Time courses of pulmonary gas exchange and heart rate changes in supine exercise

Elevated baseline work rate slows pulmonary oxygen uptake kinetics and decreases critical power during upright cycle exercise

Critical power is a fundamental parameter defining high-intensity exercise tolerance, and is related to the phase II time constant of pulmonary oxygen uptake kinetics (τV˙O2). Whether this relationship is causative is presently unclear. This study determined the impact of raised baseline work rate, which increases τV˙O2, on critical power during upright cycle exercise. Critical power was determined via four constant-power exercise tests to exhaustion in two conditions: (1) with exercise initiated from an unloaded cycling baseline (U→S), and (2) with exercise initiated from a baseline work rate of 90% of the gas exchange threshold (M→S). During these exercise transitions, τV˙O2 and the time constant of muscle deoxyhemoglobin kinetics (τ[HHb + Mb] ) (the latter via near-infrared spectroscopy) were determined. In M→S, critical power was lower (M→S = 203 ± 44 W vs. U→S = 213 ± 45 W, P = 0.011) and τV˙O2 was greater (M→S = 51 ± 14 sec vs. U→S = 34 ± 16 sec, P = 0.002) when compared with U→S. Additionally, τ[HHb + Mb] was greater in M→S compared with U→S (M→S = 28 ± 7 sec vs. U→S = 14 ± 7 sec, P = 0.007). The increase in τV˙O2 and concomitant reduction in critical power in M→S compared with U→S suggests a causal relationship between these two parameters. However, that τ[HHb + Mb] was greater in M→S exculpates reduced oxygen availability as being a confounding factor. These data therefore provide the first experimental evidence that τV˙O2 is an independent determinant of critical power. Keywords critical power, exercise tolerance, oxygen uptake kinetics, power-duration relationship, muscle deoxyhemoglobin kinetics, work-to-work exercise.

On issues of confidence in determining the time constant for oxygen uptake kinetics

BACKGROUND

TauVO(2 )at the onset of constant work rate (CWR) exercise is a variable of aerobic fitness that shortens with physical training and lengthens with cardiopulmonary disease. Determination of tauVO(2) with sufficiently high confidence has typically required multiple exercise transitions limiting its clinical application.

OBJECTIVES

To design a protocol to determine tauVO(2) reliably but simply.

METHODS

On each of three days, five healthy men performed two CWR tests on a cycle ergometer below the metabolic threshold (VO(2)theta) for blood lactate accumulation as determined by gas exchange measurements followed by an incremental work rate (IWR) test. TauVO(2) was determined (a) from the on-transit (on-tauVO(2)) and off-transit (off-tauVO(2)) of six CWR tests both individually and superimposed, using non-linear regression with a monoexponential model, and (b) by geometric analysis of the IWR tests (ramp-tauVO(2)).

RESULTS

Group means (SD) were: VO(2)max 3.84 (0.44) litres/min, VO(2)theta 1.88 (0.23) litres/min, steady state exercise VO(2) 1.67 (0.07) litres/min, on-tauVO(2) 38.0 (5.3) seconds, off-tauVO(2) 39.0 (4.3) seconds, and ramp-tauVO(2) 60.8 (15.4) seconds. On-tauVO(2) correlated with off-tauVO(2) (r = 0.87), VO(2)max (r = -0.73), and VO(2)theta (r = 0.89). The pooled mean tauVO(2) from six superimposed tests agreed with the arithmetic grand mean of the six tests.

CONCLUSIONS

The average of on-tauVO(2) and off-tauVO(2) fell within the 95% confidence interval of the pooled mean by the second test. Ramp-tauVO(2) was longer and less reproducible. These findings support the use of both on- and off-transit data for the determination of tauVO(2), an approach that reduces the number of transitions necessary for accurate determination of tauVO(2), potentially enhancing its clinical application.

