1
|
Wan X, Liu C, Olson TP, Chen X, Lu W, Jiang W. Differences in Peak Oxygen Uptake in Bicycle Exercise Test Caused by Body Positions: A Meta-Analysis. Front Cardiovasc Med 2021; 8:734687. [PMID: 34708089 PMCID: PMC8542763 DOI: 10.3389/fcvm.2021.734687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: As demand for cardiopulmonary exercise test using a supine position has increased, so have the testing options. However, it remains uncertain whether the existing evaluation criteria for the upright position are suitable for the supine position. The purpose of this meta-analysis is to compare the differences in peak oxygen uptake (VO2peak) between upright and supine lower extremity bicycle exercise. Methods: We searched PubMed, Web Of Science and Embase from inception to March 27, 2021. Self-control studies comparing VO2peak between upright and supine were included. The quality of the included studies was assessed using a checklist adapted from published papers in this field. The effect of posture on VO2peak was pooled using random/fixed effects model. Results: This meta-analysis included 32 self-control studies, involving 546 participants (63% were male). 21 studies included only healthy people, 9 studies included patients with cardiopulmonary disease, and 2 studies included both the healthy and cardiopulmonary patients. In terms of study quality, most of the studies (n = 21, 66%) describe the exercise protocol, and we judged theVO2peak to be valid in 26 (81%) studies. Meta-analysis showed that the upright VO2peak exceeded the supine VO2peak [relative VO2peak: mean difference (MD) 2.63 ml/kg/min, 95% confidence interval (CI) 1.66-3.59, I 2 = 56%, p < 0.05; absolute VO2peak: MD 0.18 L/min, 95% CI 0.10-0.26, I 2 = 63%, p < 0.05). Moreover, subgroup analysis showed there was more pooled difference in healthy people (4.04 ml/kg/min or 0.22 L/min) than in cardiopulmonary patients (1.03 ml/kg/min or 0.12 L/min). Conclusion: VO2peak in the upright position is higher than that in supine position. However, whether this difference has clinical significance needs further verification. Systematic Review Registration: identifier, CRD42021233468.
Collapse
Affiliation(s)
- Xiaohua Wan
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chang Liu
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Thomas P Olson
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, United States
| | - Xiankun Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Healthy Systems and Policy, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Weihui Lu
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei Jiang
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases, Guangzhou, China
| |
Collapse
|
2
|
Wehrle A, Waibel S, Gollhofer A, Roecker K. Power Output and Efficiency During Supine, Recumbent, and Upright Cycle Ergometry. Front Sports Act Living 2021; 3:667564. [PMID: 34179774 PMCID: PMC8222662 DOI: 10.3389/fspor.2021.667564] [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: 02/23/2021] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
Recumbent and supine cycling are common exercise modes in rehabilitation and clinical settings but the influence of postures on work efficiency is unclear. Therefore, the aim of this study was to compare metabolic and ventilatory efficiency during upright, recumbent, and supine postures. Potential differences should be assessed for suitable diagnostics and for prescriptions of training that probably is performed in alternative postures. Eighteen healthy subjects (age: 47.2 ± 18.4 years; 10 female, 8 male) participated in the study and each completed three incremental cycle ergometer tests until exhaustion in upright, recumbent (40°), and supine positions. Gas exchange, heart rate (HR), and lactate concentrations were analyzed and efficiency was calculated subsequently. Testing sessions were performed in random order within a 2-week period. Upright cycling resulted in significantly higher peak values [power output, oxygen uptake (Vo2), HR] as well as performance at lactate and ventilatory thresholds in comparison to recumbent or supine positions. Vco2/Vo2 slope and ventilatory efficiency (VE/Vco2 slope) were not affected by posture. Aerobic work efficiency (Vo2/P slope) and gross efficiency (GE) differed significantly between postures. Hereby, GE was lowest in supine cycling, particularly obvious in a mainly aerobic condition at 70 Watt [Median 11.6 (IQR 10.9-13.3) vs. recumbent: 15.9 (IQR 15.6-18.3) and upright: 17.4 (IQR 15.1-18.3)]. Peak power as well as GE and work efficiency values are influenced by cycling position, reinforcing the importance of adjusting test results for training prescriptions. Surprisingly, ventilatory efficiency was not affected in this study and therefore does not seem to falsify test results for pulmonary diagnostics.
Collapse
Affiliation(s)
- Anja Wehrle
- Institute for Exercise and Occupational Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.,Institute of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Sarah Waibel
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Albert Gollhofer
- Institute of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Kai Roecker
- Institute for Applied Health Promotion and Exercise Medicine (IfAG), Furtwangen University, Furtwangen, Germany
| |
Collapse
|
3
|
Le TT, Ang BWY, Bryant JA, Chin CY, Yeo KK, Wong PEH, Ho KW, Tan JWC, Lee PT, Chin CWL, Cook SA. Multiparametric exercise stress cardiovascular magnetic resonance in the diagnosis of coronary artery disease: the EMPIRE trial. J Cardiovasc Magn Reson 2021; 23:17. [PMID: 33658056 PMCID: PMC7931509 DOI: 10.1186/s12968-021-00705-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard. METHODS In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study. RESULTS In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ2 for the diagnosis of FFR-positive increased from 7.6 to 55.9; P < 0.001) and excellent performance [c-statistic area under the curve 0.97 (95% CI: 0.94-1.00)] in discriminating between FFR-normal and FFR-positive patients. CONCLUSION The study demonstrates the clinical potential of using in-scanner multiparametric ExCMR to accurately diagnose CAD. TRIAL REGISTRATION ClinicalTrials.gov, NCT03217227, Registered 11 July 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03217227?id=NCT03217227&draw=2&rank=1&load=cart.
