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Al Sa'idi L, Berton DC, Neder JA. The 2022 ERS/ATS z-score classification to grade airflow obstruction: relationship with exercise outcomes across the spectrum of COPD severity. Eur Respir J 2024; 64:2301960. [PMID: 38936965 DOI: 10.1183/13993003.01960-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Lamyaa Al Sa'idi
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Kingston Health Science Center and Queen's University, Kingston, ON, Canada
| | - Danilo C Berton
- Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - J Alberto Neder
- Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Kingston Health Science Center and Queen's University, Kingston, ON, Canada
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Goulart CDL, Agostoni P, Salvioni E, Silva RN, Bassi-Dibai D, Roscani MG, Arena R, Myers J, Borghi-Silva A. Phenotyping cardiopulmonary exercise testing measures in heart failure with reduced ejection fraction: A comparison between Italy and Brazil. Heart Lung 2024; 65:54-58. [PMID: 38402757 DOI: 10.1016/j.hrtlng.2024.02.002] [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: 04/23/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND While patients with heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) constitutes a global health crisis the incidence, prevalence and prognosis of the disease may differ depending on the continent and country. OBJECTIVE To profile, analyze and compare cardiopulmonary exercise testing (CPET) data of patients with HFrEF between Italian and Brazilian cohorts. METHODS In this observational study, a total of 630 patients with clinical and functional diagnosis of HFrEF (315 patients from Brazil and 315 patients from Italy) performed CPET. RESULTS Although Brazilian patients were slightly younger (Brazil 60±10 vs Italy 64±11 p<0.001) with a better peak oxygen consumption (V̇O2), circulatory power and left ventricular ejection fraction (LVEF) (p<0.01), ventilatory inefficiency and oscillation ventilation was higher when compared to the Italian cohort. When stratifying patients with LVEF≤30 % and age≥60 years, Brazilian patients presented worse ventilatory efficiency, and lower peak V̇O2 compared to the Italian cohort. CONCLUSION Patients with HFrEF from Brazil exhibited higher ventilatory inefficiency and a greater prevalence of oscillatory ventilation during CPET compared to patients with the same diagnosis from Italy.
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Affiliation(s)
- Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP 13565-905, Brazil
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan 20138, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | | | - Rebeca Nunes Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP 13565-905, Brazil
| | - Daniela Bassi-Dibai
- Postgraduate Program in Management in Health Programs and Services, Universidade CEUMA, São Luís, MA, Brazil
| | - Meliza Goi Roscani
- Cardiology and Exercise Research Center Laboratory, Department of Medicine, Federal University of São Carlos, SP, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto CA, United States
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP 13565-905, Brazil.
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Hijleh AA, Wang S, Berton DC, Neder-Serafini I, Vincent S, James M, Domnik N, Phillips D, Nery LE, O'Donnell DE, Neder JA. Reference values for leg effort during incremental cycle ergometry in non-trained healthy men and women, aged 19-85. Scand J Med Sci Sports 2024; 34:e14625. [PMID: 38597357 DOI: 10.1111/sms.14625] [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: 11/16/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Abstract
Heightened sensation of leg effort contributes importantly to poor exercise tolerance in patient populations. We aim to provide a sex- and age-adjusted frame of reference to judge symptom's normalcy across progressively higher exercise intensities during incremental exercise. Two-hundred and seventy-five non-trained subjects (130 men) aged 19-85 prospectively underwent incremental cycle ergometry. After establishing centiles-based norms for Borg leg effort scores (0-10 category-ratio scale) versus work rate, exponential loss function identified the centile that best quantified the symptom's severity individually. Peak O2 uptake and work rate (% predicted) were used to threshold gradually higher symptom intensity categories. Leg effort-work rate increased as a function of age; women typically reported higher scores at a given age, particularly in the younger groups (p < 0.05). For instance, "heavy" (5) scores at the 95th centile were reported at ~200 W (<40 years) and ~90 W (≥70 years) in men versus ~130 W and ~70 W in women, respectively. The following categories of leg effort severity were associated with progressively lower exercise capacity: ≤50th ("mild"), >50th to <75th ("moderate"), ≥75th to <95th ("severe"), and ≥ 95th ("very severe") (p < 0.05). Although most subjects reporting peak scores <5 were in "mild" range, higher scores were not predictive of the other categories (p > 0.05). This novel frame of reference for 0-10 Borg leg effort, which considers its cumulative burden across increasingly higher exercise intensities, might prove valuable to judging symptom's normalcy, quantifying its severity, and assessing the effects of interventions in clinical populations.
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Affiliation(s)
- Abed A Hijleh
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sophia Wang
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Danilo C Berton
- Pulmonary Function Tests Laboratory, Federal University of Rio Grande to Sul, Porto Alegre, RS, Brazil
| | - Igor Neder-Serafini
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sandra Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Matthew James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nicolle Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Devin Phillips
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Luiz E Nery
- Clinical Exercise Physiology Unit, Division of Pulmonology, Department o Medicine, Federal University of Sao Paulo, São Paulo, Brazil
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Sempere-Ruiz N, Sarabia JM, Baladzhaeva S, Moya-Ramón M. Reliability and validity of a non-linear index of heart rate variability to determine intensity thresholds. Front Physiol 2024; 15:1329360. [PMID: 38375458 PMCID: PMC10875128 DOI: 10.3389/fphys.2024.1329360] [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: 10/28/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Exercise intensity distribution is crucial for exercise individualization, prescription, and monitoring. As traditional methods to determine intensity thresholds present limitations, heart rate variability (HRV) using DFA a1 has been proposed as a biomarker for exercise intensity distribution. This index has been associated with ventilatory and lactate thresholds in previous literature. This study aims to assess DFA a1's reliability and validity in determining intensity thresholds during an incremental cycling test in untrained healthy adults. Sixteen volunteers (13 males and 3 females) performed two identical incremental cycling stage tests at least 1 week apart. First and second ventilatory thresholds, lactate thresholds, and HRV thresholds (DFA a1 values of 0.75 and 0.5 for HRVT1 and HRVT2, respectively) were determined in heart rate (HR), relative oxygen uptake (VO2rel), and power output (PO) values for both tests. We used intraclass correlation coefficient (ICC), change in mean, and typical error for the reliability analysis, and paired t-tests, correlation coefficients, ICC, and Bland-Altman analysis to assess the agreement between methods. Regarding reliability, HRV thresholds showed the best ICCs when measured in PO (HRVT1: ICC = .87; HRVT2: ICC = .97), comparable to ventilatory and lactate methods. HRVT1 showed the strongest agreement with LA 2.5 in PO (p = 0.09, r = .93, ICC = .93, bias = 9.9 ± 21.1), while HRVT2 reported it with VT2 in PO (p = 0.367, r = .92, ICC = .92, bias = 5.3 ± 21.9). DFA a1 method using 0.75 and 0.5 values is reliable and valid to determine HRV thresholds in this population, especially in PO values.
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Affiliation(s)
- Noemí Sempere-Ruiz
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Manuel Sarabia
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Sabina Baladzhaeva
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Manuel Moya-Ramón
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Brotto AR, Phillips DB, Rowland SD, Moore LE, Wong E, Stickland MK. Reduced tidal volume-inflection point and elevated operating lung volumes during exercise in females with well-controlled asthma. BMJ Open Respir Res 2023; 10:e001791. [PMID: 38135461 DOI: 10.1136/bmjresp-2023-001791] [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: 04/24/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Individuals with asthma breathe at higher operating lung volumes during exercise compared with healthy individuals, which contributes to increased exertional dyspnoea. In health, females are more likely to develop exertional dyspnoea than males at a given workload or ventilation, and therefore, it is possible that females with asthma may develop disproportional dyspnoea on exertion. The purpose of this study was to compare operating lung volume and dyspnoea responses during exercise in females with and without asthma. METHODS Sixteen female controls and 16 females with asthma were recruited for the study along with 16 male controls and 16 males with asthma as a comparison group. Asthma was confirmed using American Thoracic Society criteria. Participants completed a cycle ergometry cardiopulmonary exercise test to volitional exhaustion. Inspiratory capacity manoeuvres were performed to estimate inspiratory reserve volume (IRV) and dyspnoea was evaluated using the Modified Borg Scale. RESULTS Females with asthma exhibited elevated dyspnoea during submaximal exercise compared with female controls (p<0.05). Females with asthma obtained a similar IRV and dyspnoea at peak exercise compared with healthy females despite lower ventilatory demand, suggesting mechanical constraint to tidal volume (VT) expansion. VT-inflection point was observed at significantly lower ventilation and V̇O2 in females with asthma compared with female controls. Forced expired volume in 1 s was significantly associated with VT-inflection point in females with asthma (R2=0.401; p<0.01) but not female controls (R2=0.002; p=0.88). CONCLUSION These results suggest that females with asthma are more prone to experience exertional dyspnoea, secondary to dynamic mechanical constraints during submaximal exercise when compared with females without asthma.
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Affiliation(s)
- Andrew R Brotto
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Devin B Phillips
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Samira D Rowland
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Linn E Moore
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Wong
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Yamada Y, Yoshida T, Murakami H, Gando Y, Kawakami R, Ohno H, Tanisawa K, Konishi K, Tripette J, Kondo E, Nakagata T, Nanri H, Miyachi M. Body Cell Mass to Fat-Free Mass Ratio and Extra- to Intracellular Water Ratio Are Related to Maximal Oxygen Uptake. J Gerontol A Biol Sci Med Sci 2023; 78:1778-1784. [PMID: 37262316 DOI: 10.1093/gerona/glad140] [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: 01/18/2023] [Indexed: 06/03/2023] Open
Abstract
Fat-free mass (FFM) is a heterogeneous compartment comprising body cell mass (BCM), intracellular water (ICW), extracellular solids, and extracellular water (ECW). The BCM/FFM and ECW/ICW ratios vary among individuals and decrease with age. This study aimed to determine whether BCM/FFM and ECW/ICW ratios are predictors of maximal oxygen uptake (V̇̇O2peak) independently of age, sex, and objectively measured physical activity (PA). A total of 115 Japanese males and females, aged 55.3 ± 8.0 years (mean ± standard deviation), were included in the study. Anthropometry, explosive leg muscle power, and V̇̇O2peak were measured, and BCM, FFM, ICW, and ECW were estimated. Step count and PA were objectively measured using a triaxial accelerometer. Blood flow volume was assessed using ultrasonography. BCM and ICW were negatively correlated with age, whereas FFM and ECW were not significantly correlated with age. FFM, ICW/ECW, BCM/FFM, step counts, moderate and vigorous PA, and leg muscle power were positively correlated with V̇̇O2peak, even after adjusting for age and sex (p < .05). Multiple regression analysis indicated that either BCM/FFM or ECW/ICW, leg power, and objectively measured PA were associated with V̇̇O2peak independent of age, sex, and FFM. Blood flow volume was significantly correlated with ECW (p < .05), but not with BCM. The BCM/FFM and ECW/ICW ratios were significant predictors of V̇̇O2peak, independent of age, sex, FFM, leg power, and objectively measured PA.
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Affiliation(s)
- Yosuke Yamada
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Tsukasa Yoshida
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Haruka Murakami
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Yuko Gando
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Faculty of Sport Science, Surugadai University, Hanno, Saitama, Japan
| | - Ryoko Kawakami
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Hachioji, Tokyo, Japan
| | - Harumi Ohno
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Department of Nutrition, Faculty of Health Care, Kiryu University, Gumma, Japan
| | - Kumpei Tanisawa
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Kana Konishi
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Faculty of Food and Nutritional Sciences, Toyo University, Gumma, Japan
| | - Julien Tripette
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Center for Interdisciplinary AI and Data Science, Ochanomizu University, Bunkyo, Tokyo, Japan
| | - Emi Kondo
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takashi Nakagata
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Hinako Nanri
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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Marillier M, Gruet M, Bernard AC, Champigneulle B, Verges S, Moran-Mendoza O, Neder JA. Beyond the Lungs: O 2 Supplementation Improves Cerebral Oxygenation and Fatigue during Exercise in Interstitial Lung Disease. Med Sci Sports Exerc 2023; 55:1735-1744. [PMID: 37170955 DOI: 10.1249/mss.0000000000003208] [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: 05/13/2023]
Abstract
PURPOSE Cerebral hypoxia may exacerbate the perception of fatigue. We previously demonstrated that exercise-related hypoxemia, a hallmark of fibrotic interstitial lung disease ( f -ILD), dose dependently impairs cerebral oxygenation in these patients. It is unknown whether normalizing cerebral oxygenation with O 2 supplementation would be associated with positive changes in a relevant patient-centered outcome during exercise in f -ILD, such as improved perceived fatigue. METHODS Fourteen patients (12 males, 72 ± 8 yr, 8 with idiopathic pulmonary fibrosis, lung diffusing capacity for carbon monoxide = 44% ± 13% predicted) performed a constant-load (60% peak work rate) cycle test to symptom limitation (Tlim) breathing medical air. Fourteen controls cycled up to Tlim of an age- and sex-matched patient. Patients repeated the test on supplemental O 2 (fraction of inspired O 2 = 0.41 ± 0.08) for the same duration. Near-infrared spectroscopy and the rating-of-fatigue (ROF) scale assessed prefrontal cortex oxygenation and perceived fatigue, respectively. RESULTS Patients showed severe exertional hypoxemia (Tlim O 2 saturation by pulse oximetry = 80% ± 8%); they had poorer cerebral oxygenation (e.g., oxy-deoxyhemoglobin difference [HbDiff] = -3.5 ± 4.7 [range = -17.6 to +1.9] vs +1.9 ± 1.7 μmol from rest) and greater fatigue (ROF = 6.2 ± 2.0 vs 2.6 ± 2.3) versus controls under air ( P < 0.001). Reversal of exertional hypoxemia with supplemental O 2 led to improved HbDiff (+1.7 ± 2.4 μmol from rest; no longer differing from controls) and lower ROF scores (3.7 ± 1.2, P < 0.001 vs air) in patients. There was a significant correlation between O 2 -induced changes in HbDiff and ROF scores throughout exercise in f -ILD ( rrepeated-measures correlation = -0.51, P < 0.001). CONCLUSIONS Supplemental O 2 improved cerebral oxygenation during exercise in f -ILD, which was moderately associated with lower ratings of perceived fatigue. Reversing cerebral hypoxia with O 2 supplementation may thus have positive effects on patients' disablement beyond those expected from lower ventilation and dyspnea in this patient population.