Measurement of oxygen consumption on-kinetics during exercise: implications for patients with heart failure

Oxygen consumption (VO(2)) on-kinetics describes the rate change in oxygen uptake at the initiation of exercise. Several mathematical and graphical methods are used to assess VO(2) on-kinetics during constant-load or progressive exercise. VO(2) on-kinetics is prolonged in patients with heart failure (HF) compared with individuals who have normal cardiopulmonary function. Cardiac function has been implicated as one of the controlling mechanism for this observation. The contribution that pulmonary, vascular, and skeletal muscle function makes to delayed VO(2) on-kinetics in HF has yet to be determined. VO(2) on-kinetics also appears to have clinical value in HF, although evidence supporting this claim is limited. Questions about the controlling mechanism(s) and practical application of VO(2) on-kinetics in HF therefore remain unanswered. This report provides an overview of VO(2) on-kinetics assessment techniques, reviews research pertaining to the HF population, and provides direction for future investigations.

Kinetics of oxygen uptake during supine and upright heavy exercise

It is presently unclear how the fast and slow components of pulmonary oxygen uptake (VO(2)) kinetics would be altered by body posture during heavy exercise [i.e., above the lactate threshold (LT)]. Nine subjects performed transitions from unloaded cycling to work rates representing moderate (below the estimated LT) and heavy exercise (VO(2) equal to 50% of the difference between LT and peak VO(2)) under conditions of upright and supine positions. During moderate exercise, the steady-state increase in VO(2) was similar in the two positions, but VO(2) kinetics were slower in the supine position. During heavy exercise, the rate of adjustment of VO(2) to the 6-min value was also slower in the supine position but was characterized by a significant reduction in the amplitude of the fast component of VO(2), without a significant slowing of the phase 2 time constant. However, the amplitude of the slow component was significantly increased, such that the end-exercise VO(2) was the same in the two positions. The changes in VO(2) kinetics for the supine vs. upright position were paralleled by a blunted response of heart rate at 2 min into exercise during supine compared with upright heavy exercise. Thus the supine position was associated with not only a greater amplitude of the slow component for VO(2) but also, concomitantly, with a reduced amplitude of the fast component; this latter effect may be due, at least in part, to an attenuated early rise in heart rate in the supine position.

Kinetics of pulmonary gas exchange during and while recovering from exercise in patients after anterior myocardial infarction

The effect of exercise intensity on gas exchange kinetics was investigated during exercise and recovery, as well as the relationship between the kinetics during exercise and recovery. Twenty-three patients with a history of anterior myocardial infarction performed low-intensity (38.7+/-8.3 W) and high-intensity (68.8+/-15.0 W) exercise for 6 min. The time constants of oxygen uptake (VO2), carbon dioxide output (VCO2) and minute ventilation (VE) were significantly prolonged during high intensity exercise compared with low-intensity exercise (61.2+/-8.6 vs 52.3+/-10.3 s, p<0.005 for the time constant of VO2). The time constant of VO2 was similar during exercise and during recovery from exercise of high (61.2+/-8.6 vs 66.2+/-12.2 s) as well as low intensity (52.3+/-10.3 vs 55.0+/-10.1 s). However, the time constants of VCO2 and heart rate were significantly shorter during recovery than during exercise. The time constants of VCO2 and VE were significantly longer than that of VO2 during both exercise and recovery. In the present study, it was found that (1) the gas exchange kinetics were influenced by the intensity of exercise; (2) the kinetics during recovery did not necessarily reflect the kinetics during exercise except for VO2; and (3) the kinetics of VCO2 and VE were delayed as compared with the VO2 kinetics. These characteristics should be taken into account when using gas exchange kinetics to estimate cardiopulmonary responses to exercise in patients with left ventricular dysfunction.

