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Phillips DB, James MD, Vincent SG, Elbehairy AF, Neder JA, Kirby M, Ora J, Day AG, Tan WC, Bourbeau J, O'Donnell DE. Physiological Characterization of Preserved Ratio Impaired Spirometry in the CanCOLD Study: Implications for Exertional Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med 2024; 209:1314-1327. [PMID: 38170674 DOI: 10.1164/rccm.202307-1184oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/03/2024] [Indexed: 01/05/2024] Open
Abstract
Rationale: It is increasingly recognized that adults with preserved ratio impaired spirometry (PRISm) are prone to increased morbidity. However, the underlying pathophysiological mechanisms are unknown. Objectives: Evaluate the mechanisms of increased dyspnea and reduced exercise capacity in PRISm. Methods: We completed a cross-sectional analysis of the CanCOLD (Canadian Cohort Obstructive Lung Disease) population-based study. We compared physiological responses in 59 participants meeting PRISm spirometric criteria (post-bronchodilator FEV1 < 80% predicted and FEV1/FVC ⩾ 0.7), 264 control participants, and 170 ever-smokers with chronic obstructive pulmonary disease (COPD), at rest and during cardiopulmonary exercise testing. Measurements and Main Results: Individuals with PRISm had lower total lung, vital, and inspiratory capacities than healthy controls (all P < 0.05) and minimal small airway, pulmonary gas exchange, and radiographic parenchymal lung abnormalities. Compared with healthy controls, individuals with PRISm had higher dyspnea/[Formula: see text]o2 ratio at peak exercise (4.0 ± 2.2 vs. 2.9 ± 1.9 Borg units/L/min; P < 0.001) and lower [Formula: see text]o2peak (74 ± 22% predicted vs. 96 ± 25% predicted; P < 0.001). At standardized submaximal work rates, individuals with PRISm had greater Vt/inspiratory capacity (Vt%IC; P < 0.001), reflecting inspiratory mechanical constraint. In contrast to participants with PRISm, those with COPD had characteristic small airways dysfunction, dynamic hyperinflation, and pulmonary gas exchange abnormalities. Despite these physiological differences among the three groups, the relationship between increasing dyspnea and Vt%IC during cardiopulmonary exercise testing was similar. Resting IC significantly correlated with [Formula: see text]o2peak (r = 0.65; P < 0.001) in the entire sample, even after adjusting for airflow limitation, gas trapping, and diffusing capacity. Conclusions: In individuals with PRISm, lower exercise capacity and higher exertional dyspnea than healthy controls were mainly explained by lower resting lung volumes and earlier onset of dynamic inspiratory mechanical constraints at relatively low work rates. Clinical trial registered with www.clinicaltrials.gov (NCT00920348).
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Affiliation(s)
- Devin B Phillips
- School of Kinesiology and Health Science, Faculty of Health, and
- Muscle Health Research Center, York University, Toronto, Ontario, Canada
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Amany F Elbehairy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Division of Infection, Immunity, and Respiratory Medicine, The University of Manchester, and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Andrew G Day
- Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada; and
| | - Jean Bourbeau
- Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, and
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
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Aranda LC, Ribeiro IC, Freitas TO, Degani-Costa LH, Dias DS, De Angelis K, Paixão AO, Brum PC, Oliveira ASB, Vianna LC, Nery LE, Silva BM. Altered locomotor muscle metaboreflex control of ventilation in patients with COPD. J Appl Physiol (1985) 2024; 136:385-398. [PMID: 38174374 DOI: 10.1152/japplphysiol.00560.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
We investigated the locomotor muscle metaboreflex control of ventilation, circulation, and dyspnea in patients with chronic obstructive pulmonary disease (COPD). Ten patients [forced expiratory volume in 1 second (FEV1; means ± SD) = 43 ± 17% predicted] and nine age- and sex-matched controls underwent 1) cycling exercise followed by postexercise circulatory occlusion (PECO) to activate the metaboreflex or free circulatory flow to inactivate it, 2) cold pressor test to interpret whether any altered reflex response was specific to the metaboreflex arc, and 3) muscle biopsy to explore the metaboreflex arc afferent side. We measured airflow, dyspnea, heart rate, arterial pressure, muscle blood flow, and vascular conductance during reflexes activation. In addition, we measured fiber types, glutathione redox balance, and metaboreceptor-related mRNAs in the vastus lateralis. Metaboreflex activation increased ventilation versus free flow in patients (∼15%, P < 0.020) but not in controls (P > 0.450). In contrast, metaboreflex activation did not change dyspnea in patients (P = 1.000) but increased it in controls (∼100%, P < 0.001). Other metaboreflex-induced responses were similar between groups. Cold receptor activation increased ventilation similarly in both groups (P = 0.46). Patients had greater type II skeletal myocyte percentage (14%, P = 0.010), lower glutathione ratio (-34%, P = 0.015), and lower nerve growth factor (NGF) mRNA expression (-60%, P = 0.031) than controls. Therefore, COPD altered the locomotor muscle metaboreflex control of ventilation. It increased type II myocyte percentage and elicited redox imbalance, potentially producing more muscle metaboreceptor stimuli. Moreover, it decreased NGF expression, suggesting a downregulation of metabolically sensitive muscle afferents.NEW & NOTEWORTHY This study's integrative physiology approach provides evidence for a specific alteration in locomotor muscle metaboreflex control of ventilation in patients with COPD. Furthermore, molecular analyses of a skeletal muscle biopsy suggest that the amount of muscle metaboreceptor stimuli derived from type II skeletal myocytes and redox imbalance overcame a downregulation of metabolically sensitive muscle afferents.
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Affiliation(s)
- Liliane C Aranda
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Physiology, UNIFESP, São Paulo, Brazil
| | - Indyanara C Ribeiro
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Physiology, UNIFESP, São Paulo, Brazil
| | - Tiago O Freitas
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Physiology, UNIFESP, São Paulo, Brazil
| | - Luiza H Degani-Costa
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Ailma O Paixão
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Patricia C Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Lauro C Vianna
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasilia, Brasilia, Brazil
| | - Luiz E Nery
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Bruno M Silva
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Physiology, UNIFESP, São Paulo, Brazil
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3
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Kayo T, Suzuki M, Mitsuma T, Fukuda F. The effect of acupuncture on exercise capacity in patients with COPD is mediated by improvements of dyspnea and leg fatigue: a causal mediation analysis using data from a randomized controlled trial. BMC Complement Med Ther 2024; 24:44. [PMID: 38245778 PMCID: PMC10799440 DOI: 10.1186/s12906-024-04353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/13/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Acupuncture is known to improve exercise capacity in patients with chronic obstructive pulmonary disease (COPD), but its mechanism remains unknown. Whether acupuncture improves exercise capacity in patients with COPD through alleviation of leg fatigue and dyspnea is examined by applying causal mediation analysis to previous trial data. METHODS Sixty-two patients with COPD completed treatments with either real or placebo acupuncture once a week for 12 weeks. Walk distance measured using the 6-minute walk test and intensities of leg fatigue and dyspnea in the modified Borg scale were evaluated at baseline and after treatment. The intervention effect of acupuncture against the placebo acupuncture on two mediators, changes in leg fatigue and dyspnea, and whether they mediated improvements in walk distance, were analyzed. RESULTS Linear regression analysis showed that the unstandardized regression coefficients [95% confidence interval (CI)] for the intervention effect by acupuncture were -4.9 (-5.8--4.0) in leg fatigue and -3.6 (-4.3--2.9) in dyspnea. Mediation analysis showed that when changes in leg fatigue were considered as a mediator, direct effect, indirect effect and proportion mediated were 47.1 m (95% CI, 4.6-85.1), 34.3 m (-2.1-82.1), and 42.1%, respectively, and when changes in dyspnea were considered as a mediator, they were 9.8 m (-32.9-49.9), 72.5 m (31.3-121.0), and 88.1%, respectively, and the effects of joint mediator were -5.8 m (-55.4-43.9), 88.9 m (32.7-148.5), and 107.0%, respectively. CONCLUSION The improvement in exercise capacity by acupuncture is explained by changes in both leg fatigue and dyspnea.
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Affiliation(s)
- Takumi Kayo
- Department of Acupuncture and Moxibustion, Faculty of Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Nantan, Kyoto, Japan.
- Department of Kampo Medical Research Institute, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima, Japan.
| | - Masao Suzuki
- Department of Kampo Medical Research Institute, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima, Japan
| | - Tadamichi Mitsuma
- Department of Kampo Medical Research Institute, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Fukushima, Japan
| | - Fumihiko Fukuda
- Department of Acupuncture and Moxibustion, Faculty of Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Nantan, Kyoto, Japan.
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Schwendinger F, Looser V, Gerber M, Schmidt-Trucksäss A. Autonomic dysfunction and exercise intolerance in post-COVID-19 - An as yet underestimated organ system? Int J Clin Health Psychol 2024; 24:100429. [PMID: 38348143 PMCID: PMC10859561 DOI: 10.1016/j.ijchp.2023.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/11/2023] [Indexed: 02/15/2024] Open
Abstract
Individuals recovering from COVID-19 often present with persistent symptoms, particularly exercise intolerance and low cardiorespiratory fitness. Put simply, the Wasserman gear system describes the interdependence of heart, lungs, and musculature as determinants of cardiorespiratory fitness. Based on this system, recent findings indicate a contribution of peripheral, cardiovascular, and lung diffusion limitations to persistent symptoms of exercise intolerance and low cardiorespiratory fitness. The autonomic nervous system as an organ system involved in the pathophysiology of exercise intolerance and low cardiorespiratory fitness, has received only little attention as of yet. Hence, our article discusses contribution of the autonomic nervous system through four potential pathways, namely alterations in (1) cerebral hemodynamics, (2) afferent and efferent signaling, (3) central hypersensitivity, and (4) appraisal and engagement in physical activity. These pathways are summarized in a psycho-pathophysiological model. Consequently, this article encourages a shift in perspective by examining the state of the pulmonary and cardiovascular system, the periphery, and auxiliary, the autonomic nervous system as potential underlying mechanisms for exercise intolerance and low cardiorespiratory fitness in patients with post-COVID-19.
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Affiliation(s)
- F. Schwendinger
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - V.N. Looser
- Division of Sports Science, Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - M. Gerber
- Division of Sports Science, Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - A. Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Schanzenstrasse 55, 4056 Basel, Switzerland
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Peters CM, Dempsey JA, Hopkins SR, Sheel AW. Is the Lung Built for Exercise? Advances and Unresolved Questions. Med Sci Sports Exerc 2023; 55:2143-2159. [PMID: 37443459 PMCID: PMC11186580 DOI: 10.1249/mss.0000000000003255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
ABSTRACT Nearly 40 yr ago, Professor Dempsey delivered the 1985 ACSM Joseph B. Wolffe Memorial Lecture titled: "Is the lung built for exercise?" Since then, much experimental work has been directed at enhancing our understanding of the functional capacity of the respiratory system by applying complex methodologies to the study of exercise. This review summarizes a symposium entitled: "Revisiting 'Is the lung built for exercise?'" presented at the 2022 American College of Sports Medicine annual meeting, highlighting the progress made in the last three-plus decades and acknowledging new research questions that have arisen. We have chosen to subdivide our topic into four areas of active study: (i) the adaptability of lung structure to exercise training, (ii) the utilization of airway imaging to better understand how airway anatomy relates to exercising lung mechanics, (iii) measurement techniques of pulmonary gas exchange and their importance, and (iv) the interactions of the respiratory and cardiovascular system during exercise. Each of the four sections highlights gaps in our knowledge of the exercising lung. Addressing these areas that would benefit from further study will help us comprehend the intricacies of the lung that allow it to meet and adapt to the acute and chronic demands of exercise in health, aging, and disease.
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Affiliation(s)
| | - Jerome A Dempsey
- Population Health Science, John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, WI
| | - Susan R Hopkins
- Department of Radiology, University of California San Diego, La Jolla, CA
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Sietsema KE, Rossiter HB. Exercise Physiology and Cardiopulmonary Exercise Testing. Semin Respir Crit Care Med 2023; 44:661-680. [PMID: 37429332 DOI: 10.1055/s-0043-1770362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Aerobic, or endurance, exercise is an energy requiring process supported primarily by energy from oxidative adenosine triphosphate synthesis. The consumption of oxygen and production of carbon dioxide in muscle cells are dynamically linked to oxygen uptake (V̇O2) and carbon dioxide output (V̇CO2) at the lung by integrated functions of cardiovascular, pulmonary, hematologic, and neurohumoral systems. Maximum oxygen uptake (V̇O2max) is the standard expression of aerobic capacity and a predictor of outcomes in diverse populations. While commonly limited in young fit individuals by the capacity to deliver oxygen to exercising muscle, (V̇O2max) may become limited by impairment within any of the multiple systems supporting cellular or atmospheric gas exchange. In the range of available power outputs, endurance exercise can be partitioned into different intensity domains representing distinct metabolic profiles and tolerances for sustained activity. Estimates of both V̇O2max and the lactate threshold, which marks the upper limit of moderate-intensity exercise, can be determined from measures of gas exchange from respired breath during whole-body exercise. Cardiopulmonary exercise testing (CPET) includes measurement of V̇O2 and V̇CO2 along with heart rate and other variables reflecting cardiac and pulmonary responses to exercise. Clinical CPET is conducted for persons with known medical conditions to quantify impairment, contribute to prognostic assessments, and help discriminate among proximal causes of symptoms or limitations for an individual. CPET is also conducted in persons without known disease as part of the diagnostic evaluation of unexplained symptoms. Although CPET quantifies a limited sample of the complex functions and interactions underlying exercise performance, both its specific and global findings are uniquely valuable. Some specific findings can aid in individualized diagnosis and treatment decisions. At the same time, CPET provides a holistic summary of an individual's exercise function, including effects not only of the primary diagnosis, but also of secondary and coexisting conditions.