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Affiliation(s)
| | - Mathieu Gruet
- IAPS Laboratory, University of Toulon, Toulon, FRANCE
| | | | | | - Samuel Verges
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, FRANCE
| | - Onofre Moran-Mendoza
- Interstitial Lung Diseases Program, Queen's University and Hotel Dieu Hospital, Kingston, ON, CANADA
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, ON, CANADA
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Goulart CDL, Silva RN, Agostoni P, Franssen FME, Myers J, Arena R, Borghi-Silva A. Exercise oscillatory ventilation in patients with coexisting chronic obstructive pulmonary disease and heart failure: Clinical implications. Respir Med 2023; 217:107332. [PMID: 37356636 DOI: 10.1016/j.rmed.2023.107332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) is considered an important variable for predicting poor prognosis in patients with heart failure (HF) with reduced left ventricular ejection fraction (HFrEF). However, there are no studies evaluating EOV presence in the coexistence chronic obstructive pulmonary disease (COPD) and HFrEF. AIMS I) To compare the clinical characteristics of participants with coexisting HFrEF-COPD with and without EOV during cardiopulmonary exercise testing (CPET); and II) to identify the impact of EOV on mortality during follow-up for 35 months. METHODS 50 stable HFrEF-COPD (EF<50%) participants underwent CPET and were followed for 35 months. The parametric Student's t-test, chi-square tests, linear regression model and Kaplan-Meier analysis were applied. RESULTS We identified 13 (26%) participants with EOV and 37 (74%) without EOV (N-EOV) during exercise. The EOV group had worse cardiac function (LVEF: 30 ± 6% vs. N-EOV 40 ± 9%, p = 0.007), worse pulmonary function (FEV1: 1.04 ± 0.7 L vs. N-EOV 1.88 ± 0.7 L, p = 0.007), a higher mortality rate [7 (54%) vs. N-EOV 8 (27%), p = 0.02], higher minute ventilation/carbon dioxide production (V̇˙E/ V̇˙ CO2) slope (42 ± 7 vs. N-EOV 36 ± 8, p = 0.04), reduced peak ventilation (L/min) (26.2 ± 16.7 vs. N-EOV 40.3 ± 16.4, p = 0.01) and peak oxygen uptake (mlO2 kg-1 min-1) (11.0 ± 4.0 vs. N-EOV 13.5 ± 3.4 ml●kg-1●min-1, p = 0.04) when compared with N-EOV group. We found that EOV group had a higher risk of mortality during follow-up (long-rank p = 0.001) than patients with N-EOV group. CONCLUSION The presence of EOV is associated with greater severity of coexisting HFrEF and COPD and a reduced prognosis. Assessment of EOV in participants with coexisting HFrEF-COPD, as a biomarker for both clinical status and prognosis may therefore be warranted.
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Affiliation(s)
- Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Sao Carlos, SP, Brazil
| | - Rebeca Nunes Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Sao Carlos, SP, Brazil
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan, 20138, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jonathan Myers
- Division of Cardiovascular Medicine, VA Palo Alto Health Care System, USA; Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Sao Carlos, SP, Brazil.
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9
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Neder JA. Cardiopulmonary exercise testing applied to respiratory medicine: Myths and facts. Respir Med 2023; 214:107249. [PMID: 37100256 DOI: 10.1016/j.rmed.2023.107249] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
Cardiopulmonary exercise testing (CPET) remains poorly understood and, consequently, largely underused in respiratory medicine. In addition to a widespread lack of knowledge of integrative physiology, several tenets of CPET interpretation have relevant controversies and limitations which should be appropriately recognized. With the intent to provide a roadmap for the pulmonologist to realistically calibrate their expectations towards CPET, a collection of deeply entrenched beliefs is critically discussed. They include a) the actual role of CPET in uncovering the cause(s) of dyspnoea of unknown origin, b) peak O2 uptake as the key metric of cardiorespiratory capacity, c) the value of low lactate ("anaerobic") threshold to differentiate cardiocirculatory from respiratory causes of exercise limitation, d) the challenges of interpreting heart rate-based indexes of cardiovascular performance, e) the meaning of peak breathing reserve in dyspnoeic patients, f) the merits and drawbacks of measuring operating lung volumes during exercise, g) how best interpret the metrics of gas exchange inefficiency such as the ventilation-CO2 output relationship, h) when (and why) measurements of arterial blood gases are required, and i) the advantages of recording submaximal dyspnoea "quantity" and "quality". Based on a conceptual framework that links exertional dyspnoea to "excessive" and/or "restrained" breathing, I outline the approaches to CPET performance and interpretation that proved clinically more helpful in each of these scenarios. CPET to answer clinically relevant questions in pulmonology is a largely uncharted research field: I, therefore, finalize by highlighting some lines of inquiry to improve its diagnostic and prognostic yield.
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Affiliation(s)
- J Alberto Neder
- Laboratory of Clinical Exercise Physiology and Respiratory Investigation Unit, Department of Medicine, Division of Respirology, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada.
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10
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Frade MCM, Beltrame T, Gois MDO, Pinto A, Tonello SCGDM, Torres RDS, Catai AM. Toward characterizing cardiovascular fitness using machine learning based on unobtrusive data. PLoS One 2023; 18:e0282398. [PMID: 36862737 PMCID: PMC9980797 DOI: 10.1371/journal.pone.0282398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
Cardiopulmonary exercise testing (CPET) is a non-invasive approach to measure the maximum oxygen uptake ([Formula: see text]), which is an index to assess cardiovascular fitness (CF). However, CPET is not available to all populations and cannot be obtained continuously. Thus, wearable sensors are associated with machine learning (ML) algorithms to investigate CF. Therefore, this study aimed to predict CF by using ML algorithms using data obtained by wearable technologies. For this purpose, 43 volunteers with different levels of aerobic power, who wore a wearable device to collect unobtrusive data for 7 days, were evaluated by CPET. Eleven inputs (sex, age, weight, height, and body mass index, breathing rate, minute ventilation, total hip acceleration, walking cadence, heart rate, and tidal volume) were used to predict the [Formula: see text] by support vector regression (SVR). Afterward, the SHapley Additive exPlanations (SHAP) method was used to explain their results. SVR was able to predict the CF, and the SHAP method showed that the inputs related to hemodynamic and anthropometric domains were the most important ones to predict the CF. Therefore, we conclude that the cardiovascular fitness can be predicted by wearable technologies associated with machine learning during unsupervised activities of daily living.
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Affiliation(s)
| | - Thomas Beltrame
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
- Samsung R&D Institute Brazil–SRBR, Campinas, São Paulo, Brazil
- * E-mail:
| | | | - Allan Pinto
- Brazilian Synchrotron Light Laboratory (LNLS), Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, São Paulo, Brazil
| | | | - Ricardo da Silva Torres
- Department of ICT and Natural Sciences, Faculty of Information Technology and Electrical Engineering, NTNU—Norwegian University of Science and Technology, Ålesund, Norway
| | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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11
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Ashikaga K, Itoh H, Maeda T, Itoh H, Tanaka S, Ichikawa Y, Nagayama M, Akashi YJ, Isobe M. Usefulness of the predicted percentage ventilatory efficiency for carbon dioxide output during exercise in patients with chronic heart failure. Heart Vessels 2023; 38:56-65. [PMID: 35895151 DOI: 10.1007/s00380-022-02132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/29/2022] [Indexed: 01/06/2023]
Abstract
The ventilatory efficiency for carbon dioxide output ([Formula: see text]CO2) during exercise, as measured by the minute ventilation vs. [Formula: see text]CO2 slope ([Formula: see text]E vs. [Formula: see text]CO2 slope), is a powerful prognostic index in patients with chronic heart failure (CHF). This measurement is higher in women than in men, and it increases with age. This study aimed to investigate the usefulness of the predicted value of the percentage [Formula: see text]E vs. [Formula: see text]CO2 slope (%[Formula: see text]E vs. [Formula: see text]CO2 slope) as a prognostic index in patients with CHF. A total of 320 patients with CHF and a left ventricular ejection fraction (LVEF) < 45% (male, 85.6%; mean age, 64.6 years) who underwent symptom-limited cardiopulmonary exercise tests using a cycle ergometer were included in the study. The %[Formula: see text]E vs. [Formula: see text]CO2 was calculated using predictive formulae based on age and sex. Cardiovascular-related death was defined as the primary endpoint. The mean follow-up duration was 7.5 ± 3.3 years. Of 101 patients who died during the study period, 75 experienced cardiovascular-related deaths. The average [Formula: see text]E vs. [Formula: see text]CO2 slope was 32.8 ± 8.0, and the average %[Formula: see text]E vs. [Formula: see text]CO2 slope was 119.6 ± 28.2%. The cumulative incidence of cardiovascular-related death after 10 years of follow-up were 44.7% (95% CI 34.4-54.6%) in patients with %[Formula: see text]E vs. [Formula: see text]CO2 slope > 120 and 15.0% (95% CI 9.4-21.8%) in patients with %[Formula: see text]E vs. [Formula: see text]CO2 slope ≤ 120. The multivariate Cox regression analysis indicated that a %[Formula: see text]E vs. [Formula: see text]CO2 slope > 120 was an independent predictor of cardiovascular-related death (adjusted hazard ratio, 3.24; 95% confidence interval 1.65-6.67; p < 0.01). The %[Formula: see text]E vs. [Formula: see text]CO2 slope can be used for risk stratification in patients with CHF and an LVEF < 45%.
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Affiliation(s)
- Kohei Ashikaga
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan. .,Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan. .,Department of Sports Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyakaeku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Haruki Itoh
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Tomoko Maeda
- Department of Clinical Laboratory, Sakakibara Heart Institute Clinic, Tokyo, Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiori Tanaka
- Department of Clinical Laboratory, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Yuri Ichikawa
- Department of Medical Technology, School of Health Science, Tokyo University of Technology, Hachioji, Tokyo, Japan
| | - Masatoshi Nagayama
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
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12
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Marillier M, Bernard AC, Verges S, Moran-Mendoza O, Neder JA. Quantifying leg muscle deoxygenation during incremental cycling in hypoxemic patients with fibrotic interstitial lung disease. Clin Physiol Funct Imaging 2022; 43:192-200. [PMID: 36582169 DOI: 10.1111/cpf.12809] [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: 07/06/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hypoxaemia and cardiocirculatory abnormalities may impair muscle oxygen (O2 ) delivery relative to O2 requirements thereby increasing the rate of O2 extraction during incremental exercise in fibrotic interstitial lung disease (f-ILD). Using changes in deoxyhaemoglobin concentration ([HHb]) by near-infrared spectroscopy (NIRS) as a proxy of O2 extraction, we investigated whether a simplified (double-linear) approach, previously tested in heart failure, would provide useful estimates of muscle deoxygenation in f-ILD. METHODS A total of 25 patients (23 men, 72 ± 8 years; 20 with idiopathic pulmonary fibrosis, lung diffusing capacity for carbon monoxide = 44 ± 11% predicted) and 12 age- and sex-matched healthy controls performed incremental cycling to symptom limitation. Changes in vastus lateralis [HHb] assessed by NIRS were analysed in relation to work rate (WR) and O2 uptake throughout the exercise. RESULTS Patients showed lower exercise capacity than controls (e.g., peak WR = 67 ± 18% vs. 105 ± 20% predicted, respectively; p < 0.001). The [HHb] response profile was typically S-shaped, presenting three distinct phases. Exacerbated muscle deoxygenation in patients versus controls was evidenced by: (i) a steeper mid-exercise [HHb]-WR slope (0.30 ± 0.22 vs. 0.11 ± 0.08 μmol/W; p = 0.008) (Phase 2), and (ii) a larger late-exercise increase in [HHb] (p = 0.002) (Phase 3). Steeper [HHb]-WR slope was associated with lower peak WR (r = -0.70) and greater leg discomfort (r = 0.77; p < 0.001) in f-ILD. CONCLUSION This practical approach to interpreting [HHb] during incremental exercise might prove useful to determine the severity of muscle deoxygenation and the potential effects of interventions thereof in hypoxemic patients with f-ILD.