Collapse
Affiliation(s)
- Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Briana W Y Ang
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Jennifer A Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Chee Yang Chin
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Khung Keong Yeo
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Philip E H Wong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Kay Woon Ho
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jack W C Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Phong Teck Lee
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Calvin W L Chin
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Stuart A Cook
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Cardiovascular Sciences ACP, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
| |
Collapse
|
4
|
Dillon HT, Dausin C, Claessen G, Lindqvist A, Mitchell A, Wright L, Willems R, La Gerche A, Howden EJ. The effect of posture on maximal oxygen uptake in active healthy individuals. Eur J Appl Physiol 2021; 121:1487-1498. [PMID: 33638017 DOI: 10.1007/s00421-021-04630-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Semi-supine and supine cardiopulmonary exercise testing (CPET) with concurrent cardiac imaging has emerged as a valuable tool for evaluating patients with cardiovascular disease. Yet, it is unclear how posture effects CPET measures. We aimed to discern the effect of posture on maximal oxygen uptake (VO2max) and its determinants using three clinically relevant cycle ergometers. METHODS In random order, 10 healthy, active males (Age 27 ± 7 years; BMI 23 ± 2 kg m2) underwent a ramp CPET and subsequent constant workload verification test performed at 105% peak ramp power to quantify VO2max on upright, semi-supine and supine cycle ergometers. Doppler echocardiography was conducted at peak exercise to measure stroke volume (SV) which was multiplied by heart rate (HR) to calculate cardiac output (CO). RESULTS Compared to upright (46.8 ± 11.2 ml/kg/min), VO2max was progressively reduced in semi-supine (43.8 ± 10.6 ml/kg/min) and supine (38.2 ± 9.3 ml/kg/min; upright vs. semi-supine vs. supine; all p ≤ 0.005). Similarly, peak power was highest in upright (325 ± 80 W), followed by semi-supine (298 ± 72 W) and supine (200 ± 51 W; upright vs. semi-supine vs. supine; all p < 0.01). Peak HR decreased progressively from upright to semi-supine to supine (186 ± 11 vs. 176 ± 13 vs. 169 ± 12 bpm; all p < 0.05). Peak SV and CO were lower in supine relative to semi-supine and upright (82 ± 22 vs. 92 ± 26 vs. 91 ± 24 ml and 14 ± 3 vs. 16 ± 4 vs. 17 ± 4 l/min; all p < 0.01), but not different between semi-supine and upright. CONCLUSION VO2max is progressively reduced in reclined postures. Thus, posture should be considered when comparing VO2max results between different testing modalities.
Collapse
Affiliation(s)
- Hayley T Dillon
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Christophe Dausin
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Guido Claessen
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Anniina Lindqvist
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Amy Mitchell
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Leah Wright
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - André La Gerche
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.,National Centre for Sports Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Erin J Howden
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia.
| |
Collapse
|
5
|
Exercise cardiovascular magnetic resonance: feasibility and development of biventricular function and great vessel flow assessment, during continuous exercise accelerated by Compressed SENSE: preliminary results in healthy volunteers. Int J Cardiovasc Imaging 2020; 37:685-698. [PMID: 33011851 PMCID: PMC7900338 DOI: 10.1007/s10554-020-02044-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022]
Abstract
Purpose Exercise cardiovascular magnetic resonance (Ex-CMR) typically requires complex post-processing or transient exercise cessation, decreasing clinical utility. We aimed to demonstrate the feasibility of assessing biventricular volumes and great vessel flow during continuous in-scanner Ex-CMR, using vendor provided Compressed SENSE (C-SENSE) sequences and commercial analysis software (Cvi42). Methods 12 healthy volunteers (8-male, age: 35 ± 9 years) underwent continuous supine cycle ergometer (Lode-BV) Ex-CMR (1.5T Philips, Ingenia). Free-breathing, respiratory navigated C-SENSE short-axis cines and aortic/pulmonary phase contrast magnetic resonance (PCMR) sequences were validated against clinical sequences at rest and used during low and moderate intensity Ex-CMR. Optimal PCMR C-SENSE acceleration, C-SENSE-3 (CS3) vs C-SENSE-6 (CS6), was further investigated by image quality scoring. Intra-and inter-operator reproducibility of biventricular and flow indices was performed. Results All CS3 PCMR image quality scores were superior (p < 0.05) to CS6 sequences, except pulmonary PCMR at moderate exercise. Resting stroke volumes from clinical PCMR sequences correlated stronger with CS3 than CS6 sequences. Resting biventricular volumes from CS3 and clinical sequences correlated very strongly (r > 0.93). During Ex-CMR, biventricular end-diastolic volumes (EDV) remained unchanged, except right-ventricular EDV decreasing at moderate exercise. Biventricular ejection-fractions increased at each stage. Exercise biventricular cine and PCMR stroke volumes correlated very strongly (r ≥ 0.9), demonstrating internal validity. Intra-observer reproducibility was excellent, co-efficient of variance (COV) < 10%. Inter-observer reproducibility was excellent, except for resting right-ventricular, and exercise bi-ventricular end-systolic volumes which were good (COV 10–20%). Conclusion Biventricular function, aortic and pulmonary flow assessment during continuous Ex-CMR using CS3 sequences is feasible, reproducible and analysable using commercially available software.