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Affiliation(s)
- Kathy E Sietsema
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, California
| | - Harry B Rossiter
- Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, California
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7
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Dempsey JA, Welch JF. Control of Breathing. Semin Respir Crit Care Med 2023; 44:627-649. [PMID: 37494141 DOI: 10.1055/s-0043-1770342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Substantial advances have been made recently into the discovery of fundamental mechanisms underlying the neural control of breathing and even some inroads into translating these findings to treating breathing disorders. Here, we review several of these advances, starting with an appreciation of the importance of V̇A:V̇CO2:PaCO2 relationships, then summarizing our current understanding of the mechanisms and neural pathways for central rhythm generation, chemoreception, exercise hyperpnea, plasticity, and sleep-state effects on ventilatory control. We apply these fundamental principles to consider the pathophysiology of ventilatory control attending hypersensitized chemoreception in select cardiorespiratory diseases, the pathogenesis of sleep-disordered breathing, and the exertional hyperventilation and dyspnea associated with aging and chronic diseases. These examples underscore the critical importance that many ventilatory control issues play in disease pathogenesis, diagnosis, and treatment.
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Affiliation(s)
- Jerome A Dempsey
- John Rankin Laboratory of Pulmonary Medicine, Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin
| | - Joseph F Welch
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Delliaux S, Ichinose M, Watanabe K, Fujii N, Nishiyasu T. Muscle metaboreflex activation during hypercapnia modifies nonlinear heart rhythm dynamics, increasing the complexity of the sinus node autonomic regulation in humans. Pflugers Arch 2023; 475:527-539. [PMID: 36645512 DOI: 10.1007/s00424-022-02780-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 01/17/2023]
Abstract
Muscle metaboreflex activation during hypercapnia leads to enhanced pressive effects that are poorly understood while autonomic responses including baroreflex function are not documented. Thus, we assessed heart rate variability (HRV) that is partly due to autonomic influences on sinus node with linear tools (spectral analysis of instantaneous heart period), baroreflex set point and sensitivity with the heart period-arterial pressure transfer function and sequences methods, and system coupling through the complexity of RR interval dynamics with nonlinear tools (Poincaré plots and approximate entropy (ApEn)). We studied ten healthy young men at rest and then during muscle metaboreflex activation (MMA, postexercise muscle ischemia) and hypercapnia (HCA, PetCO2 = + 10 mmHg from baseline) separately and combined (MMA + HCA). The strongest pressive responses were observed during MMA + HCA, while baroreflex sensitivity was similarly lowered in the three experimental conditions. HRV was significantly different in MMA + HCA compared to MMA and HCA separately, with the lowest total power spectrum (p < 0.05), including very low frequency (p < 0.05), low frequency (p < 0.05), and high frequency (tendency) power spectra decreases, and the lowest Poincaré plot short-term variability index (SD1): SD1 = 36.2 ms (MMA + HCA) vs. SD1 = 43.1 ms (MMA, p < 0.05) and SD1 = 46.1 ms (HCA, p < 0.05). Moreover, RR interval dynamic complexity was significantly increased only in the MMA + HCA condition (ApEn increased from 1.04 ± 0.04, 1.07 ± 0.02, and 1.05 ± 0.03 to 1.10 ± 0.03, 1.13 ± 0.04, and 1.17 ± 0.03 in MMA, HCA, and MMA + HCA conditions, respectively; p < 0.01). These results suggest that in healthy young men, muscle metaboreflex activation during hypercapnia leads to interactions that reduce parasympathetic influence on the sinus node activity but complexify its dynamics.
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Affiliation(s)
- Stephane Delliaux
- Aix Marseille Univ, INSERM, INRAE, C2VN, Marseille, France.
- Assistance Publique - Hôpitaux de Marseille, APHM, Hôpital Nord, Pôle Cardiovasculaire et Thoracique, Laboratoire de Physiologie Respiratoire - Explorations à l'Exercice, Marseille, France.
- Laboratory of Physiology - Circulation, Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
- Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Masashi Ichinose
- Laboratory of Physiology - Circulation, Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
- School of Business and Administration, Meiji University, Tokyo, Japan
| | - Kazuhito Watanabe
- Laboratory of Physiology - Circulation, Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Naoto Fujii
- Laboratory of Physiology - Circulation, Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takeshi Nishiyasu
- Laboratory of Physiology - Circulation, Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
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Hucteau E, Mallard J, Pivot X, Schott R, Pflumio C, Trensz P, Favret F, Pagano AF, Hureau TJ. Exacerbated central fatigue and reduced exercise capacity in early-stage breast cancer patients treated with chemotherapy. Eur J Appl Physiol 2023:10.1007/s00421-023-05177-5. [PMID: 36939876 DOI: 10.1007/s00421-023-05177-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The present study aimed to characterize the etiology of exercise-induced neuromuscular fatigue and its consequences on the force-duration relationship to provide mechanistic insights into the reduced exercise capacity characterizing early-stage breast cancer patients. METHODS Fifteen early-stage breast cancer patients and fifteen healthy women performed 60 maximal voluntary isometric quadriceps contractions (MVCs, 3 s of contraction, 2 s of relaxation). The critical force was determined as the mean force of the last six contractions, while W' was calculated as the force impulse generated above the critical force. Quadriceps muscle activation during exercise was estimated from vastus lateralis, vastus medialis and rectus femoris EMG. Central and peripheral fatigue were quantified via changes in pre- to postexercise quadriceps voluntary activation (ΔVA) and quadriceps twitch force (ΔQTw) evoked by supramaximal electrical stimulation, respectively. RESULTS Early-stage breast cancer patients demonstrated lower MVC than controls preexercise (- 15%, P = 0.022), and this reduction persisted throughout the 60-MVC exercise (- 21%, P = 0.002). The absolute critical force was lower in patients than in controls (144 ± 29N vs. 201 ± 47N, respectively, P < 0.001), while W' was similar (P = 0.546), resulting in lower total work done (- 23%, P = 0.001). This was associated with lower muscle activation in the vastus lateralis (P < 0.001), vastus medialis (P = 0.003) and rectus femoris (P = 0.003) in patients. Immediately following exercise, ΔVA showed a greater reduction in patients compared to controls (- 21.6 ± 13.3% vs. - 12.6 ± 7.7%, P = 0.040), while ΔQTw was similar (- 60.2 ± 13.2% vs. - 52.8 ± 19.4%, P = 0.196). CONCLUSION These findings support central fatigue as a primary cause of the reduction in exercise capacity characterizing early-stage breast cancer patients treated with chemotherapy. CLINICAL TRIALS REGISTRATION No. NCT04639609-November 20, 2020.
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Affiliation(s)
- Elyse Hucteau
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Joris Mallard
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Xavier Pivot
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Roland Schott
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Carole Pflumio
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Trensz
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Fabrice Favret
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
| | - Allan F Pagano
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
| | - Thomas J Hureau
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France.
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France.
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10
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Aranda LC, Ribeiro IC, Freitas TO, Degani-Costa LH, Dias DS, DE Angelis K, Paixão AO, Brum PC, Oliveira ASB, Vianna LC, Nery LE, Silva BM. Enhanced Respiratory Frequency Response to Lower Limb Mechanoreceptors Activation in Patients with Chronic Obstructive Pulmonary Disease. Med Sci Sports Exerc 2023; 55:418-429. [PMID: 36730960 DOI: 10.1249/mss.0000000000003065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the mechanoreflex control of respiration and circulation in patients with chronic obstructive pulmonary disease (COPD). METHODS Twenty-eight patients with moderate-to-severe COPD (mean ± SD: 67.0 ± 7.9 yr, 10 women) and 14 age- and sex-matched controls (67.9 ± 2.6 yr, 7 women) participated in the study. Their dominant knee was passively moved to stimulate mechanoreceptors, whereas vastus lateralis surface electrical activity checked active contractions. A differential pressure flowmeter, an electrocardiogram, and a servo-controlled finger photoplethysmograph acquired cardiorespiratory data. To gain insight into the mechanoreflex arc, we further analyzed reduced/oxidized glutathione ratio and mechanoreceptor-related gene expression in a vastus lateralis biopsy of additional nine patients (63.9 ± 8.1 yr, 33% women) and eight controls (62.9 ± 9.1 yr, 38% women). RESULTS Patients with COPD had a greater peak respiratory frequency response (COPD: Δ = 3.2 ± 2.3 vs Controls: 1.8 ± 1.2 cycles per minute, P = 0.036) and a smaller peak tidal volume response to passive knee movement than controls. Ventilation, heart rate, stroke volume, and cardiac output peak responses, and total peripheral resistance nadir response, were unaltered by COPD. In addition, patients had a diminished glutathione ratio (COPD: 13.3 ± 3.8 vs controls: 20.0 ± 5.5 a.u., P = 0.015) and an augmented brain-derived neurotrophic factor expression (COPD: 2.0 ± 0.7 vs controls: 1.1 ± 0.4 a.u., P = 0.002) than controls. Prostaglandin E receptor 4, cyclooxygenase 2, and Piezo1 expression were similar between groups. CONCLUSIONS Respiratory frequency response to mechanoreceptors activation is increased in patients with COPD. This abnormality is possibly linked to glutathione redox imbalance and augmented brain-derived neurotrophic factor expression within locomotor muscles, which could increase mechanically sensitive afferents' stimulation and sensitivity.
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Affiliation(s)
| | | | | | - Luiza H Degani-Costa
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, BRAZIL
| | | | | | - Ailma O Paixão
- School of Physical Education and Sport, University of São Paulo, São Paulo, SP, BRAZIL
| | - Patricia C Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, SP, BRAZIL
| | - Acary S B Oliveira
- Department of Neurology and Neurosurgery, UNIFESP, São Paulo, SP, BRAZIL
| | - Lauro C Vianna
- NeuroV̇ASQ˙-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasilia, Brasilia, Federal District, BRAZIL
| | - Luiz E Nery
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Medicine, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, BRAZIL
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11
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Nicolò A, Sacchetti M. Differential control of respiratory frequency and tidal volume during exercise. Eur J Appl Physiol 2023; 123:215-242. [PMID: 36326866 DOI: 10.1007/s00421-022-05077-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
The lack of a testable model explaining how ventilation is regulated in different exercise conditions has been repeatedly acknowledged in the field of exercise physiology. Yet, this issue contrasts with the abundance of insightful findings produced over the last century and calls for the adoption of new integrative perspectives. In this review, we provide a methodological approach supporting the importance of producing a set of evidence by evaluating different studies together-especially those conducted in 'real' exercise conditions-instead of single studies separately. We show how the collective assessment of findings from three domains and three levels of observation support the development of a simple model of ventilatory control which proves to be effective in different exercise protocols, populations and experimental interventions. The main feature of the model is the differential control of respiratory frequency (fR) and tidal volume (VT); fR is primarily modulated by central command (especially during high-intensity exercise) and muscle afferent feedback (especially during moderate exercise) whereas VT by metabolic inputs. Furthermore, VT appears to be fine-tuned based on fR levels to match alveolar ventilation with metabolic requirements in different intensity domains, and even at a breath-by-breath level. This model reconciles the classical neuro-humoral theory with apparently contrasting findings by leveraging on the emerging control properties of the behavioural (i.e. fR) and metabolic (i.e. VT) components of minute ventilation. The integrative approach presented is expected to help in the design and interpretation of future studies on the control of fR and VT during exercise.
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Affiliation(s)
- Andrea Nicolò
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135, Rome, Italy.
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135, Rome, Italy
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12
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Bergevin M, Steele J, Payen de la Garanderie M, Feral-Basin C, Marcora SM, Rainville P, Caron JG, Pageaux B. Pharmacological Blockade of Muscle Afferents and Perception of Effort: A Systematic Review with Meta-analysis. Sports Med 2023; 53:415-435. [PMID: 36318384 DOI: 10.1007/s40279-022-01762-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The perception of effort provides information on task difficulty and influences physical exercise regulation and human behavior. This perception differs from other-exercise related perceptions such as pain. There is no consensus on the role of group III/IV muscle afferents as a signal processed by the brain to generate the perception of effort. OBJECTIVE The aim of this meta-analysis was to investigate the effect of pharmacologically blocking muscle afferents on the perception of effort. METHODS Six databases were searched to identify studies measuring the ratings of perceived effort during physical exercise, with and without pharmacological blockade of muscle afferents. Articles were coded based on the operational measurement used to distinguish studies in which perception of effort was assessed specifically (effort dissociated) or as a composite experience including other exercise-related perceptions (effort not dissociated). Articles that did not provide enough information for coding were assigned to the unclear group. RESULTS The effort dissociated group (n = 6) demonstrated a slight increase in ratings of perceived effort with reduced muscle afferent feedback (standard mean change raw, 0.39; 95% confidence interval 0.13-0.64). The group effort not dissociated (n = 2) did not reveal conclusive results (standard mean change raw, - 0.29; 95% confidence interval - 2.39 to 1.8). The group unclear (n = 8) revealed a slight ratings of perceived effort decrease with reduced muscle afferent feedback (standard mean change raw, - 0.27; 95% confidence interval - 0.50 to - 0.04). CONCLUSIONS The heterogeneity in results between groups reveals that the inclusion of perceptions other than effort in its rating influences the ratings of perceived effort reported by the participants. The absence of decreased ratings of perceived effort in the effort dissociated group suggests that muscle afferent feedback is not a sensory signal for the perception of effort.