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Affiliation(s)
- Mathieu Marillier
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.,HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Anne-Catherine Bernard
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada.,HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Samuel Verges
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Onofre Moran-Mendoza
- Interstitial Lung Disease Program, Queen's University and Hotel Dieu Hospital, Kingston, Ontario, Canada
| | - J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
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13
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Almeida VRD, Ostolin TLVDP, Gonze BDB, de Almeida FR, Romiti M, Arantes RL, Dourado VZ. Early flattening of the oxygen pulse during the cardiopulmonary exercise test in asymptomatic adults and its association with cardiovascular risk factors. Int J Cardiol 2022; 367:65-73. [PMID: 35944764 DOI: 10.1016/j.ijcard.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Individuals with cardiovascular exercise limitations present oxygen pulse morphology with early flattening (plateau) during the cardiopulmonary exercise test (CPET). Although this oxygen pulse response is well known in cardiac patients, these changes' prevalence and clinical relevance in asymptomatic individuals are not known. We aimed to quantify the proportion of asymptomatic adults with an early flattening of the oxygen pulse and investigate its association with classical cardiovascular risk factors. METHODS We carried out a cross-sectional study with a sample of 824 adults aged between 18 and 80 years. We assessed anthropometry, body composition, and cardiovascular risk. In addition, we obtained cardiorespiratory and metabolic responses during a ramp protocol treadmill CPET. RESULTS The prevalence of early flattening of the oxygen pulse was 36.8%. These participants were predominantly females, older, less educated, with a higher body mass and percentage of fat and a lower percentage of lean body mass. After a multinominal multiple logistic regression analysis, we identified female sex (odds ratio, 5.46: 95% confidence interval, 3.73-7.99), low education (2.24: 1.47-3.42), dyslipidemia (1.67: 1.14-2.45), smoking (1.64: 1.00-2.69), and physical inactivity (1.39: 1.02-1.96) as the leading independent predictors of the early flattening of oxygen pulse. CONCLUSION The early flattening of oxygen pulse is common in asymptomatic adults and is highly determined by modifiable cardiovascular risk factors. These results suggest that identifying the early flattening of oxygen pulse may be helpful in the prevention of cardiovascular diseases.
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Affiliation(s)
- Vitor Rossi de Almeida
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil
| | | | - Bárbara de Barros Gonze
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil
| | - Flávio Rossi de Almeida
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil
| | - Marcello Romiti
- Angiocorpore Institute of Cardiovascular Medicine, Santos, São Paulo, Brazil.
| | | | - Victor Zuniga Dourado
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil; Lown Scholars Program-Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
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14
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Marillier M, Borowik A, Chacaroun S, Baillieul S, Doutreleau S, Guinot M, Wuyam B, Tamisier R, Pépin JL, Estève F, Vergès S, Tessier D, Flore P. High-intensity interval training to promote cerebral oxygenation and affective valence during exercise in individuals with obesity. J Sports Sci 2022; 40:1500-1511. [PMID: 35942923 DOI: 10.1080/02640414.2022.2086658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Left/right prefrontal cortex (PFC) activation is linked to positive/negative affects, respectively. Besides, larger left PFC oxygenation during exercise relates to higher cardiorespiratory fitness (CRF). High-intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) in improving CRF. The influence of training on PFC oxygenation and affects during exercise in individuals with obesity is, however, currently unknown. Twenty participants with obesity (14 males, 48 ± 8 years, body-mass index = 35 ± 6 kg·m-2) were randomised to MICT [50% peak work rate (WRpeak)] or HIIT (1-min bouts 100% WRpeak; 3 sessions/week, 8 weeks). Before/after training, participants completed an incremental ergocycle test. Near-infrared spectroscopy and the Feeling Scale assessed PFC oxygenation and affects during exercise, respectively. Improvements in CRF (e.g., WRpeak: 32 ± 14 vs 20 ± 13 W) were greater after HIIT vs MICT (p < 0.05). Only HIIT induced larger left PFC oxygenation (haemoglobin difference from 7 ± 6 to 10 ± 7 μmol) and enhanced affective valence (from 0.7 ± 2.9 to 2.2 ± 2.0; p < 0.05) at intensities ≥ second ventilatory threshold. Exercise-training induced changes in left PFC oxygenation correlated with changes in CRF [e.g., WRpeak (% predicted), r = 0.46] and post-training affective valence (r = 0.45; p < 0.05). HIIT specifically improved left PFC oxygenation and affects during exercise in individuals with obesity. Implementing HIIT in exercise programmes may therefore have relevant implications for the management of obesity, since greater affective response to exercise is thought to be associated with future commitment to physical activity.
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Affiliation(s)
| | - Anna Borowik
- Inserm, CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
| | | | | | | | - Michel Guinot
- Inserm, CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
| | - Bernard Wuyam
- Inserm, CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
| | - Renaud Tamisier
- Inserm, CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pépin
- Inserm, CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
| | - François Estève
- CHU Grenoble Alpes, CLUNI, SCRIMM-Sud, Inserm - UA07 - Rayonnement Synchrotron pour la Recherche Biomédicale (STROBE) ID17 Installation Européenne du Rayonnement Synchrotron (ESRF), Grenoble, France
| | - Samuel Vergès
- Inserm, CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
| | - Damien Tessier
- Laboratoire SENS, Univ. Grenoble Alpes, Grenoble, France
| | - Patrice Flore
- Inserm, CHU Grenoble Alpes, Univ. Grenoble Alpes, Grenoble, France
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15
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Ostolin TLVDP, Gonze BDB, Sperandio EF, Arantes RL, Romiti M, Dourado VZ. Mediator Effect of Cardiorespiratory Fitness on the Association between Physical Activity and Lung Function in Adults: Cross-Sectional Results from the Epimov Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159377. [PMID: 35954734 PMCID: PMC9368432 DOI: 10.3390/ijerph19159377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 01/27/2023]
Abstract
We investigated whether cardiorespiratory fitness (CRF) mediates the association between moderate-to-vigorous physical activity (MVPA) and lung function in asymptomatic adults. We examined the cross-sectional results of 1362 adults aged 18–80 years from the Epidemiology and Human Movement Study. Participants were submitted to spirometry to obtain forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1). Additionally, we used cardiopulmonary exercise testing to obtain peak oxygen uptake (V˙O2) as a measure of CRF. Participants used a triaxial accelerometer for 4–7 days to obtain MVPA. Mediation analyses were performed considering the CRF as a mediator, MVPA as an independent variable, and FVC and FEV1 as dependent variables with adjustment for age, sex, and cardiovascular risk score. We aimed to investigate the total (path c) and direct (paths a, b, c’) effects through the regression coefficients. We also examined the indirect effect, which was obtained from the product of the coefficients (path ab). Our sample was composed mainly of overweight and middle-aged women. MVPA was positively related to CRF (path a), as well as CRF and lung function (path b). MVPA also presented a significant positive total effect (path c) in the lung function. However, this relationship became non-significant when CRF was included in the model for both FVC and FEV1 (path c’). We did not observe a direct effect of MVPA on the lung function. In contrast, the indirect effect was significant (path ab). Lastly, CRF mediated 60% of the total effect of MVPA on FVC and 61.9% on FEV1. CRF mediates the relationship between lung function and MVPA in asymptomatic adults. Therefore, our results reinforce the need to include CRF assessment in practice clinical routine and suggest that strategies focusing on CRF might be more promising to prevent respiratory diseases in adults.
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Affiliation(s)
| | - Bárbara de Barros Gonze
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos 11015-020, SP, Brazil; (T.L.V.D.P.O.); (B.d.B.G.); (E.F.S.)
| | - Evandro Fornias Sperandio
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos 11015-020, SP, Brazil; (T.L.V.D.P.O.); (B.d.B.G.); (E.F.S.)
| | - Rodolfo Leite Arantes
- Department of Cardiovascular Medicine, Angiocorpore Institute of Cardiovascular Medicine, Santos 11075-350, SP, Brazil; (R.L.A.); (M.R.)
| | - Marcello Romiti
- Department of Cardiovascular Medicine, Angiocorpore Institute of Cardiovascular Medicine, Santos 11075-350, SP, Brazil; (R.L.A.); (M.R.)
| | - Victor Zuniga Dourado
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Santos 11015-020, SP, Brazil; (T.L.V.D.P.O.); (B.d.B.G.); (E.F.S.)
- Lown Scholars Program–Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Correspondence:
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16
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Zhao K, Liu Y, Dong L, Gao B. Echocardiographic myocardial work in pre-adolescent male basketball players: a comparison with cardiopulmonary exercise test-derived aerobic capacity. Front Physiol 2022; 13:913623. [PMID: 35936902 PMCID: PMC9355256 DOI: 10.3389/fphys.2022.913623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Pressure-strain loop (PSL) analysis provides a novel, less load-dependent non-invasive method to quantify myocardial work and demonstrates a significant correlation with the contractile reserve in adult athletes. We aim to validate PSL-derived markers in characterizing LV function in pre-adolescent basketball players by comparing results before and after the cardiopulmonary exercise test (CPX) and explore its association with CPX-derived aerobic capacity.Methods: Cardiac morphology and function in 20 pre-adolescent basketball players were assessed at 9.7 years old (9.7 ± 1.1 year) before and after cardiopulmonary exercise testing. Echocardiography was performed in all subjects, including two-dimensional speckle-tracking echocardiography (STE). Simultaneous brachial-cuff-measured blood pressure was recorded to perform PSL analysis.Results: Nineteen subjects were included in the final analysis. Exercise training in pre-adolescent males was associated with lower global work index (GWI) and global work efficiency (GWE) at rest. GWE at stress was significantly correlated with VO2max and peak O2 pulse (p = 0.0122, r = 0.56; p = 0.00122, r = 0.69, respectively). When indexed by body mass, GWI and GWE both significantly correlated with relative VO2max (p = 0.0086 and 0.0011 respectively, r = 0.58 and 0.69 respectively); GWI and GWE at baseline and stress were all significantly correlated with peak O2 pulse (GWI at baseline, p< 0.0001, r = −0.90; GWE at baseline, p< 0.0001, r = −0.89; GWI at stress, p= 0.0289, r = −0.50; GWE at stress, p< 0.0001, r = −0.83).Conclusion: PSL-analysis-derived GWI and GWE at rest indexed by body mass are associated with cardiopulmonary exercise test-derived peak oxygen consumption and oxygen pulse in pre-adolescent athletes.
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Affiliation(s)
- Kewei Zhao
- High Performance Research Center, China Institute of Sport Science, Beijing, China
| | - Yu Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Lili Dong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- *Correspondence: Lili Dong, ; Binghong Gao,
| | - Binghong Gao
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China
- *Correspondence: Lili Dong, ; Binghong Gao,
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17
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Silva Queiroz D, Marques da Silva CCB, Franco Amaral A, Rodrigues Oliveira M, Salge JM, Ribeiro Carvalho CR, Guedes Baldi B, Carvalho CRF. Evaluation of maximal exercise capacity through the incremental shuttle walking test in lymphangioleiomyomatosis. Pulmonology 2022:S2531-0437(22)00117-9. [PMID: 35851263 DOI: 10.1016/j.pulmoe.2022.04.009] [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: 01/12/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The cardiopulmonary exercise test (CPET) is the gold standard for assessing aerobic fitness; however, it is expensive, not widely available, and requires specialized equipment and staff. The incremental shuttle walking test (ISWT) is an exercise field test used to evaluate exercise capacity and may be an alternative to CPET in patients with lymphangioleiomyomatosis (LAM). OBJECTIVE To investigate whether the ISWT can be used to assess maximal aerobic capacity in patients with LAM. METHODS Forty-five women were evaluated on two days, and they randomly performed the CPET and ISWT. The maximum oxygen uptake (peak VO2) was evaluated using gas analyzers in both tests. The carbon dioxide production (VCO2), respiratory exchange ratio (RER), and heart rate (HR) were compared during peak exercise. Pearson's correlation and Bland-Altman assessed the association and agreement, respectively. The intraclass correlation coefficient (ICC) was used to assess the reliability of the data. RESULTS All patients (46.1 ± 10.2 years) presented similar peak VO2, RER, and peak HR during the CPET and ISWT (15.6 ± 4.6 vs. 15.7 ± 4.4 ml·kg-1·min-1; 1.15±0.09 vs. 1.17±0.12; and 142.2 ± 18.6 vs. 141.5 ± 22.2 bpm, respectively; p>0.05). A good linear correlation (r = 0.79; p<0.001) and ICC (0.86; 95%CI 0.74-0.93) were observed between the peak VO2 in both tests. Predictive peak VO2 equations based on the ISWT performance are also presented. CONCLUSION Our results suggest that the ISWT can be used to assess maximal exercise performance in patients with LAM, and it is a valuable option to be used as an alternative to the CPET and predict maximal exercise capacity.
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Affiliation(s)
- D Silva Queiroz
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - C C B Marques da Silva
- Departament of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - A Franco Amaral
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - M Rodrigues Oliveira
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - J M Salge
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - C R Ribeiro Carvalho
- Departament of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - B Guedes Baldi
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - C R F Carvalho
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Departament of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil.