Collapse
|
6
|
Craven TP, Tsao CW, La Gerche A, Simonetti OP, Greenwood JP. Exercise cardiovascular magnetic resonance: development, current utility and future applications. J Cardiovasc Magn Reson 2020; 22:65. [PMID: 32907587 PMCID: PMC7488086 DOI: 10.1186/s12968-020-00652-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 07/01/2020] [Indexed: 12/23/2022] Open
Abstract
Stress cardiac imaging is the current first line investigation for coronary artery disease diagnosis and decision making and an adjunctive tool in a range of non-ischaemic cardiovascular diseases. Exercise cardiovascular magnetic resonance (Ex-CMR) has developed over the past 25 years to combine the superior image qualities of CMR with the preferred method of exercise stress. Presently, numerous exercise methods exist, from performing stress on an adjacent CMR compatible treadmill to in-scanner exercise, most commonly on a supine cycle ergometer. Cardiac conditions studied by Ex-CMR are broad, commonly investigating ischaemic heart disease and congenital heart disease but extending to pulmonary hypertension and diabetic heart disease. This review presents an in-depth assessment of the various Ex-CMR stress methods and the varied pulse sequence approaches, including those specially designed for Ex-CMR. Current and future developments in image acquisition are highlighted, and will likely lead to a much greater clinical use of Ex-CMR across a range of cardiovascular conditions.
Collapse
Affiliation(s)
- Thomas P Craven
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Connie W Tsao
- Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RW-453, Boston, MA, 02215, USA
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia
- National Centre for Sports Cardiology, St Vincent's Hospital, Fitzroy, Australia
| | | | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
7
|
Chew PG, Swoboda PP, Ferguson C, Garg P, Cook AL, Ibeggazene S, Brown LAE, Craven TP, Foley JR, Fent GJ, Saunderson CE, Higgins DM, Plein S, Birch KM, Greenwood JP. Feasibility and reproducibility of a cardiovascular magnetic resonance free-breathing, multi-shot, navigated image acquisition technique for ventricular volume quantification during continuous exercise. Quant Imaging Med Surg 2020; 10:1837-1851. [PMID: 32879861 DOI: 10.21037/qims-20-117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Cardiovascular magnetic resonance (CMR) image acquisition techniques during exercise typically requires either transient cessation of exercise or complex post-processing, potentially compromising clinical utility. We evaluated the feasibility and reproducibility of a navigated image acquisition method for ventricular volumes assessment during continuous physical exercise. Methods Ten healthy volunteers underwent supine cycle ergometer (Lode) exercise CMR on two separate occasions using a free-breathing, multi-shot, navigated, balanced steady-state free precession cine pulse sequence. Images were acquired at 3-stages, baseline and during steady-state exercise at 55% and 75% maximal heart rate (HRmax), based on a prior supine cardiopulmonary exercise test. Intra-and inter-observer variability and inter-scan reproducibility were derived. Clinical feasibility was tested in a separate cohort of patients with severe mitral regurgitation (n=6). Results End-diastolic volume (EDV) of both LV and RV decreased during exercise at 55% and 75% HRmax, although a reduction in RVEDV index was only observed at 75% HRmax. Ejection fractions (EF) for both ventricles were significantly higher at 75% HRmax compared to their respective baselines (LVEF 68%±3% vs. 58%±5%, P=0.001; RVEF 66%±4% vs. 58%±7%, P=0.02). Intra-observer and inter-observer reproducibility of LV parameters was excellent at all 3-stages. Although measurements of RVESV were more variable during exercise, the reproducibility of both RVEF and RV cardiac index was excellent (CV <10%). Inter-scan LV and RV ejection fraction were highly reproducible at all 3 stages, although inter-scan reproducibility of indexed RVESV was only moderate. The protocol was well tolerated by all patients. Conclusions Exercise CMR using a free-breathing, multi-shot, navigated cine imaging method allows simultaneous assessment of left and right ventricular volumes during continuous exercise. Intra- and inter-observer reproducibility were excellent. Inter-scan LV and RV ejection fraction were also highly reproducible.
