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Lopes AL, Sarro KJ, Rodrigues IM, Leite RD, Massaroni C, Amorim PRDS, Cerveri P, Silvatti AP. Breathing Motion Pattern in Cyclists: Role of Inferior against Superior Thorax Compartment. Int J Sports Med 2024; 45:450-457. [PMID: 37967867 DOI: 10.1055/a-2211-9421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
The thoracoabdominal breathing motion pattern is being considered in sports training because of its contribution, along with other physiological adaptations, to overall performance. We examined whether and how experience with cycling training modifies the thoracoabdominal motion patterns. We utilized optoelectronic plethysmography to monitor ten trained male cyclists and compared them to ten physically active male participants performing breathing maneuvers. Cyclists then participated in a self-paced time trial to explore the similarity between that observed during resting breathing. From the 3D coordinates of 32 markers positioned on each participant's trunk, we calculated the percentage of contribution of the superior thorax, inferior thorax, and abdomen and the correlation coefficient among these compartments. During the rest maneuvers, the cyclists showed a thoracoabdominal motion pattern characterized by an increased role of the inferior thorax relative to the superior thorax (26.69±5.88%, 34.93±5.03%; p=0.002, respectively), in contrast to the control group (26.69±5.88%; 25.71±6.04%, p=0.4, respectively). In addition, the inferior thorax showed higher coordination in phase with the abdomen. Furthermore, the results of the time trial test underscored the same pattern found in cyclists breathing at rest, suggesting that the development of a permanent modification in respiratory mechanics may be associated with cycling practice.
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Affiliation(s)
- Ana Luiza Lopes
- Faculdade de Educação Física, Universidade Estadual de Campinas, Campinas, Brazil
| | - Karine Jacon Sarro
- Faculdade de Educação Física, Universidade Estadual de Campinas, Campinas, Brazil
| | | | - Richard Diego Leite
- Centro de Educação Física e Desportos , Universidade Federal do Espirito Santo, Vitória, Brazil
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Universita Campus Bio-Medico di Roma, Roma, Italy
| | | | - Pietro Cerveri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
- Center for Intelligent Technologies in Sleep Medicine, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
| | - Amanda P Silvatti
- Departamento de Educação Física, Universidade Federal de Viçosa, Viçosa, Brazil
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Kipp S, Leahy MG, Sheel AW. Sports Bra Restriction on Respiratory Mechanics during Exercise. Med Sci Sports Exerc 2024; 56:1168-1176. [PMID: 38350462 DOI: 10.1249/mss.0000000000003403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
PURPOSE We set out to understand how underband tightness or pressure of a sports bra relates to respiratory function and the mechanical work of breathing ( during exercise. Our secondary purpose was to quantify the effects of underband pressure on O 2 during submaximal running. METHODS Nine highly trained female runners with normal pulmonary function completed maximal and submaximal running in three levels of underband restriction: loose, self-selected, and tight. RESULTS During maximal exercise, we observed a significantly greater during the tight condition (350 ± 78 J·min -1 ) compared with the loose condition (301 ± 78 J·min -1 ; P < 0.05), and a 5% increase in minute ventilation ( ) during the tight condition compared with the loose condition ( P < 0.05). The pattern of breathing also differed between the two conditions; the greater maximal during the tight condition was achieved by a higher breathing frequency (57 ± 6 vs. 52 ± 7 breaths·min -1 ; P < 0.05), despite tidal volume being significantly lower in the tight condition compared with the loose condition (1.97 ± 0.20 vs. 2.05 ± 0.23 L; P < 0.05). During steady-state submaximal running, O 2 increased 1.3 ± 1.1% (range: -0.3 to 3.2%, P < 0.05) in the tight condition compared with the loose condition. CONCLUSIONS Respiratory function may become compromised by the pressure exerted by the underband of a sports bra when women self-select their bra size. In the current study, loosening the underband pressure resulted in a decreased work of breathing, changed the ventilatory breathing pattern to deeper, less frequent breaths, and decreased submaximal oxygen uptake (improved running economy). Our findings suggest sports bra underbands can impair breathing mechanics during exercise and influence whole-body metabolic rate.