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Affiliation(s)
- Maxime Bergevin
- École de kinésiologie et des sciences de l'activite physique (EKSAP), Faculté de médecine, Université́ de Montréal, Montreal, QC, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
| | - James Steele
- School of Sport, Health and Social Sciences, Southampton, UK
| | - Marie Payen de la Garanderie
- École de kinésiologie et des sciences de l'activite physique (EKSAP), Faculté de médecine, Université́ de Montréal, Montreal, QC, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
| | - Camille Feral-Basin
- École de kinésiologie et des sciences de l'activite physique (EKSAP), Faculté de médecine, Université́ de Montréal, Montreal, QC, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
| | - Samuele M Marcora
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Pierre Rainville
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada.,Département de stomatologie, Faculté de médecine dentaire, Université de Montréal, Montreal, QC, Canada
| | - Jeffrey G Caron
- École de kinésiologie et des sciences de l'activite physique (EKSAP), Faculté de médecine, Université́ de Montréal, Montreal, QC, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montreal, QC, Canada
| | - Benjamin Pageaux
- École de kinésiologie et des sciences de l'activite physique (EKSAP), Faculté de médecine, Université́ de Montréal, Montreal, QC, Canada. .,Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada. .,Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Montreal, QC, Canada.
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13
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Hartmann JP, Dahl RH, Nymand S, Munch GW, Ryrsø CK, Pedersen BK, Thaning P, Mortensen SP, Berg RMG, Iepsen UW. Regulation of the microvasculature during small muscle mass exercise in chronic obstructive pulmonary disease vs. chronic heart failure. Front Physiol 2022; 13:979359. [PMID: 36134330 PMCID: PMC9483770 DOI: 10.3389/fphys.2022.979359] [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: 06/27/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: Skeletal muscle convective and diffusive oxygen (O2) transport are peripheral determinants of exercise capacity in both patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). We hypothesised that differences in these peripheral determinants of performance between COPD and CHF patients are revealed during small muscle mass exercise, where the cardiorespiratory limitations to exercise are diminished. Methods: Eight patients with moderate to severe COPD, eight patients with CHF (NYHA II), and eight age- and sex-matched controls were studied. We measured leg blood flow (Q̇leg) by Doppler ultrasound during submaximal one-legged knee-extensor exercise (KEE), while sampling arterio-venous variables across the leg. The capillary oxyhaemoglobin dissociation curve was reconstructed from paired femoral arterial-venous oxygen tensions and saturations, which enabled the estimation of O2 parameters at the microvascular level within skeletal muscle, so that skeletal muscle oxygen conductance (DSMO2) could be calculated and adjusted for flow (DSMO2/Q̇leg) to distinguish convective from diffusive oxygen transport. Results: During KEE, Q̇leg increased to a similar extent in CHF (2.0 (0.4) L/min) and controls (2.3 (0.3) L/min), but less in COPD patients (1.8 (0.3) L/min) (p <0.03). There was no difference in resting DSMO2 between COPD and CHF and when adjusting for flow, the DSMO2 was higher in both groups compared to controls (COPD: 0.97 (0.23) vs. controls 0.63 (0.24) mM/kPa, p= 0.02; CHF 0.98 (0.11) mM/kPa vs. controls, p= 0.001). The Q̇-adjusted DSMO2 was not different in COPD and CHF during KEE (COPD: 1.19 (0.11) vs. CHF: 1.00 (0.18) mM/kPa; p= 0.24) but higher in COPD vs. controls: 0.87 (0.28) mM/kPa (p= 0.02), and only CHF did not increase Q̇-adjusted DSMO2 from rest (p= 0.2). Conclusion: Disease-specific factors may play a role in peripheral exercise limitation in patients with COPD compared with CHF. Thus, low convective O2 transport to contracting muscle seemed to predominate in COPD, whereas muscle diffusive O2 transport was unresponsive in CHF.
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Affiliation(s)
- Jacob Peter Hartmann
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rasmus H Dahl
- Department of Radiology, Hvidovre Hospital, Copenhagen, Denmark.,Department of Radiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Stine Nymand
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregers W Munch
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Camilla K Ryrsø
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital, North Zealand, Hillerød, Denmark
| | - Bente K Pedersen
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pia Thaning
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre Hospital, Copenhagen, Denmark
| | - Stefan P Mortensen
- Department of Cardiovascular and Renal Research, University of Southern Denmark, Copenhagen, Denmark
| | - Ronan M G Berg
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Ulrik Winning Iepsen
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
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14
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Zhang Z, Wang T, Kuang J, Herold F, Ludyga S, Li J, Hall DL, Taylor A, Healy S, Yeung AS, Kramer AF, Zou L. The roles of exercise tolerance and resilience in the effect of physical activity on emotional states among college students. Int J Clin Health Psychol 2022; 22:100312. [PMID: 35712359 PMCID: PMC9168153 DOI: 10.1016/j.ijchp.2022.100312] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 12/13/2022] Open
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15
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Giuriato G, Paneroni M, Venturelli M, Layec G. Strategies targeting the NO pathway to counteract extra-pulmonary manifestations of COPD: A systematic review and meta-analysis. Nitric Oxide 2022; 128:59-71. [PMID: 35977691 DOI: 10.1016/j.niox.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/01/2022] [Accepted: 08/10/2022] [Indexed: 10/31/2022]
Abstract
The clinical symptoms of chronic obstructive pulmonary disease (COPD) disease are accompanied by severely debilitating extra-pulmonary manifestations, including vascular dysfunction and hypertension. This systematic review evaluated the current evidence for several therapeutic interventions, targeting the nitric oxide (NO) pathway on hemodynamics and, secondarily, exercise capacity in patients with COPD. A comprehensive search on COPD and NO donors was performed on online databases. Of 934 initially found manuscripts, 27 were included in the review, and 16 in the meta-analysis. The analysis indicated inconsistent effects of dietary nitrate supplementation on exercise tolerance in COPD patients. Dietary nitrate supplementation decreased systolic (-3.7 ± 4.3 mmHg; p = 0.10) and diastolic blood pressure (BP; -2.6 ± 3.2 mmHg; p = 0.05) compared with placebo. When restricted to acute studies, a clinically relevant BP lowering effect of nitrate supplementation during diastole was observed (-4.7 ± 3.2 mmHg; n = 5; p = 0.05). In contrast, inhaled NO (iNO) at doses <20 ppm (+9.2 ± 11.3 mmHg) and 25-40 ppm (-5±2 mmHg) resulted in inconsistent effects on PaO2 (p = 0.48). Data on the effect of iNO on exercise capacity were too limited and inconsistent, but preliminary evidence suggests a possible benefit of iNO on pulmonary vascular resistance during exercise in severe COPD patients. Overall, the effects of acute dietary nitrate supplementation on BP may be of clinical relevance as an adjunct therapy and deserve further investigation in large sample size studies of COPD patients with and without cardiovascular comorbidities. iNO exerted inconsistent physiological effects, with the use of high doses posing safety risks.
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Affiliation(s)
- Gaia Giuriato
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Kinesiology, University of Massachusetts Amherst, USA
| | - Mara Paneroni
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Massimo Venturelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Department of Internal Medicine, University of Utah, USA
| | - Gwenael Layec
- Department of Kinesiology, University of Massachusetts Amherst, USA; Institute of Applied Life Science, University of Massachusetts Amherst, USA.
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16
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Paneroni M, Vitacca M, Comini L, Salvi B, Saleri M, Schena F, Venturelli M. Relationship between perceived and neuromuscular fatigue in COPD patients with chronic respiratory failure with long-term oxygen therapy: a cross-sectional study. Eur J Appl Physiol 2022; 122:2403-2416. [PMID: 35951129 DOI: 10.1007/s00421-022-05021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate perceived fatigue (PF) and neuromuscular fatigue (NMF) in patients with COPD and chronic respiratory failure (CRF) on long-term oxygen therapy (CRF-COPD group), and the relationships between PF, NMF, patient's characteristics, comparing severe patients with COPD to patients without CRF (COPD group). METHODS This cross-sectional study compared 19 CRF-COPD patients with 10 COPD patients attending a rehabilitation program. PF was determined by Fatigue Severity Scale (FSS), while dyspnea by the Barthel Dyspnea Index (BDI). We assessed quadriceps NMF via electrical nerve stimulation during and following a Maximal Voluntary Contraction (MVC) detecting changes after a Constant Workload Cycling Test (CWCT) at 80% of the peak power output at exhaustion. RESULTS CRF-COPD patients showed higher PF (+ 1.79 of FSS score, p = 0.0052) and dyspnea (+ 21.03 of BDI score, p = 0.0023) than COPD patients. After the fatiguing task and normalization for the total work, there was a similar decrease in the MVC (CRF-COPD -1.5 ± 2.4 vs COPD -1.1 ± 1.2% baseline kJ-1, p = 0.5819), in the potentiated resting twitch force (CRF-COPD -2.8 ± 4.7 vs COPD -2.0 ± 3.3% baseline kJ-1, p = 0.7481) and in the maximal voluntary activation (CRF-COPD -0.1 ± 3.9 vs COPD -0.9 ± 1.2 -2.0 ± 3.3% baseline kJ-1, p = 0.4354). FSS and BDI were closely related (R = 0.5735, p = 0.0011), while no correlation between PF and NMF was found. CONCLUSION Patients with CRF-COPD develop higher levels of perceived fatigue and dyspnea than patients with COPD; while neuromuscular fatigue is similar, suggesting a mismatch between symptoms and neuromuscular dysfunction.
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Affiliation(s)
- Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy.
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Lumezzane, 25065, Brescia, Italy
| | - Beatrice Salvi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy
| | - Manuela Saleri
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Via G Mazzini 129, Lumezzane, 25065, Brescia, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine, and Movement Science, Section of Movement Science, University of Verona, 37134, Verona, Italy
| | - Massimo Venturelli
- Department of Neuroscience, Biomedicine, and Movement Science, Section of Movement Science, University of Verona, 37134, Verona, Italy.,Department of Internal Medicine Section of Geriatrics, University of Utah, Salt Lake City, UT, 84132, USA
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17
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Yen HT, Kurosawa M, Kirimoto T, Hakozaki Y, Matsui T, Sun G. A medical radar system for non-contact vital sign monitoring and clinical performance evaluation in hospitalized older patients. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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18
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Cao M, Calmelat RA, Kierstead P, Carraro N, Stringer WW, Porszasz J, Casaburi R, Rossiter HB. A randomized, crossover, placebo controlled, double blind trial of the effects of tiotropium-olodaterol on neuromuscular performance during exercise in COPD. J Appl Physiol (1985) 2022; 132:1145-1153. [PMID: 35323052 PMCID: PMC9054255 DOI: 10.1152/japplphysiol.00332.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exercise intolerance in COPD is associated with dyspnea, reduced inspiratory capacity (IC) and occurs with a neuromuscular "power reserve" i.e. an acute ability to increase isokinetic locomotor power. This power reserve is associated with resting FEV1/FVC suggesting that treatments to target pulmonary function may protect neuromuscular performance and extend whole-body exercise in COPD. We, therefore, tested whether combination long-acting β-agonist and muscarinic antagonist bronchodilator therapy (LAMA+LABA; Stiolto Respimat®) would ameliorate the decline in neuromuscular performance and increase endurance time during constant power cycling at 80% peak incremental power. Fourteen COPD patients (4 female; 64[58,72] years; FEV1 67[56,75]% predicted; median[25th,75th percentile]), participated in a randomized, placebo-controlled cross-over trial (NCT02845752). Pulmonary function and cardiopulmonary exercise responses were assessed before and after 1 week of treatment, with 2 weeks washout between conditions. Performance fatigue was assessed using a ~4-second maximal isokinetic cycling effort at pre-exercise, isotime and intolerance. Isotime was the shorter exercise duration of the two treatment conditions. Significance was assessed using ANOVA with treatment as fixed factor and subject as random factor. FEV1 was greater with LAMA+LABA vs. placebo (1.81[1.58,1.98] L vs 1.72[1.29,1.99] L; P=0.006), but IC at isotime, performance fatigue at isotime and constant power endurance time were not different between condition (each P>0.05). A modest (~95 mL) FEV1 increase in following 1 week of combination LAMA+LABA treatment did not alleviate neuromuscular performance fatigue or enhance cycle exercise tolerance in mild to severe COPD patients with largely preserved "static" lung volumes.
