1
|
Kershner CE, Hardie WD, Chin C, Opotowsky AR, Aronoff EB, Mays WA, Knecht SK, Powell AW. Pulmonary responses following cardiac rehabilitation and the relationship with functional outcomes in children and young adults with heart disease. Front Surg 2024; 11:1356501. [PMID: 38831786 PMCID: PMC11144918 DOI: 10.3389/fsurg.2024.1356501] [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: 12/15/2023] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Patients with congenital heart disease (CHD) often have pulmonary abnormalities and exercise intolerance following cardiac surgery. Cardiac rehabilitation (CR) improves exercise capacity in patients with CHD, but minimal study has been performed to see if resting and dynamic pulmonary performance improves following CR in those with prior cardiac surgery. Methods This was a retrospective cohort study of all patients who completed ≥12 weeks of CR from 2018 through 2022. Demographic, cardiopulmonary exercise test (CPET), spirometry, 6-minute walk, functional strength measures, and outcomes data were collected. Data are presented as median[IQR]. A Student's t-test was used for comparisons between groups and serial measurements were measured with a paired t-test. A p < 0.05 was considered significant. Results There were a total of 37 patients [age 16.7 (14.2-20.1) years; 46% male] included. Patients with prior surgery (n = 26) were more likely to have abnormal spirometry data than those without heart disease (n = 11) (forced vital capacity [FVC] 76.7 [69.1-84.3]% vs. 96.4 [88.1-104.7]%, p = 0.002), but neither group experienced a significant change in spirometry. On CPET, peak oxygen consumption increased but there was no change in other pulmonary measures during exercise. Percent predicted FVC correlated with hand grip strength (r = 0.57, p = 0.0003) and percent predicted oxygen consumption (r = 0.43, p = 0.009). The number of prior sternotomies showed negative associations with both percent predicted FVC (r = -0.43, p = 0.04) and FEV1 (r = -0.47, p = 0.02). Discussion Youth and young adults with a prior history of cardiac surgery have resting and dynamic pulmonary abnormalities that do not improve following CR. Multiple sternotomies are associated with worse pulmonary function.
Collapse
Affiliation(s)
- Cassidy E. Kershner
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - William D. Hardie
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Department of Pediatric Pulmonology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Clifford Chin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Alexander R. Opotowsky
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Elizabeth B. Aronoff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Wayne A. Mays
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Sandra K. Knecht
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Adam W. Powell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| |
Collapse
|
2
|
Wang RJ, Bhakta NR. The Puzzle of Marijuana Use and Forced Vital Capacity. Ann Am Thorac Soc 2024; 21:683-691. [PMID: 38271695 PMCID: PMC11109910 DOI: 10.1513/annalsats.202312-1010cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Abstract
In study after study, marijuana use has been found to be associated with increased forced vital capacity (FVC). This is puzzling, because marijuana is commonly consumed by inhalation of its smoke, and smoke exposure of any kind is not generally considered a cause of increased FVC. Although this observation was first made decades ago, a satisfactory explanation remains elusive. In this review we survey the evidence supporting the relationship between marijuana use and increased FVC, discuss potential threats to validity when inferring causation, and, presupposing a possible causal relationship, pose two key questions. First, what are possible physiologic or pathophysiologic mechanisms by which marijuana use might increase FVC? Second, why might this effect be consistently observed with marijuana use but not with tobacco use? Explanations for the first question include lung and chest growth and remodeling from strenuous marijuana smoke inhalation and reductions in lung elastic recoil from marijuana smoke exposure. Explanations for the second include differences between marijuana and tobacco in smoke composition and patterns of consumption, such as smoking topography. Finally, the possibility that smoke, whether from marijuana or tobacco, might have nonmonotonic effects on FVC depending on the degree of exposure is explored. In synthesizing a curated breadth of epidemiologic and physiologic science, we leverage a perplexing observation to generate potential insights and avenues for further research into the biological effects of smoke, from marijuana or otherwise, on the respiratory system.