Collapse
Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Carrie Ferguson
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Abigail L Cook
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Said Ibeggazene
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Louise A E Brown
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Thomas P Craven
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James R Foley
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Graham J Fent
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Christopher E Saunderson
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Karen M Birch
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
8
|
Forbregd TR, Aloyseus MA, Berg A, Greve G. Cardiopulmonary Capacity in Children During Exercise Testing: The Differences Between Treadmill and Upright and Supine Cycle Ergometry. Front Physiol 2019; 10:1440. [PMID: 31849698 PMCID: PMC6897055 DOI: 10.3389/fphys.2019.01440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/07/2019] [Indexed: 11/30/2022] Open
Abstract
Background/Hypothesis: Cardiopulmonary exercise testing (CPET) is used in the assessment of function and prognosis of cardiopulmonary health in children with cardiac and pulmonary diseases. Techniques, such as cardiac MRi, and PET-scan, can be performed simultaneously with exercise testing. Thus, it is desirable to have a broader knowledge about children’s normal cardiopulmonary function in different body postures and exercise modalities. The aim of this study was to investigate the effect of different body positions on cardiopulmonary function in healthy subjects performing CPETs. Materials and Methods: Thirty-one healthy children aged 9, 12, and 15 years did four CPETs: one treadmill test with a modified Bruce protocol and three different bicycle tests with different body postures, sitting, tilted 45°, and lying flat (0°). For the bicycle tests, a 20-watt ramp protocol with a pedal frequency of 60 ± 5 rotations per minute was used. Continous ECG and breath-by-breath V.O2 measurements was done throughout the tests. Cardiac structure and function including aortic diameter were evaluated by transthoracic echocardiography prior to the tests. Doppler measurements of the blood velocity in the ascending aorta were measured prior to and during the test. Prior to every test, the participants performed pulmonary function tests with maximum voluntary ventilation test. Results: There is a significantly (p < 0.05) lower peak V.O2 in all bicycle tests compared with the treadmill test. There is lower corrected peak V.O2 (ml kg−0.67 min−1), but not relative peak V.O2 (ml kg−1 min−1), in the supine compared with the upright bicycle test. There are no differences in peak stroke volume or cardiac output between the bicycle modalities when calculated from aortic blood flow. Peak heart rate decreases from both treadmill to upright bicycle and from upright bicycle to the supine test (0°). Conclusion: There are no differences in peak cardiac output between the upright bicycle test and supine bicycle tests. Heart rate and corrected peak V.O2 are lower in the supine test (0°) than the upright bicycle test. In the treadmill test, it is a higher absolute and relative peak V.O2. Despite the latter differences, we are convinced that both upright and supine bicycle tests are apt in the clinical setting when needed.
Collapse
Affiliation(s)
| | | | - Ansgar Berg
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescents Medicine, Haukeland University Hospital, Bergen, Norway
| | - Gottfried Greve
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Diseases, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
9
|
Kim BJ, Kim Y, Oh J, Jang J, Kang SM. Characteristics and Safety of Cardiopulmonary Exercise Testing in Elderly Patients with Cardiovascular Diseases in Korea. Yonsei Med J 2019; 60:547-553. [PMID: 31124338 PMCID: PMC6536393 DOI: 10.3349/ymj.2019.60.6.547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Clinical use of cardiopulmonary exercise tests (CPETs) is increasing in elderly patients with cardiovascular (CV) diseases. However, data on Korean populations are limited. In this study, we aimed to examine the characteristics and safety of CPET in an elderly Korean population with CV disease. MATERIALS AND METHODS We retrospectively analyzed records of 1485 patients (older than 65 years in age, with various underlying CV diseases) who underwent CPET. All CPET was performed using the modified Bruce ramp protocol. RESULTS The mean age of patients was 71.6±4.7 years with 63.9% being men, 567 patients aged 60-65 years, 818 patients aged 70-79 years, and 100 patients aged 80-89 years. The mean respiratory exchange ratio was 1.09±0.14. During CPET, three adverse cardiovascular events occurred (total 0.20%), all ventricular tachycardia. All subjects showed an average exercise capacity of 21.3±5.5 mL/kg/min at peak VO₂ and 6.1±1.6 metabolic equivalents of task, and men showed better exercise capacity than women on most CEPT parameters. A significant difference was seen in peak oxygen uptake according to age group (65-69 years, 22.9±5.8; 70-79 years, 20.7±5.1; 80-89 years, 17.0±4.5 mL/kg/min, p<0.001). The most common causes for CPET termination were dyspnea (64.8%) and leg pain (24.3%), with higher incidence of leg pain in octogenarians compared to other age groups (65-69 years, 22.4%; 70-79 years, 24.6%; 80-89 years, 32.0%, p<0.001). CONCLUSION CPET was relatively a safe and useful modality to assess exercise capacity, even in an elderly Korean population with underlying CV diseases.