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Affiliation(s)
- Min Cao
- Rehabilitation Clinical Trials Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States.,Department of Respiratory and Critical Care Medicine, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Robert A Calmelat
- Rehabilitation Clinical Trials Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Peter Kierstead
- Antioch Medical Center, Pulmonary Medicine, Antioch, CA, United States
| | - Nicolo Carraro
- High Specialization Rehabilitation Hospital, ORAS, Motta di Livenza, Italy
| | - William W Stringer
- Rehabilitation Clinical Trials Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Janos Porszasz
- Rehabilitation Clinical Trials Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
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19
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Gelinas J, Harper M, Sasso J, Wright S, Melzer B, Agar G, Guenette J, duManoir G, Roman M, Rolf JD, Eves N. Phenotyping Cardiopulmonary Exercise Limitations in Chronic Obstructive Pulmonary Disease. Front Physiol 2022; 13:816586. [PMID: 35242051 PMCID: PMC8886157 DOI: 10.3389/fphys.2022.816586] [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: 11/16/2021] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Exercise limitation in chronic obstructive pulmonary disease (COPD) is commonly attributed to abnormal ventilatory mechanics and/or skeletal muscle function, while cardiovascular contributions remain relatively understudied. To date, the integrative exercise responses associated with different cardiopulmonary exercise limitation phenotypes in COPD have not been explored but may provide novel therapeutic utility. This study determined the ventilatory, cardiovascular, and metabolic responses to incremental exercise in patients with COPD with different exercise limitation phenotypes. Methods Patients with COPD (n = 95, FEV1:23–113%pred) performed a pulmonary function test and incremental cardiopulmonary exercise test. Exercise limitation phenotypes were classified as: ventilatory [peak ventilation (VEpeak)/maximal ventilatory capacity (MVC) ≥ 85% or MVC-VEpeak ≤ 11 L/min, and peak heart rate (HRpeak) < 90%pred], cardiovascular (VEpeak/MVC < 85% or MVC-VEpeak > 11 L/min, and HRpeak ≥ 90%pred), or combined (VEpeak/MVC ≥ 85% or MVC-VEpeak ≤ 11 L/min, and HRpeak ≥ 90%pred). Results FEV1 varied within phenotype: ventilatory (23–75%pred), combined (28–90%pred), and cardiovascular (68–113%pred). The cardiovascular phenotype had less static hyperinflation, a lower end-expiratory lung volume and larger tidal volume at peak exercise compared to both other phenotypes (p < 0.01 for all). The cardiovascular phenotype reached a higher VEpeak (60.8 ± 11.5 L/min vs. 45.3 ± 15.5 L/min, p = 0.002), cardiopulmonary fitness (VO2peak: 20.6 ± 4.0 ml/kg/min vs. 15.2 ± 3.3 ml/kg/min, p < 0.001), and maximum workload (103 ± 34 W vs. 72 ± 27 W, p < 0.01) vs. the ventilatory phenotype, but was similar to the combined phenotype. Conclusion Distinct exercise limitation phenotypes were identified in COPD that were not solely dependent upon airflow limitation severity. Approximately 50% of patients reached maximal heart rate, indicating that peak cardiac output and convective O2 delivery contributed to exercise limitation. Categorizing patients with COPD phenotypically may aid in optimizing exercise prescription for rehabilitative purposes.
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Affiliation(s)
- Jinelle Gelinas
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Megan Harper
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - John Sasso
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Stephen Wright
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Bernie Melzer
- Interior Health Authority, Kelowna General Hospital, Kelowna, BC, Canada
| | - Gloria Agar
- Interior Health Authority, Kelowna General Hospital, Kelowna, BC, Canada
| | - Jordan Guenette
- Department of Physical Therapy and Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Gregory duManoir
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Michael Roman
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - J Douglass Rolf
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Neil Eves
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, BC, Canada
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Ducrocq GP, Blain GM. Relationship between neuromuscular fatigue, muscle activation and the work done above the critical power during severe intensity exercise. Exp Physiol 2022; 107:312-325. [PMID: 35137992 DOI: 10.1113/ep090043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/02/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does the work done above critical power (W') or muscle activation determine the degree of peripheral fatigue induced by cycling time-trials performed in the severe intensity domain? What is the main finding and its importance? We found that peripheral fatigue increased when power output and muscle activation increased whereas W' did not change between the time-trials. Therefore, no relationship was found between W' and exercise-induced peripheral fatigue such as previously postulated in the literature. In contrast, we found a significant association between EMG amplitude during exercise and exercise-induced reduction in the potentiated quadriceps twitch, suggesting that muscle activation plays a key role in determining peripheral fatigue during severe intensity exercise. ABSTRACT In order to determine the relationship between peripheral fatigue, muscle activation and the total work done above critical power (W'), ten men and four women performed, on separated days, self-paced cycling time-trials of 3, 6, 10, and 15 min. Exercise-induced quadriceps fatigue was quantified using pre- to post-exercise (15 s through 15 min recovery) changes in maximal voluntary contraction peak force (MVC), voluntary activation (VA) and potentiated twitch force (QT). VA was measured using the interpolated twitch technique, and QT was evoked by electrical stimulations of the femoral nerve. Quadriceps muscle activation was determined using the root mean square of surface electromyography of vastus lateralis (VLRMS ), vastus medialis (VMRMS ) and rectus femoris (RFRMS ). Critical power and W' were calculated from the power/duration relationship from the four time-trials. Mean power output and mean VLRMS , VMRMS and RFRMS were greater during shorter compared to longer exercises (P<0.05) whereas no significant between-trials change in W' was found. The magnitude of exercise-induced reductions in QT increased with the increase in power output (P<0.001) and were associated with mean VLRMS and VMRMS (P<0.001, r2 >0.369) but not W' (P>0.150, r2 <0.044). Reduction in VA tended (P = 0.067) to be more pronounced with the lengthening in time-trial duration while no significant between-trials change in MVC were found. Our data suggest that peripheral fatigue is not related to the amount of work done above the critical power but rather to the level of muscle activation during exercise the severe intensity domain. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Guillaume P Ducrocq
- LAMHESS, Université Côte d'Azur, Nice, France.,Faculty of Medicine, Mitochondria, Oxidative Stress and Muscular Protection laboratory (UR 3072), University of Strasbourg, Strasbourg, France.,Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, Strasbourg, France
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21
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Dempsey JA, Neder JA, Phillips DB, O'Donnell DE. The physiology and pathophysiology of exercise hyperpnea. HANDBOOK OF CLINICAL NEUROLOGY 2022; 188:201-232. [PMID: 35965027 DOI: 10.1016/b978-0-323-91534-2.00001-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In health, the near-eucapnic, highly efficient hyperpnea during mild-to-moderate intensity exercise is driven by three obligatory contributions, namely, feedforward central command from supra-medullary locomotor centers, feedback from limb muscle afferents, and respiratory CO2 exchange (V̇CO2). Inhibiting each of these stimuli during exercise elicits a reduction in hyperpnea even in the continuing presence of the other major stimuli. However, the relative contribution of each stimulus to the hyperpnea remains unknown as does the means by which V̇CO2 is sensed. Mediation of the hyperventilatory response to exercise in health is attributed to the multiple feedback and feedforward stimuli resulting from muscle fatigue. In patients with COPD, diaphragm EMG amplitude and its relation to ventilatory output are used to decipher mechanisms underlying the patients' abnormal ventilatory responses, dynamic lung hyperinflation and dyspnea during exercise. Key contributions to these exercise-limiting responses across the spectrum of COPD severity include high dead space ventilation, an excessive neural drive to breathe and highly fatigable limb muscles, together with mechanical constraints on ventilation. Major controversies concerning control of exercise hyperpnea are discussed along with the need for innovative research to uncover the link of metabolism to breathing in health and disease.
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Affiliation(s)
- Jerome A Dempsey
- John Rankin Laboratory of Pulmonary Medicine, Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States.
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, ON, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, ON, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, ON, Canada
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22
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Neder JA, Berton DC, Phillips DB, O'Donnell DE. Exertional ventilation/carbon dioxide output relationship in COPD: from physiological mechanisms to clinical applications. Eur Respir Rev 2021; 30:30/161/200190. [PMID: 34526312 PMCID: PMC9489189 DOI: 10.1183/16000617.0190-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/30/2020] [Indexed: 01/09/2023] Open
Abstract
There is well established evidence that the minute ventilation (V′E)/carbon dioxide output (V′CO2) relationship is relevant to a number of patient-related outcomes in COPD. In most circumstances, an increased V′E/V′CO2 reflects an enlarged physiological dead space (“wasted” ventilation), although alveolar hyperventilation (largely due to increased chemosensitivity) may play an adjunct role, particularly in patients with coexistent cardiovascular disease. The V′E/V′CO2 nadir, in particular, has been found to be an important predictor of dyspnoea and poor exercise tolerance, even in patients with largely preserved forced expiratory volume in 1 s. As the disease progresses, a high nadir might help to unravel the cause of disproportionate breathlessness. When analysed in association with measurements of dynamic inspiratory constraints, a high V′E/V′CO2 is valuable to ascertain a role for the “lungs” in limiting dyspnoeic patients. Regardless of disease severity, cardiocirculatory (heart failure and pulmonary hypertension) and respiratory (lung fibrosis) comorbidities can further increase V′E/V′CO2. A high V′E/V′CO2 is a predictor of poor outcome in lung resection surgery, adding value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of disease severity. Considering its potential usefulness, the V′E/V′CO2 should be valued in the clinical management of patients with COPD. The minute ventilation/carbon dioxide production relationship is relevant to a number of patient-related outcomes in COPD. Minute ventilation/carbon dioxide production, therefore, should be valued in the clinical management of these patients.https://bit.ly/3df2upH
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Affiliation(s)
- J Alberto Neder
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Danilo C Berton
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada.,Division of Respiratory Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Devin B Phillips
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, Canada
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Louvaris Z, Langer D, Vogiatzis I. Extradiaphragmatic respiratory muscle perfusion during exercise in patients with COPD: impact on dyspnea. ACTA ACUST UNITED AC 2021; 47:e20210212. [PMID: 34406230 PMCID: PMC8352762 DOI: 10.36416/1806-3756/e20210212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zafeiris Louvaris
- . Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Respiratory Research Unit, KU Leuven, Belgium.,. Department of Respiratory Diseases, University Hospital Leuven, Leuven, Belgium
| | - Daniel Langer
- . Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Respiratory Research Unit, KU Leuven, Belgium.,. Department of Respiratory Diseases, University Hospital Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- . Faculty of Health and Life Sciences, Department of Sport, Exercise, and Rehabilitation, Northumbria University Newcastle, Newcastle, United Kingdom
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Davies MJ, Lyall GK, Benson AP, Cannon DT, Birch KM, Rossiter HB, Ferguson C. Power Reserve at Intolerance in Ramp-Incremental Exercise Is Dependent on Incrementation Rate. Med Sci Sports Exerc 2021; 53:1606-1614. [PMID: 34261991 DOI: 10.1249/mss.0000000000002645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The mechanism(s) of exercise intolerance at V˙O2max remain poorly understood. In health, standard ramp-incremental (RI) exercise is limited by fatigue-induced reductions in maximum voluntary cycling power. Whether neuromuscular fatigue also limits exercise when the RI rate is slow and RI peak power at intolerance is lower than standard RI exercise, is unknown. METHODS In twelve healthy participants, maximal voluntary cycling power was measured during a short (~6 s) isokinetic effort at 80 rpm (Piso) at baseline and, using an instantaneous switch from cadence-independent to isokinetic cycling, immediately at the limit of RI exercise with RI rates of 50, 25, and 10 W·min-1 (RI-50, RI-25, and RI-10). Breath-by-breath pulmonary gas exchange was measured throughout. RESULTS Baseline Piso was not different among RI rates (analysis of variance; P > 0.05). Tolerable duration increased with decreasing RI rate (RI-50, 411 ± 58 s vs RI-25, 732 ± 93 s vs RI-10, 1531 ± 288 s; P < 0.05). At intolerance, V˙O2peak was not different among RI rates (analysis of variance; P > 0.05), but RI peak power decreased with RI rate (RI-50, 361 ± 48 W vs RI-25, 323 ± 39 W vs RI-10, 275 ± 38 W; P < 0.05). Piso at intolerance was 346 ± 43 W, 353 ± 45 W, and 392 ± 69 W for RI-50, RI-25, and RI-10, respectively (P < 0.05 for RI-10 vs RI-50 and RI-25). At intolerance, in RI-50 and RI-25, Piso was not different from RI peak power (P > 0.05), thus there was no "power reserve." In RI-10, Piso was greater than RI peak power at intolerance (P < 0.001), that is, there was a "power reserve." CONCLUSIONS In RI-50 and RI-25, the absence of a power reserve suggests the neuromuscular fatigue-induced reduction in Piso coincided with V˙O2max and limited the exercise. In RI-10, the power reserve suggests neuromuscular fatigue was insufficient to limit the exercise, and additional mechanisms contributed to intolerance at V˙O2max.