Collapse
Affiliation(s)
- Richard J Wang
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Nirav R Bhakta
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California
| |
Collapse
|
3
|
Does Regular Exercise Impact the Lung Function of Healthy Children and Adolescents? A Systematic Review and Meta-Analysis. Pediatr Exerc Sci 2022:1-9. [PMID: 36538934 DOI: 10.1123/pes.2022-0045] [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: 04/03/2022] [Revised: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess the quality of the available evidence on the effect of exercise for the improvement of lung function in healthy children and adolescents. METHOD We performed a systematic review and meta-analysis of intervention studies examining the effects of regular exercise on spirometric parameters of healthy children and adolescents aged ≤18 years. RESULTS Within the exercise groups, there were significant improvements in forced vital capacity (mean difference: 0.17 L; 95% confidence interval, 0.07 to 0.26; P < .05) and forced expiratory volume in the first second (mean difference: 0.14 L; 95% confidence interval, 0.06 to 0.22; P < .05). Results were consistent across different age groups and duration of interventions. In the between-group analysis, forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow were higher in the exercise group compared with the nonexercise group, but the differences did not reach statistical relevance. There was significant statistical heterogeneity between studies. CONCLUSION Regular exercise has the potential to improve lung function parameters in healthy children and adolescents; however, the small number of studies and the heterogeneity between them raise concern about the quality of the currently available evidence. These findings bring to attention the need for well-designed trials addressing this important public health issue.
Collapse
|
4
|
Zavorsky GS, Cao J. Reference equations for pulmonary diffusing capacity using segmented regression show similar predictive accuracy as GAMLSS models. BMJ Open Respir Res 2022; 9:9/1/e001087. [PMID: 35172984 PMCID: PMC8852756 DOI: 10.1136/bmjresp-2021-001087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine whether generalised additive models of location, scale and shape (GAMLSS) developed for pulmonary diffusing capacity are superior to segmented (piecewise) regression models, and to update reference equations for pulmonary diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), which may be affected by the equipment used for its measurement. Methods Data were pooled from five studies that developed reference equations for DLCO and DLNO (n=530 F/546 M; 5–95 years old, body mass index 12.4–39.0 kg/m2). Reference equations were created for DLCO and DLNO using both GAMLSS and segmented linear regression. Cross-validation was applied to compare the prediction accuracy of the two models as follows: 80% of the pooled data were used to create the equations, and the remaining 20% was used to examine the fit. This was repeated 100 times. Then, the root-mean-square error was compared between both models. Results In males, GAMLSS models were 7% worse to 3% better compared to segmented regression for DLCO and DLNO. In females, GAMLSS models were 2% worse to 5% better compared to segmented linear regression for DLCO and DLNO. The Hyp'Air Compact measured DLNO and alveolar volume (VA) that was approximately 16–20 mL/min/mm Hg and 0.2–0.4 L higher, respectively, compared to the Jaeger MasterScreen Pro. The measured DLCO was similar between devices after controlling for altitude. Conclusions For the development of pulmonary function reference equations, we propose that segmented linear regression can be used instead of GAMLSS due to its simplicity, especially when the predictive accuracy is similar between the two models, overall.
Collapse
Affiliation(s)
| | - Jiguo Cao
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
5
|
Rochat I, Côté A, Boulet L. Determinants of lung function changes in athletic swimmers. A review. Acta Paediatr 2022; 111:259-264. [PMID: 34480504 PMCID: PMC9292748 DOI: 10.1111/apa.16095] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 01/22/2023]
Abstract
AIM To summarise lung function characteristics of athletic swimmers and discuss mechanisms explaining these changes while putting forward the lack of a clear understanding of the precise physiological factors implicated. METHODS Literature search until 07.2021 on Medline and EMBASE using keywords swimming, athletes, respiratory physiology, lung development, lung function tests. Relevant articles in French and English were reviewed. RESULTS We found insufficient data to perform a meta-analysis. However, there is evidence that swimmers have better expiratory flows and increased baseline lung volumes than non-athletes or non-swimmers. Although these features can result from changes in lung development following intense training over the years, the contribution of a genetic predisposition and positive selection cannot be totally excluded. CONCLUSION Disentangling the participation of constitutional factors and years of hard training to explain the larger lung volumes of athletic swimmers is in favour of an adaptative response of the lungs to early swim training through modification of the pathway of lung development. There seems to be an optimal window of opportunity before the end of growth for these adaptational changes to occur. Precise mechanisms, and contribution of adaptative change on lung physiology, remain to be further studied.