Alveolar oxygen uptake and femoral artery blood flow dynamics in upright and supine leg exercise in humans

We tested the hypothesis that the slower increase in alveolar oxygen uptake (VO2) at the onset of supine, compared with upright, exercise would be accompanied by a slower rate of increase in leg blood flow (LBF). Seven healthy subjects performed transitions from rest to 40-W knee extension exercise in the upright and supine positions. LBF was measured continuously with pulsed and echo Doppler methods, and VO2 was measured breath by breath at the mouth. At rest, a smaller diameter of the femoral artery in the supine position (P < 0. 05) was compensated by a greater mean blood flow velocity (MBV) (P < 0.05) so that LBF was not different in the two positions. At the end of 6 min of exercise, femoral artery diameter was larger in the upright position and there were no differences in VO2, MBV, or LBF between upright and supine positions. The rates of increase of VO2 and LBF in the transition between rest and 40 W exercise, as evaluated by the mean response time (time to 63% of the increase), were slower in the supine [VO2 = 39.7 +/- 3.8 (SE) s, LBF = 27.6 +/- 3.9 s] than in the upright positions (VO2 = 29.3 +/- 3.0 s, LBF = 17.3 +/- 4.0 s; P < 0.05). These data support our hypothesis that slower increases in alveolar VO2 at the onset of exercise in the supine position are accompanied by a slower increase in LBF.

Ventilatory and gas exchange response during walking in severe peripheral vascular disease

It has long been recognized that at the onset of a dynamic muscular exercise the ventilatory and the circulatory (blood flow) responses appear to be matched, thereby maintaining arterial blood gas homeostasis. Such a coupling has recently been suggested to rely upon ventilatory reflex triggered by mechanoreceptors encoding changes in muscle blood flow or, more likely, blood volume. The aim of this study was to investigate whether patients with severe peripheral blood flow limitation to the lower extremities have a normal ventilatory response during a light intensity exercise. The ventilatory and gas exchange temporal response characteristics were studied during a 6 min walking test in seven patients with severe ischemic peripheral vascular disease and in six normal age-matched subjects. The magnitude of the overall ventilatory and Vo2 increment at the end of the tests was similar in both groups. However, in contrast to the control subjects, who presented an almost rectangular response, the patients had a considerably slowed response dynamics (t50 = 33 +/- 4 vs. 9 +/- 3 sec for Vo2 and 37 +/- 5 vs. 10 +/- 8 sec for VE) with a dramatic reduction in the magnitude of the initial 20 sec of the responses. Although the slow Vo2 dynamics in patients presumably reflected the impeded perfusion of the working muscles. the accompanying sluggishness of the V1 course implies that either muscular ischemia actually inhibits ventilatory response to exercise or, more likely, that this response is strongly linked to the magnitude of the hyperemia in the exercising muscles.

Blood pressure and heart rate during rest-exercise and exercise-rest transitions

The transients of mean arterial blood pressure (BPa) and heart rate (fc) during rest-exercise and exercise-rest transitions have been studied in six healthy sport students. After 5 min of rest in an upright position on a cycle ergometer they exercised for 15 min and remained seated for a further 5 min. The subjects exercised at four different constant intensities (40 W, 80 W, 120 W, 160 W) in random order separated by at least 24 h. The BPa was determined by a noninvasive and continuous method. During the first minute of exercise, three phases of response could be distinguished, with the first two showing no clear relationship to intensity. Phase 1 consisted of simultaneous increases in both fc and BP during the first 6 s. In phase 2, BPa decreased while fc continued to increase. During phase 3, BPa and fc approximated constant values or a linear increase. Both parameters showed no comparable intensity-independent reactions during the off-transients. In conclusion, during the first 15 s of rest-exercise transitions there seems to be a fast and uniform cardiovascular drive which overrode other influences on fc.

Influence of body position and pre-exercise activity on cardiac output and oxygen uptake following step changes in exercise intensity

Parallel measurements of breath-by-breath oxygen uptake, cardiac output (Doppler technique), blood pressure (Finapres technique) and heart rate were performed in nine subjects during cycle ergometer exercise in the upright and supine positions. Transients were monitored during power steps starting from and leading to either rest or lower levels of exercise intensity. Oxygen uptake (VO2) and cardiac output kinetics were markedly faster than in all other conditions when exercise was started from rest. In contrast to exercise-exercise on steps, the computed arteriovenous difference in O2 content increased almost immediately in this situation, indicating that not only the additional energy expenditure due to the acceleration of the flywheel but also an increased venous admixture from non-exercising parts of the body contributed to the early kinetics. The off kinetics generally showed a more uniform pattern and did not simply mirror the on transients. The present findings indicate that transitions from rest should be avoided when muscle VO2 kinetics are to be assessed on the basis of VO2 measurements at the mouth.