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Affiliation(s)
- Matthew J Davies
- School of Biomedical Sciences, Faculty of Biological Sciences and Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UNITED KINGDOM
| | - Gemma K Lyall
- School of Biomedical Sciences, Faculty of Biological Sciences and Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UNITED KINGDOM
| | - Alan P Benson
- School of Biomedical Sciences, Faculty of Biological Sciences and Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UNITED KINGDOM
| | - Daniel T Cannon
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA
| | - Karen M Birch
- School of Biomedical Sciences, Faculty of Biological Sciences and Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UNITED KINGDOM
| | | | - Carrie Ferguson
- School of Biomedical Sciences, Faculty of Biological Sciences and Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UNITED KINGDOM
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25
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Schaeffer MR, Guenette JA, Jensen D. Impact of ageing and pregnancy on the minute ventilation/carbon dioxide production response to exercise. Eur Respir Rev 2021; 30:30/161/200225. [PMID: 34289982 PMCID: PMC9488679 DOI: 10.1183/16000617.0225-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/27/2020] [Indexed: 11/28/2022] Open
Abstract
Ventilatory efficiency can be evaluated using the relationship between minute ventilation (V′E) and the rate of CO2 production (V′CO2). In accordance with the modified alveolar ventilation equation, this relationship is determined by changes in dead space volume (VD) and/or the arterial CO2 tension (PaCO2) equilibrium point. In this review, we summarise the physiological factors that may account for normative ageing and pregnancy induced increases in V′E/V′CO2 during exercise. Evidence suggests that age-related increases in VD and pregnancy-related decreases in the PaCO2 equilibrium point are mechanistically linked to the increased V′E/V′CO2 during exercise. Importantly, the resultant increase in V′E/V′CO2 (ratio or slope), with normal ageing or pregnancy, remains below the critical threshold for prognostic indication in cardiopulmonary disease, is not associated with increased risk of adverse health outcomes, and does not affect the respiratory system's ability to fulfil its primary role of eliminating CO2 and maintaining arterial oxygen saturation during exercise. The minute ventilation/carbon dioxide production response to exercise is elevated with advancing age and in healthy pregnancy due to increased dead space and lowering of the arterial partial pressure of carbon dioxide equilibrium point, respectively.https://bit.ly/2GJXm0o
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Affiliation(s)
- Michele R Schaeffer
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada.,Dept of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada .,Dept of Physical Therapy, The University of British Columbia, Vancouver, Canada.,School of Kinesiology, The University of British Columbia, Vancouver, Canada
| | - Dennis Jensen
- Dept of Kinesiology and Physical Education, McGill University, Montréal, Canada.,Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program, Montréal, Canada.,Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, Canada
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26
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Decker ST, Kwon OS, Zhao J, Hoidal JR, Heuckstadt T, Richardson RS, Sanders KA, Layec G. Skeletal muscle mitochondrial adaptations induced by long-term cigarette smoke exposure. Am J Physiol Endocrinol Metab 2021; 321:E80-E89. [PMID: 34121449 PMCID: PMC8321829 DOI: 10.1152/ajpendo.00544.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
Because patients with chronic obstructive pulmonary disease (COPD) are often physically inactive, it is still unclear whether the lower respiratory capacity in the locomotor muscles of these patients is due to cigarette smoking per se or is secondary to physical deconditioning. Accordingly, the purpose of this study was to examine mitochondrial alterations in the quadriceps muscle of 10 mice exposed to 8 mo of cigarette smoke, a sedentary mouse model of emphysema, and 9 control mice, using immunoblotting, spectrophotometry, and high-resolution respirometry in permeabilized muscle fibers. Mice exposed to smoke displayed a twofold increase in the oxidative stress marker, 4-HNE, (P < 0.05) compared with control mice. This was accompanied by significant decrease in protein expression of UCP3 (65%), ANT (58%), and mitochondrial complexes II-V (∼60%-75%). In contrast, maximal ADP-stimulated respiration with complex I and II substrates (CON: 23.6 ± 6.6 and SMO: 19.2 ± 8.2 ρM·mg-1·s-1) or octanoylcarnitine (CON: 21.8 ± 9.0 and SMO: 16.5 ± 6.6 ρM·mg-1·s-1) measured in permeabilized muscle fibers, as well as citrate synthase activity, were not significantly different between groups. Collectively, our findings revealed that sedentary mice exposed to cigarette smoke for 8 mo, which is typically associated with pulmonary inflammation and emphysema, exhibited a preserved mitochondrial respiratory capacity for various substrates, including fatty acid, in the skeletal muscle. However, the mitochondrial adaptations induced by cigarette smoke favored the development of chronic oxidative stress, which can indirectly contribute to augment the susceptibility to muscle fatigue and exercise intolerance.NEW & NOTEWORTHY It is unclear whether the exercise intolerance and skeletal muscle mitochondrial dysfunction observed in patients with COPD is due to cigarette smoke exposure, per se, or if they are secondary consequences to inactivity. Herein, while long-term exposure to cigarette smoke induces oxidative stress and an altered skeletal muscle phenotype, cigarette smoke does not directly contribute to mitochondrial dysfunction. With this evidence, we demonstrate the critical role of physical inactivity in cigarette smoke-related skeletal muscle dysfunction.
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Affiliation(s)
- Stephen T Decker
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Oh-Sung Kwon
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- UConn Center on Aging and Department of Orthopaedic Surgery, University of Connecticut, School of Medicine, Farmington, Connecticut
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
| | - Jia Zhao
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
| | - John R Hoidal
- Department of Internal Medicine, Pulmonary Division, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Thomas Heuckstadt
- Department of Internal Medicine, Pulmonary Division, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Karl A Sanders
- Department of Internal Medicine, Pulmonary Division, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Gwenael Layec
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
- Institute of Applied Life Science, University of Massachusetts Amherst, Amherst, Massachusetts
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
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Malenfant S, Lebret M, Breton-Gagnon É, Potus F, Paulin R, Bonnet S, Provencher S. Exercise intolerance in pulmonary arterial hypertension: insight into central and peripheral pathophysiological mechanisms. Eur Respir Rev 2021; 30:200284. [PMID: 33853885 PMCID: PMC9488698 DOI: 10.1183/16000617.0284-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/08/2020] [Indexed: 11/05/2022] Open
Abstract
Exercise intolerance is a cardinal symptom of pulmonary arterial hypertension (PAH) and strongly impacts patients' quality of life (QoL). Although central cardiopulmonary impairments limit peak oxygen consumption (V' O2peak ) in patients with PAH, several peripheral abnormalities have been described over the recent decade as key determinants in exercise intolerance, including impaired skeletal muscle (SKM) morphology, convective O2 transport, capillarity and metabolism indicating that peripheral abnormalities play a greater role in limiting exercise capacity than previously thought. More recently, cerebrovascular alterations potentially contributing to exercise intolerance in patients with PAH were also documented. Currently, only cardiopulmonary rehabilitation has been shown to efficiently improve the peripheral components of exercise intolerance in patients with PAH. However, more extensive studies are needed to identify targeted interventions that would ultimately improve patients' exercise tolerance and QoL. The present review offers a broad and comprehensive analysis of the present literature about the complex mechanisms and their interactions limiting exercise in patients and suggests several gaps in knowledge that need to be addressed in the future for a better understanding of exercise intolerance in patients with PAH.
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Affiliation(s)
- Simon Malenfant
- Pulmonary Hypertension and Vascular Biology Research Group, Quebec Heart and Lung Institute Research Center, Quebec City, Canada
- Dept of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Marius Lebret
- Pulmonary Hypertension and Vascular Biology Research Group, Quebec Heart and Lung Institute Research Center, Quebec City, Canada
- Dept of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Émilie Breton-Gagnon
- Pulmonary Hypertension and Vascular Biology Research Group, Quebec Heart and Lung Institute Research Center, Quebec City, Canada
- Dept of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - François Potus
- Pulmonary Hypertension and Vascular Biology Research Group, Quebec Heart and Lung Institute Research Center, Quebec City, Canada
| | - Roxane Paulin
- Pulmonary Hypertension and Vascular Biology Research Group, Quebec Heart and Lung Institute Research Center, Quebec City, Canada
- Dept of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Sébastien Bonnet
- Pulmonary Hypertension and Vascular Biology Research Group, Quebec Heart and Lung Institute Research Center, Quebec City, Canada
- Dept of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Steeve Provencher
- Pulmonary Hypertension and Vascular Biology Research Group, Quebec Heart and Lung Institute Research Center, Quebec City, Canada
- Dept of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
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Marillier M, Bernard AC, Verges S, Moran-Mendoza O, O'Donnell DE, Neder JA. Oxygen supplementation during exercise improves leg muscle fatigue in chronic fibrotic interstitial lung disease. Thorax 2021; 76:672-680. [PMID: 33542089 DOI: 10.1136/thoraxjnl-2020-215135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Exercise-induced hypoxaemia is a hallmark of chronic fibrotic interstitial lung disease (f-ILD). It remains unclear whether patients' severe hypoxaemia may exaggerate locomotor muscle fatigue and, if so, to what extent oxygen (O2) supplementation can ameliorate these abnormalities. METHODS Fifteen patients (12 males, 9 with idiopathic pulmonary fibrosis) performed a constant-load (60% peak work rate) cycle test to symptom limitation (Tlim) while breathing medical air. Fifteen age-matched and sex-matched controls cycled up to patients' Tlim. Patients repeated the exercise test on supplemental O2 (42%±7%) for the same duration. Near-infrared spectroscopy assessed vastus lateralis oxyhaemoglobin concentration ((HbO2)). Pre-exercise to postexercise variation in twitch force (∆Tw) induced by femoral nerve magnetic stimulation quantified muscle fatigue. RESULTS Patients showed severe hypoxaemia (lowest O2 saturation by pulse oximetry=80.0%±7.6%) which was associated with a blunted increase in muscle (HbO2) during exercise vs controls (+1.3±0.3 µmol vs +4.4±0.4 µmol, respectively; p<0.001). Despite exercising at work rates ∼ one-third lower than controls (42±13 W vs 66±13 W), ∆Tw was greater in patients (∆Tw/external work performed by the leg muscles=-0.59±0.21 %/kJ vs -0.25±0.19 %/kJ; p<0.001). Reversal of exertional hypoxaemia with supplemental O2 was associated with a significant increase in muscle (HbO2), leading to a reduced decrease in ∆Tw in patients (-0.33±0.19 %/kJ; p<0.001 vs air). Supplemental O2 significantly improved leg discomfort (p=0.005). CONCLUSION O2 supplementation during exercise improves leg muscle oxygenation and fatigue in f-ILD. Lessening peripheral muscle fatigue to enhance exercise tolerance is a neglected therapeutic target that deserves clinical attention in this patient population.
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Affiliation(s)
- Mathieu Marillier
- Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
- 2HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, Isere, France
| | - Anne-Catherine Bernard
- Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
- 2HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, Isere, France
| | - Samuel Verges
- 2HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, Isere, France
| | - Onofre Moran-Mendoza
- Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Denis E O'Donnell
- Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - José Alberto Neder
- Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Smith JR, Joyner MJ, Curry TB, Borlaug BA, Keller-Ross ML, Van Iterson EH, Olson TP. Locomotor muscle group III/IV afferents constrain stroke volume and contribute to exercise intolerance in human heart failure. J Physiol 2020; 598:5379-5390. [PMID: 32886795 PMCID: PMC10039366 DOI: 10.1113/jp280333] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/24/2020] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Heart failure patients with reduced ejection fraction (HFrEF) exhibit severe limitations in exercise capacity ( V̇O2 peak). One of the primary peripheral mechanisms suggested to underlie exercise intolerance in HFrEF is excessive locomotor muscle group III/IV afferent feedback; however, this has never been investigated in human heart failure. HFrEF patients and controls performed an incremental exercise test to volitional exhaustion to determine V̇O2 peak with lumbar intrathecal fentanyl or placebo. During exercise, cardiac output, leg blood flow and radial artery and femoral venous blood gases were measured. With fentanyl, compared with placebo, patients with HFrEF achieved a higher peak workload, V̇O2 peak, cardiac output, stroke volume and leg blood flow. These findings suggest that locomotor muscle group III/IV afferent feedback in HFrEF leads to increased systemic vascular resistance, which constrains stroke volume, cardiac output and O2 delivery thereby impairing V̇O2 peak and thus exercise capacity. ABSTRACT To better understand the underlying mechanisms contributing to exercise limitation in heart failure with reduced ejection fraction (HFrEF), we investigated the influence of locomotor muscle group III/IV afferent inhibition via lumbar intrathecal fentanyl on peak exercise capacity ( V̇O2 peak) and the contributory mechanisms. Eleven HFrEF patients and eight healthy matched controls were recruited. The participants performed an incremental exercise test to volitional exhaustion to determine V̇O2 peak with lumbar intrathecal fentanyl or placebo. During exercise, cardiac output and leg blood flow ( Q̇L ) were measured via open-circuit acetylene wash-in technique and constant infusion thermodilution, respectively. Radial artery and femoral venous blood gases were measured. V̇O2 peak was 15% greater with fentanyl compared with placebo for HFrEF (P < 0.01), while no different in the controls. During peak exercise with fentanyl, cardiac output was 12% greater in HFrEF secondary to significant decreases in systemic vascular resistance and increases in stroke volume compared with placebo (all, P < 0.01). From placebo to fentanyl, leg V̇O2 , Q̇L and O2 delivery were greater for HFrEF during peak exercise (all, P < 0.01), but not control. These findings indicate that locomotor muscle group III/IV afferent feedback in patients with HFrEF leads to increased systemic vascular resistance, which constrains stroke volume, cardiac output and O2 delivery, thereby impairing V̇O2 peak and thus exercise capacity. These findings have important clinical implications as V̇O2 peak is highly predictive of morbidity and mortality in HF.