Collapse
Affiliation(s)
- Isabelle Rochat
- Pediatric Pulmonology Unit Lausanne University Hospital Lausanne Switzerland
- Quebec Heart and Lung Institute Laval University Quebec Quebec Canada
| | - Andréanne Côté
- Quebec Heart and Lung Institute Laval University Quebec Quebec Canada
| | | |
Collapse
|
6
|
Çelik Z, Güzel NA, Yüksel F, Kafa N. Lung age and respiratory muscle strength in female volleyball players. Rev Assoc Med Bras (1992) 2021; 67:1432-1436. [DOI: 10.1590/1806-9282.20210639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/17/2021] [Indexed: 11/22/2022] Open
|
7
|
Respiratory Muscle Strength and Ventilatory Function Outcome: Differences Between Trained Athletes and Healthy Untrained Persons. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 32583143 DOI: 10.1007/5584_2020_554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
It is known that the maximum mouth inspiratory pressure (MIP) and expiratory pressure (MEP) vary with age, weight, height, and skeletal muscle mass. However, the influence of physical training on ventilatory function outcomes is an area of limited understanding. The aim of this study was to investigate the respiratory muscle strength and its relation to spirometry variables in untrained healthy persons versus trained athletes. MIP and MEP were assessed in 22 power athletes and 28 endurance athletes, and in 24 age- and sex-matched normal healthy subjects (control group). The measurement was done with a mouth pressure meter. We found that respiratory muscle strength and ventilatory function in endurance athletes were outstandingly superior to that in power athletes; the latter's muscle strength was better than that of healthy untrained controls. Both MIP and MEP significantly correlated with the maximum voluntary ventilation (MVV) in both power athletes and controls, but not so in endurance athletes. The corollary is that the intensive endurance training could result in the improvement of respiratory muscle strength, meeting the maximum upper limit of functional reserve of respiratory muscles and the corresponding ventilation. On the other hand, targeted training of respiratory muscle strength may be an effective strategy to increase ventilatory function in power athletes, particularly those having a low maximum inspiratory and expiratory pressure, and in less physically fit healthy persons.
Collapse
|
8
|
Dempsey JA, La Gerche A, Hull JH. Is the healthy respiratory system built just right, overbuilt, or underbuilt to meet the demands imposed by exercise? J Appl Physiol (1985) 2020; 129:1235-1256. [PMID: 32790594 DOI: 10.1152/japplphysiol.00444.2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In the healthy, untrained young adult, a case is made for a respiratory system (airways, pulmonary vasculature, lung parenchyma, respiratory muscles, and neural ventilatory control system) that is near ideally designed to ensure a highly efficient, homeostatic response to exercise of varying intensities and durations. Our aim was then to consider circumstances in which the intra/extrathoracic airways, pulmonary vasculature, respiratory muscles, and/or blood-gas distribution are underbuilt or inadequately regulated relative to the demands imposed by the cardiovascular system. In these instances, the respiratory system presents a significant limitation to O2 transport and contributes to the occurrence of locomotor muscle fatigue, inhibition of central locomotor output, and exercise performance. Most prominent in these examples of an "underbuilt" respiratory system are highly trained endurance athletes, with additional influences of sex, aging, hypoxic environments, and the highly inbred equine. We summarize by evaluating the relative influences of these respiratory system limitations on exercise performance and their impact on pathophysiology and provide recommendations for future investigation.
Collapse
Affiliation(s)
- Jerome A Dempsey
- John Robert Sutton Professor of Population Health Sciences, John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia.,National Center for Sports Cardiology, St. Vincent's Hospital, Melbourne, Fitzroy, Australia
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,Institute of Sport, Exercise and Health (ISEH), University College London, United Kingdom
| |
Collapse
|
9
|
Messerli M, Aaldijk D, Haberthür D, Röss H, García-Poyatos C, Sande-Melón M, Khoma OZ, Wieland FAM, Fark S, Djonov V. Adaptation mechanism of the adult zebrafish respiratory organ to endurance training. PLoS One 2020; 15:e0228333. [PMID: 32023296 PMCID: PMC7001924 DOI: 10.1371/journal.pone.0228333] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/13/2020] [Indexed: 11/19/2022] Open
Abstract
In order to study the adaptation scope of the fish respiratory organ and the O2 metabolism due to endurance training, we subjected adult zebrafish (Danio rerio) to endurance exercise for 5 weeks. After the training period, the swimmer group showed a significant increase in swimming performance, body weight and length. In scanning electron microscopy of the gills, the average length of centrally located primary filaments appeared significantly longer in the swimmer than in the non-trained control group (+6.1%, 1639 μm vs. 1545 μm, p = 0.00043) and the average number of secondary filaments increased significantly (+7.7%, 49.27 vs. 45.73, p = 9e-09). Micro-computed tomography indicated a significant increase in the gill volume (p = 0.048) by 11.8% from 0.490 mm3 to 0.549 mm3. The space-filling complexity dropped significantly (p = 0.0088) by 8.2% from 38.8% to 35.9%., i.e. making the gills of the swimmers less compact. Respirometry after 5 weeks showed a significantly higher oxygen consumption (+30.4%, p = 0.0081) of trained fish during exercise compared to controls. Scanning electron microscopy revealed different stages of new secondary filament budding, which happened at the tip of the primary lamellae. Using BrdU we could confirm that the growth of the secondary filaments took place mainly in the distal half and the tip and for primary filaments mainly at the tip. We conclude that the zebrafish respiratory organ-unlike the mammalian lung-has a high plasticity, and after endurance training increases its volume and changes its structure in order to facilitate O2 uptake.
