The effects of posture on the ventilatory responses during exercise

Cerebrovascular responses to a 90° tilt in healthy neonates

BACKGROUND

Tilts can induce alterations in cerebral hemodynamics in healthy neonates, but prior studies have only examined systemic parameters or used small tilt angles (<90°). The healthy neonatal population, however, are commonly subjected to large tilt angles (≥90°). We sought to characterize the cerebrovascular response to a 90° tilt in healthy term neonates.

METHODS

We performed a secondary descriptive analysis on 44 healthy term neonates. We measured cerebral oxygen saturation (rcSO2), oxygen saturation (SpO2), heart rate (HR), breathing rate (BR), and cerebral fractional tissue oxygen extraction (cFTOE) over three consecutive 90° tilts. These parameters were measured for 2-min while neonates were in a supine (0°) position and 2-min while tilted to a sitting (90°) position. We measured oscillometric mean blood pressure (MBP) at the start of each tilt.

RESULTS

rcSO2 and BR decreased significantly in the sitting position, whereas cFTOE, SpO2, and MBP increased significantly in the sitting position. We detected a significant position-by-time interaction for all physiological parameters.

CONCLUSION

A 90° tilt induces a decline in rcSO2 and an increase in cFTOE in healthy term neonates. Understanding the normal cerebrovascular response to a 90° tilt in healthy neonates will help clinicians to recognize abnormal responses in high-risk infant populations.

IMPACT

Healthy term neonates (≤14 days old) had decreased cerebral oxygen saturation (~1.1%) and increased cerebral oxygen extraction (~0.01) following a 90° tilt. We detected a significant position-by-time interaction with all physiological parameters measured, suggesting the effect of position varied across consecutive tilts. No prior study has characterized the cerebral oxygen saturation response to a 90° tilt in healthy term neonates.

Recumbent Ergometer vs Treadmill Cardiopulmonary Exercise Test in HFpEF: Implications for Chronotropic Response and Exercise Capacity

BACKGROUND

Cardiopulmonary exercise testing (CPET) can identify mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF), but exercise modalities with differing body positions (eg, recumbent ergometer, treadmill) are broadly used. In this study, we aimed to determine whether body position affects CPET parameters in patients with HFpEF.

METHODS

Subjects with stable HFpEF (n = 23) underwent noninvasive treadmill CPET, followed by an invasive recumbent-cycle ergometer CPET within 3 months. A comparison group undergoing similar studies included healthy subjects (n = 5) and subjects with pulmonary arterial hypertension (n = 6).

RESULTS

The peak oxygen consumption (VO₂peak) and peak heart rate were significantly lower in the recumbent vs the upright position (10.1 vs 13.1 mL/kg/min [Δ-3 mL/kg/min]; P < 0.001; and 95 vs 113 bpm [Δ-18 bpm]; P < 0.001, respectively). No significant differences were found in the minute ventilation to carbon dioxide production ratio, end-tidal pressure of carbon dioxide or respiratory exchange ratio. A similar pattern was observed in the comparison groups.

CONCLUSIONS

Compared to recumbent ergometer, treadmill CPET revealed higher VO₂peak and peak heart rate response. When determining chronotropic incompetence to adjust beta-blocker administration in HFpEF, body position should be taken into account.

Influence of simulated hypogravity on oxygen uptake during treadmill running

Prolonged exposure to microgravity during spaceflights leads to severe deterioration in the physical performance of astronauts. To understand the effectiveness of existing in‐flight daily countermeasures and to plan exercise onboard the International Space Station, we compared supine treadmill running to traditional upright treadmill running on earth. Specifically, we assessed the cardiorespiratory responses to conventional upright running to the responses to supine treadmill running under 0.3 g, 0.6 g, and 1 g of body weight in younger (20–30 years, n = 14, 8 females) and older healthy adults (50–60 years, n = 12, 6 females). Maximal cardiorespiratory capacity was additionally evaluated by performing an incremental running protocol on each treadmill. Maximum speed was greater for 0.3 g and 0.6 g in supine than for upright running (18.5 km/h (1.1) and 15.9 (3.1) vs 13.2 (2.4) p < 0.001). In contrast, maximum oxygen uptake (V˙O2max) and maximum heart rate (HR_max) were greater in upright running than in all supine conditions (Upright treadmill running vs S1.0G vs S0.6G vs S0.3G, 41.7 ml kg⁻¹ min⁻¹ (7.2) vs 30.5 (6.6) vs 32.9 (7.0) vs 30.9 (5.2), p < 0.001 and 171 beats min⁻¹ (14) vs 152 (24) vs 155 (20) vs 152 (18), p < 0.001, respectively). The reduction in V˙O2max was remarkably similar across all three supine conditions, could not be increased by higher running speeds and can be well explained by reduced ground reaction forces (GRF). Thus, although a gravity‐related restriction of pulmonary gas exchange or perfusion of the legs when exercising in the supine position can be suspected, findings are also explicable on grounds of the vertical treadmill mechanics. Reduced loading will constitute a substantial limitation to V˙O2 in space with implications for crew health and the physical deterioration of astronauts.

