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Wang S, Gao B, Shi M, Qumu S, Dong F, Wang P, Yang T, Jiang S. Exercise-Induced Oxygen Desaturation Increases Arterial Stiffness in Patients with COPD During the 6WMT. Int J Chron Obstruct Pulmon Dis 2024; 19:1479-1489. [PMID: 38948910 PMCID: PMC11214759 DOI: 10.2147/copd.s465843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/20/2024] [Indexed: 07/02/2024] Open
Abstract
Objective Given the established impact of exercise in reducing arterial stiffness and the potential for intermittent hypoxia to induce its elevation, this study aims to understand how oxygen desaturation during exercise affects arterial stiffness in individuals with COPD. Methods We enrolled patients with stable COPD from China-Japan Friendship Hospital from November 2022 to June 2023. The 6-minute walk test (6-MWT) was performed with continuous blood oxygen saturation (SpO2) monitoring in these patients. The patients were classified into three groups: non-exercise induced desaturation (EID), mild-EID and severe-EID, according to the changes in SpO2 during the 6-MWT. The Cardio-Ankle Vascular Index (CAVI) and the change in CAVI (ΔCAVI, calculated as CAVI before 6MWT minus CAVI after the 6MWT) were measured before and immediately after the 6MWT to assess the acute effects of exercise on arterial stiffness. GOLD Stage, pulmonary function, and other functional outcomes were also measured in this study. Results A total of 37 patients with stable COPD underwent evaluation for changes in CAVI (ΔCAVI) before and after the 6-MWT. Stratification based on revealed three subgroups: non-EID (n=12), mild-EID (n=15), and severe-EID (n=10). The ΔCAVI values was -0.53 (-0.95 to -0.31) in non-EID group, -0.20 (-1.45 to 0.50) in mild-EID group, 0.6 (0.08 to 0.73) in severe-EID group. Parametric tests indicated significant differences in ΔCAVI among EID groups (p = 0.005). Pairwise comparisons demonstrated significant distinctions between mild-EID and severe-EID groups, as well as between non-EID and severe-EID groups (p = 0.048 and p = 0.003, respectively). Multivariable analysis, adjusting for age, sex, GOLD stage, diffusion capacity, and blood pressure, identified severe-EID as an independent factor associated with ΔCAVI (B = 1.118, p = 0.038). Conclusion Patients with COPD and severe-EID may experience worsening arterial stiffness even during short periods of exercise.
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Affiliation(s)
- Siyuan Wang
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Beiyao Gao
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Minghui Shi
- National Center for Respiratory Medicine, Beijing, People’s Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China
- Capital Medical University, Beijing, People’s Republic of China
| | - Shiwei Qumu
- National Center for Respiratory Medicine, Beijing, People’s Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Fen Dong
- National Center for Respiratory Medicine, Beijing, People’s Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China
- Department of Clinical Research and Data management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Peijian Wang
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Ting Yang
- National Center for Respiratory Medicine, Beijing, People’s Republic of China
- National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Shan Jiang
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, People’s Republic of China
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Alexiou C, Ward L, Hume E, Armstrong M, Wilkinson M, Vogiatzis I. Effect of interval compared to continuous exercise training on physiological responses in patients with chronic respiratory diseases: A systematic review and meta-analysis. Chron Respir Dis 2021; 18:14799731211041506. [PMID: 34666528 PMCID: PMC8532221 DOI: 10.1177/14799731211041506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Current evidence suggests that interval exercise training (IET) and continuous exercise training (CET) produce comparable benefits in exercise capacity, cardiorespiratory fitness and symptoms in patients with chronic obstructive pulmonary disease (COPD). However, the effects of these modalities have only been reviewed in patients with COPD. This meta-analysis compares the effectiveness of IET versus CET on exercise capacity, cardiorespiratory fitness and exertional symptoms in patients with chronic respiratory diseases (CRDs). Methods: PubMed, CINHAL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Nursing and Allied health were searched for randomised controlled trials from inception to September 2020. Eligible studies included the comparison between IET and CET, reporting measures of exercise capacity, cardiorespiratory fitness and symptoms in individuals with CRDs. Results: Thirteen randomised control trials (530 patients with CRDs) with fair to good quality on the PEDro scale were included. Eleven studies involved n = 446 patients with COPD, one involved n = 24 patients with cystic fibrosis (CF) and one n = 60 lung transplantation (LT) candidates. IET resulted in greater improvements in peak work rate (WRpeak) (2.40 W, 95% CI: 0.83 to 3.97 W; p = 0.003) and lower exercise-induced dyspnoea (−0.47, 95% CI: −0.86 to 0.09; p = 0.02) compared to CET; however, these improvements did not exceed the minimal important difference for these outcomes. No significant differences in peak values for oxygen uptake (VO2peak), heart rate (HRpeak), minute ventilation (VEpeak), lactate threshold (LAT) and leg discomfort were found between the interventions. Conclusions: IET is superior to CET in improving exercise capacity and exercise-induced dyspnoea sensations in patients with CRDs; however, the extent of the clinical benefit is not considered clinically meaningful.