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18
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Beaudry RI, Brotto AR, Varughese RA, de Waal S, Fuhr DP, Damant RW, Ferrara G, Lam GY, Smith MP, Stickland MK. Persistent dyspnea after COVID-19 is not related to cardiopulmonary impairment; a cross-sectional study of persistently dyspneic COVID-19, non-dyspneic COVID-19 and controls. Front Physiol 2022; 13:917886. [PMID: 35874528 PMCID: PMC9297912 DOI: 10.3389/fphys.2022.917886] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Up to 53% of individuals who had mild COVID-19 experience symptoms for >3-month following infection (Long-CoV). Dyspnea is reported in 60% of Long-CoV cases and may be secondary to impaired exercise capacity (VO2peak) as a result of pulmonary, pulmonary vascular, or cardiac insult. This study examined whether cardiopulmonary mechanisms could explain exertional dyspnea in Long-CoV. Methods: A cross-sectional study of participants with Long-CoV (n = 28, age 40 ± 11 years, 214 ± 85 days post-infection) and age- sex- and body mass index-matched COVID-19 naïve controls (Con, n = 24, age 41 ± 12 years) and participants fully recovered from COVID-19 (ns-CoV, n = 14, age 37 ± 9 years, 198 ± 89 days post-infection) was conducted. Participants self-reported symptoms and baseline dyspnea (modified Medical Research Council, mMRC, dyspnea grade), then underwent a comprehensive pulmonary function test, cardiopulmonary exercise test, exercise pulmonary diffusing capacity measurement, and rest and exercise echocardiography. Results: VO2peak, pulmonary function and cardiac/pulmonary vascular parameters were not impaired in Long- or ns-CoV compared to normative values (VO2peak: 106 ± 25 and 107 ± 25%predicted, respectively) and cardiopulmonary responses to exercise were otherwise normal. When Long-CoV were stratified by clinical dyspnea severity (mMRC = 0 vs mMRC≥1), there were no between-group differences in VO2peak. During submaximal exercise, dyspnea and ventilation were increased in the mMRC≥1 group, despite normal operating lung volumes, arterial saturation, diffusing capacity and indicators of pulmonary vascular pressures. Interpretation: Persistent dyspnea after COVID-19 was not associated with overt cardiopulmonary impairment or exercise intolerance. Interventions focusing on dyspnea management may be appropriate for Long-CoV patients who report dyspnea without cardiopulmonary impairment.
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Affiliation(s)
- Rhys I. Beaudry
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andrew R. Brotto
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rhea A. Varughese
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Stephanie de Waal
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Desi P. Fuhr
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ronald W. Damant
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Grace Y. Lam
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Maeve P. Smith
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michael K. Stickland
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
- *Correspondence: Michael K. Stickland,
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da Luz Goulart C, Agostoni P, Salvioni E, Kaminsky LA, Myers J, Arena R, Borghi-Silva A. Exercise Oscillatory Breathing in Heart Failure with reduced ejection fraction: clinical implication. Eur J Prev Cardiol 2022; 29:1692-1698. [PMID: 35708730 DOI: 10.1093/eurjpc/zwac116] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/22/2022] [Accepted: 06/01/2022] [Indexed: 01/26/2023]
Abstract
AIM I) to evaluate the impact of exertional oscillatory ventilation (EOV) in patients with heart failure (HF) with reduced left ventricular ejection fraction (HFrEF) during cardiopulmonary exercise testing (CPET) compared with patients without EOV (N-EOV); II) to identify the influence of EOV persistence (P-EOV) and EOV disappearance (D-EOV) during CPET on the outcomes of mortality and hospitalization in HFrEF patients; and III) to identify further predictors of mortality and hospitalization in patients with P-EOV. METHODS AND RESULTS 315 stable HFrEF patients underwent CPET and were followed for 35 months. We identified 202 patients N-EOV and 113 patients with EOV. Patients with EOV presented more symptoms (NYHA III: 35% vs. N-EOV 20%, p < 0.05), worse cardiac function (LVEF: 28 ± 6 vs. N-EOV 39 ± 1, p < 0.05), higher minute ventilation/carbon dioxide production (V̇E/V̇CO2 slope: 41 ± 11 vs. N-EOV 37 ± 8, p < 0.05) and a higher rate of deaths (26% vs. N-EOV 6%, p < 0.05) and hospitalization (29% vs. N-EOV 9%, p < 0.05). P-EOV patients had more severe HFrEF (NYHA IV: 23% vs D-EOV: 9%, p < 0.05), had worse cardiac function (LVEF: 24 ± 5 vs. D-EOV: 34 ± 3, p < 0.05) and had lower peak oxygen consumption (V̇O2) (12.0 ± 3.0 vs D-EOV: 13.3 ± 3.0 mlO2.kg-1.min-1, p < 0.05). Among P-EOV, other independent predictors of mortality were V̇E/V̇CO2 slope ≥36 and V̇O2 peak ≤12 mlO2.kg-1.min-1; a V̇E/V̇CO2 slope≥34 was a significant predictor of hospitalization. Kaplan-Meier survival analysis showed that, HFrEF patients with P-EOV had a higher risk of mortality and higher risk of hospitalization (p < 0.05) than patients with D-EOV and N-EOV. CONCLUSION In HFrEF patients, EOV persistence during exercise had a strong prognostic role. In P-EOV patients V̇E/V̇CO2 ≥36 and V̇O2 peak ≤12 mlO2.kg-1.min-1, had a further additive negative prognostic role.
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Affiliation(s)
- Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, Milan20138, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | | | | | - Jon Myers
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
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20
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Pick Your Threshold. Chest 2022; 162:1106-1115. [DOI: 10.1016/j.chest.2022.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/15/2022] [Accepted: 05/04/2022] [Indexed: 01/20/2023] Open
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21
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da Luz Goulart C, Oliveira MR, Sendín FA, Mendes RG, Arena R, Borghi-Silva A. Prognostic value of key variables from cardiopulmonary exercise testing in patients with COPD: 42-month follow-up. Respir Med 2022; 197:106856. [PMID: 35461168 DOI: 10.1016/j.rmed.2022.106856] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/29/2022] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
AIM To identify better predictors of early death in patients with chronic obstructive pulmonary disease (COPD) using potential predictors derived from key measures obtained from cardiopulmonary exercise testing (CPET). METHODS This is a prospective, cohort study with 42-month follow-up in 126 COPD patients. Every patient completed the clinical evaluation, followed by a pulmonary function test and CPET. CPET was performed on a cycle ergometer with electromagnetic braking and ventilatory expired analysis was measured breath-by-breath using a computer-based system. Peak oxygen consumption (V̇O2, mlO2. kg-1. min-1), minute ventilation/carbon dioxide production and the, minute ventilation (V̇E, L/min), and the V̇E/carbon dioxide production (V̇E/V̇CO2) slope were obtained from CPET. RESULTS 48 (38%) patients died during the 42-month follow-up. Kaplan Meier analysis revealed a V̇E/V̇CO2 slope ≥30, peak V̇E ≤ 25.7L/min and peak V̇O2 ≤ 13.8 mlO2. kg-1. min-1were strong predictors of mortality in COPD patients. Cox regression revealed that the V̇O2 peak ≤13.8 mlO2. kg-1. min-1 (CI 95% 0.08-0.93), V̇E/V̇CO2 slope ≥30 (CI 95% 0.07-0.94), V̇E peak ≤25.7 L/min (CI 95% 0.01-0.15), Sex (CI 95% 0.04-0.55) and Age (CI 95% 1.03-1.2) were the main predictors of mortality risk. CONCLUSION Diminished exercise capacity and peak ventilation as well as ventilatory inefficiency are independent prognostic markers. Similar to patients with heart failure, CPET may be a valuable clinical assessment in the COPD population.
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Affiliation(s)
- Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Murilo Rezende Oliveira
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Francisco Alburquerque Sendín
- Profesor Titular de Universidad, departamento de enfermería, farmacología y fisioterapia facultad de medicina y enfermería, Cordoba, Spain
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
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22
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Systolic and diastolic function during cycling at the respiratory threshold between elderly and young healthy individuals. Sci Rep 2022; 12:3825. [PMID: 35264702 PMCID: PMC8907329 DOI: 10.1038/s41598-022-07933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
Abstract
The hemodynamic consequences of aging have been extensively investigated during maximal incremental exercise. However, less is known about the effects of aging on hemodynamics during submaximal steady-state exercise. The aim of the present investigation was to compare the hemodynamics of healthy elderly and young subjects during an exercise bout conducted at the gas threshold (GET) intensity. Two groups of healthy, physically active subjects were studied: the elderly group—EG (n = 11; > 60 years old) and the young group—YG (n = 13; < 35 years old). Both groups performed a 5-min rectangular exercise test at the GET intensity. Hemodynamics were measured using echocardiography. The main finding was that stroke volume responses were higher in the YG than the EG (72.5 ± 16.7 vs. 52.4 ± 8.4 ml, respectively). The increased stroke volume capacity in the YG was the consequence of a greater capacity to increase cardiac preload and contractility and, to a lesser extent, to reduce systemic vascular resistance. Importantly, the atrial contribution to ventricular diastolic filling was substantially higher in the YG when compared to the EG.
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23
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Dos Santos PB, Simões RP, Goulart CL, Arêas GPT, Marinho RS, Camargo PF, Roscani MG, Arbex RF, Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Responses to incremental exercise and the impact of the coexistence of HF and COPD on exercise capacity: a follow-up study. Sci Rep 2022; 12:1592. [PMID: 35102201 PMCID: PMC8803920 DOI: 10.1038/s41598-022-05503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/31/2021] [Indexed: 11/15/2022] Open
Abstract
Our aim was to evaluate: (1) the prevalence of coexistence of heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the studied patients; (2) the impact of HF + COPD on exercise performance and contrasting exercise responses in patients with only a diagnosis of HF or COPD; and (3) the relationship between clinical characteristics and measures of cardiorespiratory fitness; (4) verify the occurrence of cardiopulmonary events in the follow-up period of up to 24 months years. The current study included 124 patients (HF: 46, COPD: 53 and HF + COPD: 25) that performed advanced pulmonary function tests, echocardiography, analysis of body composition by bioimpedance and symptom-limited incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Key CPET variables were calculated for all patients as previously described. The [Formula: see text]E/[Formula: see text]CO2 slope was obtained through linear regression analysis. Additionally, the linear relationship between oxygen uptake and the log transformation of [Formula: see text]E (OUES) was calculated using the following equation: [Formula: see text]O2 = a log [Formula: see text]E + b, with the constant 'a' referring to the rate of increase of [Formula: see text]O2. Circulatory power (CP) was obtained through the product of peak [Formula: see text]O2 and peak systolic blood pressure and Ventilatory Power (VP) was calculated by dividing peak systolic blood pressure by the [Formula: see text]E/[Formula: see text]CO2 slope. After the CPET, all patients were contacted by telephone every 6 months (6, 12, 18, 24) and questioned about exacerbations, hospitalizations for cardiopulmonary causes and death. We found a 20% prevalence of HF + COPD overlap in the studied patients. The COPD and HF + COPD groups were older (HF: 60 ± 8, COPD: 65 ± 7, HF + COPD: 68 ± 7). In relation to cardiac function, as expected, patients with COPD presented preserved ejection fraction (HF: 40 ± 7, COPD: 70 ± 8, HF + COPD: 38 ± 8) while in the HF and HF + COPD demonstrated similar levels of systolic dysfunction. The COPD and HF + COPD patients showed evidence of an obstructive ventilatory disorder confirmed by the value of %FEV1 (HF: 84 ± 20, COPD: 54 ± 21, HF + COPD: 65 ± 25). Patients with HF + COPD demonstrated a lower work rate (WR), peak oxygen uptake ([Formula: see text]O2), rate pressure product (RPP), CP and VP compared to those only diagnosed with HF and COPD. In addition, significant correlations were observed between lean mass and peak [Formula: see text]O2 (r: 0.56 p < 0.001), OUES (r: 0.42 p < 0.001), and O2 pulse (r: 0.58 p < 0.001), lung diffusing factor for carbon monoxide (DLCO) and WR (r: 0.51 p < 0.001), DLCO and VP (r: 0.40 p: 0.002), forced expiratory volume in first second (FEV1) and peak [Formula: see text]O2 (r: 0.52; p < 0.001), and FEV1 and WR (r: 0.62; p < 0.001). There were no significant differences in the occurrence of events and deaths contrasting both groups. The coexistence of HF + COPD induces greater impairment on exercise performance when compared to patients without overlapping diseases, however the overlap of the two diseases did not increase the probability of the occurrence of cardiopulmonary events and deaths when compared to groups with isolated diseases in the period studied. CPET provides important information to guide effective strategies for these patients with the goal of improving exercise performance and functional capacity. Moreover, given our findings related to pulmonary function, body composition and exercise responses, evidenced that the lean mass, FEV1 and DLCO influence important responses to exercise.
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Affiliation(s)
- Polliana B Dos Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Rodrigo P Simões
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
- Sciences of Motricity Institute, Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, MG, Brazil
| | - Cássia L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | | | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Patrícia F Camargo
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata F Arbex
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Claudio R Oliveira
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil.
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Brotto AR, Phillips DB, Meah VL, Ross BA, Fuhr DP, Beaudry RI, van Diepen S, Stickland MK. Inhaled nitric oxide does not improve maximal oxygen consumption in endurance trained and untrained healthy individuals. Eur J Appl Physiol 2022; 122:703-715. [DOI: 10.1007/s00421-021-04866-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
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25
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Borghi-Silva A, Goulart CDL, Carrascosa CR, Oliveira CC, Berton DC, de Almeida DR, Nery LE, Arena R, Neder JA. Proportional Assist Ventilation Improves Leg Muscle Reoxygenation After Exercise in Heart Failure With Reduced Ejection Fraction. Front Physiol 2021; 12:685274. [PMID: 34234692 PMCID: PMC8255967 DOI: 10.3389/fphys.2021.685274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/21/2021] [Indexed: 12/31/2022] Open
Abstract
Background Respiratory muscle unloading through proportional assist ventilation (PAV) may enhance leg oxygen delivery, thereby speeding off-exercise oxygen uptake ( V . O 2 ) kinetics in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Methods Ten male patients (HFrEF = 26 ± 9%, age 50 ± 13 years, and body mass index 25 ± 3 kg m2) underwent two constant work rate tests at 80% peak of maximal cardiopulmonary exercise test to tolerance under PAV and sham ventilation. Post-exercise kinetics of V . O 2 , vastus lateralis deoxyhemoglobin ([deoxy-Hb + Mb]) by near-infrared spectroscopy, and cardiac output (Q T ) by impedance cardiography were assessed. Results PAV prolonged exercise tolerance compared with sham (587 ± 390 s vs. 444 ± 296 s, respectively; p = 0.01). PAV significantly accelerated V . O 2 recovery (τ = 56 ± 22 s vs. 77 ± 42 s; p < 0.05), being associated with a faster decline in Δ[deoxy-Hb + Mb] and Q T compared with sham (τ = 31 ± 19 s vs. 42 ± 22 s and 39 ± 22 s vs. 78 ± 46 s, p < 0.05). Faster off-exercise decrease in Q T with PAV was related to longer exercise duration (r = -0.76; p < 0.05). Conclusion PAV accelerates the recovery of central hemodynamics and muscle oxygenation in HFrEF. These beneficial effects might prove useful to improve the tolerance to repeated exercise during cardiac rehabilitation.
