Cardiac output during positive and negative work

Reduced cardiovascular and metabolic responses during eccentric stepping exercise: A pilot study

This study compared cardiovascular and metabolic responses during concentric and eccentric stepping. Eight participants (5 m, 3f; 22 ± 2 years) performed maximal concentric and eccentric ramp incremental tests on a modified stepping ergometer. Subsequently, three randomized 15-min constant-power tests were performed (1) concentric stepping at 90% of the concentric lactate threshold (LT), (2) eccentric stepping at the same power, and (3) eccentric stepping at the same oxygen uptake (V̇O2). At equivalent power (36 ± 6 W, p = 0.62), eccentric stepping resulted in 46 ± 8% lower V̇O2, 16 ± 6% lower heart rate (HR), and 11 ± 5% lower mean arterial blood pressure compared to concentric (p < 0.01). Matching V̇O2 required 65 ± 19% more power during eccentric stepping (p < 0.01). During this test, eccentric V̇O2 and HR continued to increase, resulting in a 22 ± 29% higher V̇O2 and 19 ± 16% higher HR in the final minute (p < 0.001). Reduced cardiorespiratory demand during eccentric stepping at the same power as concentric demonstrates a higher eccentric power is required to produce the same V̇O2. However, despite being below the concentric LT, eccentric V̇O2 and HR continued to increase past the predicted steady state, indicating a higher exercise intensity.

Mathematical modeling of antihypertensive therapy

Hypertension is a multifactorial disease arising from complex pathophysiological pathways. Individual characteristics of patients result in different responses to various classes of antihypertensive medications. Therefore, evaluating the efficacy of therapy based on in silico predictions is an important task. This study is a continuation of research on the modular agent-based model of the cardiovascular and renal systems (presented in the previously published article). In the current work, we included in the model equations simulating the response to antihypertensive therapies with different mechanisms of action. For this, we used the pharmacodynamic effects of the angiotensin II receptor blocker losartan, the calcium channel blocker amlodipine, the angiotensin-converting enzyme inhibitor enalapril, the direct renin inhibitor aliskiren, the thiazide diuretic hydrochlorothiazide, and the β-blocker bisoprolol. We fitted therapy parameters based on known clinical trials for all considered medications, and then tested the model's ability to show reasonable dynamics (expected by clinical observations) after treatment with individual drugs and their dual combinations in a group of virtual patients with hypertension. The extended model paves the way for the next step in personalized medicine that is adapting the model parameters to a real patient and predicting his response to antihypertensive therapy. The model is implemented in the BioUML software and is available at https://gitlab.sirius-web.org/virtual-patient/antihypertensive-treatment-modeling.

Eccentric Training in Pulmonary Rehabilitation of Post-COVID-19 Patients: An Alternative for Improving the Functional Capacity, Inflammation, and Oxidative Stress

The purpose of this narrative review is to highlight the oxidative stress induced in COVID-19 patients (SARS-CoV-2 infection), describe longstanding functional impairments, and provide the pathophysiologic rationale that supports aerobic eccentric (ECC) exercise as a novel alternative to conventional concentric (CONC) exercise for post-COVID-19 patients. Patients who recovered from moderate-to-severe COVID-19 respiratory distress demonstrate long-term functional impairment. During the acute phase, SARS-CoV-2 induces the generation of reactive oxygen species that can be amplified to a "cytokine storm". The resultant inflammatory and oxidative stress process causes organ damage, particularly in the respiratory system, with the lungs as the tissues most susceptible to injury. The acute illness often requires a long-term hospital stay and consequent sarcopenia. Upon discharge, muscle weakness compounded by limited lung and cardiac function is often accompanied by dyspnea, myalgia, anxiety, depression, and sleep disturbance. Consequently, these patients could benefit from pulmonary rehabilitation (PR), with exercise as a critical intervention (including sessions of strength and endurance or aerobic exercises). Unfortunately, conventional CONC exercises induce significant cardiopulmonary stress and increase inflammatory and oxidative stress (OS) when performed at moderate/high intensity, which can exacerbate debilitating dyspnoea and muscle fatigue post-COVID-19. Eccentric training (ECC) is a well-tolerated alternative that improves muscle mass while mitigating cardiopulmonary stress in patients with COPD and other chronic diseases. Similar benefits could be realized in post-COVID-19 patients. Consequently, these patients could benefit from PR with exercise as a critical intervention.