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Affiliation(s)
- Charikleia Alexiou
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Lesley Ward
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Matthew Armstrong
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Mick Wilkinson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, 373117Northumbria University Newcastle, Newcastle Upon Tyne, UK
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Beekman E, Mesters I, Hendriks EJM, Muris JWM, Wesseling G, Evers SMAA, Asijee GM, Fastenau A, Hoffenkamp HN, Gosselink R, van Schayck OCP, de Bie RA. Exacerbations in patients with chronic obstructive pulmonary disease receiving physical therapy: a cohort-nested randomised controlled trial. BMC Pulm Med 2014; 14:71. [PMID: 24767519 PMCID: PMC4108017 DOI: 10.1186/1471-2466-14-71] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/10/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Physical exercise training aims at reducing disease-specific impairments and improving quality of life in patients with chronic obstructive pulmonary disease (COPD). COPD exacerbations in particular negatively impact COPD progression. Physical therapy intervention seems indicated to influence exacerbations and their consequences. However, information on the effect of physical therapy on exacerbation occurrence is scarce. This study aims to investigate the potential of a protocol-directed physical therapy programme as a means to prevent or postpone exacerbations, to shorten the duration or to decrease the severity of exacerbations in patients with COPD who have recently experienced an exacerbation. Besides, this study focuses on the effect of protocol-directed physical therapy on health status and quality of life and on cost-effectiveness and cost-utility in patients with COPD who have recently experienced an exacerbation. METHODS/DESIGN A prospective cohort of 300 COPD patients in all GOLD stages will be constructed. Patients will receive usual multidisciplinary COPD care including guideline-directed physical therapy. Patients in this cohort who have GOLD stage 2 to 4 (post-bronchodilator FEV1/FVC < 0.7 and FEV1 < 80% of predicted), who receive reimbursement by health insurance companies for physical therapy (post-bronchodilator Tiffeneau-index < 0.6) and who experience a COPD exacerbation will be asked within 56 days to participate in a cohort-nested prospective randomised controlled trial (RCT). In this RCT, the intervention group will receive a strict physical therapy programme for patients with COPD. This protocol-directed physical therapy (pdPT) will be compared to a control group that will receive sham-treatment, meaning no or very low-intensity exercise training (ST). An economic evaluation will be embedded in the RCT. Anthropometric measurements, comorbidities, smoking, functional exercise capacity, peripheral muscle strength, physical activity level, health related quality of life, patients' perceived benefit, physical therapy compliance, motivation level, level of effective mucus clearance, exacerbation symptoms and health care contacts due to COPD will be recorded. Follow-up measurements are scheduled at 3 and 6 weeks, 3, 6, 12 and 24 months after inclusion. DISCUSSION Ways to minimise potential problems regarding the execution of this study will be discussed. TRIAL REGISTRATION The Netherlands National Trial Register NTR1972.