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Affiliation(s)
- Joshua R Smith
- Department of Cardiovascular Medicine, Mayo Clinic, MN, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, MN, USA
| | - Timothy B Curry
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, MN, USA
| | | | - Manda L Keller-Ross
- Division of Physical Therapy and Rehabilitation Sciences, University of Minnesota, MN, USA
| | - Erik H Van Iterson
- Section of Preventative Cardiology and Rehabilitation, Cleveland Clinic, MN, USA
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic, MN, USA
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Amann M, Wan HY, Thurston TS, Georgescu VP, Weavil JC. On the Influence of Group III/IV Muscle Afferent Feedback on Endurance Exercise Performance. Exerc Sport Sci Rev 2020; 48:209-216. [PMID: 32658041 DOI: 10.1249/jes.0000000000000233] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review discusses evidence suggesting that group III/IV muscle afferents affect locomotor performance by influencing neuromuscular fatigue. These neurons regulate the hemodynamic and ventilatory response to exercise and, thus, assure appropriate locomotor muscle O2 delivery, which optimizes peripheral fatigue development and facilitates endurance performance. In terms of central fatigue, group III/IV muscle afferents inhibit motoneuronal output and thereby limit exercise performance.
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Affiliation(s)
| | - Hsuan-Yu Wan
- Department of Anesthesiology, University of Utah
| | - Taylor S Thurston
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, Salt Lake City, UT
| | - Vincent P Georgescu
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, Salt Lake City, UT
| | - Joshua C Weavil
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, Salt Lake City, UT
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Iepsen UW, Ryrsø CK, Rugbjerg M, Secher NH, Barbosa TC, Lange P, Thaning P, Pedersen BK, Mortensen SP, Fadel PJ. Cardiorespiratory responses to high-intensity skeletal muscle metaboreflex activation in chronic obstructive pulmonary disease. Clin Physiol Funct Imaging 2020; 41:146-155. [PMID: 33159389 DOI: 10.1111/cpf.12678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/08/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Augmented skeletal muscle metaboreflex activation may accompany chronic obstructive pulmonary disease (COPD). The maintained metaboreflex control of mean arterial pressure (MAP) that has been reported may reflect limited evaluation using only one moderate bout of static handgrip (HG) and following postexercise ischaemia (PEI). OBJECTIVE We tested the hypothesis that cardiovascular and respiratory responses to high-intensity static HG and isolated metaboreflex activation during PEI are augmented in COPD patients. METHODS Ten patients with moderate to severe COPD and eight healthy age- and BMI-matched controls performed two-minute static HG at moderate (30% maximal voluntary contraction; MVC) and high (40% MVC) intensity followed by PEI. RESULTS Despite similar ratings of perceived exertion, arm muscle mass and strength, COPD patients demonstrated lower MAP responses during both HG intensities compared with controls (time × group interaction, p < .05). Indeed, during high-intensity HG at 40% MVC, peak MAP responses were significantly lower in COPD patients (ΔMAP: COPD 41 ± 9 mmHg vs. controls 56 ± 14 mmHg, p < .05). Notably, no group differences in MAP were observed during PEI (e.g. 40% MVC PEI: ΔMAP COPD 33 ± 9 mmHg vs. controls 33 ± 6 mmHg, p > .05). We found no between-group differences in heart rate, respiratory rate, or estimated minute ventilation during HG or PEI. CONCLUSION These results suggest that the pressor response to high-intensity HG is blunted in COPD patients. Moreover, despite inducing a strong cardiovascular and respiratory stimulus, skeletal muscle metaboreflex activation evoked similar responses in COPD patients and controls.
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Affiliation(s)
- Ulrik Winning Iepsen
- Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Koch Ryrsø
- Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mette Rugbjerg
- Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels H Secher
- Department of Anaesthesiology, Institute of Clinical Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Lange
- Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Medical Department O, Respiratory Section, Herlev and Gentofte Hospital, Herlev, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Pia Thaning
- Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Respiratory Medicine, University Hospital Hvidovre, Hvidovre, Denmark
| | - Bente K Pedersen
- Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sefan P Mortensen
- Centre of Inflammation and Metabolism and The Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Paul J Fadel
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
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Marillier M, Bernard AC, Verges S, Neder JA. The role of peripheral muscle fatigability on exercise intolerance in COPD. Expert Rev Respir Med 2020; 15:117-129. [PMID: 33148059 DOI: 10.1080/17476348.2021.1836964] [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: 10/23/2022]
Abstract
INTRODUCTION Exercise limitation in chronic obstructive pulmonary disease (COPD) is multi-factorial; however, growing evidence indicates that muscle dysfunction may contribute in some patients. AREAS COVERED This work outlines current evidence for and against increased peripheral muscle fatigability in COPD through a comprehensive review of relevant literature available on PubMed/MEDLINE until May 2020. The authors first discuss key methodological issues relative to muscle fatigue assessment by non-volitional techniques, particularly magnetic stimulation. The authors then provide a detailed discussion of critical studies to have objectively measured skeletal muscle fatigue in individuals with COPD. EXPERT OPINION Current evidence indicates that localized (knee extension) and cycling exercise are associated with increased quadriceps fatigability in most COPD patients. Increased fatigability, however, has not been consistently found in response to walking, likely reflecting the tendency of 'central' respiratory constraints to overshadow potential functional impairments in the appendicular muscles in this form of exercise. Thus, addressing skeletal muscle abnormalities may be critical to translate improvements in lung mechanics (e.g., due to bronchodilator therapy) into better exercise tolerance. The positive effects of pulmonary rehabilitation on muscle fatigability are particularly encouraging and suggest a role for these measurements to test the efficacy of emerging adjunct training strategies focused on the peripheral muscles.
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Affiliation(s)
- Mathieu Marillier
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital , Kingston, ON, Canada.,HP2 Laboratory, INSERM U1042, Grenoble Alpes University , Grenoble, France
| | - Anne-Catherine Bernard
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital , Kingston, ON, Canada.,HP2 Laboratory, INSERM U1042, Grenoble Alpes University , Grenoble, France
| | - Samuel Verges
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University , Grenoble, France
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital , Kingston, ON, Canada
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White M, Bruce R. The role of muscle mechano and metaboreflexes in the control of ventilation: breathless with (over) excitement? Exp Physiol 2020; 105:2250-2253. [DOI: 10.1113/ep088460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Michael White
- School of Sport Exercise and Rehabilitation Sciences University of Birmingham Birmingham UK
| | - Richard Bruce
- Centre for Human and Applied Physiological Sciences School of Basic and Medical Sciences King's College London London UK
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Wan HY, Weavil JC, Thurston TS, Georgescu VP, Bledsoe AD, Jessop JE, Buys MJ, Richardson RS, Amann M. The muscle reflex and chemoreflex interaction: ventilatory implications for the exercising human. J Appl Physiol (1985) 2020; 129:691-700. [PMID: 32816637 DOI: 10.1152/japplphysiol.00449.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We examined the interactive influence of the muscle reflex (MR) and the chemoreflex (CR) on the ventilatory response to exercise. Eleven healthy subjects (5 women/6 men) completed three bouts of constant-load single-leg knee-extension exercise in a control trial and an identical trial conducted with lumbar intrathecal fentanyl to attenuate neural feedback from lower-limb group III/IV muscle afferents. The exercise during the two trials was performed while breathing ambient air ([Formula: see text] ~97%, [Formula: see text]~84 mmHg, [Formula: see text] ~32 mmHg, pH ~7.39), or under normocapnic hypoxia ([Formula: see text] ~79%, [Formula: see text] ~43 mmHg, [Formula: see text] ~33 mmHg, pH ~7.39) or normoxic hypercapnia ([Formula: see text] ~98%, [Formula: see text] ~105 mmHg, [Formula: see text] ~50 mmHg, pH ~7.26). During coactivation of the MR and the hypoxia-induced CR (O2-CR), minute ventilation (V̇e) and tidal volume (VT) were significantly greater compared with the sum of the responses to the activation of each reflex alone; there was no difference between the observed and summated responses in terms of breathing frequency (fB; P = 0.4). During coactivation of the MR and the hypercapnia-induced CR (CO2-CR), the observed ventilatory responses were similar to the summated responses of the reflexes (P ≥ 0.1). Therefore, the interaction between the MR and the O2-CR exerts a hyperadditive effect on V̇e and VT and an additive effect on fB, whereas the interaction between the MR and the CO2-CR is simply additive for all ventilatory parameters. These findings reveal that the MR:CR interaction further augments the ventilatory response to exercise in hypoxia.NEW & NOTEWORTHY Although the muscle reflex and the chemoreflex are recognized as independent feedback mechanisms regulating breathing during exercise, the ventilatory implications resulting from their interaction remain unclear. We quantified the individual and interactive effects of these reflexes during exercise and revealed differential modes of interaction. Importantly, the reflex interaction further amplifies the ventilatory response to exercise under hypoxemic conditions, highlighting a potential mechanism for optimizing arterial oxygenation in physically active humans at high altitude.
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Affiliation(s)
- Hsuan-Yu Wan
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Joshua C Weavil
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Utah
| | - Taylor S Thurston
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Vincent P Georgescu
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Amber D Bledsoe
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Jacob E Jessop
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Michael J Buys
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Markus Amann
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah.,Geriatric Research, Education, and Clinical Center, Salt Lake City Veterans Affairs Medical Center, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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Dempsey JA, La Gerche A, Hull JH. Is the healthy respiratory system built just right, overbuilt, or underbuilt to meet the demands imposed by exercise? J Appl Physiol (1985) 2020; 129:1235-1256. [PMID: 32790594 DOI: 10.1152/japplphysiol.00444.2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In the healthy, untrained young adult, a case is made for a respiratory system (airways, pulmonary vasculature, lung parenchyma, respiratory muscles, and neural ventilatory control system) that is near ideally designed to ensure a highly efficient, homeostatic response to exercise of varying intensities and durations. Our aim was then to consider circumstances in which the intra/extrathoracic airways, pulmonary vasculature, respiratory muscles, and/or blood-gas distribution are underbuilt or inadequately regulated relative to the demands imposed by the cardiovascular system. In these instances, the respiratory system presents a significant limitation to O2 transport and contributes to the occurrence of locomotor muscle fatigue, inhibition of central locomotor output, and exercise performance. Most prominent in these examples of an "underbuilt" respiratory system are highly trained endurance athletes, with additional influences of sex, aging, hypoxic environments, and the highly inbred equine. We summarize by evaluating the relative influences of these respiratory system limitations on exercise performance and their impact on pathophysiology and provide recommendations for future investigation.
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Affiliation(s)
- Jerome A Dempsey
- John Robert Sutton Professor of Population Health Sciences, John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia.,National Center for Sports Cardiology, St. Vincent's Hospital, Melbourne, Fitzroy, Australia
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,Institute of Sport, Exercise and Health (ISEH), University College London, United Kingdom
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Chuang ML. Mechanisms affecting exercise ventilatory inefficiency-airflow obstruction relationship in male patients with chronic obstructive pulmonary disease. Respir Res 2020; 21:206. [PMID: 32762752 PMCID: PMC7409645 DOI: 10.1186/s12931-020-01463-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
Background Exercise ventilatory inefficiency is usually defined as high ventilation (\documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{CO}2 $$\end{document}V˙CO2). The inefficiency may be lowered when airflow obstruction is severe because \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E} $$\end{document}V˙E cannot be adequately increased in response to exercise. However, the ventilatory inefficiency-airflow obstruction relationship differs to a varying degree. This has been hypothesized to be affected by increased dead space fraction of tidal volume (VD/VT), acidity, hypoxemia, and hypercapnia. Methods A total of 120 male patients with chronic obstructive pulmonary disease were enrolled. Lung function and incremental exercise tests were conducted, and \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E} $$\end{document}V˙E versus \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{S} $$\end{document}V˙E/V˙CO2S) and intercept (\documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{I} $$\end{document}V˙E/V˙CO2I) were obtained by linear regression. Arterial blood gas analysis was also performed in 47 of the participants during exercise tests. VD/VT and lactate level were measured. Results VD/VTpeak was moderately positively related to \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{S} $$\end{document}V˙E/V˙CO2S (r = 0.41) and negatively related to forced expired volume in 1 sec % predicted (FEV1%) (r = − 0.27), and hence the FEV1%- \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{S} $$\end{document}V˙E/V˙CO2S relationship was paradoxical. The higher the \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{S} $$\end{document}V˙E/V˙CO2S, the higher the pH and PaO2, and the lower the PaCO2 and exercise capacity. \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{I} $$\end{document}V˙E/V˙CO2I was marginally related to VD/VTrest. The higher the \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{I} $$\end{document}V˙E/V˙CO2I, the higher the inspiratory airflow, work rate, and end-tidal PCO2peak. Conclusion 1) Dead space ventilation perturbs the airflow- \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{S} $$\end{document}V˙E/V˙CO2S relationship, 2) increasing ventilation thereby increases \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{S} $$\end{document}V˙E/V˙CO2S to maintain biological homeostasis, and 3) the physiology- \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{S} $$\end{document}V˙E/V˙CO2S- \documentclass[12pt]{minimal}
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\begin{document}$$ \dot{\mathrm{V}}\mathrm{E}/\dot{\mathrm{V}}\mathrm{CO}2\mathrm{I} $$\end{document}V˙E/V˙CO2I relationships are inconsistent in the current and previous studies. Trial Registration MOST 106–2314-B-040-025.