Different Hemodynamic Responses of the Primary Motor Cortex Accompanying Eccentric and Concentric Movements: A Functional NIRS Study

The literature contains limited evidence on how our brains control eccentric movement. A higher activation is expected in the contralateral motor cortex (M1) but consensus has not yet been reached. Therefore, the present study aimed to compare patterns of M1 activation between eccentric and concentric movements. Nine healthy participants performed in a randomized order three sets of five repetitions of eccentric or concentric movement with the dominant elbow flexors over a range of motion of 60&deg; at two velocities (30&deg;/s and 60&deg;/s). The tests were carried out using a Biodex isokinetic dynamometer with the forearm supported in the horizontal plane. The peak torque values were not significantly different between concentric and eccentric movements (p = 0.42). Hemodynamic responses of the contralateral and ipsilateral M1 were measured with a near-infrared spectroscopy system (Oxymon MkIII, Artinis). A higher contralateral M1 activity was found during eccentric movements (p = 0.04, &eta;&sup2; = 0.47) and at the velocity of 30&deg;/s (p = 0.039, &eta;&sup2; = 0.48). These preliminary findings indicate a specific control mechanism in the contralateral M1 to produce eccentric muscle actions at the angular velocities investigated, although the role of other brain areas in the motor control network cannot be excluded.

Deciphering the metabolic and mechanical contributions to the exercise-induced circulatory response: insights from eccentric cycling

Metabolic demand and muscle mechanical tension are closely coupled during exercise, making their respective drives to the circulatory response difficult to establish. This coupling being altered in eccentric cycling, we implemented an experimental design featuring eccentric vs. concentric constant-load cycling bouts to gain insights into the control of the exercise-induced circulatory response in humans. Heart rate (HR), stroke volume (SV), cardiac output (Q̇), oxygen uptake (V̇o2), and electromyographic (EMG) activity of quadriceps muscles were measured in 11 subjects during heavy concentric (heavy CON: 270 ± 13 W; V̇o2 = 3.59 ± 0.20 l/min), heavy eccentric (heavy ECC: 270 ± 13 W, V̇o2 = 1.17 ± 0.15 l/min), and light concentric (light CON: 70 ± 9 W, V̇o2 = 1.14 ± 0.12 l/min) cycle bouts. Using a reductionist approach, the circulatory responses observed between heavy CON vs. light CON (difference in V̇o2 and power output) was ascribed either to metabolic demand, as estimated from heavy CON vs. heavy ECC (similar power output, different V̇o2), or to muscle mechanical tension, as estimated from heavy ECC vs. light CON (similar V̇o2, different power output). 74% of the Q̇ response was determined by the metabolic demand, also accounting for 65% and 84% of HR and SV responses, respectively. Consequently, muscle mechanical tension determined 26%, 35%, and 16% of the Q̇, HR, and SV responses, respectively. Q̇ was significantly related to V̇o2 ( r2 = 0.83) and EMG activity ( r2 = 0.82; both P < 0.001). These results suggest that the exercise-induced circulatory response is mainly under metabolic control and support the idea that the level of muscle activation plays a role in the cardiovascular regulation during cycle exercise in humans.

Eccentric Cycle Exercise: Training Application of Specific Circulatory Adjustments

PURPOSE

Despite identical oxygen uptake (VO2), enhanced heart rate (HR) and cardiac output (Q) responses have been reported in eccentric (ECC) versus concentric (CON) cycle exercise. The aim of this study was to describe the specific circulatory adjustments (HR and stroke volume (SV)) to incremental ECC cycle exercise in order to: 1) determine the HR values leading to identical VO2 in ECC and CON cycling; and 2) estimate the interindividual variability of this HR correspondence between the two exercise modes, with emphasis upon rehabilitation and training purposes.