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Affiliation(s)
- Emmylou Beekman
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands
- Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, The Netherlands
- Physical therapy practice in multidisciplinary centre, ParaMedisch Centrum Sittard Zuid, Sittard, The Netherlands
| | - Ilse Mesters
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands
- Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, The Netherlands
| | - Erik JM Hendriks
- Physical therapy practice, Fysiotherapie Maasstaete, Druten, The Netherlands
| | - Jean WM Muris
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Geertjan Wesseling
- Department of Respiratory Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Silvia MAA Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Guus M Asijee
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Boehringer Ingelheim, Alkmaar, The Netherlands
| | - Annemieke Fastenau
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Hannah N Hoffenkamp
- International Victimology Institute Tilburg, Tilburg University, Tilburg, The Netherlands
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Onno CP van Schayck
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands
- Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, The Netherlands
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4
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Eves ND, Davidson WJ. Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease. Appl Physiol Nutr Metab 2013; 36 Suppl 1:S80-100. [PMID: 21800949 DOI: 10.1139/h11-057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The 2 most common respiratory diseases are chronic obstructive pulmonary disease (COPD) and asthma. Growing evidence supports the benefits of exercise for all patients with these diseases. Due to the etiology of COPD and the pathophysiology of asthma, there may be some additional risks of exercise for these patients, and hence accurate risk assessment and clearance is needed before patients start exercising. The purpose of this review was to evaluate the available literature regarding the risks of exercise for patients with respiratory disease and provide evidence-based recommendations to guide the screening process. A systematic review of 4 databases was performed. The literature was searched to identify adverse events specific to exercise. For COPD, 102 randomized controlled trials that involved an exercise intervention were included (n = 6938). No study directly assessed the risk of exercise, and only 15 commented on exercise-related adverse events. For asthma, 30 studies of mixed methodologies were included (n = 1278). One study directly assessed the risk of exercise, and 15 commented on exercise-related adverse events. No exercise-related fatalities were reported. The majority of adverse events in COPD patients were musculoskeletal or cardiovascular in nature. In asthma patients, exercise-induced bronchoconstriction and (or) asthma symptoms were the primary adverse events. There is no direct evidence regarding the risk of exercise for patients with COPD or asthma. However, based on the available literature, it would appear that with adequate screening and optimal medical therapy, the risk of exercise for these respiratory patients is low.
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Affiliation(s)
- Neil D Eves
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
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5
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Ramos RP, Alencar MCN, Treptow E, Arbex F, Ferreira EMV, Neder JA. Clinical usefulness of response profiles to rapidly incremental cardiopulmonary exercise testing. Pulm Med 2013; 2013:359021. [PMID: 23766901 PMCID: PMC3666297 DOI: 10.1155/2013/359021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 12/17/2012] [Accepted: 01/15/2013] [Indexed: 02/06/2023] Open
Abstract
The advent of microprocessed "metabolic carts" and rapidly incremental protocols greatly expanded the clinical applications of cardiopulmonary exercise testing (CPET). The response normalcy to CPET is more commonly appreciated at discrete time points, for example, at the estimated lactate threshold and at peak exercise. Analysis of the response profiles of cardiopulmonary responses at submaximal exercise and recovery, however, might show abnormal physiologic functioning which would not be otherwise unraveled. Although this approach has long been advocated as a key element of the investigational strategy, it remains largely neglected in practice. The purpose of this paper, therefore, is to highlight the usefulness of selected submaximal metabolic, ventilatory, and cardiovascular variables in different clinical scenarios and patient populations. Special care is taken to physiologically justify their use to answer pertinent clinical questions and to the technical aspects that should be observed to improve responses' reproducibility and reliability. The most recent evidence in favor of (and against) these variables for diagnosis, impairment evaluation, and prognosis in systemic diseases is also critically discussed.