Kinetics of ventilation and gas exchange during supine and upright cycle exercise

The dynamics of ventilation (VE), oxygen uptake (VO2), carbon dioxide output (VCO2), and heart rate (fc) were studied in 12 healthy young men during upright and supine exercise. Responses to maximal and to two different types of submaximal exercise tests were contrasted. During incremental exercise to exhaustion, the maximal work rate, VO2max, VEmax, fc,max, and ventilatory threshold were all significantly reduced in supine compared to upright exercise (P less than 0.01-0.001). Following step increases or decreases in work rate between 25 W and 105 W, both VO2 and VCO2 responded more slowly in supine than upright exercise. Dynamics were also studied in two different pseudorandom binary-sequence (PRBS) exercise tests, with the work rate varying between 25 W and 105 W with either 5-s or 30-s durations of each PRBS unit. In both of these tests, there were no differences caused by body position in the amplitude or phase shifts obtained from Fourier analysis for any observed variable. These data show that the body position alters the dynamic response to the more traditional step increase in work rate, but not during PRBS exercise. It is speculated that the elevation of cardiac output observed with supine exercise in combination with the continuously varying work-rate pattern of the PRBS exercise allowed adequate, perhaps near steady-state, perfusion of the working muscles in these tests, whereas at the onset of a step increase in work rate, greater demands were placed on the mechanisms of blood flow redistribution.

The role of fitness on VO2 and VCO2 kinetics in response to proportional step increases in work rate

The purpose of this study was to determine the effect of fitness and work level on the O2 uptake and CO2 output kinetics when the increase in work rate step is adjusted to the subject's maximum work capacity. Nine normal male subjects performed progressive incremental cycle ergometer exercise tests in 3-min steps to their maximum tolerance. The work rate step size was selected so that the symptom-limited maximum work rate would be reached in four steps at 12 min in all subjects. Oxygen consumption (VO2) and carbon dioxide production (VCO2) were calculated breath by breath. For the group, the time (mean, SEM) to reach 75% of the 3-min response (T0.75) for VO2 increased significantly (P less than 0.01) at progressively higher work rate steps, being 53.3 (5.5) s, 63.5 (4.6) s, 79.5 (5.0) s, and 94.5 (5.8) s, respectively. In contrast, T0.75 for VCO2 did not change significantly [74.9 (7.4) s, 75.6 (5.0) s, 85.1 (5.3) s, and 89.4 (6.3) s, respectively]. VCO2 kinetics were slower than VO2 kinetics at the low fractions of the subjects' work capacities but were the same or faster at the high fractions because of the slowing of VO2 kinetics. The first step showed the fastest rise in VO2. While VO2 kinetics slowed at each step, they were faster at each fraction of the work capacity in the fitter subjects. The step pattern in VO2 disappeared at high work rates for the less fit subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence that diffusion limitation determines oxygen uptake kinetics during exercise in humans

To determine the role of arterial O2 content on the mechanism of muscle O2 utilization, we studied the effect of 2, 11, and 20% carboxyhemoglobin (COHb) on O2 uptake (VO2), and CO2 output (VCO2) kinetics in response to 6 min of constant moderate- and heavy-intensity cycle exercise in 10 subjects. Increased COHb did not affect resting heart rate, VO2 or VCO2. Also, the COHb did not affect the asymptotic VO2 in response to exercise. However, VO2 and VCO2 kinetics were affected differently. The time constant (TC) of VO2 significantly increased with increased COHb for both moderate and heavy work intensities. VO2 TC was positively correlated with blood lactate. In contrast, VCO2 TC was negatively correlated with increased COHb for the moderate but unchanged for the heavy work intensity. The gas exchange ratio reflected a smaller increase in CO2 stores and faster VCO2 kinetics relative to VO2 with increased COHb. These changes can be explained by compensatory cardiac output (heart rate) increase in response to reduced arterial O2 content. The selective slowing of VO2 kinetics, with decreased blood O2 content and increased cardiac output, suggests that O2 is diffusion limited at the levels of exercise studied.