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Affiliation(s)
- Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos (UFSCar), São Paulo, Brazil.,Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Cassia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos (UFSCar), São Paulo, Brazil
| | - Cláudia R Carrascosa
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | | | - Danilo C Berton
- Pulmonary Physiology Unit, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Dirceu Rodrigues de Almeida
- Division of Cardiology, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Luiz Eduardo Nery
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - J Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil.,Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Science Center and Queen's University, Kingston, ON, Canada
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Evaluating the Accuracy of Using Fixed Ranges of METs to Categorize Exertional Intensity in a Heterogeneous Group of Healthy Individuals: Implications for Cardiorespiratory Fitness and Health Outcomes. Sports Med 2021; 51:2411-2421. [PMID: 33900580 DOI: 10.1007/s40279-021-01476-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Appropriate quantification of exertional intensity remains elusive. OBJECTIVE To compare, in a large and heterogeneous cohort of healthy females and males, the commonly used intensity classification system (i.e., light, moderate, vigorous, near-maximal) based on fixed ranges of metabolic equivalents (METs) to an individualized schema based on the exercise intensity domains (i.e., moderate, heavy, severe). METHODS A heterogenous sample of 565 individuals (females 165; males 400; age range 18-83 years old) were included in the study. Individuals performed a ramp-incremental exercise test from which gas exchange threshold (GET), respiratory compensation point (RCP) and maximum oxygen uptake (VO2max) were determined to build the exercise intensity domain schema (moderate = METs ≤ GET; heavy = METs > GET but ≤ RCP; severe = METs > RCP) for each individual. Pearson's chi-square tests over contingency tables were used to evaluate frequency distribution within intensity domains at each MET value. A multi-level regression model was performed to identify predictors of the amplitude of the exercise intensity domains. RESULTS A critical discrepancy existed between the confines of the exercise intensity domains and the commonly used fixed MET classification system. Overall, the upper limit of the moderate-intensity domain ranged between 2 and 13 METs and of the heavy-intensity domain between 3 and 18 METs, whereas the severe-intensity domain included METs from 4 onward. CONCLUSIONS Findings show that the common practice of assigning fixed values of METs to relative categories of intensity risks misclassifications of the physiological stress imposed by exercise and physical activity. These misclassifications can lead to erroneous interpretations of the dose-response relationship of exercise and physical activity.
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Hussid MF, Cepeda FX, Jordão CP, Lopes-Vicente RRP, Virmondes L, Katayama KY, de Oliveira EF, Oliveira LVF, Consolim-Colombo FM, Trombetta IC. Visceral Obesity and High Systolic Blood Pressure as the Substrate of Endothelial Dysfunction in Obese Adolescents. Arq Bras Cardiol 2021; 116:795-803. [PMID: 33886731 PMCID: PMC8121384 DOI: 10.36660/abc.20190541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/11/2019] [Accepted: 12/27/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Obesity affects adolescence and may lead to metabolic syndrome (MetS) and endothelial dysfunction, an early marker of cardiovascular risk. Albeit obesity is strongly associated with obstructive sleep apnea (OSA), it is not clear the role of OSA in endothelial function in adolescents with obesity. OBJECTIVE To investigate whether obesity during adolescence leads to MetS and/or OSA; and causes endothelial dysfunction. In addition, we studied the possible association of MetS risk factors and apnea hypopnea index (AHI) with endothelial dysfunction. METHODS We studied 20 sedentary obese adolescents (OA; 14.2±1.6 years, 100.9±20.3kg), and 10 normal-weight adolescents (NWA, 15.2±1.2 years, 54.4±5.3kg) paired for sex. We assessed MetS risk factors (International Diabetes Federation criteria), vascular function (Flow-Mediated Dilation, FMD), functional capacity (VO2peak) and the presence of OSA (AHI>1event/h, by polysomnography). We considered statistically significant a P<0.05. RESULTS OA presented higher waist (WC), body fat, triglycerides, systolic (SBP) and diastolic blood pressure (DBP), LDL-c and lower HDL-c and VO2peak than NWA. MetS was presented in the 35% of OA, whereas OSA was present in 86.6% of OA and 50% of EA. There was no difference between groups in the AHI. The OA had lower FMD than NWA (6.17±2.72 vs. 9.37±2.20%, p=0.005). There was an association between FMD and WC (R=-0.506, p=0.008) and FMD and SBP (R=-0.493, p=0.006). CONCLUSION In adolescents, obesity was associates with MetS and caused endothelial dysfunction. Increased WC and SBP could be involved in this alteration. OSA was observed in most adolescents, regardless of obesity. (Arq Bras Cardiol. 2021; 116(4):795-803).
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Affiliation(s)
- Maria Fernanda Hussid
- Universidade Nove de JulhoSão PauloSPBrasilUniversidade Nove de Julho (UNINOVE), São Paulo, SP - Brasil.
| | - Felipe Xerez Cepeda
- Universidade Nove de JulhoSão PauloSPBrasilUniversidade Nove de Julho (UNINOVE), São Paulo, SP - Brasil.
| | - Camila P. Jordão
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
| | | | - Leslie Virmondes
- Universidade Nove de JulhoSão PauloSPBrasilUniversidade Nove de Julho (UNINOVE), São Paulo, SP - Brasil.
| | - Keyla Y. Katayama
- Universidade Nove de JulhoSão PauloSPBrasilUniversidade Nove de Julho (UNINOVE), São Paulo, SP - Brasil.
| | - Ezequiel F. de Oliveira
- Universidade Nove de JulhoSão PauloSPBrasilUniversidade Nove de Julho (UNINOVE), São Paulo, SP - Brasil.
| | - Luis V. F. Oliveira
- Centro Universitário de AnápolisAnápolisGOBrasilCentro Universitário de Anápolis (UniEvangélica), Anápolis, GO - Brasil.
| | - Fernanda Marciano Consolim-Colombo
- Universidade Nove de JulhoSão PauloSPBrasilUniversidade Nove de Julho (UNINOVE), São Paulo, SP - Brasil.
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
| | - Ivani Credidio Trombetta
- Universidade Nove de JulhoSão PauloSPBrasilUniversidade Nove de Julho (UNINOVE), São Paulo, SP - Brasil.
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilInstituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
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Characteristics and reference values for cardiopulmonary exercise testing in the adult Chinese population - The Xiangya hospital exercise testing project (the X-ET project). Int J Cardiol 2021; 332:15-21. [PMID: 33716041 DOI: 10.1016/j.ijcard.2021.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/09/2021] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Reference values of cardiopulmonary exercise testing (CPX) vary with race/ethnicity. Chinese Americans are the fastest-growing racial/ethnic group in the United States. However, there is limited information about the reference values of cardiopulmonary exercise testing (CPX) variables in the Chinese population. METHODS As part of the Xiangya Hospital Exercise Testing project (the X-ET project), this cross-sectional study screened 20,696 consecutive CPXs performed by 17,802 unique individuals at Xiangya Hospital of Central South University, China, from January 1, 2002, to December 31, 2019. A total of 964 unique healthy adults/tests (42% female) aged 49 ± 12 who completed a maximal ramp incremental CPX with cycle ergometry were included in this study. The reference values of primary CPX variables were expressed as the lower limit or upper limit of normal. Stepwise linear regression was used to fit the equations of key CPX variables. Predictive accuracy analysis for the equations with a comparison between present and previous studies were performed. RESULTS Peak oxygen consumption (V̇O2), carbon dioxide production, ventilation/min, work rate, and V̇O2 at the anaerobic threshold were regressed on age, height, weight, and sex. These predictive equations showed good in- and out-sample predictive accuracy. Comparison with prior research revealed that prediction equations of peak V̇O2 resultant from studies in which populations were entirely or primarily Caucasian had overestimated our subjects' actual values. CONCLUSION The reference values and predicted equations of CPX variables in this study may provide a more appropriate framework to interpret the response to maximal ramp incremental cycle ergometry in the Chinese adult population.
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Messina CMS, Ferreira EVM, Singh I, Fonseca AXC, Ramos RP, Nery LE, Systrom DM, Oliveira RKF, Ota-Arakaki JS. Impact of right ventricular work and pulmonary arterial compliance on peak exercise oxygen uptake in idiopathic pulmonary arterial hypertension. Int J Cardiol 2021; 331:230-235. [PMID: 33545265 DOI: 10.1016/j.ijcard.2021.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/26/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is associated with increased right ventricular (RV) afterload, RV dysfunction and decreased peak oxygen uptake (pVO2). However, the pulmonary hemodynamic mechanisms measured by exercise right heart catheterization (RHC) that contribute to reduced pVO2 in idiopathic PAH (IPAH) are not completely characterized. Therefore, we sought to evaluate the exercise RHC determinants of pVO2 in patients with IPAH. METHODS 519 consecutive patients with suspected and/or confirmed pulmonary hypertension were prospectively screened to identify 20 patients with IPAH. All IPAH patients were prospectively evaluated with resting and exercise RHC and cardiopulmonary exercise testing. RESULTS 85% of the patients were female; the median age was 34[29-42] years old. At peak exercise, mean pulmonary arterial (PA) pressure was 76 ± 17 mmHg, PA wedge pressure was 14 ± 5 mmHg, cardiac output (CO) was 5.7 ± 1.9 L/min, pulmonary vascular resistance was 959 ± 401 dynes/s/cm5 and PA compliance was 0.9[0.6-1.2] ml/mmHg. On univariate analysis, pVO2 positively correlated to peak CO, peak cardiac index, peak stroke volume index, peak RV stroke work index (RVSWI) and peak oxygen saturation. There was a negative correlation between pVO2 and Δ (rest to peak change) PA compliance. In age-adjusted multivariate model, peak RVSWI (Coefficient = 0.15, Beta = 0.63, 95% CI [0.07-0.22], p < 0.01) and ΔPA compliance (Coefficient = -2.51, Beta = -0.43, 95% CI [-4.34-(-0.68)], p = 0.01) had the best performance predicting pVO2 (R2 = 0.66). CONCLUSIONS In conclusion, a load dependent measurement of RV function (RVSWI) and the pulsatile component of RV afterload (ΔPA compliance) significantly influence pVO2 in IPAH, further highlighting the pivotal role of hemodynamic coupling to IPAH exercise capacity.
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Affiliation(s)
- Carolina M S Messina
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Eloara V M Ferreira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Inderjit Singh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Angelo X C Fonseca
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Roberta P Ramos
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Luiz E Nery
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - David M Systrom
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rudolf K F Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Jaquelina S Ota-Arakaki
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Dos Santos PB, Simões RP, Goulart CDL, Roscani MG, Marinho RS, Camargo PF, Arbex RF, Casale G, Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Eccentric Left Ventricular Hypertrophy and Left and Right Cardiac Function in Chronic Heart Failure with or without Coexisting COPD: Impact on Exercise Performance. Int J Chron Obstruct Pulmon Dis 2021; 16:203-214. [PMID: 33568904 PMCID: PMC7868200 DOI: 10.2147/copd.s285812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Our aim was to assess: 1) the impact of the eccentric left ventricular hypertrophy (ELVH) on exercise performance in patients diagnosed with chronic heart failure (CHF) alone and in patients with co-existing CHF and chronic obstructive pulmonary disease (COPD) and 2) the relationship between left and right cardiac function measurements obtained by doppler echocardiography, clinical characteristics and primary measures of cardiorespiratory fitness. Methods The current study included 46 patients (CHF:23 and CHF+COPD:23) that performed advanced pulmonary function tests, echocardiography and symptom-limited, incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Results Patients with CHF+COPD demonstrated a lower work rate, peak oxygen uptake (VO2), oxygen pulse, rate pressure product (RPP), circulatory power (CP) and ventilatory power (VP) compared to those only diagnosed with CHF. In addition, significant correlations were observed between VP and relative wall thickness (r: 0.45 p: 0.03),VE/VCO2 intercept and Mitral E/e' ratio (r: 0.70 p: 0.003) in the CHF group. Significant correlations were found between indexed left ventricle mass and RPP (r: -0.47; p: 0.02) and relative VO2 and right ventricle diameter (r: -0.62; p: 0.001) in the CHF+COPD group. Conclusion Compared to a diagnosis of CHF alone, a combined diagnosis of CHF+COPD induced further impairments in cardiorespiratory fitness. Moreover, echocardiographic measures of cardiac function are related to cardiopulmonary exercise performance and therefore appear to be an important therapeutic target when attempting to improve exercise performance and functional capacity.