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Affiliation(s)
- Roberta P. Ramos
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Maria Clara N. Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Erika Treptow
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Flávio Arbex
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - Eloara M. V. Ferreira
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
| | - J. Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Federal University of Sao Paulo (UNIFESP), Rua Francisco de Castro 54, Vila Mariana, 04020-050 São Paulo, SP, Brazil
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University and Kingston General Hospital, Richardson House, 102 Stuart Street, Kingston, ON, Canada K7L 2V6
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6
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Zainuldin R, Mackey MG, Alison JA. Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011; 2011:CD008008. [PMID: 22071841 PMCID: PMC8939846 DOI: 10.1002/14651858.cd008008.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intensity of exercise is considered a key determinant of training response, however, no systematic review has investigated the effects of different levels of training intensity on exercise capacity, functional exercise capacity and health-related quality of life (HRQoL) in people with chronic obstructive pulmonary disease (COPD). As type of training (continuous or interval) may also affect training response, the effects of the type of training in COPD also require investigation. OBJECTIVES To determine the effects of training intensity (higher versus lower) or type (continuous versus interval training) on primary outcomes in exercise capacity and secondary outcomes in symptoms and HRQoL for people with COPD. SEARCH METHODS We searched for studies in any language from the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO and PubMed. Searches were current as of June 2011. SELECTION CRITERIA We included randomised controlled trials comparing higher training intensity to lower training intensity or comparing continuous training to interval training in people with COPD. We excluded studies that compared exercise training with no exercise training. DATA COLLECTION AND ANALYSIS We pooled results of comparable groups of studies and calculated the treatment effect and 95% confidence intervals (CI) using a random-effects model. We made two separate comparisons of effects between: 1) higher and lower training intensity; 2) continuous and interval training. We contacted authors of missing data. MAIN RESULTS We analysed three included studies (231 participants) for comparisons between higher and lower-intensity training and eight included studies (367 participants) for comparisons between continuous and interval training. Primary outcomes were outcomes at peak exercise (peak work rate, peak oxygen consumption, peak minute ventilation and lactate threshold), at isowork or isotime, endurance time on a constant work rate test and functional exercise capacity (six-minute walk distance). When comparing higher versus lower-intensity training, the pooled primary outcomes were endurance time and six-minute walk distance. There were no significant differences in endurance time improvement (mean difference (MD) 1.07 minutes; 95% CI -1.53 to 3.67) and six-minute walk distance improvement (MD 2.8 metres; 95% CI -10.1 to 15.6) following higher or lower-intensity training. However, heterogeneity of the endurance time results between studies was significant. When comparing continuous and interval training, there were no significant differences in any of the primary outcomes, except for oxygen consumption at isotime (MD 0.08; 95% CI 0.01 to 0.16) but the treatment effect was not considered clinically important. According to the GRADE system, studies were of low to moderate quality. AUTHORS' CONCLUSIONS Comparisons between the higher and lower training intensity were limited due to the small number of included studies and participants. Consequently, there are insufficient data to draw any conclusions on exercise capacity, symptoms and HRQoL for this comparison. For comparisons between continuous and interval training, both appear to be equally effective in improving exercise capacity, symptoms and HRQoL.
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Affiliation(s)
- Rahizan Zainuldin
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia.