Dynamics and dimensions of cardiac output changes in humans at the onset and at the end of moderate rhythmic exercise

1. An improved Doppler ultrasound technique was used to measure stroke volume (SV) and cardiac output (CO) on a beat-to-beat basis in a group of supine humans before, during and after periods of standardized, rhythmic exercise, involving the quadriceps muscle groups on both sides. The development of CO on such bouts of exercise was compared to Doppler ultrasound records of the simultaneous femoral arterial flow (FF) response. 2. Records of CO at rest revealed spontaneous fluctuations around a mean level, with differences between the minimal and maximal values of the order of 1 l min-1. The mean CO level at rest again varied considerably from one day to another and from test run to test run. 3. Upon start of exercise an immediate and rapid increase in heart rate (HR) and CO took place. The entire increase, the size of which varied appreciably from test run to test run, was completed within 10-15 s. No or only minor changes were seen in the mean SV level during the exercise periods. 4. The time course of the increase in FF was indistinguishable from that of the increase in CO, which occurred without any detectable delay relative to the changes in FF. These closely parallel developments indicate a tight regulatory coupling between the two types of flow changes. 5. In the majority of tests the total and two-sided increase in FF seen in the steady-state situation in the last part of an exercise period was significantly larger than the recorded increase in CO. This discrepancy implies that some redistribution of flow from tissues other than the working muscles might take place, even at this moderate level of work. 6. Upon the end of exercise a striking but transient increase in CO occurred, resulting from an increase in SV concomitant with a maintained HR. In the course of five to eight post-exercise cardiac cycles about 100 extra milliliters of blood were expelled from the heart. This cardiac outflow overshoot was found to occur during a post-exercise fall in mean arterial blood pressure (MAP).

The effect of treadmill speed on ventilation at the start of exercise in man

1. The change in ventilation at the start of exercise was determined during both hyperoxic rebreathing and air breathing in four volunteers. 2. In order to differentiate between the effects of limb-movement frequency and exercise load in terms of oxygen uptake, three treadmill exercises were tested: E1, at an oxygen uptake of 1 l/min on a level treadmill; E2, at 2 l/min on an inclined treadmill at the same speed as E1; E3, at 2 l/min on a level treadmill at a higher speed. All of the exercises were performed at a walking pace. 3. Prior to rebreathing, hyperventilation for 5 min to 20 mmHg was used to reduce carbon dioxide to below the central chemoreceptor threshold. From eleven to fourteen rebreathing experiments were done on each volunteer for each of the three exercises, with the treadmill started at carbon dioxide levels which ranged from 36 (below threshold) to 58 mmHg (above threshold). 4. Ten experiments were performed on each volunteer for each of the three exercises during air breathing, with the treadmill started after 5 min of rest. 5. In both the rebreathing experiments and the air breathing experiments it was found that the change in ventilation at the start of exercise was the same for exercises E1 and E2, and significantly greater for exercise E3. 6. It was concluded that the frequency of limb movement, rather than exercise load (oxygen consumption) is a determinant of the change in ventilation at the start of exercise.