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Affiliation(s)
- Polliana B Dos Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Rodrigo P Simões
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil.,Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Minas Gerais, Brazil
| | - Cássia da L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Patrícia Faria Camargo
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata F Arbex
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Guilherme Casale
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Cláudio R Oliveira
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
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de Camargo AA, de Castro RAS, Vieira RP, Oliveira-Júnior MC, de Araujo AA, De Angelis K, Rached SZ, Athanazio RA, Stelmach R, Corso SD. Systemic Inflammation and Oxidative Stress in Adults with Bronchiectasis: Association with Clinical and Functional Features. Clinics (Sao Paulo) 2021; 76:e2474. [PMID: 33886789 PMCID: PMC8024943 DOI: 10.6061/clinics/2021/e2474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/24/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To compare the inflammatory and oxidative stress (OS) states of adults with bronchiectasis with those of healthy controls and correlate inflammatory and OS levels with lung function and physical capacity. METHODS This study used a cross-sectional design. Seventy-four adults with bronchiectasis (age: 49±15 years, forced expiratory volume in 1 second [FEV1]: 52.5±25.6%) and 42 healthy controls (age: 44±17 years, FEV1: 95.9±14.0%) performed cardiopulmonary exercise tests and incremental shuttle walking tests. Their physical activity in daily life, inflammatory cytokine, and antioxidant levels in plasma were measured. RESULTS Compared to that of the controls, the levels of interleukin (IL)-6 (p<0.001), IL-10 (p<0.001), carbonylated proteins (p=0.001), and superoxide anions (p=0.046) were significantly increased in adults with bronchiectasis. Catalase activity was also reduced in this group (p<0.001). The inflammatory markers IL-1β, IL-6, and tumor necrosis factor-α correlated negatively with aerobic capacity (r=-0.408, r=-0.308, and r=-0.207, respectively). We observed similar correlations with OS markers (thiobarbituric acid and carbonyls; r=-0.290 and r=0.379, respectively), and these markers also significantly correlated with the aerobic capacity. CONCLUSIONS Adults with bronchiectasis presented an increased systemic inflammatory response that correlated negatively with physical capacity.
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Affiliation(s)
- Anderson Alves de Camargo
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Universidade Nove de Julho (UNINOVE), Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | - Rodolfo P. Vieira
- Departamento de Ciencias do Movimento, Universidade Federal de Sao Paulo (UNIFESP), Santos, SP, BR
- Programa de Pos-Graduacao em Bioengenharia, Universidade Brasil, Sao Paulo, SP, BR
| | | | - Amanda Aparecida de Araujo
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Universidade Nove de Julho (UNINOVE), Sao Paulo, SP, BR
| | - Kátia De Angelis
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Universidade Nove de Julho (UNINOVE), Sao Paulo, SP, BR
- Departamento de Fisiologia, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Samia Zahi Rached
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rodrigo Abensur Athanazio
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rafael Stelmach
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Simone Dal Corso
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Universidade Nove de Julho (UNINOVE), Sao Paulo, SP, BR
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Poole DC, Rossiter HB, Brooks GA, Gladden LB. The anaerobic threshold: 50+ years of controversy. J Physiol 2020; 599:737-767. [PMID: 33112439 DOI: 10.1113/jp279963] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/16/2020] [Indexed: 12/23/2022] Open
Abstract
The anaerobic threshold (AT) remains a widely recognized, and contentious, concept in exercise physiology and medicine. As conceived by Karlman Wasserman, the AT coalesced the increase of blood lactate concentration ([La- ]), during a progressive exercise test, with an excess pulmonary carbon dioxide output ( V ̇ C O 2 ). Its principal tenets were: limiting oxygen (O2 ) delivery to exercising muscle→increased glycolysis, La- and H+ production→decreased muscle and blood pH→with increased H+ buffered by blood [HCO3 - ]→increased CO2 release from blood→increased V ̇ C O 2 and pulmonary ventilation. This schema stimulated scientific scrutiny which challenged the fundamental premise that muscle anoxia was requisite for increased muscle and blood [La- ]. It is now recognized that insufficient O2 is not the primary basis for lactataemia. Increased production and utilization of La- represent the response to increased glycolytic flux elicited by increasing work rate, and determine the oxygen uptake ( V ̇ O 2 ) at which La- accumulates in the arterial blood (the lactate threshold; LT). However, the threshold for a sustained non-oxidative contribution to exercise energetics is the critical power, which occurs at a metabolic rate often far above the LT and separates heavy from very heavy/severe-intensity exercise. Lactate is now appreciated as a crucial energy source, major gluconeogenic precursor and signalling molecule but there is no ipso facto evidence for muscle dysoxia or anoxia. Non-invasive estimation of LT using the gas exchange threshold (non-linear increase of V ̇ C O 2 versus V ̇ O 2 ) remains important in exercise training and in the clinic, but its conceptual basis should now be understood in light of lactate shuttle biology.
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Affiliation(s)
- David C Poole
- Departments of Kinesiology and Anatomy and Physiology, Kansas State University, Manhattan, KS, USA
| | - Harry B Rossiter
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine, and The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - George A Brooks
- Department of Integrative Biology, Exercise Physiology Laboratory, University of California, Berkeley, CA, USA
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Novoa NM, Esteban P, Gómez Hernández MT, Fuentes MG, Varela G, Jiménez MF. Early exercise pulmonary diffusing capacity of carbon monoxide after anatomical lung resection: a word of caution for fast-track programmes. Eur J Cardiothorac Surg 2020; 56:143-149. [PMID: 30726898 DOI: 10.1093/ejcts/ezz007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/10/2018] [Accepted: 12/16/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES In healthy individuals, increasing pulmonary blood flow during exercise also increases the % of the diffusing capacity of the lungs for carbon monoxide (DLCO%), but its evolution after lung resection is unknown. In this study, our goal was to measure changes in exercise DLCO% during the first 3 days after anatomical lung resection. METHODS We performed a prospective observational study on consecutive patients with non-small-cell lung cancer scheduled for anatomical resection, except pneumonectomy, during a 6-month period. Patients underwent measurement of the DLCO% by a single-breath technique adjusted by the concentration of haemoglobin-before and after standardized exercise the day before and 3 consecutive days after surgery. The delta (Δ) variation (basal versus exercise) was calculated. The number of functioning resected segments was calculated by bronchoscopy. Postoperative pain and pleural air leak were estimated using a visual analogue scale and graduated conventional pleural drainage systems, respectively, and their influence on ΔDLCO each postoperative day was evaluated by linear regression analysis. RESULTS Fifty-seven patients were included. The visual analogue scale of pain and pleural air leaks were not correlated to Δ values (model R2: 0.0048). The evolution of Δ values during 3 postoperative days showed a progressive recovery of values, but on the third day, DLCO% capacity during exercise was still impaired (P < 0.01), especially in patients who underwent a resection of more than 3 functioning segments. CONCLUSIONS Physiological increase in DLCO% during exercise is still impaired on the third postoperative day in patients undergoing resection of more than 3 functioning pulmonary segments. This fact should be considered before discharging those patients after anatomical lung resection.
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Affiliation(s)
- Nuria M Novoa
- Thoracic Surgery Service, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Pedro Esteban
- Thoracic Surgery Service, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Maria Teresa Gómez Hernández
- Thoracic Surgery Service, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Marta G Fuentes
- Thoracic Surgery Service, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Gonzalo Varela
- Institute of Biomedical Research of Salamanca. Salamanca, Spain
| | - Marcelo F Jiménez
- Thoracic Surgery Service, Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
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Pinto TF, Fagundes Xavier R, Lunardi AC, Marques da Silva CCB, Moriya HT, Lima Vitorasso R, Torsani V, Amato MBP, Stelmach R, Salge JM, Carvalho-Pinto RM, Carvalho CR. Effects of elastic tape on thoracoabdominal mechanics, dyspnea, exercise capacity, and physical activity level in nonobese male subjects with COPD. J Appl Physiol (1985) 2020; 129:492-499. [DOI: 10.1152/japplphysiol.00690.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Elastic tape can be used as a new and low-cost intervention to reduce thoracoabdominal asynchrony and sedentary behavior as well as improve exercise capacity and physical activity level in nonobese male subjects with severe-to-very severe chronic obstructive pulmonary disease.
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Affiliation(s)
- Thiago Fernandes Pinto
- Department of Physical Therapy, Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Henrique Takachi Moriya
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Renato Lima Vitorasso
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Vinicius Torsani
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Marcelo Brito Passos Amato
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - João Marcos Salge
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Regina Maria Carvalho-Pinto
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Celso R.F. Carvalho
- Department of Physical Therapy, Medical School, University of São Paulo, São Paulo, Brazil
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Heiden GI, Sobral JB, Freitas CSG, Pereira de Albuquerque AL, Salge JM, Kairalla RA, Fernandes CJCDS, Carvalho CRR, Souza R, Baldi BG. Mechanisms of Exercise Limitation and Prevalence of Pulmonary Hypertension in Pulmonary Langerhans Cell Histiocytosis. Chest 2020; 158:2440-2448. [PMID: 32615192 DOI: 10.1016/j.chest.2020.05.609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/18/2020] [Accepted: 05/29/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pulmonary Langerhans cell histiocytosis (PLCH) determines reduced exercise capacity. The speculated mechanisms of exercise impairment in PLCH are ventilatory and cardiocirculatory limitations, including pulmonary hypertension (PH). RESEARCH QUESTION What are the mechanisms of exercise limitation, the exercise capacity, and the prevalence of dynamic hyperinflation (DH) and PH in PLCH? STUDY DESIGN AND METHODS In a cross-sectional study, patients with PLCH underwent an incremental treadmill cardiopulmonary exercise test with an evaluation of DH, pulmonary function tests, and transthoracic echocardiography. Those patients with lung diffusing capacity for carbon monoxide (Dlco) < 40% predicted and/or transthoracic echocardiogram with tricuspid regurgitation velocity > 2.5 m/s and/or with indirect PH signs underwent right heart catheterization. RESULTS Thirty-five patients were included (68% women; mean age, 47 ± 11 years). Ventilatory and cardiocirculatory limitations, impairment suggestive of PH, and impaired gas exchange occurred in 88%, 67%, 29%, and 88% of patients, respectively. The limitation was multifactorial in 71%, exercise capacity was reduced in 71%, and DH occurred in 68% of patients. FEV1 and Dlco were 64 ± 22% predicted and 56 ± 21% predicted. Reduction in Dlco, an obstructive pattern, and air trapping occurred in 80%, 77%, and 37% of patients. FEV1 and Dlco were good predictors of exercise capacity. The prevalence of PH was 41%, predominantly with a precapillary pattern, and mean pulmonary artery pressure correlated best with FEV1 and tricuspid regurgitation velocity. INTERPRETATION PH is frequent and exercise impairment is common and multifactorial in PLCH. The most prevalent mechanisms are ventilatory, cardiocirculatory, and suggestive of PH limitations. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT02665546; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Glaucia Itamaro Heiden
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Juliana Barbosa Sobral
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carolina Salim Gonçalves Freitas
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - André Luis Pereira de Albuquerque
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - João Marcos Salge
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ronaldo Adib Kairalla
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Caio Júlio César Dos Santos Fernandes
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Roberto Ribeiro Carvalho
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rogério Souza
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Guedes Baldi
- Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Reference Values and Predictive Equations for Cardiopulmonary Exercise Testing in Thai Adults. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.101808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: A series of racial specific predictive equations for exercise parameters are needed to determine a lack of cardiopulmonary fitness or having an exercise limitation on cardiopulmonary exercise testing (CPET). Objectives: The study aimed to develop a new set of predictive equations of CPET parameters during maximal cycling exercise for Thai adults. Methods: A sample of 580 Thai adults whom could pass screening tests were asked to fill a health questionnaire and the Global Physical Activity questionnaire. Participants with history of symptomatic heart and pulmonary diseases, current smokers, history of smoking ≥ 10 pack-years, and abnormal spirometry were excluded. The CPET was performed using a cycle ergometer with an incremental symptom-limited protocol. Values of CPET parameters at the peak exercise (oxygen uptake [V̇O2], work rate, heart rate, oxygen pulse, and minute ventilation), lactic acidosis threshold, and ventilatory equivalents for oxygen and carbon dioxide were documented. Analyses were stratified using age and gender criterion. Predictive equations for CPET parameters were established using multivariable linear regression with age (A), weight (W), height (H), and physical activity level (Act) as independent variables. Results: A total of 493 participants (208 men and 285 women) were analysed. The predictive equation of V̇O2peak (L.min-1) for males was: -2.268 + (0.037 × A) - (0.0005 × A2) + (0.016 × W) + (0.014 × H) + (0.104 × Act), (R2 = 0.41, SEE = 0.392), and for females, it was: -0.34 + (0.009 × A) - (0.0002 × A2) + (0.012 × W) + (0.005 × H) + (0.058 × Act), (R2 = 0.44, SEE = 0.220). Conclusions: This is the first study that constructed the predictive equations for cycling CPET parameters in Thai adults. These equations are useful to evaluate the cardiopulmonary health of the Thai population and may be generalized to other populations with geographical or ethnic proximity to the Thai people.