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Affiliation(s)
- Ming-Lung Chuang
- Department of Internal Medicine and Division of Pulmonary Medicine, Chung Shan Medical University Hospital, #110, Section 1, Chien-Kuo North Road, South District, Taichung, 40201, Taiwan, Republic of China. .,School of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan, Republic of China.
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Kebe M, Gadhafi R, Mohammad B, Sanduleanu M, Saleh H, Al-Qutayri M. Human Vital Signs Detection Methods and Potential Using Radars: A Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E1454. [PMID: 32155838 PMCID: PMC7085680 DOI: 10.3390/s20051454] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 02/04/2023]
Abstract
Continuous monitoring of vital signs, such as respiration and heartbeat, plays a crucial role in early detection and even prediction of conditions that may affect the wellbeing of the patient. Sensing vital signs can be categorized into: contact-based techniques and contactless based techniques. Conventional clinical methods of detecting these vital signs require the use of contact sensors, which may not be practical for long duration monitoring and less convenient for repeatable measurements. On the other hand, wireless vital signs detection using radars has the distinct advantage of not requiring the attachment of electrodes to the subject's body and hence not constraining the movement of the person and eliminating the possibility of skin irritation. In addition, it removes the need for wires and limitation of access to patients, especially for children and the elderly. This paper presents a thorough review on the traditional methods of monitoring cardio-pulmonary rates as well as the potential of replacing these systems with radar-based techniques. The paper also highlights the challenges that radar-based vital signs monitoring methods need to overcome to gain acceptance in the healthcare field. A proof-of-concept of a radar-based vital sign detection system is presented together with promising measurement results.
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Affiliation(s)
- Mamady Kebe
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
| | - Rida Gadhafi
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
- College of Engineering & IT (CEIT), University of Dubai, P.O. Box 14143, Dubai, UAE
| | - Baker Mohammad
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
| | - Mihai Sanduleanu
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
| | - Hani Saleh
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
| | - Mahmoud Al-Qutayri
- System on Chip Center, Khalifa University, P.O. Box 127788, Abu Dhabi, UAE; (M.K.); (R.G.); (M.S.); (H.S.); (M.A.-Q.)
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Dempsey JA, Smith CA. Update on Chemoreception: Influence on Cardiorespiratory Regulation and Pathophysiology. Clin Chest Med 2020; 40:269-283. [PMID: 31078209 DOI: 10.1016/j.ccm.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examine recent findings that have revealed interdependence of function within the chemoreceptor pathway regulating breathing and sympathetic vasomotor activity and the hypersensitization of these reflexes in chronic disease states. Recommendations are made as to how these states of hyperreflexia in chemoreceptors and muscle afferents might be modified in treating sleep apnea, drug-resistant hypertension, chronic heart failure-induced sympathoexcitation, and the exertional dyspnea of chronic obstructive pulmonary disease.
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Affiliation(s)
- Jerome A Dempsey
- Department Population Health Sciences, University of Wisconsin-Madison, 707 WARF Building, 610 N. Walnut Street, WI 53726, USA.
| | - Curtis A Smith
- Department Population Health Sciences, University of Wisconsin-Madison, 707 WARF Building, 610 N. Walnut Street, WI 53726, USA
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40
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Angius L, Crisafulli A. Exercise intolerance and fatigue in chronic heart failure: is there a role for group III/IV afferent feedback? Eur J Prev Cardiol 2020; 27:1862-1872. [PMID: 32046526 PMCID: PMC7672669 DOI: 10.1177/2047487320906919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Exercise intolerance and early fatiguability are hallmark symptoms of chronic heart failure. While the malfunction of the heart is certainly the leading cause of chronic heart failure, the patho-physiological mechanisms of exercise intolerance in these patients are more complex, multifactorial and only partially understood. Some evidence points towards a potential role of an exaggerated afferent feedback from group III/IV muscle afferents in the genesis of these symptoms. Overactivity of feedback from these muscle afferents may cause exercise intolerance with a double action: by inducing cardiovascular dysregulation, by reducing motor output and by facilitating the development of central and peripheral fatigue during exercise. Importantly, physical inactivity appears to affect the progression of the syndrome negatively, while physical training can partially counteract this condition. In the present review, the role played by group III/IV afferent feedback in cardiovascular regulation during exercise and exercise-induced muscle fatigue of healthy people and their potential role in inducing exercise intolerance in chronic heart failure patients will be summarised.
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Affiliation(s)
- Luca Angius
- Faculty of Health and Life Sciences, Sport, Exercise and Rehabilitation, Northumbria University, UK
| | - Antonio Crisafulli
- Department of Medical Sciences and Public Health, Sports Physiology Laboratory, University of Cagliari, Italy
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41
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Broxterman RM, Hoff J, Wagner PD, Richardson R. Determinants of the diminished exercise capacity in patients with chronic obstructive pulmonary disease: looking beyond the lungs. J Physiol 2020; 598:599-610. [PMID: 31856306 PMCID: PMC6995414 DOI: 10.1113/jp279135] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022] Open
Abstract
KEY POINTS Peak oxygen uptake, a primary determinant of prognosis, mortality and quality of life, is diminished in patients with chronic obstructive pulmonary disease (COPD), with mounting evidence supporting an important role for peripheral dysfunction, particularly within skeletal muscle. In patients with severe COPD and activity-matched controls, muscle oxygen transport and utilization were assessed at peak effort during single-leg knee-extensor exercise (KE), where ventilation is assumed to be submaximal. This strategy removes ventilation as the major constraint to exercise capacity in COPD, allowing maximal muscle function to be attained and evaluated. During maximal KE, both convective arterial oxygen delivery to the skeletal muscle microvasculature and subsequent diffusive oxygen delivery to the mitochondria were diminished in patients with COPD compared to control subjects. These findings emphasize the importance of factors, beyond the lungs, that influence exercise capacity in this patient population and may, ultimately, influence the prognosis, mortality and quality of life for patients with COPD. ABSTRACT Peak oxygen uptake ( V ̇ O 2 peak ), a primary determinant of prognosis, mortality and quality of life, is diminished in patients with chronic obstructive pulmonary disease (COPD). Mounting evidence supports an important role of the periphery, particularly skeletal muscle, in the diminished V ̇ O 2 peak with COPD. However, the peripheral determinants of V ̇ O 2 peak have not been comprehensively assessed in this cohort. Thus, the hypothesis was tested that both muscle convective and diffusive oxygen (O2 ) transport, and therefore skeletal muscle peak O2 uptake ( V ̇ M O 2 peak ), are diminished in patients with COPD compared to matched healthy controls, even when ventilatory limitations (i.e. attainment of maximal ventilation) are minimized by using small muscle mass exercise. Muscle O2 transport and utilization were assessed at peak exercise from femoral arterial and venous blood samples and leg blood flow (by thermodilution) in eight patients with severe COPD (forced expiratory volume in 1s (FEV1 ) ± SEM = 0.9 ± 0.1 l, 30% of predicted) and eight controls during single-leg knee-extensor exercise. Both muscle convective O2 delivery (0.44 ± 0.06 vs. 0.69 ± 0.07 l min-1 , P < 0.05) and muscle diffusive O2 conductance (6.6 ± 0.8 vs. 10.4 ± 0.9 ml min-1 mmHg-1 , P < 0.05) were ∼1/3 lower in patients with COPD than controls, resulting in an attenuated V ̇ M O 2 peak in the patients (0.27 ± 0.04 vs. 0.42 ± 0.05 l min-1 , P < 0.05). When cardiopulmonary limitations to exercise are minimized, the convective and diffusive determinants of V ̇ M O 2 peak , at the level of the skeletal muscle, are greatly attenuated in patients with COPD. These findings emphasize the importance of factors, beyond the lungs, that may ultimately influence this population's prognosis, mortality and quality of life.
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Affiliation(s)
- Ryan M. Broxterman
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah
| | - Jan Hoff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Peter D. Wagner
- Department of Medicine, University of California, San Diego, La Jolla, California
| | - Russell.S. Richardson
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
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42
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O'Donnell DE, Milne KM, James MD, de Torres JP, Neder JA. Dyspnea in COPD: New Mechanistic Insights and Management Implications. Adv Ther 2020; 37:41-60. [PMID: 31673990 PMCID: PMC6979461 DOI: 10.1007/s12325-019-01128-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 12/29/2022]
Abstract
Dyspnea is the most common symptom experienced by patients with chronic obstructive pulmonary disease (COPD). To avoid exertional dyspnea, many patients adopt a sedentary lifestyle which predictably leads to extensive skeletal muscle deconditioning, social isolation, and its negative psychological sequalae. This “dyspnea spiral” is well documented and it is no surprise that alleviation of this distressing symptom has become a key objective highlighted across COPD guidelines. In reality, this important goal is often difficult to achieve, and successful symptom management awaits a clearer understanding of the underlying mechanisms of dyspnea and how these can be therapeutically manipulated for the patients’ benefit. Current theoretical constructs of the origins of activity-related dyspnea generally endorse the classical demand–capacity imbalance theory. Thus, it is believed that disruption of the normally harmonious relationship between inspiratory neural drive (IND) to breathe and the simultaneous dynamic response of the respiratory system fundamentally shapes the expression of respiratory discomfort in COPD. Sadly, the symptom of dyspnea cannot be eliminated in patients with advanced COPD with relatively fixed pathophysiological impairment. However, there is evidence that effective symptom palliation is possible for many. Interventions that reduce IND, without compromising alveolar ventilation (VA), or that improve respiratory mechanics and muscle function, or that address the affective dimension, achieve measurable benefits. A common final pathway of dyspnea relief and improved exercise tolerance across the range of therapeutic interventions (bronchodilators, exercise training, ambulatory oxygen, inspiratory muscle training, and opiate medications) is reduced neuromechanical dissociation of the respiratory system. These interventions, singly and in combination, partially restore more harmonious matching of excessive IND to ventilatory output achieved. In this review we propose, on the basis of a thorough review of the recent literature, that effective dyspnea amelioration requires combined interventions and a structured multidisciplinary approach, carefully tailored to meet the specific needs of the individual.
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Affiliation(s)
- Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada.
| | - Kathryn M Milne
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
- Clinician Investigator Program, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
| | - Juan Pablo de Torres
- Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Division of Respirology, Department of Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada
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43
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Cabibel V, Alexandre F, Oliver N, Varray A, Héraud N. Psychoactive medications in chronic obstructive pulmonary disease patients: From prevalence to effects on motor command and strength. Respir Med 2019; 159:105805. [PMID: 31704592 DOI: 10.1016/j.rmed.2019.105805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION In chronic-obstructive pulmonary disease (COPD) patients, the peripheral muscle weakness is partly due to reduced motor command. The psychoactive medications, which are often prescribed in COPD, are mainly inhibitory and thus may contribute to motor command reduction. The aims were to characterize and quantify the use of these drugs and determine their effects on cortical excitability and inhibition and thus on motor command and muscle weakness in these patients. METHODS First, a prevalence study was conducted on 421 COPD patients. Second, cortical excitability, inhibition and voluntary activation were assessed in 40 patients (15 under psychoactive medications vs. 25 controls) by transcranial magnetic stimulation of the rectus femoris. Quadriceps maximal isometric strength was also assessed. RESULTS About 48% of the patients were taking psychoactive medication. Benzodiazepines (21%) and antidepressants (13.5%) were the most prescribed. Patients with medications tended to be younger and isolated (p < 0.05). They also showed impaired cortical inhibition and decreased cortical excitability (+36%, p = 0.02). Voluntary activation was reduced (-3.6%, p = 0.04) but quadriceps strength was comparable between groups. CONCLUSIONS Psychoactive medications are prevalent in COPD patients. Patients under these medications exhibited brain impairment and reduced motor command. Paradoxically, voluntary strength was unaltered.