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Affiliation(s)
- Shalaya Kipp
- School of Kinesiology, University of British Columbia, Vancouver, BC, CANADA
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Haddad T, Mons V, Meste O, Dempsey JA, Abbiss CR, Brisswalter J, Blain GM. Breathing a low-density gas reduces respiratory muscle force development and marginally improves exercise performance in master athletes. Eur J Appl Physiol 2024; 124:651-665. [PMID: 37973652 DOI: 10.1007/s00421-023-05346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION We tested the hypothesis that breathing heliox, to attenuate the mechanical constraints accompanying the decline in pulmonary function with aging, improves exercise performance. METHODS Fourteen endurance-trained older men (67.9 ± 5.9 year, [Formula: see text]O2max: 50.8 ± 5.8 ml/kg/min; 151% predicted) completed two cycling 5-km time trials while breathing room air (i.e., 21% O2-79% N2) or heliox (i.e., 21% O2-79% He). Maximal flow-volume curves (MFVC) were determined pre-exercise to characterize expiratory flow limitation (EFL, % tidal volume intersecting the MFVC). Respiratory muscle force development was indirectly determined as the product of the time integral of inspiratory and expiratory mouth pressure (∫Pmouth) and breathing frequency. Maximal inspiratory and expiratory pressure maneuvers were performed pre-exercise and post-exercise to estimate respiratory muscle fatigue. RESULTS Exercise performance time improved (527.6 ± 38 vs. 531.3 ± 36.9 s; P = 0.017), and respiratory muscle force development decreased during inspiration (- 22.8 ± 11.6%, P < 0.001) and expiration (- 10.8 ± 11.4%, P = 0.003) with heliox compared with room air. EFL tended to be lower with heliox (22 ± 23 vs. 30 ± 23% tidal volume; P = 0.054). Minute ventilation normalized to CO2 production ([Formula: see text]E/[Formula: see text]CO2) increased with heliox (28.6 ± 2.7 vs. 25.1 ± 1.8; P < 0.001). A reduction in MIP and MEP was observed post-exercise vs. pre-exercise but was not different between conditions. CONCLUSIONS Breathing heliox has a limited effect on performance during a 5-km time trial in master athletes despite a reduction in respiratory muscle force development.
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Affiliation(s)
- Toni Haddad
- LAMHESS, Sciences et Techniques des Activités Physiques et Sportives, Université Côte d'Azur, 261 Bd du Mercantour, 06200, Nice, France.
- Centre VADER, Université Côte d'Azur, Nice, France.
- Centre for Exercise and Sport Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - Valentin Mons
- LAMHESS, Sciences et Techniques des Activités Physiques et Sportives, Université Côte d'Azur, 261 Bd du Mercantour, 06200, Nice, France
- Centre VADER, Université Côte d'Azur, Nice, France
- LJAD, Université Côte d'Azur, CNRS, Nice, France
| | - Olivier Meste
- Lab I3S, Université Côte d'Azur, CNRS, Sophia Antipolis, Nice, France
| | - Jerome A Dempsey
- John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Chris R Abbiss
- Centre for Exercise and Sport Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Jeanick Brisswalter
- LAMHESS, Sciences et Techniques des Activités Physiques et Sportives, Université Côte d'Azur, 261 Bd du Mercantour, 06200, Nice, France
- Centre VADER, Université Côte d'Azur, Nice, France
| | - Gregory M Blain
- LAMHESS, Sciences et Techniques des Activités Physiques et Sportives, Université Côte d'Azur, 261 Bd du Mercantour, 06200, Nice, France
- Centre VADER, Université Côte d'Azur, Nice, France
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Peters CM, Dempsey JA, Hopkins SR, Sheel AW. Is the Lung Built for Exercise? Advances and Unresolved Questions. Med Sci Sports Exerc 2023; 55:2143-2159. [PMID: 37443459 DOI: 10.1249/mss.0000000000003255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
ABSTRACT Nearly 40 yr ago, Professor Dempsey delivered the 1985 ACSM Joseph B. Wolffe Memorial Lecture titled: "Is the lung built for exercise?" Since then, much experimental work has been directed at enhancing our understanding of the functional capacity of the respiratory system by applying complex methodologies to the study of exercise. This review summarizes a symposium entitled: "Revisiting 'Is the lung built for exercise?'" presented at the 2022 American College of Sports Medicine annual meeting, highlighting the progress made in the last three-plus decades and acknowledging new research questions that have arisen. We have chosen to subdivide our topic into four areas of active study: (i) the adaptability of lung structure to exercise training, (ii) the utilization of airway imaging to better understand how airway anatomy relates to exercising lung mechanics, (iii) measurement techniques of pulmonary gas exchange and their importance, and (iv) the interactions of the respiratory and cardiovascular system during exercise. Each of the four sections highlights gaps in our knowledge of the exercising lung. Addressing these areas that would benefit from further study will help us comprehend the intricacies of the lung that allow it to meet and adapt to the acute and chronic demands of exercise in health, aging, and disease.