Collapse
Affiliation(s)
- Bong Joon Kim
- Cardiology Division, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Youngju Kim
- Cardiology Division, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewon Oh
- Cardiology Division, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jihun Jang
- Cardiology Division, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Min Kang
- Cardiology Division, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
10
|
Cade WT, Bohnert KL, Reeds DN, Peterson LR, Bittel AJ, Bashir A, Byrne BJ, Taylor CL. Peak oxygen uptake (VO2peak) across childhood, adolescence and young adulthood in Barth syndrome: Data from cross-sectional and longitudinal studies. PLoS One 2018; 13:e0197776. [PMID: 29795646 PMCID: PMC5967725 DOI: 10.1371/journal.pone.0197776] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/04/2018] [Indexed: 11/19/2022] Open
Abstract
Barth syndrome (BTHS) is an ultra-rare, X-linked recessive disorder characterized by cardio-skeletal myopathy, exercise intolerance, and growth delay. Oxygen uptake during peak exercise (VO2peak) has been shown to be severely limited in individuals with BTHS however; the trajectory of VO2peak from childhood to young adulthood is unknown. The objective of this study was to describe VO2peak from childhood through young adulthood in BTHS. METHODS AND MATERIALS VO2peak over time was presented through cross-sectional (n = 33 participants) and a longitudinal analyses (n = 12 participants). Retrospective data were obtained through maximal exercise testing on a cycle ergometer from individuals with BTHS who were or are currently enrolled in a research study during July 2006-September 2017. Participants included in the cross-sectional analysis were divided into 3 groups for analysis: 1) children (n = 13), 2) adolescents (n = 8), and 3) young adults (n = 12). Participants in the longitudinal analysis had at least two exercise tests over a span of 2-9 years. RESULTS VO2peak relative to body weight (ml/kgBW/min), fat-free mass (FFM) and by percent of predicted VO2peak obtained were not significantly different between children, adolescents and young adults. VO2peak did not longitudinally change over a mean time of ~5 years in late adolescent and young adult participants with repeated tests. A model including both cardiac and skeletal muscle variables best predicted VO2peak. CONCLUSIONS In conclusion, VO2peak relative to body weight and fat-free mass demonstrates short- and long-term stability from childhood to young adulthood in BTHS with some variability among individuals.
Collapse
Affiliation(s)
- William Todd Cade
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Kathryn L. Bohnert
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Dominic N. Reeds
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Linda R. Peterson
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Adam J. Bittel
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Adil Bashir
- Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama, United States of America
| | - Barry J. Byrne
- Department of Pediatrics, University of Florida, Gainesville, Florida, United States of America
| | - Carolyn L. Taylor
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| |
Collapse
|
11
|
Faulkner J, Stoner L, Grigg R, Fryer S, Stone K, Lambrick D. Acute effects of exercise posture on executive function in transient ischemic attack patients. Psychophysiology 2017; 54:1239-1248. [DOI: 10.1111/psyp.12868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- James Faulkner
- Department of Sport and Exercise; University of Winchester; Winchester United Kingdom
| | - Lee Stoner
- School of Sport and Exercise; Massey University; Wellington New Zealand
- Department of Exercise and Sport Science; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Rebecca Grigg
- School of Sport and Exercise; Massey University; Wellington New Zealand
| | - Simon Fryer
- School of Sport and Exercise; University of Gloucestershire; Gloucester United Kingdom
| | - Keeron Stone
- School of Sport and Exercise; University of Gloucestershire; Gloucester United Kingdom
| | - Danielle Lambrick
- School of Health and Life Sciences; University of Southampton; Southampton United Kingdom
| |
Collapse
|
12
|
Le TT, Bryant JA, Ting AE, Ho PY, Su B, Teo RCC, Gan JSJ, Chung YC, O'Regan DP, Cook SA, Chin CWL. Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017. [PMID: 28110638 DOI: 10.1186/s12968-0170322-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (ExCMR) has great potential for clinical use but its development has been limited by a lack of compatible equipment and robust real-time imaging techniques. We developed an exCMR protocol using an in-scanner cycle ergometer and assessed its performance in differentiating athletes from non-athletes. METHODS Free-breathing real-time CMR (1.5T Aera, Siemens) was performed in 11 athletes (5 males; median age 29 [IQR: 28-39] years) and 16 age- and sex-matched healthy volunteers (7 males; median age 26 [interquartile range (IQR): 25-33] years). All participants underwent an in-scanner exercise protocol on a CMR compatible cycle ergometer (Lode BV, the Netherlands), with an initial workload of 25W followed by 25W-increment every minute. In 20 individuals, exercise capacity was also evaluated by cardiopulmonary exercise test (CPET). Scan-rescan reproducibility was assessed in 10 individuals, at least 7 days apart. RESULTS The exCMR protocol demonstrated excellent scan-rescan (cardiac index (CI): 0.2 ± 0.5L/min/m2) and inter-observer (ventricular volumes: 1.2 ± 5.3mL) reproducibility. CI derived from exCMR and CPET had excellent correlation (r = 0.83, p < 0.001) and agreement (1.7 ± 1.8L/min/m2). Despite similar values at rest (P = 0.87), athletes had increased exercise CI compared to healthy individuals (at peak exercise: 12.2 [IQR: 10.2-13.5] L/min/m2 versus 8.9 [IQR: 7.5-10.1] L/min/m2, respectively; P < 0.001). Peak exercise CI, where image acquisition lasted 13-17 s, outperformed that at rest (c-statistics = 0.95 [95% confidence interval: 0.87-1.00] versus 0.48 [95% confidence interval: 0.23-0.72], respectively; P < 0.0001 for comparison) in differentiating athletes from healthy volunteers; and had similar performance as VO2max (c-statistics = 0.84 [95% confidence interval = 0.62-1.00]; P = 0.29 for comparison). CONCLUSIONS We have developed a novel in-scanner exCMR protocol using real-time CMR that is highly reproducible. It may now be developed for clinical use for physiological studies of the heart and circulation.