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Affiliation(s)
- Vincent Cabibel
- EuroMov Laboratory, Univ. Montpellier, Montpellier, France; Les Cliniques du Souffle, Groupe 5 Santé, France.
| | | | | | - Alain Varray
- EuroMov Laboratory, Univ. Montpellier, Montpellier, France
| | - Nelly Héraud
- Les Cliniques du Souffle, Groupe 5 Santé, France
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Bruce RM, Jolley C, White MJ. Control of exercise hyperpnoea: Contributions from thin-fibre skeletal muscle afferents. Exp Physiol 2019; 104:1605-1621. [PMID: 31429500 DOI: 10.1113/ep087649] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/16/2019] [Indexed: 12/16/2022]
Abstract
NEW FINDINGS What is the topic of this review? In this review, we examine the evidence for control mechanisms underlying exercise hyperpnoea, giving attention to the feedback from thin-fibre skeletal muscle afferents, and highlight the frequently conflicting findings and difficulties encountered by researchers using a variety of experimental models. What advances does it highlight? There has been a recent resurgence of interest in the role of skeletal muscle afferent involvement, not only as a mechanism of healthy exercise hyperpnoea but also in the manifestation of breathlessness and exercise intolerance in chronic disease. ABSTRACT The ventilatory response to dynamic submaximal exercise is immediate and proportional to metabolic rate, which maintains isocapnia. How these respiratory responses are controlled remains poorly understood, given that the most tightly controlled variable (arterial partial pressure of CO2 /H+ ) provides no error signal for arterial chemoreceptors to trigger reflex increases in ventilation. This review discusses evidence for different postulated control mechanisms, with a focus on the feedback from group III/IV skeletal muscle mechanosensitive and metabosensitive afferents. This concept is attractive, because the stimulation of muscle mechanoreceptors might account for the immediate increase in ventilation at the onset of exercise, and signals from metaboreceptors might be proportional to metabolic rate. A variety of experimental models have been used to establish the contribution of thin-fibre muscle afferents in ventilatory control during exercise, with equivocal results. The inhibition of afferent feedback via the application of lumbar intrathecal fentanyl during exercise suppresses ventilation, which provides the most compelling supportive evidence to date. However, stimulation of afferent feedback at rest has no consistent effect on respiratory output. However, evidence is emerging for synergistic interactions between muscle afferent feedback and other stimulatory inputs to the central respiratory neuronal pool. These seemingly hyperadditive effects might explain the conflicting findings encountered when using different experimental models. We also discuss the increasing evidence that patients with certain chronic diseases exhibit exaggerated muscle afferent activation during exercise, resulting in enhanced cardiorespiratory responses. This might provide a neural link between the well-established limb muscle dysfunction and the associated exercise intolerance and exertional dyspnoea, which might offer therapeutic targets for these patients.
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Affiliation(s)
- Richard M Bruce
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Sciences, King's College London, London, UK
| | - Caroline Jolley
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Sciences, King's College London, London, UK
| | - Michael J White
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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45
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A comparison of different methods to analyse data collected during time-to-exhaustion tests. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00585-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose
Despite their widespread use in exercise physiology, time-to-exhaustion (TTE) tests present an often-overlooked challenge to researchers, which is how to computationally deal with between- and within-subject differences in exercise duration. We aimed to verify the best analysis method to overcome this problem.
Methods
Eleven cyclists performed an incremental test and three TTE tests differing in workload as preliminary tests. The TTEs were used to derive the individual power–duration relationship needed to set the workload (corresponding to an estimated TTE of 1200 s) for four identical experimental TTE tests. Within individuals, the four tests were subsequently rank ordered by performance. Physiological and psychological variables expected to change with performance were analysed using different methods, with the main aim being to compare the traditional “group isotime” method and a less-used “individual isotime” method.
Results
The four tests, ranked from the best to the worst, had a TTE of 1526 ± 332, 1425 ± 313, 1295 ± 325, and 1026 ± 265 s. Ratings of perceived exertion, minute ventilation, respiratory frequency, and affective valence were sensitive to changes in performance when their responses were analysed with the “individual isotime” method (P < 0.022, ηp2 > 0.144) but not when using the “group isotime” method, because the latter resulted in partial data loss.
Conclusions
The use of the “individual isotime” method is strongly encouraged to avoid the misinterpretation of the phenomenon under study. Important implications are not limited to constant-workload exercise, but extend to incremental exercise, which is another commonly used test of exercise tolerance.
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Bonnevie T, Gravier FE, Prieur G, Combret Y, Debeaumont D, Patout M, Lamia B, Muir JF, Médrinal C, Cuvelier A. Lumbar transcutaneous electrical nerve stimulation to improve exercise performance in COPD patients. Eur Respir J 2019; 54:13993003.00784-2019. [PMID: 31515403 DOI: 10.1183/13993003.00784-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/29/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France .,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Guillaume Prieur
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Intensive Care Unit Dept, Le Havre Hospital, Le Havre, France
| | - Yann Combret
- Physiotherapy Dept, Le Havre Hospital, Le Havre, France.,Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium
| | - David Debeaumont
- Dept of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Maxime Patout
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Dept, Rouen University Hospital, Rouen, France
| | - Bouchra Lamia
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Intensive Care Unit Dept, Le Havre Hospital, Le Havre, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Dept, Rouen University Hospital, Rouen, France
| | - Jean-François Muir
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Dept, Rouen University Hospital, Rouen, France
| | - Clement Médrinal
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Intensive Care Unit Dept, Le Havre Hospital, Le Havre, France
| | - Antoine Cuvelier
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Dept, Rouen University Hospital, Rouen, France
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47
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Hureau TJ, Weavil JC, Thurston TS, Wan HY, Gifford JR, Jessop JE, Buys MJ, Richardson RS, Amann M. Pharmacological attenuation of group III/IV muscle afferents improves endurance performance when oxygen delivery to locomotor muscles is preserved. J Appl Physiol (1985) 2019; 127:1257-1266. [PMID: 31513446 DOI: 10.1152/japplphysiol.00490.2019] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We sought to investigate the role of group III/IV muscle afferents in limiting endurance exercise performance, independently of their role in optimizing locomotor muscle O2 delivery. While breathing 100% O2 to ensure a similar arterial O2 content ([Formula: see text]) in both trials, eight male cyclists performed 5-km time trials under control conditions (HCTRL) and with lumbar intrathecal fentanyl (HFENT) impairing neural feedback from the lower limbs. After each time trial, common femoral artery blood flow (FBF) was quantified (Doppler ultrasound) during constant-load cycling performed at the average power of the preceding time trial. The assessment of end-tidal gases, hemoglobin content and saturation, and FBF facilitated the calculation of leg O2 delivery. Locomotor muscle activation during cycling was estimated from vastus lateralis EMG. With electrical femoral nerve stimulation, peripheral and central fatigue were quantified by pre- to postexercise decreases in quadriceps twitch torque (ΔQtw) and voluntary activation (ΔVA), respectively. FBF (~16 mL·min-1·W-1; P = 0.6), [Formula: see text] (~24 mL O2/dL; P = 0.9), and leg O2 delivery (~0.38 mL O2·min-1·W-1; P = 0.9) were not different during HCTRL and HFENT. Mean power output and time to completion were significantly improved by 9% (~310 W vs. ~288 W) and 3% (~479 s vs. ~463 s), respectively, during HFENT compared with HCTRL. Quadriceps muscle activation was 9 ± 7% higher during HFENT compared with HCTRL (P < 0.05). ΔQtw was significantly greater in HFENT compared with HCTRL (54 ± 8% vs. 39 ± 9%), whereas ΔVA was not different (~5%; P = 0.3) in both trials. These findings reveal that group III/IV muscle afferent feedback limits whole body endurance exercise performance and peripheral fatigue by restricting neural activation of locomotor muscle.NEW & NOTEWORTHY Group III/IV muscle afferent feedback facilitates endurance performance by optimizing locomotor muscle O2 delivery but also limits performance by restricting neural drive to locomotor muscle. To isolate the performance-limiting effect of these sensory neurons, we pharmacologically attenuated their central projection during a cycling time trial while controlling for locomotor muscle O2 delivery. With no difference in leg O2 delivery, afferent blockade attenuated the centrally mediated restriction in motoneuronal output and improved cycling performance.
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Affiliation(s)
- Thomas J Hureau
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Medicine and EA 3072: Mitochondria, Oxidative Stress and Muscular Protection Laboratory, University of Strasbourg, Strasbourg, France
| | - Joshua C Weavil
- Geriatric Research, Education, and Clinical Center, Salt Lake City Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Taylor S Thurston
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Hsuan-Yu Wan
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Jayson R Gifford
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jacob E Jessop
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Michael J Buys
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Russell S Richardson
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Geriatric Research, Education, and Clinical Center, Salt Lake City Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Markus Amann
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Geriatric Research, Education, and Clinical Center, Salt Lake City Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah.,Department of Anesthesiology, University of Utah, Salt Lake City, Utah
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48
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Berton DC, Marques RD, Palmer B, O'Donnell DE, Neder JA. Effects of lung deflation induced by tiotropium/olodaterol on the cardiocirculatory responses to exertion in COPD. Respir Med 2019; 157:59-68. [PMID: 31522031 DOI: 10.1016/j.rmed.2019.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hyperinflation has been associated with negative cardiocirculatory consequences in patients with chronic obstructive pulmonary disease (COPD). These abnormalities are likely to worsen when the demands for O2 increase, e.g., under the stress of exercise. Thus, pharmacologically-induced lung deflation may improve cardiopulmonary interactions and exertional cardiac output leading to higher limb muscle blood flow and oxygenation in hyperinflated patients with COPD. METHODS 20 patients (residual volume = 201.6 ± 63.6% predicted) performed endurance cardiopulmonary exercise tests (75% peak) 1 h after placebo or tiotropium/olodaterol 5/5 μg via the Respimat® inhaler (Boehringer Ingelheim, Ingelheim am Rhein, Germany). Cardiac output was assessed by signal-morphology impedance cardiography. Near-infrared spectroscopy determined quadriceps blood flow (indocyanine green dye) and intra-muscular oxygenation. RESULTS Tiotropium/olodaterol was associated with marked lung deflation (p < 0.01): residual volume decreased by at least 0.4 L in 14/20 patients (70%). The downward shift in the resting static lung volumes was associated with less exertional inspiratory constraints and dyspnoea thereby increasing exercise endurance by ~50%. Contrary to our premises, however, neither central and peripheral hemodynamics nor muscle oxygenation improved after active intervention compared to placebo. These results were consistent with those found in a subgroup of patients showing the largest decrements in residual volume (p < 0.05). CONCLUSIONS The beneficial effects of tiotropium/olodaterol on resting and operating lung volumes are not translated into enhanced cardiocirculatory responses to exertion in hyperinflated patients with COPD. Improvement in exercise tolerance after dual bronchodilation is unlikely to be mechanistically linked to higher muscle blood flow and/or O2 delivery.
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Affiliation(s)
- Danilo C Berton
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada; Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal Do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata D Marques
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada; Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal Do Rio Grande do Sul, Porto Alegre, Brazil
| | - Brandon Palmer
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit & Laboratory of Clinical Exercise Physiology, Queen's University & Kingston General Hospital, Kingston, ON, Canada.
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49
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Louvaris Z, Vogiatzis I. Contrasting the physiological effects of heliox and oxygen during exercise in a patient with advanced COPD. Breathe (Sheff) 2019; 15:250-257. [PMID: 31508165 PMCID: PMC6717618 DOI: 10.1183/20734735.0197-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In COPD patients the ergogenic effect of heliox or oxygen breathing might be related both to improvements in ventilatory parameters (that lessen dyspnoea) and to enhanced oxygen delivery to respiratory and locomotor muscles http://bit.ly/2JlJBTc.
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Affiliation(s)
- Zafeiris Louvaris
- Faculty of Movement and Rehabilitation Sciences, Division of Respiratory Rehabilitation, Dept Rehabilitation Sciences KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Ioannis Vogiatzis
- Dept of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle, UK
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50
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Marklund S, Bui KL, Nyberg A. Measuring and monitoring skeletal muscle function in COPD: current perspectives. Int J Chron Obstruct Pulmon Dis 2019; 14:1825-1838. [PMID: 31695351 PMCID: PMC6707440 DOI: 10.2147/copd.s178948] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Skeletal muscle dysfunction is an important systemic consequence of chronic obstructive pulmonary disease (COPD) that worsens the natural cause of the disease. Up to a third of all people with COPD express some form of impairment which encompasses reductions in strength and endurance, as well as an increased fatigability. Considering this complexity, no single test could be used to measure and monitor all aspects of the impaired skeletal muscle function within the COPD population, resulting in a wide range of available tests and measurement techniques. The aim of the current review is to highlight current and new perspectives relevant to skeletal muscle function measurements within the COPD population in order to provide guidance for researchers as well as for clinicians. First of all, standardized and clinically feasible measurement protocols, as well as normative values and predictive equations across the spectrum of impaired function in COPD, are needed before assessment of skeletal muscle function can become a reality in clinical praxis. This should minimally target the quadriceps muscle; however, depending on the objective of measurements, eg, to determine upper limb muscle function or walking capacity, other muscles could also be tested. Furthermore, even though muscle strength measurements are important, current evidence suggests that other aspects, such as the endurance and power capacity of the muscle, should also be considered. Moreover, although static (isometric) measurements have been favored, dynamic measurements of skeletal muscle function should not be neglected as they, in a larger extent than static measurements, are related to tasks of daily living. Lastly, the often modest relationships between functional tests and skeletal muscle function measurements indicate that they evaluate different constructs and thus cannot replace one another. Therefore, for accurate measurements of skeletal muscle function in people with COPD, specific and formal measurements should still be prioritized.
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Affiliation(s)
- Sarah Marklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Kim-Ly Bui
- Rehabilitation Department, Faculty of Medicine Laval University and Centre de recherche, Laval University Quebec Heart and Lung Institute (CRIUCPQ), Québec, QC, Canada
| | - Andre Nyberg
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
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