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Affiliation(s)
| | - Jerome A Dempsey
- Population Health Science, John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, WI
| | - Susan R Hopkins
- Department of Radiology, University of California San Diego, La Jolla, CA
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Schaer CE, Erne D, Tageldin D, Wüthrich TU, Beltrami FG, Spengler CM. Effects of Sprint Interval and Endurance Respiratory Muscle Training on Postcycling Inspiratory and Quadriceps Fatigue. Med Sci Sports Exerc 2023; 55:1683-1694. [PMID: 37076980 DOI: 10.1249/mss.0000000000003192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
PURPOSE We investigated whether a 4-wk period of respiratory muscle endurance training (RMET) or respiratory muscle sprint interval training (RMSIT) would lead to an attenuation of inspiratory muscle and quadriceps fatigue after a bout of high-intensity cycling compared with a placebo intervention (PLAT), as predicted by the respiratory metaboreflex model. METHODS Thirty-three active, young healthy adults performed RMET, RMSIT, or PLAT. Changes in inspiratory muscle and quadriceps twitches in response to a cycling test at 90% of peak work capacity were assessed before and after training. EMG activity and deoxyhemoglobin (HHb, via near-infrared spectroscopy) of the quadriceps and inspiratory muscles were also monitored during the cycling test, along with cardiorespiratory and perceptual variables. RESULTS At pretraining, cycling reduced the twitch force of the inspiratory muscles (86% ± 11% baseline) and quadriceps (66% ± 16% baseline). Training did not attenuate the drop in twitch force of the inspiratory muscles (PLAT, -3.5 ± 4.9 percent-points [p.p.]; RMET, 2.7 ± 11.3 p.p.; RMSIT, 4.1 ± 8.5 p.p.; group-training interaction, P = 0.394) or quadriceps (PLAT, 3.8 ± 18.6 p.p.; RMET, -2.6 ± 14.0 p.p.; RMSIT, 5.2 ± 9.8 p.p.; group-training interaction P = 0.432). EMG activity and HHb levels during cycling did not change after training for either group. Only RMSIT showed a within-group decrease in the perception of respiratory exertion with training. CONCLUSIONS Four weeks of RMET or RMSIT did not attenuate the development of exercise-induced inspiratory or quadriceps fatigue. The ergogenic effects of respiratory muscle training during whole-body exercise might be related to an attenuation of perceptual responses.
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Affiliation(s)
- Corina E Schaer
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
| | - Desirée Erne
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
| | - Dina Tageldin
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
| | - Thomas U Wüthrich
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
| | - Fernando G Beltrami
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
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Dominelli PB, Molgat-Seon Y. Sex, gender and the pulmonary physiology of exercise. Eur Respir Rev 2022; 31:31/163/210074. [PMID: 35022254 PMCID: PMC9488949 DOI: 10.1183/16000617.0074-2021] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/09/2021] [Indexed: 01/11/2023] Open
Abstract
In this review, we detail how the pulmonary system's response to exercise is impacted by both sex and gender in healthy humans across the lifespan. First, the rationale for why sex and gender differences should be considered is explored, and then anatomical differences are highlighted, namely that females typically have smaller lungs and airways than males. Thereafter, we describe how these anatomical differences can impact functional aspects such as respiratory muscle energetics and activation, mechanical ventilatory constraints, diaphragm fatigue, and pulmonary gas exchange in healthy adults and children. Finally, we detail how gender can impact the pulmonary response to exercise. Biological sex can influence the pulmonary response to exercise in healthy individuals across the lifespanhttps://bit.ly/3ejMDrv
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Affiliation(s)
| | - Yannick Molgat-Seon
- Dept of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, MB, Canada.,Centre for Heart and Lung Innovation, Providence Health Care Research Institute, St Paul's Hospital, Vancouver, BC, Canada
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The association of breathing pattern with exercise tolerance and perceived fatigue in women with systemic lupus erythematosus: an exploratory case-control study. Rheumatol Int 2021; 42:2003-2011. [PMID: 34727196 DOI: 10.1007/s00296-021-05005-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/19/2021] [Indexed: 10/19/2022]
Abstract
The aims of the study were to (1) to characterize the breathing pattern and work of breathing during peak exercise in patients with SLE; (2) to examine the extent to which the breathing pattern and work of breathing impact the exercise capacity and fatigue. Forty-one women participated in the study (SLE: n = 23, median = 35, range = 21-57 years, control: n = 18, median = 38, range = 22-45 years). Each subject performed a treadmill cardiopulmonary exercise test (a modified Bruce treadmill protocol) ending with volitional exhaustion. Breathing mechanic was characterized by measures of expired minute volume (VE), tidal volume (Vt), respiratory rate (f), work of breathing, and cardiorespiratory fitness was quantified by measures of peak oxygen consumption (VO2) and time to exhaustion. Data presented as median and interquartile range (IQR). Women with SLE had lower Vt {1221 [488.8] mL/min vs. 1716 [453.1] mL; p = .006}, VE {58.9 [18.9] L/min vs 70 [28.1] L/min, p = 0.04} and increased breathing frequency {51.5 [10.8] vs 43.6 [37.8] bpm, p = 0.01} compared to the control group. The time to exhaustion and peak VO2 during the CPET were significantly reduced in those with SLE compared to controls {13.3 [10.2] vs 16.1 [2.2] min; p = 0.004}, {20 [6.1] mL/kg/min vs 26.6 [7] mL/kg/min p < 0.001}, respectively. Differences remained when the analyses were controlled for the observed differences in peak VO2. When the regression model adjusted for the peak VO2, it had been shown that Vt, WOB and f were explained variances in the fatigue severity by 64% [p < 0.001]. The decline in VE and Vt coupled with a decreased peak VO2, and work of breathing may have contributed to low cardiorespiratory fitness and fatigue in patients with systemic lupus erythematosus.
