rheumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina, Rua Botucatu, 740, São Paulo, SP, 04023-900, Brazil.
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Gollie JM, Herrick JE, Keyser RE, Chin LMK, Collins JP, Shields RK, Panza GS, Guccione AA. Fatigability, oxygen uptake kinetics and muscle deoxygenation in incomplete spinal cord injury during treadmill walking. Eur J Appl Physiol 2017; 117:1989-2000. [PMID: 28744558 DOI: 10.1007/s00421-017-3685-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/20/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of the present study was to characterize hypothesized relationships among fatigability and cardiorespiratory fitness in individuals with chronic motor-incomplete SCI (iSCI) during treadmill walking. The theoretical framework was that exacerbated fatigability would occur concomitantly with diminished cardiorespiratory fitness in people with iSCI. METHODS Subjects with iSCI (n = 8) and an able-bodied reference group (REF) (n = 8) completed a 6-min walking bout followed by a walking bout of 30-min or until volitional exhaustion, both at a self-selected walking speed. Fatigability was assessed using both perceived fatigability and performance fatigability measures. Pulmonary oxygen uptake kinetics (VO2 on-kinetics) was measured breath-by-breath and changes in deoxygenated hemoglobin/myoglobin concentration (∆[HHb]) of the lateral gastrocnemius was measured by near-infrared spectroscopy. Adjustment of VO2 and ∆[HHb] on-kinetics were modeled using a mono-exponential equation. RESULTS Perceived fatigability and performance fatigability were 52% and 44% greater in the iSCI group compared to the REF group (p = 0.003 and p = 0.004). Phase II time constant (τp) of VO2 on-kinetics and ∆[HHb] ½ time during resting arterial occlusion were 55.4% and 16.3% slower in iSCI vs REF (p < 0.01 and p = 0.047, respectively). CONCLUSIONS The results of the present study may suggest that compromised O2 delivery and/or utilization may have contributed to the severity of fatigability in these individuals with iSCI. The understanding of the extent to which fatigability and VO2 and Δ[HHb] on-kinetics impacts locomotion after iSCI will assist in the future development of targeted interventions to enhance function.
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Affiliation(s)
- Jared M Gollie
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA.
| | - Jeffrey E Herrick
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - Randall E Keyser
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - Lisa M K Chin
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - John P Collins
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - Richard K Shields
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa, Iowa, USA
| | - Gino S Panza
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
| | - Andrew A Guccione
- Department of Rehabilitation Science, George Mason University, 4400 University Drive MS2G7, Fairfax, VA, 22030, USA
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9
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Boström C, Elfving B, Dupré B, Opava CH, Lundberg IE, Jansson E. Effects of a one-year physical activity programme for women with systemic lupus erythematosus - a randomized controlled study. Lupus 2016; 25:602-16. [PMID: 26768748 DOI: 10.1177/0961203315622817] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/24/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the effects of a one-year physical activity programme on aerobic capacity, physical activity and health-related quality of life (HRQL) in patients with systemic lupus erythematosus (SLE) by a randomized control design. METHODS Thirty-five women with low or moderate disease activity and organ damage were randomized to intervention (I) or control (C) group. The intervention during months 0-3 consisted of education, supervised aerobic exercise at high intensity and individual coaching, as well as self-managed physical activity at low-to-moderate intensity. During months 4-12, the physical activity was self-managed and the coaching was successively reduced over time. Outcome measures included: maximal oxygen uptake (VO2 max) from a bicycle ergometer test, self-reported physical activity and HRQL (SF-36). RESULTS VO2 at sub-max. and max. increased, independent of group, during the one-year study period (main effect of time p < 0.0001). VO2 max. increased between baseline and month 3 (p < 0.0001), between months 3 and 6 (p = 0.01) and the increase was sustained at month 12 (ns). Frequency of physical activity at high intensity also increased, independent of group, during the study period. It was increased at months 3, 6 and 12 compared to baseline (p = 0.02, p < 0.001, p = 0.03). Improvement in mental health between baseline and month 6 (p = 0.002) was seen for the I-group, not the C-group (p = 0.03). Disease activity and organ damage did not change. CONCLUSIONS Physical activity and aerobic capacity increased after supervised exercise and coaching, and the improvement was sustained during the one-year programme. However, no interactions between the group differences were seen, which suggests that repeated measurements could motivate to increased physical activity and thereby to increased aerobic capacity. As sub-max. VO2 increased over time, training-induced changes in VO2 on-kinetics could be another explanation. Little influence on HRQL was seen after the programme. The study indicates that physical activity at high intensity over one year is tolerated by patients with mild to moderate SLE.
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Affiliation(s)
- C Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - B Elfving
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - B Dupré
- Rheumatology unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - C H Opava
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Rheumatology unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - I E Lundberg
- Rheumatology unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - E Jansson
- Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm Sweden
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