Collapse
Affiliation(s)
- Thu-Thao Le
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
| | - Jennifer Ann Bryant
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Alicia Er Ting
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Pei Yi Ho
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Boyang Su
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | | | | | | | | | - Stuart A Cook
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
| | - Calvin Woon-Loong Chin
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
13
|
Le TT, Bryant JA, Ting AE, Ho PY, Su B, Teo RCC, Gan JSJ, Chung YC, O’Regan DP, Cook SA, Chin CWL. Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:7. [PMID: 28110638 PMCID: PMC5256575 DOI: 10.1186/s12968-017-0322-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/06/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (ExCMR) has great potential for clinical use but its development has been limited by a lack of compatible equipment and robust real-time imaging techniques. We developed an exCMR protocol using an in-scanner cycle ergometer and assessed its performance in differentiating athletes from non-athletes. METHODS Free-breathing real-time CMR (1.5T Aera, Siemens) was performed in 11 athletes (5 males; median age 29 [IQR: 28-39] years) and 16 age- and sex-matched healthy volunteers (7 males; median age 26 [interquartile range (IQR): 25-33] years). All participants underwent an in-scanner exercise protocol on a CMR compatible cycle ergometer (Lode BV, the Netherlands), with an initial workload of 25W followed by 25W-increment every minute. In 20 individuals, exercise capacity was also evaluated by cardiopulmonary exercise test (CPET). Scan-rescan reproducibility was assessed in 10 individuals, at least 7 days apart. RESULTS The exCMR protocol demonstrated excellent scan-rescan (cardiac index (CI): 0.2 ± 0.5L/min/m2) and inter-observer (ventricular volumes: 1.2 ± 5.3mL) reproducibility. CI derived from exCMR and CPET had excellent correlation (r = 0.83, p < 0.001) and agreement (1.7 ± 1.8L/min/m2). Despite similar values at rest (P = 0.87), athletes had increased exercise CI compared to healthy individuals (at peak exercise: 12.2 [IQR: 10.2-13.5] L/min/m2 versus 8.9 [IQR: 7.5-10.1] L/min/m2, respectively; P < 0.001). Peak exercise CI, where image acquisition lasted 13-17 s, outperformed that at rest (c-statistics = 0.95 [95% confidence interval: 0.87-1.00] versus 0.48 [95% confidence interval: 0.23-0.72], respectively; P < 0.0001 for comparison) in differentiating athletes from healthy volunteers; and had similar performance as VO2max (c-statistics = 0.84 [95% confidence interval = 0.62-1.00]; P = 0.29 for comparison). CONCLUSIONS We have developed a novel in-scanner exCMR protocol using real-time CMR that is highly reproducible. It may now be developed for clinical use for physiological studies of the heart and circulation.
Collapse
Affiliation(s)
- Thu-Thao Le
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Jennifer Ann Bryant
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Alicia Er Ting
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Pei Yi Ho
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | - Boyang Su
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
| | | | | | | | | | - Stuart A. Cook
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart and Lung Institute, Imperial College, London, UK
| | - Calvin Woon-Loong Chin
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609 Singapore
- Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
14
|
Evans RA, Dolmage TE, Robles PG, Brooks D, Goldstein RS. The effects of exercise modality and intensity on energy expenditure and cardiorespiratory response in adults with obesity and treated obstructive sleep apnoea. Chron Respir Dis 2016; 14:342-351. [PMID: 27075360 DOI: 10.1177/1479972316643699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
To inform recommendations for the exercise component of a healthy lifestyle intervention for adults with obesity and treated obstructive sleep apnoea (OSA), we investigated the total energy expenditure (EE) and cardiorespiratory response to weight-supported (cycling) and unsupported (walking) exercise. Individuals with treated OSA and a body mass index (BMI) > 30 kg/m2 performed an incremental cardiopulmonary exercise test on a cycle ergometer and a treadmill to determine the peak oxygen uptake [Formula: see text]. Participants subsequently completed two endurance tests on each modality, matched at 80% and 60% of the highest [Formula: see text] determined by the incremental tests, to intolerance. The cardiorespiratory response was measured and total EE was estimated from the [Formula: see text]. Sixteen participants completed all six tests: mean [SD] age 57 [13] years and median [IQ range] BMI 33.3 [30.8-35.3] kg/m2. Total EE during treadmill walking was greater than cycling at both high (158 [101] vs. 29 [15] kcal; p < 0.001) and moderate (178 [100] vs. 85 [59] kcal; p = 0.002) intensities, respectively, with similar cardiorespiratory responses and pattern of EE during rest, exercise and recovery. Contrary to current guidelines, walking might be the preferred training modality to achieve the combination of weight loss and increased cardiorespiratory fitness in adults with obesity and treated OSA.