METHODS

Eight healthy male subjects (age, 28 +/- 2 yr) participated in this study. They performed CON and ECC cycle incremental exercises (power output increases of 50 W every 3 min). Breath-by-breath gas exchange analysis and beat-by-beat thoracic impedancemetry were used to determine VO2 and Q, respectively.

RESULTS

At the same metabolic power (VO2 of 1.08 +/- 0.05 L x min(-1) in CON vs 1.04 +/- 0.06 L x min in ECC), SV was not different, but HR was 17% higher in ECC (P < 0.01), leading to a 27% enhanced Q (P < 0.01). Q and HR net adjustments (exercise minus resting values) in ECC versus CON muscle involvement demonstrated important interindividual variability with coefficients of variation amounting to 32% and 30%, respectively.

CONCLUSION

In practice, if a given level of VO2 is to be reached, ECC HR has to be set above the CON one. Taking into account the interindividual variability of the circulatory adjustments in ECC versus CON muscle involvement, a precise HR correspondence can be established individually from the VO2/HR relationship obtained using ECC incremental testing, allowing prescription of accurate target HR for rehabilitation or training purposes.

Eccentric exercise in coronary patients: central hemodynamic and metabolic responses

PURPOSE

With lengthening (eccentric) muscle contractions, the magnitude of locomotor-muscle mass and strength increase has been demonstrated to be greater compared with shortening (concentric) muscle contractions. In healthy subjects, energy demand and heart rate responses with eccentric exercise are small relative to the amount of muscle force produced. Thus, eccentric exercise may be an attractive alternative to resistance exercise for patients with limited cardiovascular exercise tolerance.

METHODS

We tested the cardiovascular tolerance of eccentric exercise in 13 coronary patients (ages 40-66) with preserved and/or mild reduced left ventricular function. Patients were randomly assigned to either an eccentric (ECC; N = 7) or a concentric (CON; N = 6) training group and trained for 8 wk. Training workload was increased progressively (from week 1 to 5) to an intensity equivalent to 60% [OV0312]O(2peak).

RESULTS

On average, maximum power output achieved with ECC was fourfold compared with CON (357 +/- 96 W vs 97 +/- 21 W; P < 0.005), whereas measures of oxygen uptake and blood lactate were significantly lower (P < 0.05 each), and ratings of perceived exertion were similar for ECC and CON. During a 20-min session of ECC and CON, central hemodynamics was measured by means of right heart catheterization. During ECC, responses of mean arterial blood pressure, systemic vascular resistance, pulmonary capillary pressure, cardiac index, and stroke work of the left ventricle on average were in the normal range of values and similar to those observed during CON. Compared with baseline, after 8 wk of training, echocardiographic left ventricular function was unchanged.

CONCLUSION

The results indicate uncoupling of skeletal muscle load and cardiovascular stress during ECC. For low-risk patients with coronary heart disease without angina, inducible ischemia, or left ventricular dysfunction, ECC can be recommended as a safe new approach to perform high-load muscular exercise training with minimal cardiovascular stress.

Ventilatory response to positive and negative work in patients with chronic obstructive pulmonary disease

In healthy subjects, oxygen consumption and cardiorespiratory responses are lower during eccentric exercise (negative work, Wneg) than during concentric exercise (positive work, Wpos) at the same work load. The aim of the present study was to investigate the ventilatory response to Wneg in patients with chronic obstructive pulmonary disease (COPD). The study population consisted of 12 subjects with COPD [forced expiratory volume in 1 s (FEV1) mean (SD): 1.5 (0.4) 1, 46 (16)% of predicted]. Concentric and eccentric exercise tests (6 min exercise; interval > or = 1 h) were performed in random order at constant work loads of 25 and 50% of the individual maximal (positive) work capacity. Expired ventilation per minute (VE), oxygen consumption (VO2) and carbon dioxide production (VCO2) were 30% lower during Wneg than during Wpos for both work intensities. The breathing reserve during 25% Wneg was 11 (8)% and during 50% Wneg was 18 (14)% higher than during Wpos at corresponding work loads (P < 0.01). VE/VO2 and VE/VCO2 were similar during Wpos and Wneg. Arterial carbon dioxide tension (PaCO2) increased by 0.1 (0.4) kPa during 50% Wneg and by 0.7 (0.5) kPa during 50% Wpos (P < 0.01). During 50% Wneg' perceived leg effort (modified Borg scale) tended to be higher than perceived breathlessness (2.4 (1.2) vs. 2.0 (1.1). It was concluded that in subjects with COPD, the ventilatory requirements of Wneg were considerably lower than those of Wpos at similar work loads up to 50% of maximal work capacity. During Wneg, the ventilatory reserve was higher and gas exchange was less disturbed as a result of a lower VO2 and VCO2.