Dynamics of oxygen uptake during exercise in adults with cyanotic congenital heart disease

The dynamic increase in oxygen uptake (VO2) at the start of exercise reflects the circulatory adjustments to metabolic changes induced by the exercise. Because VO2 measured at the lungs is the product of pulmonary blood flow and arteriovenous oxygen difference, pathologic conditions affecting the capacity of these factors to change would be expected to alter VO2 kinetics. To determine whether measurement of VO2 kinetics can detect conditions in which the pulmonary blood flow response to exercise is abnormal, VO2 was measured, breath-by-breath, during the transition from rest to exercise in 13 adults with cyanotic congenital heart disease (central venoarterial shunting) and in nine normal subjects. The increase in VO2 above baseline during the first 20 sec of exercise (phase I), reflecting the immediate increase in pulmonary blood flow, was diminished in the patients compared with that in normal subjects (14.8 +/- 10.9 vs. 49.8 +/- 19.2 ml of oxygen) (p less than .001). The patients' phase I responses correlated with their reported physical activity tolerance (p less than .01). In addition, the second phase of the VO2 response kinetics was prolonged in patients compared with normal subjects (half-time = 63 +/- 13 vs 15 +/- 13 sec) (p less than .001). We conclude that striking disturbances in VO2 kinetics occur in patients with cyanotic congenital heart disease and that these measurements provide a useful noninvasive means of evaluating the degree to which the increase in pulmonary blood flow is constrained in response to exercise.

Comparison of oxygen kinetics in young and old subjects

Five older men (aged 60-69 yr) and five young men (aged 21-29 yr) with approximately equal levels of age-corrected VO2 max were compared with respect to oxygen kinetics at equal absolute workloads (100 watts) and at equal relative workloads (45% VO2 max) on a cycle ergometer. At 45% VO2 max, half times for VO2 response to instantaneous transition from unloaded pedalling were 30.0 s and 27.4 s for old and young respectively (t = 0.260, p less than 0.80). No significant differences were found in the VE response and by inference none existed in O2 extraction. Mean half times for heart rate responses at a workload of 100 W were 24.2 s and 20.6 s for old and young groups respectively (t = 0.722, p less than 0.49). Mechanical efficiency estimated from steady state data at 100 W was 19.8% and 20.5% for old and young groups respectively (t = 0.574). The close similarity in responses to submaximal work in old and young subjects of equivalent fitness suggests caution in the interpretation of agewise decrements observed in physiological variables which may be sensitive to physical fitness status.

Gas exchanges during exercise in normoxia and hyperoxia

Exercises of constant workload (90 watt) have been carried out during normoxia or hyperoxia FIO2 = 0.45). It has been shown that, in spite of a significant dispersion in the values of O2 deficit and O2 debt calculated, these values are related to the increased blood lactate level which contributes to the marked acidosis observed in both conditions of oxygenation. Hyperoxia reduces lactate level as well as the O2 debt. In addition to the significant increase in arterial [H+] and PCO2, exercise provokes a slight decrease in PO2. It is suggested that the significant variations of these humoral factors might contribute to the control of ventilation during exercise in both conditions of oxygenation.

Oxygen uptake transients at the onset and offset of arm and leg work

The halftimes (t1/2) of the VO2 on-and off-responses have been determined on 4 moderately active subjects (1) in arm cranking (VO2 congruent to 1 1/min). (2) in leg pedaling at 4 graded submaximal (VO2 congruent to 0.8 to 2.51/min) work loads, and (3) when superimposing arm cranking on preexisting leg pedaling, both in the supine and in the upright position. In supine experiments the mean t1/2 of the VO2 on-response was longer for arm cranking than for leg pedaling (64 vs 44-49 sec) at equal VO2; however, at the same percentage of arm and leg VO2 max the respective t1/2 were similar. In sitting experiments all t1/2 of the VO2 on-response were shorter than when supine, but the t1/2 for the arms were still slightly longer than those for the legs. When arm cranking was superimposed on preexisting leg pedaling, the t1/4 for arms was reduced both in supine (from 64 to 35-38 sec) and in the sitting position (from 44 to 40 sec). The halftime of the VO2 off-response were much shorter (20-32 sec) than those of the on-response and similar in all experiments. In all conditions the O2 deficits at work onset were considerably larger than the fast component of the corresponding O2 debts during the first minutes of recovery. The difference was totally accounted for by anaerobic glycolysis occurring early during the VO2 on-response, particularly in arm exercise. It is concluded that at submaximal work loads the O2 deficit is accounted for the fast component of the O2 debt plus the O2 equivalent of the early lactate production.