Collapse
Affiliation(s)
- Rachael A Evans
- 1 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada.,2 Department of Infection, immunity and Inflammation, University of Leicester, Leicester, UK.,3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas E Dolmage
- 1 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada.,4 Department of Respiratory Diagnostic and Evaluation Services, West Park Healthcare Centre, Toronto, Canada
| | - Priscila G Robles
- 1 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada.,5 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- 1 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada.,5 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Roger S Goldstein
- 1 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Canada.,3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,4 Department of Respiratory Diagnostic and Evaluation Services, West Park Healthcare Centre, Toronto, Canada.,5 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Takahashi T, Yamada S, Tanabe K, Nakayama M, Osada N, Itoh H, Murayama M. The effects of posture on the ventilatory responses during exercise. JOURNAL OF THE JAPANESE PHYSICAL THERAPY ASSOCIATION 2015; 1:13-7. [PMID: 25792876 DOI: 10.1298/jjpta.1.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/1997] [Accepted: 12/20/1997] [Indexed: 11/23/2022]
Abstract
This study was undertaken to evaluate the postural effect on ventilatory responses during both supine and sitting exercise. Seven healthy men performed two exercise tests utilizing the ramp protocol (20 watts/min) with a cycle ergometer in each position. The results were as follows: The oxygen uptake and the oxygen pulse measured at 180 watts and at anaerobic threshold in the sitting were significantly higher compared with those in the supine position. The average of carbon-dioxide output, minute ventilation and tidal volume at lower exercise intensities showed higher values in the sitting compared with those in the supine position, whereas there were no significant differences for respiratory rate. There was significant difference in the slope of the minute ventilation to carbon-dioxide output plot between sitting and supine position. In conclusion, the higher minute ventilation in the sitting position was mainly performed by higher tidal volume which may counteract the effects of an increase in physiological dead space. The lower slope of the minute ventilation to carbon-dioxide output plot which shows more effective ventilation in the supine position may be due to decreased physiological dead space and higher diffusion capacity.
Collapse
Affiliation(s)
- T Takahashi
- Dept. of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kanagawa-ken 216, Japan
| | - S Yamada
- Dept. of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kanagawa-ken 216, Japan
| | - K Tanabe
- Dept. of 2nd Internal Medicine, St. Marianna University School of Medicine, Kanagawa-ken 216, Japan
| | - M Nakayama
- Dept. of 2nd Internal Medicine, St. Marianna University School of Medicine, Kanagawa-ken 216, Japan
| | - N Osada
- Dept. of 2nd Internal Medicine, St. Marianna University School of Medicine, Kanagawa-ken 216, Japan
| | - H Itoh
- Dept. of 2nd Internal Medicine, St. Marianna University School of Medicine, Kanagawa-ken 216, Japan
| | - M Murayama
- Dept. of 2nd Internal Medicine, St. Marianna University School of Medicine, Kanagawa-ken 216, Japan
| |
Collapse
|
16
|
Supine cycling in pediatric exercise testing: disparity in performance measures. Pediatr Cardiol 2014; 35:705-10. [PMID: 24253612 DOI: 10.1007/s00246-013-0841-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/06/2013] [Indexed: 12/11/2022]
Abstract
Supine cycling may be an important alternative modality for exercise testing. Subtle differences in supine and upright exercise physiology have been suggested but not fully explored in the pediatric population. The aim of this study was to compare peak and submaximal metabolic data in the upright and supine exercise positions. Healthy children (N = 100) performed cardiopulmonary exercise tests using supine and upright cycle ergometry. Recruitment was governed by grant funding and not based on sample size calculations. Subjects exercised to exhaustion. Paired Student's t-tests were used to compare upright and supine data; simple linear regression analyses examined correlations between the two modalities. Peak heart rate was similar in both testing positions. Although peak oxygen uptake (peak VO2), oxygen uptake at anaerobic threshold (VO2@AT), VO2 when the respiratory exchange ratio is consistently at or above 1.0 (VO2@RER1.0), and the oxygen uptake efficiency slope were significantly higher in the upright position, no difference was considered of practical significance when applying Cohen's effect size criteria. Therefore, it may be reasonable for pediatric exercise laboratories to use established normative data and predictions for upright cycling position and apply them to metabolic measures obtained in supine exercise testing. Supine cycling with submaximal parameters may allow objective assessment of exercise capacity in children who undergo exercise echocardiography or cannot perform upright exercise testing.
Collapse
|
17
|
Matsumoto T, Masuda T, Hotta K, Shimizu R, Ishii A, Kutsuna T, Yamamoto K, Hara M, Takahira N, Matsunaga A. Effects of prolonged expiration breathing on cardiopulmonary responses during incremental exercise. Respir Physiol Neurobiol 2011; 178:275-82. [PMID: 21763472 DOI: 10.1016/j.resp.2011.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 06/13/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022]
Abstract
This study was designed to clarify the effects of breathing with prolonged expiration on cardiopulmonary responses and autonomic nervous activity during incremental exercise. Eleven healthy men were randomly assigned to breathing mode: a prolonged expiration breathing with a 2-s inspired time and 4-s expired time and a spontaneous breathing without any constraints. Oxygen uptake (V(O2)), ventilation efficiency (V(E)/V(CO2)) and rate pressure product were measured. Low- (LF) and high-frequency (HF) components of blood pressure and heart rate variability were analyzed to assess sympathetic and parasympathetic nervous activities, respectively. V(E)/V(CO2), rate pressure product and LF were significantly lower, and [Formula: see text] and HF were significantly higher during exercise with prolonged expiration than with spontaneous breathing. Striking effects of prolonged expiration breathing included the improvement of ventilation efficiency, the suppression of sympathetic nervous activity and the activation of parasympathetic one during incremental exercise. Furthermore, prolonged expiration breathing may have suppressed the exercise-induced increase in myocardial V(O2).