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D'Alleva M, Gonnelli F, Vaccari F, Boirie Y, Montaurier C, Thivel D, Isacco L, Vermorel M, Lazzer S. Energy cost of walking and body composition changes during a 9-month multidisciplinary weight reduction program and 4-month follow-up in adolescents with obesity. Appl Physiol Nutr Metab 2021; 47:1-9. [PMID: 34516928 DOI: 10.1139/apnm-2021-0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of the present study was to investigate changes in the energy cost of locomotion during walking (Cw) related to changes in body mass (BM, kg) and body composition in adolescents with obesity. Twenty-six (12 boys and 14 girls) obese adolescents (mean: body mass index, 33.6 ± 3.7 kg·m-2; 42.7 ± 4.5% fat mass (FM)) followed a 9-month multidisciplinary inpatient weight-reduction program consisting of lifestyle education, moderate energy restriction, and regular physical activity in a specialised institution. At baseline (M0), the end of the 9-month program (M9), and after the 4-month follow-up (M13), oxygen consumption and carbon dioxide production of the standardised activity program were assessed by whole-body indirect calorimetry over 24 hours, and body composition was assessed by dual-energy X-ray absorptiometry. At M9, adolescents showed an 18% reduction in BM (p < 0.001) and 40% in total FM, while fat-free mass (kg) remained stable in boys but decreased by ∼6% in girls (p = 0.001). Similarly, the mean Cw decreased by 20% (p < 0.001). At M13, BM, FM, and Cw were slightly higher compared with at M9. In conclusion, moderate energy restriction and regular moderate physical activities improved walking economy, improved exercise tolerance, and induced beneficial changes in the body composition of adolescents with obesity. Novelty: Reduction of FM in the trunk region, and consequently reducing the work carried out by respiratory muscles, contributes to reducing Cw in adolescents with obesity. A lower walking cost can be effective in improving exercise tolerance and quality of life in obese adolescents.
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Affiliation(s)
- Mattia D'Alleva
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Federica Gonnelli
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Filippo Vaccari
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
| | - Yves Boirie
- CHU Clermont-Ferrand, Department of Clinical Nutrition, Clermont-Ferrand, France
- Clermont-Auvergne University, INRAE, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - Christophe Montaurier
- Clermont-Auvergne University, INRAE, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - David Thivel
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, CRNH Auvergne, Clermont-Ferrand, France
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Laurie Isacco
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, CRNH Auvergne, Clermont-Ferrand, France
| | - Michel Vermorel
- Clermont-Auvergne University, INRAE, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France
| | - Stefano Lazzer
- Department of Medicine, University of Udine, Udine, Italy
- School of Sport Sciences, University of Udine, Udine, Italy
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Arend M, Kivastik J, Talts J, Mäestu J. The Effect of Inspiratory Muscle Warm-Up on VO 2 Kinetics during Submaximal Rowing. Sports (Basel) 2021; 9:sports9030042. [PMID: 33809874 PMCID: PMC8004257 DOI: 10.3390/sports9030042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to investigate the effect of an inspiratory muscle warm-up on the VO2 kinetics during submaximal intensity ergometer rowing. Ten competitive male rowers (age 23.1 ± 3.8 years; height 188.1 ± 6.3 cm; body mass 85.6 ± 6.6 kg) took part in this investigation. A submaximal constant intensity (90% PVO2max) rowing test to volitional exhaustion was carried out twice with the standard rowing warm-up (Test 1) and with the standard rowing warm-up with additional specific inspiratory muscle warm-up of two sets of 30 repetitions at 40% maximal inspiratory pressure (Test 2). We found a significant correlation between time constant (τ1) and the VO2 value at 400 s in Test 1 (r = 0.78; p < 0.05); however, no correlation was found between those parameters in Test 2. In addition, we found a positive association between VO2max from the incremental rowing test and τ1 from Test 1 (r = 0.71; p < 0.05), whereas VO2 did not correlate with τ1 from Test 2. Adding inspiratory muscle warm-up of 40% maximal inspiratory pressure to regular rowing warm-up had no significant effect on oxygen consumption kinetics during submaximal rowing tests.