Downhill walking induces rapid shallow breathing

To examine the effect of downhill walking a form of negative work on ventilation, we studied the exercise responses of 13 healthy subjects during uphill and downhill walking on a treadmill. Each test lasted 16 min and the peak work rate was 5.6 kph with either a positive or negative 14% grade. Throughout each test we recorded VO2, VE, f, VT, HR, systolic BP and Borg's rating of perceived exertion. At the target work rates of 5.6 kph +/- 14% grade, VO2 and VE were three times greater in uphill compared with downhill walking. However, in downhill walking, f was greater compared with uphill walking wherein VT approximated baseline values, reflecting rapid shallow breathing, and VT appeared to increase after reaching some critically-low level. These trends persisted when VO2 was held constant (p less than 0.01). HR and systolic BP increased and decreased with the positive and negative grade respectively. At a constant VO2 however, HR was significantly higher during downhill compared with horizontal walking (p less than 0.01) whereas systolic BP was not significantly different (p greater than 0.05). We conclude that there is a significant difference in the ventilatory responses between the two types of work performed on a treadmill. Specifically, downhill walking is associated with rapid shallow breathing which may be countered by a protective feedback mechanism at critically-low levels of VT.

Effects of positive and negative exercise on ventilatory CO2 sensitivity

Investigations in our laboratory have shown an increased slope of the ventilatory response curve to CO2 (CO2 sensitivity) during positive and negative exercise as compared with the resting condition. CO2 sensitivity during positive and negative exercise did not differ in spite of differences in metabolism (VO2, VCO2) and type of muscle contraction (concentric or eccentric). Various aspects of positive and negative exercise were examined in order to find out whether they can explain the identical CO2 sensitivity. Cardiac output, oxygen consumption, rectal temperature and venous catecholamine concentration appeared to be higher in positive exercise than in negative exercise, and higher in negative exercise than at rest. However, these differences between the two types of exercise contrast with the identical CO2 sensitivity and thus cannot be of major importance in determining CO2 sensitivity. It is hypothesized that one or more of these variables might be responsible for increased CO2 sensitivity during exercise as compared with rest. The CO2 sensitivity, once increased, seems to be unaffected by further increases in these variables.

Cardiorespiratory and metabolic responses to positive, negative and minimum-load dynamic leg exercise

Cardiorespiratory and metabolic responses to steady-state dynamic leg exercise were studied in seven male subjects who performed positive and negative work on a modified Krogh cycle ergometer at loads of 0, 16, 33, 49, 98, and 147 W with a pedalling rate of 60 rpm. In positive work, O2 uptake increased with the ergometric load in a parabolic fashion. Net O2 uptake averaged averaged 220 ml-min-1 at 0 W (loadless pedalling), and was 75 ml-min-1 lower at the point of physiological minimum load which occurred in negative work at approximately 9 W. The O2 cost of loadless pedalling is for one-third attributed to the work of overcoming elastic and viscous resistance, the remaining part being due mainly to the work of antagonistic muscle contraction in the moving legs. Although at a given VO2, work rate was much higher in negative than in positive work, corresponding values for VE were similar, suggesting that the mechanical tension in working muscles is of little or no importance in the control of ventilation in steady-state exercise. Heart rate increased linearly with VO2 in both positive and negative work, with a steeper slope in negative work. Evidence is presented that none of the current definitions of muscular efficiency yields the true efficiency of muscular contraction in cycle ergometry, net efficiency calculation resulting in too low estimates, and work and delta efficiency calculations in overestimated values in the low-intensity work range, and in underestimated values in the high-intensity range.