Collapse
Affiliation(s)
- Takuya Matsumoto
- Department of Angiology and Cardiology, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Magal M, Zoeller RF. A pilot study comparing physiological responses of phase III cardiac patients to recumbent and upright exercise using the RPE scale. Percept Mot Skills 2005; 100:357-61. [PMID: 15974344 DOI: 10.2466/pms.100.2.357-361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ratings of perceived exertion (RPE) are used for exercise programming of cardiac rehabilitation patients, whenever it is difficult to use heart rate to set intensity due to medication or other factors. This investigation examined the physiological responses to two stepping exercise modes (upright and recumbent) at the same RPE. Analysis indicated significant physiological differences between the modes of exercise which may be mediated by postural differences. Specifically, the physiological responses to the recumbent exercise, but not the upright exercise, had the expected relationship with RPE, with recumbent stepping requiring less physiological effort than the upright stepping at the same RPE. As such, we cannot recommend with confidence that the prescription for upright exercise be made based on data from recumbent exercise or vice-versa.
Collapse
Affiliation(s)
- Meir Magal
- North Carolina Wesleyan College, Rocky Mount, NC 27804, USA.
| | | |
Collapse
|
19
|
Saitoh M, Matsunaga A, Kamiya K, Ogura MN, Sakamoto J, Yonezawa R, Kasahara Y, Watanabe H, Masuda T. Comparison of cardiovascular responses between upright and recumbent cycle ergometers in healthy young volunteers performing low-intensity exercise: assessment of reliability of the oxygen uptake calculated by using the ACSM metabolic equation. Arch Phys Med Rehabil 2005; 86:1024-9. [PMID: 15895352 DOI: 10.1016/j.apmr.2004.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To clarify (1) differences in cardiovascular response during low-intensity exercise in the upright versus the recumbent position, and (2) whether the oxygen uptake (V o 2 ) calculated by the American College of Sports Medicine (ACSM) metabolic equation reflects the actual V o 2 at low-intensity testing. DESIGN Repeated-measures comparison study. SETTING University research laboratory. PARTICIPANTS Thirty-one healthy, young volunteers (age, 23+/-2y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Blood pressure, rate pressure product (RPP), V o 2 , oxygen pulse, carbon dioxide output (V co 2 ), and ventilatory equivalent (V e ) were measured during graded exercise testing using upright and recumbent cycle ergometers. The estimated V o 2 was calculated by using the ACSM metabolic equation. RESULTS Systolic blood pressure, RPP, V o 2 , oxygen pulse, V co 2 , and V e at 15 or 30W were significantly higher in the recumbent position than in the upright one ( P <.05), however, no significant differences were observed at 50 and 70W. The estimated V o 2 during exercise was significantly higher than the actual one, at every level of intensity, from 15 to 70W ( P <.05). CONCLUSIONS Cardiovascular responses should be carefully monitored even during low-intensity exercise using a recumbent cycle ergometer. The V o 2 estimated using the ACSM metabolic equation did not reflect the actual V o 2 during low-intensity exercise at 70W or less.
Collapse
Affiliation(s)
- Masakazu Saitoh
- Department of Angiology and Cardiology, Graduate School of Medical Sciences, Kanagawa, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Larson JL, Covey MK, Berry J, Wirtz S, Alex CG, Matsuo M. Discontinuous incremental threshold loading test: measure of respiratory muscle endurance in patients with COPD. Chest 1999; 115:60-7. [PMID: 9925063 DOI: 10.1378/chest.115.1.60] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To assess the discontinuous incremental threshold loading (DC-ITL) test as a measure of respiratory muscle endurance for patients with COPD in terms of perceived breathing difficulty, reliability, and validity. DESIGN The DC-ITL test was repeated three times at weekly intervals under identical test conditions. SETTING Clinical research laboratory. PATIENTS Forty-eight patients with moderate to severe COPD. MEASUREMENTS AND RESULTS Rating of perceived breathing difficulty (RPBD) was measured at the end of each stage of the DC-ITL test with a Borg category-ratio scale. The maximal inspiratory pressure (PImax) was measured before and after the DC-ITL test. Breathing patterns were measured during the DC-ITL test. The mean (+/-SD) for RPBD at the maximal load was 6.3 (3.1), 6.6 (2.8), and 6.7 (2.7) for visits one, two, and three, respectively (not significant). The mean relative maximal load for the DC-ITL test (peak mouth pressure as a percent of PImax) at the last completed stage was 59+/-23%, 62+/-20%, and 63+/-19% for visits one, two, and three, respectively (not significant). Test-retest reliability was r1,2=0.82 and r2,3=0.69 for relative maximal load and r1,2=0.90 and r2,3=0.90 for absolute maximal load (peak mouth pressure). Tidal volume decreased (p < 0.01) and respiratory rate increased (p < 0.01) from the next-to-the-last to the last completed stage. PImax decreased after the DC-ITL test (p < 0.01). CONCLUSIONS Moderate breathing difficulty was experienced during the DC-ITL test. The test was reliable and the results of this study support its validity as a measure of respiratory muscle endurance.
Collapse
Affiliation(s)
- J L Larson
- Department of Medical Surgical Nursing, University of Illinois at Chicago 60612, USA.
| | | | | | | | | | | |
Collapse
|