Priel E, Wahab M, Mondal T, Freitag A, O'Byrne PM, Killian KJ, Satia I. The Impact of beta blockade on the cardio-respiratory system and symptoms during exercise.
Curr Res Physiol 2022;
4:235-242. [PMID:
34988470 PMCID:
PMC8710988 DOI:
10.1016/j.crphys.2021.10.002]
[Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background
Beta blockers prolong life in patients with cardiovascular diseases. Negative chronotropic and inotropic effects carry the potential to adversely effect peripheral skeletal and airway smooth muscle contributing to further fatigue, dyspnea and exercise intolerance.
Research questions
Do beta-blockers reduce maximal power output (MPO), VO2 max, cardiorespiratory responses, increase the perceived effort required to cycle and breath during cardiopulmonary exercise tests (CPET) and limit the capacity to exercise?
Methods
Retrospective observational study of subjects performing CPET to capacity from 1988 to 2012. Subjects with and without beta-blockers were compared: baseline physiological characteristics, MPO, VO2 max, heart rate max, ventilation responses and perceived exertion required to cycle and breathe (modified Borg scale). Forward stepwise linear additive regression was performed with MPO as the dependent factor with height, age, gender, muscle strength, FEV1 and DLCO as independent contributors.
Results
42,771 subjects were included 7,787 were receiving beta-blocker [mean age 61 yrs, BMI 28.40 kg/m2, 9% airflow obstruction (FEV1/FVC<0.7)] and 34,984 were not [mean age 51yrs, BMI 27.40 kg/m2, 11% airflow obstruction]. Heart rate was lower by 18.2% (95% C.I. 18.15–18.38) (p<0.0001) while Oxygen pulse (VO2/HR) was higher by 19.5% (95% C.I. 19.3–19.7) in those receiving beta blockers. Maximum power output (MPO) was 3.3% lower in those taking beta-blockers. The perceived effort required to cycle and breathe (mBorg) was 8% lower in those taking beta-blockers.
Interpretation
Increases in oxygen pulse minimize the reduction in exercise intolerance and symptom handicap associated with beta-blockers.
Comprehensive set of exercise physiology measurements in a large cohort, to delineate any hazardous effects of beta blockade.
Beta-blockers attenuate the heart rate at rest and during exercise.
Beta-blockade has no meaningful effects on muscle strength, breathing capacity or exercise induced bronchoconstriction.
Beta Blockers were not associated with a reduction in Maximal power output.
Increases in Oxygen pulse minimize the reduction in exercise intolerance and symptom handicap associated with beta-blockers.
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