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7
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Butcher SJ, Jones RL. The impact of exercise training intensity on change in physiological function in patients with chronic obstructive pulmonary disease. Sports Med 2006; 36:307-25. [PMID: 16573357 DOI: 10.2165/00007256-200636040-00003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Pulmonary rehabilitation incorporating exercise training is an effective method of enhancing physiological function and quality of life for patients with chronic obstructive pulmonary disease (COPD). Despite the traditional belief that exercise is primarily limited by the inability to adequately increase ventilation to meet increased metabolic demands in these patients, significant deficiencies in muscle function, oxygen delivery and cardiac function are observed that contribute to exercise limitation. Because of this multifactorial exercise limitation, defining appropriate exercise training intensities is difficult. The lack of a pure cardiovascular limitation to exercise prohibits the use of training guidelines that are based on cardiovascular factors such as oxygen consumption or heart rate. Current recommendations for exercise training intensity for patients with COPD include exercising at a 'maximally tolerable level', at an intensity corresponding with 50% of peak oxygen consumption (V-O2peak), or at 60-80% of peak power output obtained on a symptom-limited exercise tolerance test. In general, it appears that higher intensity training elicits greater physiological change than lower intensity training; however, there is no consensus as to the exercise training intensity that elicits the greatest physiological benefit while remaining tolerable to patients. The 'optimal' intensity of training likely depends upon the individual goals of each patient. If the goal is to increase the ability to sustain tasks that are currently able to be performed, lower to moderate-intensity training is likely to be sufficient. If the goal of training, however, is to increase the ability to perform tasks that are above the current level of tolerance, higher intensity training is likely to elicit greater performance increases. In order to perform higher intensity exercise, an interval training model is likely required. High-intensity interval training involves significant anaerobic energy utilisation and, therefore, may better mimic the physiological requirements of activities of daily living. Also, high-intensity interval training is tolerable to patients and may, in fact, reduce the degree of dyspnoea and dynamic hyperinflation through a reduced ventilatory demand. Another factor that will determine the optimal intensity of training is the relative contribution of ventilatory limitation to exercise tolerance. If peak exercise tolerance is limited by a patient's ability to increase ventilation, it is possible that interval training at an intensity higher than peak will elicit greater muscular adaptation than an intensity at or below peak power on an incremental exercise test. More research is required to determine the optimal training intensity for pulmonary rehabilitation patients.
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Affiliation(s)
- Scott J Butcher
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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8
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Péronnet F, Aguilaniu B. Lactic acid buffering, nonmetabolic CO2 and exercise hyperventilation: a critical reappraisal. Respir Physiol Neurobiol 2006; 150:4-18. [PMID: 15890562 DOI: 10.1016/j.resp.2005.04.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Revised: 03/29/2005] [Accepted: 04/02/2005] [Indexed: 12/12/2022]
Abstract
It has been suggested that hyperventilation and the disproportionate increase in VCO2 versus VO2 above the ventilatory threshold (V(TH)) in ramp exercise are due to the production of nonmetabolic CO2 in muscle because of lactic acid buffering by plasma bicarbonate entering the cell in exchange with lactate [Wasserman, K., 1982. Dyspnea on exertion. Is it the heart or the lungs? JAMA 248, 2039-2043]. According to this model, plasma standard bicarbonate concentration decreases in a approximately 1:1 ratio with the increase in plasma lactate concentration, 1 mmol of CO2 is generated above that produced by aerobic metabolism for each mmol of lactic acid buffered, and nonmetabolic CO2 produced in the muscle is partly responsible for hyperventilation because of the resulting increase in the CO2 flow to the lungs. The present report shows that this model is not consistent with experimental data: (1) bicarbonate is not the main buffer in the muscle; (2) the decrease in standard bicarbonate concentration is not the mirror image of the increase in lactate concentration; (3) buffering by bicarbonate does not increase CO2 production in muscle (no nonmetabolic CO2 is produced in tissues); (4) the CO2 flow to the lungs, which should not be confused with VCO2 at the mouth, does not increase at a faster rate above than below V(TH). The disproportionate increase in VCO2 at the mouth above V(TH) is due to hyperventilation (not the reverse) and to the low plasma pH which both reduce the pool of bicarbonate readily available in the body.
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Affiliation(s)
- François Péronnet
- Département de kinésiologie, Université de Montréal, CP 6128 Centre Ville, Montréal, Que., Canada H3C 3J7.
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9
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Vanuxem P, Vanuxem D, Raharison L, Aubert M, Pouliquen G, Deslangles O. Maximal exercise and muscle energy metabolism after recovery from exercise hyperthermia syndrome. Muscle Nerve 2001; 24:1071-7. [PMID: 11439383 DOI: 10.1002/mus.1112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Muscle energy metabolism was studied in 30 subjects after recovery from exercise hyperthermia syndrome (EHTS subjects) and 15 healthy men with identical physical activities. Blood lactate, free fatty acid (FFA), serum creatine kinase activity (CK), and glycerol and the temperature in the auditory duct (T(c)) and on the thumb pad (T(sk)) were measured at rest and during and after maximal exercise on a cycloergometer. The EHTS subjects had a limitation of physical performance, with lowered values for maximal oxygen uptake (VO(2max), P < 0.0005), maximal workload (P < 0.05), and ventilatory threshold (V(t), P < 0.0005). The discrepancy between high plasma concentrations of FFA and the lack of decrease in respiratory ratio (RR) suggests that, in EHTS subjects, a very active release of FFA was not balanced by a proportional increase in catabolism. The increased skin temperature was smaller in EHTS subjects (P < 0.05 at 180 and 200 W). At the end of exercise, auditory duct temperature increase was higher in EHTS subjects than in control subjects (P < 0.05). This study thus showed an impairment of muscle metabolism and an abnormality of thermoregulatory mechanisms. These results may provide insight into the underlying physiopathological disturbance.