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Affiliation(s)
- Mati Arend
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, 51014 Tartu, Estonia;
- Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, 50406 Tartu, Estonia
- Correspondence: ; Tel.: +372-737-5364
| | - Jana Kivastik
- Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, 50411 Tartu, Estonia; (J.K.); (J.T.)
| | - Jaak Talts
- Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, 50411 Tartu, Estonia; (J.K.); (J.T.)
| | - Jarek Mäestu
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, 51014 Tartu, Estonia;
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Hackett D. Acute impairment in respiratory muscle strength following a high-volume versus low-volume resistance exercise session. J Sports Med Phys Fitness 2021; 62:395-403. [PMID: 33721982 DOI: 10.23736/s0022-4707.21.12116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diminished respiratory muscle has been shown following a strenuous bout of sit-ups however there is a paucity of evidence for this effect following a strenuous upper and lower body resistance training session. This study investigated the acute effect of a highvolume compared to a low-volume resistance exercise session on respiratory muscle strength. METHODS Twenty resistance-trained males (age 25.1 ± 7.4 y) participated in this randomised and cross-over design study. Participants completed two resistance training protocols (highand low-volume) and a control session (no exercise). Sessions involved 5 sets (high-volume) and 2 sets (low-volume) of 10 repetitions at 65% one-repetition maximum for each exercise (bench press, squat, seated shoulder press, and deadlift) with 90 s recovery between sets. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) was assessed pre-and post-session and respiratory gases were measured during the recovery between sets. RESULTS Following the high-volume session MIP and MEP decreased by a median of 10.0% (interquartile range, IQR = -15.2 to -2.6%) and 12.1% (IQR = -22.2 to -3.9%), respectively, which was significant compared to the low-volume (p<0.001) and control sessions (p≤ 0.001). At 20-min post high-volume session MEP returned to baseline whereas MIP returned to baseline values at 40-min. Greater metabolic stress was associated with the higher-volume session as demonstrated by a lower recovery end-tidal CO2 partial pressure across the majority of exercises (p≤0.008). CONCLUSIONS Findings suggest that respiratory muscle strength is impaired following a highvolume session resistance exercise session, however it appears to be restored within an hour post-exercise.
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Affiliation(s)
- Daniel Hackett
- Exercise, Health and Performance Faculty Research Group, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, Australia -
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Respiratory impact of a grand tour: insight from professional cycling. Eur J Appl Physiol 2021; 121:1027-1036. [PMID: 33420604 DOI: 10.1007/s00421-020-04587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the respiratory function and symptom perception in professional cyclists completing a Grand Tour (GT). METHODS Nine male cyclists completed La Vuelta or Tour de France (2018/19). At study entry, airway inflammation was measured via fractional exhaled nitric oxide (FeNO). Respiratory symptoms and pulmonary function were assessed prior to the first stage (Pre-GT), at the second rest day (Mid-GT) and prior to the final stage of the GT (Late-GT). Sniff nasal inspiratory pressure (SNIP) was assessed at pre and late-GT timepoints. RESULTS Seven cyclists reported respiratory symptoms during the race (with a prominence of upper airway issues). Symptom severity increased either mid or late-GT for most cyclists. A decline in FEV1 from pre-to-mid GT (- 0.27 ± 0.24 l, - 5.7%) (P = 0.02) and pre-to-late GT (- 0.27 ± 0.13 l, - 5.7%) (P < 0.001) was observed. Similarly, a decline in FVC (- 0.22 ± 0.17 l, - 3.7%) (P = 0.01) and FEF25-75 (- 0.49 ± 0.34 l/s, - 11%) (P = 0.02) was observed pre-to-late GT. Overall, eight (89%) and six (67%) demonstrated a clinically meaningful decline (> 200 ml) in FEV1 and FVC during the GT follow-up, respectively. SNIP remained unchanged pre-to-late GT (n = 5), however, a positive correlation was observed between ΔSNIP and ΔFVC (r = 0.99, P = 0.002). CONCLUSION GT competition is associated with a high prevalence of upper respiratory symptoms and a meaningful decline in lung function in professional cyclists. Further research is now required to understand the underpinning physiological mechanisms and determine the impact on overall respiratory health and elite cycling performance and recovery.