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An Overview of Non-exercise Estimated Cardiorespiratory Fitness: Estimation Equations, Cross-Validation and Application. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42978-019-0003-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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O’Donnell DE, Milne KM, Vincent SG, Neder JA. Unraveling the Causes of Unexplained Dyspnea. Clin Chest Med 2019; 40:471-499. [DOI: 10.1016/j.ccm.2019.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Blanchard J, Blais S, Chetaille P, Bisson M, Counil FP, Huard-Girard T, Berbari J, Boulay P, Dallaire F. New Reference Values for Cardiopulmonary Exercise Testing in Children. Med Sci Sports Exerc 2019; 50:1125-1133. [PMID: 29346167 PMCID: PMC6023574 DOI: 10.1249/mss.0000000000001559] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Cardiopulmonary exercise testing is an essential tool to assess cardiorespiratory fitness (CRF) in children. There is a paucity of adequate pediatric reference values that are independent of body size and pubertal stage. The purpose of this study is to provide Z score equations for several maximal and submaximal CRF parameters derived from a prospectively recruited sample of healthy children. METHODS In this cross-sectional multicenter study, we prospectively recruited 228 healthy children 12 to 17 yr old in local schools. We performed a symptom-limited cardiopulmonary exercise testing progressive ramp protocol on an electronically braked cycle ergometer. Eighteen CRF parameters were analyzed. We tested several regression models to obtain prediction curves that minimized residual association with age, body size, and pubertal stage. Both the predicted mean and the predicted SD were modeled to account for heteroscedasticity. RESULTS We identified nonlinear association of CRF parameters with body size and significant heteroscedasticity. To normalize CRF parameters, the use of a single body size variable was not sufficient. We therefore used multivariable models with various combination of height, corrected body mass, and age. Final prediction models yielded adjusted CRF parameters that were independent of age, sex, body mass, height, body mass index, and Tanner stages. CONCLUSIONS We present Z score equations for several CRF parameters derived from a healthy pediatric population. These reference values provide updated predicted means and range of normality that are independent of sex and body size. Further testing is needed to assess if these reference values increase sensitivity and specificity to identify abnormal cardiorespiratory response in children with chronic diseases.
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Affiliation(s)
- Joel Blanchard
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, and Sherbrooke University Hospital Research Center, Sherbrooke, CANADA.,Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, CANADA
| | - Samuel Blais
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, and Sherbrooke University Hospital Research Center, Sherbrooke, CANADA
| | - Philippe Chetaille
- Department of Pediatrics, Mother-Child Sun Center, CHU of Quebec City, and Research Center of the Quebec City Hospital Center, Laval University, Quebec City, CANADA
| | - Michele Bisson
- Department of Pediatrics, Mother-Child Sun Center, CHU of Quebec City, and Research Center of the Quebec City Hospital Center, Laval University, Quebec City, CANADA
| | - François P Counil
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, and Sherbrooke University Hospital Research Center, Sherbrooke, CANADA
| | - Thelma Huard-Girard
- Department of Pediatrics, Mother-Child Sun Center, CHU of Quebec City, and Research Center of the Quebec City Hospital Center, Laval University, Quebec City, CANADA
| | - Jade Berbari
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, and Sherbrooke University Hospital Research Center, Sherbrooke, CANADA
| | - Pierre Boulay
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, CANADA
| | - Frederic Dallaire
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, and Sherbrooke University Hospital Research Center, Sherbrooke, CANADA
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Freitas PD, Silva AG, Ferreira PG, DA Silva A, Salge JM, Carvalho-Pinto RM, Cukier A, Brito CM, Mancini MC, Carvalho CRF. Exercise Improves Physical Activity and Comorbidities in Obese Adults with Asthma. Med Sci Sports Exerc 2019; 50:1367-1376. [PMID: 29432326 DOI: 10.1249/mss.0000000000001574] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Obese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated. OBJECTIVE This study aimed to assess the effects of exercise on DLPA, asthma symptoms, and psychosocial comorbidities in obese adults with asthma. METHODS Fifty-five grade II obese adults with asthma were randomly assigned to either a weight loss program + exercise program (WL + E group, n = 28) or a weight loss program + sham (WL + S group, n = 27). The WL + E group incorporated aerobic and resistance muscle training into the weight loss program (nutrition and psychological therapies), whereas the WL + S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality, and anxiety and depression symptoms were quantified before and after treatment. RESULTS After 3 months, the WL + E group presented a significant increase in daily step counts (3068 ± 2325 vs 729 ± 1118 steps per day) and the number of asthma symptom-free days (14.5 ± 9.6 vs 8.6 ± 11.4 d·month) compared with the WL + S group. The proportion of participants with improvements in depression symptoms (76.4% vs 16.6%) and a lower risk of developing obstructive sleep apnea (56.5% vs 16.3%) was greater in the WL + E group than that in the WL + S group (P < 0.05). Significant improvements in sleep efficiency (6.6% ± 5.1% vs 1.3% ± 4.7%) and latency (-3.7 ± 5.9 vs 0.2 ± 5.6 min) were also observed in the WL + E group. CONCLUSIONS Our results strongly suggest that exercise training plus a weight loss program improves DLPA, sleep efficiency, and depression and asthma symptoms in obese adults with asthma.
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Affiliation(s)
- Patrícia Duarte Freitas
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, BRAZIL
| | - Aline Grandi Silva
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, BRAZIL
| | | | | | - João Marcos Salge
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, BRAZIL
| | - Regina Maria Carvalho-Pinto
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, BRAZIL
| | - Alberto Cukier
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, BRAZIL
| | - Claudia M Brito
- Obesity and Metabolic Syndrome, Endocrinology and Metabolic Service of Clinics Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, BRAZIL
| | - Marcio C Mancini
- Obesity and Metabolic Syndrome, Endocrinology and Metabolic Service of Clinics Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, BRAZIL
| | - Celso R F Carvalho
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, BRAZIL
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Kuo A, Todd JJ, Witherspoon JW, Lawal TA, Elliott J, Chrismer IC, Shelton MO, Razaqyar MS, Jain MS, Vasavada R, Waite M, Drinkard B, Michael D, Richarte A, Bönnemann CG, Meilleur KG. Reliability and Validity of Self-Report Questionnaires as Indicators of Fatigue in RYR1-Related Disorders. J Neuromuscul Dis 2019; 6:133-141. [PMID: 30714968 DOI: 10.3233/jnd-180335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND RYR1-related disorders (RYR1-RD), are a spectrum of genetic neuromuscular disorders. Affected individuals frequently experience fatigue yet appropriate tools to assess RYR1-RD-associated fatigue remain underdeveloped. OBJECTIVE This study assessed the reliability and validity of two self-report questionnaires, the multidimensional fatigue inventory (MFI-20) and adult/pediatric functional assessment of chronic illness-fatigue (FACIT-F/Peds-FACIT-F) as potential fatigue measures in RYR1-RD affected individuals. METHODS Participants (n = 37) were enrolled in an RYR1-RD combined natural history study and clinical trial. At baseline, participants completed fatigue questionnaires, six-minute walk test (6MWT), cardiopulmonary exercise test (CPET) and saliva collection for fatigue biomarker index (FBI) quantification. RESULTS All questionnaires exhibited good test-retest reliability (n = 18, ICC > 0.80). MFI-20 (n = 37), and FACIT-F (n = 28) also showed good internal consistency (Cronbach's α> 0.80). All MFI-20 subscales, except mental fatigue, and FACIT-F demonstrated evidence of criterion validity when correlated against percent predicted 6MWT distance (MFI-20 n = 37; r = -0.34 to -0.47, all p < 0.05, mental fatigue, r = -0.16, p = 0.35; FACIT-F n = 28, r = 0.41, p = 0.03). This was not the case for percent predicted VO2 peak (all p > 0.05). FBI correlated with MFI-20 general fatigue dimension only (r = -0.35, p = 0.03). Comparison of standardized questionnaire scores revealed that RYR1-RD affected individuals experience significantly greater fatigue than the general population. CONCLUSIONS MFI-20 and FACIT-F are valid and reliable tools for assessing RYR1-RD-associated fatigue, a symptom centrally implicated in this rare disorder.
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Affiliation(s)
- Anna Kuo
- Neuromuscular Symptoms Unit, National Institute of Nursing Research (NIH), United States
| | - Joshua J Todd
- Neuromuscular Symptoms Unit, National Institute of Nursing Research (NIH), United States
| | - Jessica W Witherspoon
- Neuromuscular Symptoms Unit, National Institute of Nursing Research (NIH), United States
| | - Tokunbor A Lawal
- Neuromuscular Symptoms Unit, National Institute of Nursing Research (NIH), United States
| | - Jeffery Elliott
- Neuromuscular Symptoms Unit, National Institute of Nursing Research (NIH), United States
| | - Irene C Chrismer
- Neuromuscular Symptoms Unit, National Institute of Nursing Research (NIH), United States
| | - Monique O Shelton
- Neuromuscular Symptoms Unit, National Institute of Nursing Research (NIH), United States
| | - Muslima S Razaqyar
- Neuromuscular Symptoms Unit, National Institute of Nursing Research (NIH), United States
| | - Minal S Jain
- Mark O Hatfield Clinical Center, National Institutes of Health (NIH), United States
| | - Ruhi Vasavada
- Mark O Hatfield Clinical Center, National Institutes of Health (NIH), United States
| | - Melissa Waite
- Mark O Hatfield Clinical Center, National Institutes of Health (NIH), United States
| | - Bart Drinkard
- Mark O Hatfield Clinical Center, National Institutes of Health (NIH), United States
| | - Darren Michael
- Hyperion Biotechnology Inc., San Antonio TX, United States
| | | | - Carsten G Bönnemann
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke - NINDS (NIH), United States
| | - Katherine G Meilleur
- Neuromuscular Symptoms Unit, National Institute of Nursing Research (NIH), United States
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Frazão M, França LMDSM, Bezerra SCM, Silva PE. Relationship of ventilatory inefficiency and low cardiorespiratory fitness in the elderly: a retrospective observational study. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.190025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objectives : To check if ventilatory inefficiency is related to low cardiorespiratory fitness in the elderly and to identify the variable(s) of the cardiopulmonary exercise test (CPET) best suited to determining this relationship. Methods : A retrospective analysis of 1357 CPETs was performed. Sixty-one subjects over 60 years old with a ventilatory efficiency slope (VE/VCO2) index >35 were selected and divided into two groups: low cardiorespiratory fitness (VO2<80% predicted) (n=22) and normal cardiorespiratory fitness (VO2>80% predicted) (n=39) and were compared with a control group of healthy elderly persons with normal cardiorespiratory fitness and VE/VCO2 slope index <35 (n=16), matched by gender, weight, height, and age. Results : Oxygen consumption had a low correlation with VE/VCO2 slope (r= -0.35, p<0.01), a moderate correlation with the cardiorespiratory optimal point (COP) (r= -0.59, p<0.001) and a strong correlation with oxygen uptake efficiency Slope (OUES) =0.92, p<0.0001). In relation to the ROC curve, the VE/VCO2 slope presented an area under the curve of 0.65, but without statistical significance (p> 0.05); the COP showed an area under the curve of 0.84 (p <0.0001) and the OUES presented an area under the curve of 0.81 (p<0.0001). Conclusion : Ventilatory inefficiency is related to poor cardiorespiratory fitness in the elderly. The COP and OUES were more accurate at predicting low cardiorespiratory fitness.
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Sperandio EF, Guerra RLF, Romiti M, Gagliardi ARDT, Arantes RL, Dourado VZ. Reference values for the 6-min walk test in healthy middle-aged and older adults: from the total distance traveled to physiological responses. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Physiological responses to the 6-min walk test (6MWT) have been increasingly evaluated in patients with cardiopulmonary diseases. However, previous studies did not include healthy persons. Objective: To evaluate the intensity of 6MWT, to develop a series of predictive equations for the physiological variables and to test their reliability in healthy middle-aged and older adults. Method: We evaluated 102 non-trained healthy adults (54 women, aged 61 ± 10 years) and a cross-validation sample of 30 participants. We measured physiological responses to the 6MWT and a cardiopulmonary exercise testing (CPET) on a treadmill. Results: The R2 values for regression analysis adjusted by age, body mass, stature, and sex ranged from 0.25 for heart rate and 0.46 for peak V ˙ O 2 The 6MWT distance and 6MWT peak V ˙ O 2 represented 110 ± 10% and 102 ± 15% of the predicted values, respectively, using our equations. The intensity of 6MWT corresponded to 72 ± 13% of the peak O2 and 78 ± 23% of the peak HR in the CPET. Peak V ˙ O 2 in the CPET was adequately predicted by 6MWT peak V ˙ O 2 (R2 = 0.76) and 6MWD (R2 = 0.54). Conclusion: The 6MWT represents a moderate to high-intensity test in middle-aged and older healthy adults and is valid for assessing maximal aerobic exercise capacity. Physiological responses to the 6MWT may be adequately predicted with a combination of anthropometrics and demographics.