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Affiliation(s)
- P Vanuxem
- Laboratoire Physiologie Respiratoire, Faculté de Médecine, Marseille, France.
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10
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Kirsten DK, Taube C, Lehnigk B, Jörres RA, Magnussen H. Exercise training improves recovery in patients with COPD after an acute exacerbation. Respir Med 1998; 92:1191-8. [PMID: 9926148 DOI: 10.1016/s0954-6111(98)90420-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Clinical experience suggests that exercise is beneficial for recovery after an acute exacerbation in patients with severe chronic obstructive pulmonary disease (COPD). The aim of this study was to quantify the clinical benefit of exercise in these patients. Twenty-nine inpatients were randomly assigned to a training group (n = 15, FEV1 34% pred) or a control group (n = 14, FEV1 38% pred). On ten consecutive days, patients in the training group performed a 6-min treadmill walking test and, in addition, five walking sessions per day at > or = 75% of the respective treadmill walking distance. Patients in the control group performed only treadmill walking tests on days 1, 5, and 10. To directly compare the possible benefit of exercise training all patients had an exercise test on day 11 at the same work load as on day 1. In the training group, 6-min walking distance increased from 237 to 420 m, in the control group from 230 to 255 m over the 10 day period which was significantly different (P < 0.0001). Minute ventilation and oxygen uptake increased significantly (P < 0.05) in the training but not in the control group. When comparing exercise tests on days 1 and 11, minute ventilation, oxygen uptake, PaCO2, lactic acid concentration, and Borg scale were significantly reduced to achieve the same work load (P < 0.01) only in the training group. Intrathoracic gas volume and residual volume decreased, and FEV1 and vital capacity increased in the training (P < 0.05) but not in the control group. Our data demonstrate that exercise training significantly improves the exercise capacity in patients with severe COPD after an acute exacerbation of their disease.
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Affiliation(s)
- D K Kirsten
- Krankenhaus Grosshansdorf, Zentrum für Pneumologie und Thoraxchirurgie, LVA Freie, Germany
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Milani RV, Lavie CJ. Disparate effects of out-patient cardiac and pulmonary rehabilitation programs on work efficiency and peak aerobic capacity in patients with coronary disease or severe obstructive pulmonary disease. JOURNAL OF CARDIOPULMONARY REHABILITATION 1998; 18:17-22. [PMID: 9494878 DOI: 10.1097/00008483-199801000-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Exercise intolerance is an integral component of chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) and is caused by several mechanisms that ultimately impact overall functional capacity. We assessed various components of exercise function in patients with CHD and COPD during the course of cardiac and pulmonary rehabilitation to evaluate changes unique to each condition. METHODS Work efficiency (WEf, defined as delta watts/delta VO2) and peak VO2 were measured and compared at baseline and after 3 months (36 sessions) of outpatient cardiac and pulmonary rehabilitation programs in 25 patients (mean age = 66 +/- 7 years) with severe COPD (mean FEV1.0 = 0.90 +/- 0.35 L) and in 25 patients (mean age = 65 +/- 8 years) with CHD. RESULTS At baseline, patients with COPD had significantly reduced values of WEf (2.04 +/- 0.86 versus 3.23 +/- 1.38 watts/mL/kg/min; P = 0.004) and peak VO2 (13.2 +/- 3.9 versus 17.1 +/- 3.9 mL/kg/min; P = 0.005) compared with patients with CHD. After rehabilitation, patients with CHD increased peak VO2 by 12% (17.1 +/- 3.9 to 19.1 +/- 4.9 mL/kg/min; P = 0.01) with no change in WEf (3.23 +/- 1.38 to 3.32 +/- 1.43 watts/mL/kg/min; P = not significant). In contrast, patients with COPD increased peak VO2 by only 5% (13.2 +/- 3.9 to 13.9 +/- 3.8 mL/kg/min; P = 0.0008), but WEf increased by 36% (2.04 +/- 0.86 to 2.78 +/- 0.84 watts/mL/kg/min; P = 0.0002). Subjective measures of functional status improved similarly in both groups. CONCLUSIONS In contrast to patients with CHD, work inefficiency contributes significantly to exercise intolerance in patients with severe COPD. Outpatient rehabilitation programs enhance functional status in patients with CHD and COPD by differing mechanisms, depending on the underlying disease. These data show the disparate effects of out-patient rehabilitation on peak VO2 and WEf in cardiac and pulmonary patients.