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Gonçalves TR, Soares PPDS. Positive Pressure Ventilation Improves Exercise Performance and Attenuates the Fall of Postexercise Inspiratory Muscular Strength in Rower Athletes. J Strength Cond Res 2021; 35:253-259. [PMID: 29309387 DOI: 10.1519/jsc.0000000000002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Gonçalves, TR and Soares, PP. Positive pressure ventilation improves exercise performance and attenuates the fall of postexercise inspiratory muscular strength in rower athletes. J Strength Cond Res 35(1): 253-259, 2021-Positive pressure ventilation (PPV) can increase exercise performance in cyclists, but its effects are unclear in other exercise modes, especially those using large muscle mass. The aim of this study was to compare the exercise performance and postexercise inspiratory muscles' strength with and without PPV (NO-PPV) during rowing. Nine male rowers (19 ± 1 year) participated in 3 experimental days (M1, M2, and M3) separated by 1 week. In M1, rowers performed a 2,000-m test (2k) on a rowing ergometer to obtain average power (W2k). In M2 and M3, the rowers performed 4 minutes' workouts at 55, 65, 75, and 85% W2k, respectively, separated by 1 minute of recovery, with PPV and NO-PPV application in randomized order. Blood lactate (La) was measured during intervals. After submaximal exercises, with 10 minutes of "cool down," the rowers performed a maximal performance test of 4 minutes (4-minute all-out rowing). Traveled distance was computed and correlated with maximal inspiratory pressure (MIP) changes from pretest to posttest (∆). Positive pressure ventilation application increased the traveled distance in relation to NO-PPV exercise (1,210.7 ± 45.5 vs. 1,199.8 ± 43.4 m, p ≤ 0.05). The ∆MIP (cmH2O) was lower in PPV as compared to NO-PPV exercise (-19.1 ± 10.2 vs. -26.3 ± 7.9 cmH2O, p ≤ 0.05). The [La] showed no significant difference between PPV and NO-PPV exercises (p > 0.05). Therefore, the PPV during whole-body rowing exercise improved the exercise performance and attenuated the inspiratory postexercise fatigue. These findings suggest that inspiratory muscles' strength plays a role during high-intensity exercise with large muscle mass.
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Affiliation(s)
- Thiago R Gonçalves
- Department of Physiology and Pharmacology, Laboratory of Experimental and Applied Exercise Physiology, Fluminense Federal University, Niterói, Brazil
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13
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Rodrigues A, Muñoz Castro G, Jácome C, Langer D, Parry SM, Burtin C. Current developments and future directions in respiratory physiotherapy. Eur Respir Rev 2020; 29:29/158/200264. [PMID: 33328280 DOI: 10.1183/16000617.0264-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/24/2020] [Indexed: 01/06/2023] Open
Abstract
Respiratory physiotherapists have a key role within the integrated care continuum of patients with respiratory diseases. The current narrative review highlights the profession's diversity, summarises the current evidence and practice, and addresses future research directions in respiratory physiotherapy. Herein, we describe an overview of the areas that respiratory physiotherapists can act in the integrated care of patients with respiratory diseases based on the Harmonised Education in Respiratory Medicine for European Specialists syllabus. In addition, we highlight areas in which further evidence needs to be gathered to confirm the effectiveness of respiratory therapy techniques. Where appropriate, we made recommendations for clinical practice based on current international guidelines.
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Affiliation(s)
- Antenor Rodrigues
- Laboratory of Research in Respiratory Physiotherapy - LFIP, State University of Londrina, Londrina, Brazil.,Dept of Physical Therapy, University of Toronto, Toronto, Canada
| | - Gerard Muñoz Castro
- Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Girona, Spain.,Dept of Physical Therapy EUSES, University of Girona, Girona, Spain
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Dept of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Daniel Langer
- Faculty of Movement and Rehabilitation Sciences, KU Leuven, Dept of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium.,Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Selina M Parry
- Dept of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Chris Burtin
- Reval Rehabilitation Research, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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14
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Acute respiratory muscle unloading improves time-to-exhaustion during moderate- and heavy-intensity cycling in obese adolescent males. Sci Rep 2020; 10:17036. [PMID: 33046823 PMCID: PMC7550339 DOI: 10.1038/s41598-020-74240-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/23/2020] [Indexed: 11/08/2022] Open
Abstract
Obesity significantly impairs breathing during exercise. The aim was to determine, in male obese adolescents (OB), the effects of acute respiratory muscle unloading, obtained by switching the inspired gas from ambient air (AIR) to a normoxic helium + oxygen gas mixture (HeO2) (AIR → HeO2) during moderate [below gas exchange threshold (GET)] and heavy [above GET] constant work rate cycling. Ten OB [age 16.0 ± 2.0 years (mean ± SD); body mass index (BMI) 38.9 ± 6.1 kg/m2] and ten normal-weight age-matched controls (CTRL) inspired AIR for the entire exercise task, or underwent AIR → HeO2 when they were approaching volitional exhaustion. In OB time to exhaustion (TTE) significantly increased in AIR → HeO2 vs. AIR during moderate [1524 ± 480 s vs. 1308 ± 408 (P = 0.024)] and during heavy [570 ± 306 s vs. 408 ± 150 (P = 0.0154)] exercise. During moderate exercise all CTRL completed the 40-min task. During heavy exercise no significant differences were observed in CTRL for TTE (582 ± 348 s [AIR → HeO2] vs. 588 ± 252 [AIR]). In OB, but not in CTRL, acute unloading of respiratory muscles increased TTE during both moderate- and heavy-exercise. In OB, but not in CTRL, respiratory factors limit exercise tolerance during both moderate and heavy exercise.