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Grandi Silva A, Duarte Freitas P, Ferreira PG, Stelmach R, Carvalho-Pinto RM, Salge JM, Arruda Martins M, Carvalho CRF. Effects of weight loss on dynamic hyperinflation in obese women asthmatics. J Appl Physiol (1985) 2018; 126:413-421. [PMID: 30521428 DOI: 10.1152/japplphysiol.00341.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Obese adults with asthma are more likely to develop dynamic hyperinflation (DH) and expiratory flow limitation (EFL) than nonobese asthmatics, and weight-loss seems to improve the breathing mechanics during exercise. However, studies evaluating the effect of weight loss on DH in obese adults with asthma have not been performed. We sought to evaluate the effect of a weight loss program on DH in obese adults with asthma. Forty-two asthma patients were enrolled in a weight loss program (diet, psychological support, and exercise) and were subsequently divided into two groups according to the percentage of weight loss: a ≥5% group ( n = 19) and a <5% group ( n = 23). Before and after the intervention, DH and EFL (constant load exercise), health-related quality of life (HRQoL), asthma control, quadriceps muscle strength and endurance, body composition, and lung function were assessed. Both groups exhibited a decrease of ≥10% in inspiratory capacity (DH) before intervention, and only the ≥5% group showed clinical improvement in DH compared with the <5% group postintervention (-9.1 ± 14.5% vs. -12.5 ± 13.5%, respectively). In addition, the ≥5% group displayed a significant delay in the onset of both DH and EFL and a clinically significant improvement in HRQoL and asthma control. Furthermore, a correlation was observed between reduced waist circumference and increased inspiratory capacity ( r = -0.45, P = 0.05) in the ≥5% group. In conclusion, a weight-loss of ≥5% of the body weight improves DH, which is associated with waist circumference in obese adults with asthma. In addition, the group with greater weight-loss showed a delayed onset of DH and EFL during exercise and improved asthma clinical control and HRQoL. NEW & NOTEWORTHY This is the first study to evaluate dynamic hyperinflation (DH) after a weight loss program in obese patients with asthma. Our results demonstrate that moderate weight loss can improve DH in obese patients with asthma that is associated with a decrease in abdominal fat. Moreover, a minimum of 5% in weight loss delays the onset of DH and expiratory flow limitation besides inducing a clinical improvement in asthma quality of life and clinical control.
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Affiliation(s)
- Aline Grandi Silva
- Department of Physical Therapy, School of Medicine, University of Sao Paulo , Sao Paulo , Brazil
| | - Patricia Duarte Freitas
- Department of Physical Therapy, School of Medicine, University of Sao Paulo , Sao Paulo , Brazil
| | | | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, School of Medicine, University of Sao Paulo , Sao Paulo , Brazil
| | - Regina Maria Carvalho-Pinto
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, School of Medicine, University of Sao Paulo , Sao Paulo , Brazil
| | - Joao Marcos Salge
- Pulmonary Division, Heart Institute (InCor), Clinics Hospital, School of Medicine, University of Sao Paulo , Sao Paulo , Brazil
| | - Milton Arruda Martins
- Department of Medicine, School of Medicine, University of Sao Paulo , Sao Paulo , Brazil
| | - Celso R F Carvalho
- Department of Physical Therapy, School of Medicine, University of Sao Paulo , Sao Paulo , Brazil
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Inspiratory muscle weakness contributes to exertional dyspnea in chronic thromboembolic pulmonary hypertension. PLoS One 2018; 13:e0204072. [PMID: 30260970 PMCID: PMC6160017 DOI: 10.1371/journal.pone.0204072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/31/2018] [Indexed: 11/20/2022] Open
Abstract
Determination of potentially-reversible factors contributing to exertional dyspnea remains an unmet clinical need in chronic thromboembolic pulmonary hypertension (CTEPH). Therefore, we aimed to evaluate the influence of inspiratory muscle weakness (IMW) on exercise capacity and dyspnea during effort in patients with CTEPH. We performed a prospective cross-sectional study that included thirty-nine consecutive patients with CTEPH (48 ± 15 yrs, 61% female) confirmed by right heart catheterization that underwent an incremental cardiopulmonary exercise test, 6-minute walk test and maximum inspiratory pressure (MIP) measurement. MIP < 70%pred was found in 46% of patients. On a multiple linear regression analysis, MIP was independently associated with 6MWD and V˙O2PEAK. Patients with MIP < 70% presented greater ΔV˙E/ΔV˙CO2 than those with MIP ≥ 70%. Additionally, they also presented stronger sensations of dyspnea throughout exercise, even when adjusted for ventilation. At rest and at different levels of exercise, mean inspiratory flow (VT/TI) was significantly higher in patients with MIP < 70%. In conclusion, IMW is associated with a rapid increase of dyspnea, higher inspiratory load and poor exercise capacity in patients with CTEPH.
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Lopes AJ, Vigário PS, Hora AL, Deus CA, Soares MS, Guimaraes FS, Ferreira AS. Ventilation distribution, pulmonary diffusion and peripheral muscle endurance as determinants of exercise intolerance in elderly patients with chronic obstructive pulmonary disease. Physiol Res 2018; 67:863-874. [PMID: 30204461 DOI: 10.33549/physiolres.933867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive and disabling disease that has been associated with aging. Several factors may potentially impair performance during exercise in elderly patients with COPD. This study was conducted to evaluate what characteristics related to lung function, peripheral muscle strength and endurance can predict the performance of elderly patients with COPD during cardiopulmonary exercise testing (CPET). Forty elderly patients with COPD underwent resting lung function tests, knee isokinetic dynamometry, and CPET. Three models were developed to explain the variability in peak oxygen uptake (VO(2) peak) after controlling for age as an independent confounder. The pulmonary function model showed the highest explained variance (65.6 %); in this model, ventilation distribution (p<0.001) and pulmonary diffusion (0.013) were found to be independent predictors. Finally, the models that included the muscle strength and endurance variables presented explained variances of 51 % and 57.4 %, respectively. In these models that involved muscular dysfunction, however, only the endurance variables were found to be independent predictors (p<0.05). In conclusion, ventilation distribution and pulmonary diffusion, but not the degree of airway obstruction, independently predict CPET performance in elderly patients with COPD. In addition, peripheral muscle endurance, but not strength, also predicts CPET performance in these subjects.
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Affiliation(s)
- A J Lopes
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Center, Rio de Janeiro, Brazil.
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Dias OM, Baldi BG, Ferreira JG, Cardenas LZ, Pennati F, Salito C, Carvalho CRR, Aliverti A, Pereira de Albuquerque AL. Mechanisms of exercise limitation in patients with chronic hypersensitivity pneumonitis. ERJ Open Res 2018; 4:00043-2018. [PMID: 30151370 PMCID: PMC6104296 DOI: 10.1183/23120541.00043-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/05/2018] [Indexed: 01/02/2023] Open
Abstract
Small airway and interstitial pulmonary involvements are prominent in chronic hypersensitivity pneumonitis (cHP). However, their roles on exercise limitation and the relationship with functional lung tests have not been studied in detail. Our aim was to evaluate exercise performance and its determinants in cHP. We evaluated maximal cardiopulmonary exercise testing performance in 28 cHP patients (forced vital capacity 57±17% pred) and 18 healthy controls during cycling. Patients had reduced exercise performance with lower peak oxygen production (16.6 (12.3–19.98) mL·kg−1·min−1versus 25.1 (16.9–32.0), p=0.003), diminished breathing reserve (% maximal voluntary ventilation) (12 (6.4–34.8)% versus 41 (32.7–50.8)%, p<0.001) and hyperventilation (minute ventilation/carbon dioxide production slope 37±5 versus 31±4, p<0.001). All patients presented oxygen desaturation and augmented Borg dyspnoea scores (8 (5–10) versus 4 (1–7), p=0.004). The prevalence of dynamic hyperinflation was found in only 18% of patients. When comparing cHP patients with normal and low peak oxygen production (<84% pred, lower limit of normal), the latter exhibited a higher minute ventilation/carbon dioxide production slope (39±5.0 versus 34±3.6, p=0.004), lower tidal volume (0.84 (0.78–0.90) L versus 1.15 (0.97–1.67) L, p=0.002), and poorer physical functioning score on the Short form-36 health survey. Receiver operating characteristic curve analysis showed that reduced lung volumes (forced vital capacity %, total lung capacity % and diffusing capacity of the lung for carbon dioxide %) were high predictors of poor exercise capacity. Reduced exercise capacity was prevalent in patients because of ventilatory limitation and not due to dynamic hyperinflation. Reduced lung volumes were reliable predictors of lower performance during exercise. Besides significant small airway involvement, reduced exercise capacity is due to ventilatory limitation and not due to dynamic hyperinflation in chronic hypersensitivity pneumonitishttp://ow.ly/Ou9230kSBQz
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Affiliation(s)
- Olívia Meira Dias
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Bruno Guedes Baldi
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Jeferson George Ferreira
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Letícia Zumpano Cardenas
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Caterina Salito
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Carlos Roberto Ribeiro Carvalho
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - André Luis Pereira de Albuquerque
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
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Wagner J, Agostoni P, Arena R, Belardinelli R, Dumitrescu D, Hager A, Myers J, Rauramaa R, Riley M, Takken T, Schmidt-Trucksäss A. The Role of Gas Exchange Variables in Cardiopulmonary Exercise Testing for Risk Stratification and Management of Heart Failure with Reduced Ejection Fraction. Am Heart J 2018; 202:116-126. [PMID: 29933148 DOI: 10.1016/j.ahj.2018.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/18/2018] [Indexed: 01/14/2023]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is common in the developed world and results in significant morbidity and mortality. Accurate risk assessment methods and prognostic variables are therefore needed to guide clinical decision making for medical therapy and surgical interventions with the ultimate goal of decreasing risk and improving health outcomes. The purpose of this review is to examine the role of cardiopulmonary exercise testing (CPET) and its most commonly used ventilatory gas exchange variables for the purpose of risk stratification and management of HFrEF. We evaluated five widely studied gas exchange variables from CPET in HFrEF patients based on nine previously used systematic criteria for biomarkers. This paper provides clinicians with a comprehensive and critical overview, class recommendations and evidence levels. Although some CPET variables met more criteria than others, evidence supporting the clinical assessment of variables beyond peak V̇O2 is well-established. A multi-variable approach also including the V̇E-V̇CO2 slope and EOV is therefore recommended.
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Affiliation(s)
- Jonathan Wagner
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy & Department of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Romualdo Belardinelli
- Department of Cardiovascular Sciences, Cardiac Rehabilitation Lancisi, Ancona, Italy
| | - Daniel Dumitrescu
- Herzzentrum der Universitaet zu Koeln, Klinik III fuer Innere Medizin, Cologne, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technical University of Munich, Germany
| | - Jonathan Myers
- Cardiology Division, VA Palo Alto Health Care System and Stanford University, Palo Alto, CA
| | - Rainer Rauramaa
- Foundation for Research in Health, Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Marshall Riley
- Department of Medicine, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Tim Takken
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
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Bravo DM, Gimenes AC, Amorim BC, Alencar MC, Berton DC, O’Donnell DE, Nery LE, Neder JA. Excess ventilation in COPD: Implications for dyspnoea and tolerance to interval exercise. Respir Physiol Neurobiol 2018; 250:7-13. [DOI: 10.1016/j.resp.2018.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/31/2017] [Accepted: 01/21/2018] [Indexed: 12/20/2022]
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50
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de Camargo AA, Boldorini JC, Holland AE, de Castro RAS, Lanza FDC, Athanazio RA, Rached SZ, Carvalho-Pinto R, Cukier A, Stelmach R, Corso SD. Determinants of Peripheral Muscle Strength and Activity in Daily Life in People With Bronchiectasis. Phys Ther 2018; 98:153-161. [PMID: 29237078 DOI: 10.1093/ptj/pzx123] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 12/07/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Bronchiectasis is characterized by a progressive structural lung damage, recurrent infections and chronic inflammation which compromise the exertion tolerance, and may have an impact on skeletal muscle function and physical function. OBJECTIVE The purpose of this study was to compare peripheral muscle strength, exercise capacity, and physical activity in daily life between participants with bronchiectasis and controls and to investigate the determinants of the peripheral muscle strength and physical activity in daily life in bronchiectasis. DESIGN This study used a cross-sectional design. METHODS The participants' quadriceps femoris and biceps brachii muscle strength was measured. They performed the incremental shuttle walk test (ISWT) and cardiopulmonary exercise testing, and the number of steps/day was measured by a pedometer. RESULTS Participants had reduced quadriceps femoris muscle strength (mean difference to control group = 7 kg, 95% CI = 3.8-10.1 kg), biceps brachii muscle strength (2.1 kg, 95% CI = 0.7-3.4 kg), ISWT (227 m, 95% CI = 174-281 m), peak VO2 (6.4 ml/Kg/min, 95% CI = 4.0-8.7 ml/Kg/min), and number of steps/day (3,332 steps/day, 95% CI = 1,758-4,890 steps/day). A lower quadriceps femoris strength is independently associated to an older age, female sex, lower body mass index (BMI), higher score on the modified Medical Research Council scale, and shorter distance on the ISWT (R2 = 0.449). Biceps brachii strength is independently associated with sex, BMI, and dyspnea (R2 = 0.447). The determinants of number of daily steps were dyspnea and distance walked in ISWT, explaining only 27.7% of its variance. LIMITATIONS Number of steps per day was evaluated by a pedometer. CONCLUSIONS People with bronchiectasis have reduced peripheral muscle strength, and reduced aerobic and functional capacities, and they also are less active in daily life. Modifiable variables such as BMI, dyspnea, and distance walked on the ISWT are associated with peripheral muscle strength and physical activity in daily life.
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Affiliation(s)
- Anderson Alves de Camargo
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, Rua Vergueiro, 235/249 - 2o subsolo, 01504-001, São Paulo, -Brazil
| | | | - Anne E Holland
- Alfred Health, Melbourne, Victoria, Australia. Physiotherapy, La Trobe University, Melbourne, Australia and Institute for Breathing and Sleep, Heidelberg, Australia
| | | | | | - Rodrigo A Athanazio
- Pulmonary Division, Heart Insitute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Samia Z Rached
- Pulmonary Division, Heart Insitute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo
| | - Regina Carvalho-Pinto
- Pulmonary Division, Heart Insitute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo
| | - Alberto Cukier
- Pulmonary Division, Heart Insitute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo
| | - Rafael Stelmach
- Pulmonary Division, Heart Insitute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo
| | - Simone Dal Corso
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE
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