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Affiliation(s)
- R V Milani
- Department of Internal Medicine, Ochsner Medical Institution, New Orleans, Louisiana, USA
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Vanuxem D, Badier M, Guillot C, Delpierre S, Jahjah F, Vanuxem P. Impairment of muscle energy metabolism in patients with sleep apnoea syndrome. Respir Med 1997; 91:551-7. [PMID: 9415356 DOI: 10.1016/s0954-6111(97)90089-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Impairment of muscle energy metabolism has been demonstrated in normal subjects with chronic hypoxaemia (altitude chronic respiratory failure). The purpose of this study was to verify the hypothesis that a comparable condition could develop in patients with sleep apnoea syndrome (SAS), considering that they are exposed to prolonged and repeated hypoxaemia periods. Muscle metabolism was assessed in 11 patients with SAS performing a maximal effort on cycloergometer. In comparison with normal subjects, SAS patients reached lower maximal loads [144 +/- 7 vs. 182 +/- 10 W (P < 0.005)] and lower peak oxygen uptakes [26.4 +/- 1.2 vs 33.2 +/- 1.4 ml kg-1 min-1 (P < 0.005)]. Abnormal metabolic features were found: maximal blood lactate concentration was significantly lower than in normal subjects [0.034 +/- 0.004 vs. 0.044 +/- 0.002 mmol l-1 W-1 (P < 0.05)]; and lactate elimination rate, calculated during a 30-min recovery period, was reduced [0.127 +/- 0.017 vs, 0.175 +/- 0.014 mmol l-1 min-1 (P < 0.025)]. The extent of these anomalies correlated with the severity of SAS. The patients also showed higher maximal diastolic blood pressures than normal subjects [104 +/- 5 vs. 92 +/- 4 mmHg (P < 0.05)]. These results can be interpreted as indications of an impairment of muscle energy metabolism in patients with SAS. Decrease in maximum blood lactate concentration suggests an impairment of glycolytic metabolism, while decrease in the rate of lactate elimination indicates a defect in oxidative metabolism. Since no respiratory pathology apart from SAS was found in this group of patients, it seems legitimate to link the genesis of these impairments to repeated bouts of nocturnal hypoxaemia.
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Affiliation(s)
- D Vanuxem
- Laboratoire d'Exploration de la Fonction Respiratoire et du Métabolisme Musculaire, Hôpital Sainte Marguerite, Marseille, France
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13
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Weaver TE. Factors Affecting Functional Status in Chronic Obstructive Pulmonary Disease (COPD). Worldviews Evid Based Nurs 1995. [DOI: 10.1111/j.1524-475x.1995.00029.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Servera E, Marín J, Pérez ME, Giménez M. [Ventilatory muscle training]. Arch Bronconeumol 1994; 30:94-100. [PMID: 8136998 DOI: 10.1016/s0300-2896(15)31126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- E Servera
- Servicio de Neumología, Hospital Clínico Universitario, Valencia
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