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15
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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.
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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
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16
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Lorca-Santiago J, Jiménez SL, Pareja-Galeano H, Lorenzo A. Inspiratory Muscle Training in Intermittent Sports Modalities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124448. [PMID: 32575827 PMCID: PMC7344680 DOI: 10.3390/ijerph17124448] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
Abstract
The fatigue of the respiratory muscles causes the so-called metabolic reflex or metaboreflex, resulting in vasoconstriction of the blood vessels in the peripheral muscles, which leads to a decrease in respiratory performance. Training the respiratory muscles is a possible solution to avoid this type of impairment in intermittent sports. The objective of this systematic review was to evaluate the results obtained with inspiratory muscle training (IMT) in intermittent sports modalities, intending to determine whether its implementation would be adequate and useful in intermittent sports. A search in the Web of Science (WOS) and Scopus databases was conducted, following the Preferred Reporting Elements for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality of the articles was assessed using the PEDro (Physiotherapy Evidence Database) scale. In conclusion, the introduction of specific devices of IMT seems to be a suitable method to improve performance in intermittent sports, mainly due to a reduction of the metaboreflex, fatigue sensation, and dyspnea. The ideal protocol would consist of a combination of acute and chronic treatment, and, even if IMT is done daily, the duration will not exceed one hour per week.
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Affiliation(s)
- Juan Lorca-Santiago
- Faculty of Sport Sciences, Universidad Europea De Madrid, 28670 Madrid, Spain; (J.L.-S.); (H.P.-G.)
| | - Sergio L. Jiménez
- Faculty of Sport Sciences, Universidad Europea De Madrid, 28670 Madrid, Spain; (J.L.-S.); (H.P.-G.)
- Correspondence: ; Tel.: +34-670-723-696
| | - Helios Pareja-Galeano
- Faculty of Sport Sciences, Universidad Europea De Madrid, 28670 Madrid, Spain; (J.L.-S.); (H.P.-G.)
| | - Alberto Lorenzo
- Sport Department, Facultad de Ciencias de la Actividad Física y del Deporte, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
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17
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Dominelli PB, Molgat-Seon Y, Sheel AW. Sex Differences in the Pulmonary System Influence the Integrative Response to Exercise. Exerc Sport Sci Rev 2020; 47:142-150. [PMID: 30817330 DOI: 10.1249/jes.0000000000000188] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Healthy women have proportionally smaller lungs and airways compared with height-matched men. These anatomical sex-based differences result in greater mechanical ventilatory constraints and may influence the integrative response to exercise. Our review will examine this hypothesis in healthy humans in the context of dynamic whole-body exercise.
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Affiliation(s)
- Paolo B Dominelli
- Department of Anesthesia, Mayo Clinic, Rochester, MN.,Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Yannick Molgat-Seon
- Centre for Heart and Lung Innovation, St. Paul's Hospital.,Department of Physical Therapy, Faculty of Medicine, and
| | - A William Sheel
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
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18
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Tiller NB. Pulmonary and Respiratory Muscle Function in Response to Marathon and Ultra-Marathon Running: A Review. Sports Med 2020; 49:1031-1041. [PMID: 31030408 PMCID: PMC6548745 DOI: 10.1007/s40279-019-01105-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The physiological demands of marathon and ultra-marathon running are substantial, affecting multiple body systems. There have been several reviews on the physiological contraindications of participation; nevertheless, the respiratory implications have received relatively little attention. This paper provides an up-to-date review of the literature pertaining to acute pulmonary and respiratory muscle responses to marathon and ultra-marathon running. Pulmonary function was most commonly assessed using spirometry, with infrequent use of techniques including single-breath rebreathe and whole-body plethysmography. All studies observed statistically significant post-race reductions in one-or-more metrics of pulmonary function, with or without evidence of airway obstruction. Nevertheless, an independent analysis revealed that post-race values rarely fell below the lower-limit of normal and are unlikely, therefore, to be clinically significant. This highlights the virtue of healthy baseline parameters prior to competition and, although speculative, there may be more potent clinical manifestations in individuals with below-average baseline function, or those with pre-existing respiratory disorders (e.g., asthma). Respiratory muscle fatigue was most commonly assessed indirectly using maximal static mouth-pressure manoeuvres, and respiratory muscle endurance via maximum voluntary ventilation (MVV12). Objective nerve-stimulation data from one study, and others documenting the time-course of recovery, implicate peripheral neuromuscular factors as the mechanism underpinning such fatigue. Evidence of respiratory muscle fatigue was more prevalent following marathon compared to ultra-marathon, and might be a factor of work rate, and thus exercise ventilation, which is tempered during longer races. Potential implications of respiratory muscle fatigue on health and marathon/ultra-marathon performance have been discussed, and include a diminished postural stability that may increase the risk of injury when running on challenging terrain, and possible respiratory muscle fatigue-induced effects on locomotor limb blood flow. This review provides novel insights that might influence marathon/ultra-marathon preparation strategies, as well as inform medical best-practice of personnel supporting such events.