Effects of body position during cardiopulmonary exercise testing with right heart catheterization

Cardiopulmonary exercise testing (CPX) with right heart catheterization (RHC) widely used for early diagnosis and evaluation of pulmonary vascular disease in patients with pulmonary arterial hypertension and early stage heart failure with preserved ejection fraction, who display normal hemodynamics at rest. The aim of this study was to investigate that whether body position affects pulmonary hemodynamics, pulmonary arterial wedge pressure (PAWP), and CPX parameters during invasive CPX. Seventeen patients (58 ± 14 years; 5/12 male/female) with chronic thromboembolic pulmonary hypertension treated with percutaneous transluminal pulmonary angioplasty and near-normal pulmonary artery pressure (PAP) underwent invasive CPX twice in supine and upright position using a cycle ergometer with 6 months interval. The mean PAP (peak: 45 ± 7 vs. 40 ± 11 mmHg, P = 0.006) and PAWP (peak: 17 ± 4 vs. 11 ± 7 mmHg, P = 0.008, supine vs. upright, respectively) throughout the test in supine position were significantly higher compared with in upright position, because of preload increase. However, transpulmonary pressure gradient, pulmonary vascular resistance, and mPA-Q slope during exercise were of no significant difference between two positions. There were no differences between the results of two positions in peak VO2 (15.9 ± 4.0 vs. 16.6 ± 3.2 mL/min per kg, P = 0.456), the VE versus VCO2 slope (37.8 ± 9.2 vs. 35.9 ± 8.0, P = 0.397), or the peak work-rate (79 ± 29 vs. 84 ± 27W, P = 0.118). Body position had a significant influence on PAP and PAWP during exercise, but no influence on the pulmonary circulation, or peak VO2 , or VE vs.VCO2 slope.

Cardiopulmonary responses at various angles of cycle backrest inclination

The purpose of this study was to evaluate cardiopulmonary responses during submaximal cycle exercise at various angles of backrest inclination. Ten healthy Japanese men of mean age 25.9 yrs, height 170.6 cm, and body mass 66.1 kg, performed cycle exercises at a constant workload which reached the anaerobic threshold, at 20 degrees, 40 degrees, and 60 degrees of backrest inclination from the vertical plane, but the angle between the seat and back rest was kept at 110 degrees. The results were as follows: 1) Both cardiac output and stroke volume showed a higher value at the resting control state and during exercise as the backrest angle increased. 2) Oxygen consumption, carbon dioxide output, heart rate, gas exchange ratio, and oxygen pulse were not affected by the angle of backrest inclination. 3) Tidal volume at 20 degrees of backrest inclination was higher than at 60 degrees. 4) No significant differences were found in minute ventilation between each backrest angle. These findings suggest that changes in the backrest angle significantly alter cardiopulmonary parameters at rest and during exercise; in particular, an angle difference of 40 degrees may be enough to alter tidal volume, cardiac output and stroke volume, but not the minute ventilation.

Characteristics of maximum performance of pedaling exercise in recumbent and supine positions

To determine the characteristics of maximum pedaling performance in the recumbent and supine positions, maximum isokinetic leg muscle strength was measured in eight healthy male subjects during pedaling at three velocities (300°/s, 480°/s, and 660°/s), and maximum incremental tests were performed for each position. The maximum isokinetic muscle strength in the recumbent position was 210.0 ± 29.2 Nm at 300°/s, 158.4 ± 19.8 Nm at 480°/s, and 110.6 ± 13.2 at 660°/s. In contrast, the muscle strength in the supine position was 229.3 ± 36.7 Nm at 300°/s, 180. 7 ± 20.3 Nm at 480°/s, and 129.6 ± 14.0 Nm at 660°/s. Thus, the maximum isokinetic muscle strength showed significantly higher values in the supine position than in the recumbent position at all angular velocities. The knee and hip joint angles were measured at peak torque using a goniometer; the knee joint angle was not significantly different between both positions, whereas the hip joint angle was greater in the supine position than in the recumbent position (Supine position: 137.3 ± 9. 33 degree at 300°/s, 140.0 ± 11.13 degrees at 480°/s, and 141.0 ± 9.61 degrees at 660°/s. Recumbent position: 99.5 ± 12.21 degrees at 300°/s, 101.6 ± 12.29 degrees at 480°/s, and 105.8 ± 14.28 degrees at 660°/s). Peak oxygen uptake was higher in the recumbent position (50.3 ± 4.43 ml·kg(-1)·min(-1)) than in the supine position (48.7 ± 5.10 ml·kg(-1)·min(-1)). At maximum exertion, the heart rate and whole-body rate of perceived exertion (RPE) were unaffected by position, but leg muscle RPE was higher in the supine position (19.5 ± 0.53 than in the recumbent position (18.8 ± 0.71). These results suggest that the supine position is more suitable for muscle strength exertion than the recumbent position, and this may be due to different hip joint angles between the positions. On the contrary, the endurance capacity was higher in the recumbent position than in the supine position. Since leg muscle RPE was higher in the supine position than in the recumbent position, it was suggested that different burdens imposed on active muscles in both positions exerted an impact on the result of the endurance capacity. Key pointsIsokinetic maximal peak torque measured in this study during pedaling showed higher values in the supine position than in the recumbent position at all angular velocities.Maximum oxygen uptake as evaluated by maximum incremental testing showed higher values in the recumbent position than in the supine position.No significant changes in the angle of peak torque for the knee joint or hip joint were observed in either the recumbent or supine position even at an increased angular velocity. These observations indicate the effectiveness of a cycle-type muscle strength assessment device for evaluating leg muscle strength.