Collapse
Affiliation(s)
- Matthias Messerli
- Topographic and clinical Anatomy, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
| | - Dea Aaldijk
- Topographic and clinical Anatomy, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
| | - David Haberthür
- Topographic and clinical Anatomy, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
| | - Helena Röss
- Topographic and clinical Anatomy, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
| | - Carolina García-Poyatos
- Developmental Biology and Regeneration, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
| | - Marcos Sande-Melón
- Developmental Biology and Regeneration, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
| | - Oleksiy-Zakhar Khoma
- Topographic and clinical Anatomy, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
| | - Fluri A. M. Wieland
- Topographic and clinical Anatomy, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
| | - Sarya Fark
- Topographic and clinical Anatomy, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
| | - Valentin Djonov
- Topographic and clinical Anatomy, Institute of Anatomy, University of Bern, 3012 Bern, Switzerland
- * E-mail:
| |
Collapse
|
10
|
Abstract
Asthma is a chronic lower respiratory disease that is very common worldwide, and its incidence is increasing year by year. Since the 1970s, asthma has become widespread, with approximately 300 million people affected worldwide and about 250,000 people have lost their lives. Asthma seriously affects people's physical and mental health, resulting in reduced learning efficiency, limited physical activities, and decreased quality of life. Therefore, raising awareness of the risk of asthma and how to effectively treat asthma have become important targets for the prevention and management of asthma in recent years. For patients with asthma, exercise training is a widely accepted adjunct to drug-based and non-pharmacological treatment. It has been recommended abroad that exercise prescriptions are an important part of asthma management.
Collapse
Affiliation(s)
- Shengguang Ding
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Chongjun Zhong
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, Nantong, China
| |
Collapse
|
11
|
Okrzymowska P, Kurzaj M, Seidel W, Rożek-Piechura K. Eight Weeks of Inspiratory Muscle Training Improves Pulmonary Function in Disabled Swimmers-A Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1747. [PMID: 31108842 PMCID: PMC6571650 DOI: 10.3390/ijerph16101747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND According to the literature, inspiratory muscle fatigue may increase after swimming training (ST). This study aimed to examine the efficacy of 8-week inspiratory muscular training (IMT) in disabled swimmers, combined with standard sports training, on selected parameters of lung ventilation and the function of respiratory muscles. METHODS A total of 16 disabled swimming division athletes from Wroclaw's 'Start' Regional Sports Association qualified for the study. The subjects were randomly divided into two groups (ST and IMT). Both groups participated in swimming training for 8 weeks (8 times a week). The IMT group additionally participated in inspiratory muscle training (8 weeks). In all respondents, a functional lung test and the respiratory muscle strength was measured. RESULTS After 8 weeks of training, a significant increase in ventilation parameters and respiratory muscle strength was observed only in the IMT group. In ST group 1, a 20% improvement in the strength of inspiratory muscles was achieved. CONCLUSIONS The inclusion of IMT is an important element that complements swimming training, allowing for greater increases in lung ventilation parameters and the strength of respiratory muscles in disabled swimmers.
Collapse
Affiliation(s)
- Paulina Okrzymowska
- Department for Rehabilitation in Internal Medicine, University School of Physical Education, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wrocław, Poland.
| | - Monika Kurzaj
- Department for Rehabilitation in Internal Medicine, University School of Physical Education, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wrocław, Poland.
| | - Wojciech Seidel
- Department of Paralympic Sports, University School of Physical Education, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wrocław, Poland.
| | - Krystyna Rożek-Piechura
- Department for Rehabilitation in Internal Medicine, University School of Physical Education, Al. I.J. Paderewskiego 35, Building P4, 51-612 Wrocław, Poland.
| |
Collapse
|
12
|
Abstract
This commentary highlights 23 noteworthy publications from 2018, selected by leading scientists in pediatric exercise science. These publications have been deemed as significant or exciting in the field as they (a) reveal a new mechanism, (b) highlight a new measurement tool, (c) discuss a new concept or interpretation/application of an existing concept, or (d) describe a new therapeutic approach or clinical tool in youth. In some cases, findings in adults are highlighted, as they may have important implications in youth. The selected publications span the field of pediatric exercise science, specifically focusing on: aerobic exercise and training; neuromuscular physiology, exercise, and training; endocrinology and exercise; resistance training; physical activity and bone strength; growth, maturation, and exercise; physical activity and cognition; childhood obesity, physical activity, and exercise; pulmonary physiology or diseases, exercise, and training; immunology and exercise; cardiovascular physiology and disease; and physical activity, inactivity, and health.
Collapse
|