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Affiliation(s)
- Nicholas B Tiller
- Academy of Sport and Physical Activity, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP, UK.
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19
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López-Pérez ME, Romero-Arenas S, Colomer-Poveda D, Keller M, Márquez G. Psychophysiological Responses During a Cycling Test to Exhaustion While Wearing the Elevation Training Mask. J Strength Cond Res 2020; 36:1282-1289. [PMID: 32379243 DOI: 10.1519/jsc.0000000000003626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
López-Pérez, ME, Romero-Arenas, S, Colomer-Poveda, D, Keller, M, and Márquez, G. Psychophysiological responses during a cycling test to exhaustion while wearing the elevation training mask. J Strength Cond Res XX(X): 000-000, 2020-The aim of this study was to investigate the psychophysiological effects of wearing the elevation training mask (ETM). Twelve men performed time-to-exhaustion (TTE) tests at 75% of peak power output with and without wearing the ETM. Heart rate (HR), rating of perceived exertion (RPE), breathing discomfort (BD), and oxygen saturation (SpO2) were measured during the TTE. Prefrontal cortex (PFC) and vastus lateralis oxygenated, deoxygenated, and total hemoglobin were monitored using near-infrared spectroscopy. At the end of each test, blood lactate values (La-) were collected, and subjects completed the Beck Anxiety Inventory (BAI). The mask caused a reduction in the TTE (-37.7%; p < 0.001) and in the SpO2 (-2%; p < 0.001). Beck Anxiety Inventory scores were negatively correlated with the changes observed in the TTE (r = -0.77; p < 0.01). La-, HR, and muscle oxygenation displayed similar results across conditions. In conjunction with an increased hemodynamic response in the PFC, subjects reported higher RPE and BD values in the ETM condition (p < 0.01). Finally, BAI scores were negatively correlated with the changes observed in the TTE (r = -0.77; p < 0.01). This study suggests that wearing the ETM induces psychophysiological alterations affecting the exercise tolerance and limiting the performance.
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Affiliation(s)
- María E López-Pérez
- Department of Physical Education and Sport, Faculty of Sport Sciences, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Salvador Romero-Arenas
- Department of Physical Education and Sport, Faculty of Sport Sciences, Catholic University of Murcia (UCAM), Murcia, Spain
| | - David Colomer-Poveda
- Department of Physical Education and Sport, Faculty of Sport Sciences, Catholic University of Murcia (UCAM), Murcia, Spain
| | - Martin Keller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Gonzalo Márquez
- Department of Physical Education and Sport, Faculty of Sport Sciences, Catholic University of Murcia (UCAM), Murcia, Spain.,University of A Coruña, Department of Physical Education and Sport, Faculty of Sport Sciences and Physical Education, A Coruña, Spain
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20
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Abstract
BACKGROUND The aim of this study was to examine the effect of the menstrual cycle on running economy (RE). METHODS Using a repeated-measures design, ten eumenorrheic, trained female runners (age: 32±6 yrs, V̇O2max: 59.7±4.7 mL·kg-1·min-1) completed four, weekly, identical sub-maximal and maximal incremental step tests on a treadmill to measure physiological responses across a full menstrual cycle. For phase comparison, the results from the trials that fell in the early follicular (low estrogen, low progesterone), late follicular (high estrogen, low progesterone) and mid-luteal (high estrogen, high progesterone) phases were used. RESULTS There was a significant effect of menstrual cycle phase on RE (P=0.001), with RE in the mid-luteal (ML) phase being worse than that of the early follicular (EF) (+2.33 mL·kg-1·min-1; P=0.026) and late follicular (LF) (+2.17 mL·kg-1·min-1; P=0.011) phases. The ML phase also resulted in elevated core temperature versus the EF (+0.51 ºC; P=0.001) and LF (+0.66 ºC; P=0.037) phases, and elevated minute ventilation versus the EF phase (+3.83 L·min-1; P=0.003). No significant effects of menstrual cycle phase were found on body mass, heart rate, ratings of perceived exertion, time-to-exhaustion, maximal oxygen consumption, or blood lactate concentration. CONCLUSIONS In the ML phase, which causes increased core temperature and minute ventilation, RE is impaired at exercise intensities that are applicable to training and performance. In physiologically stressful environments, this impairment in RE may have a significant impact on training and performance.
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Affiliation(s)
- Esther Goldsmith
- Faculty of Sport, Health, and Applied Sciences, St Mary's University, Strawberry Hill, Twickenham, UK -
| | - Mark Glaister
- Faculty of Sport, Health, and Applied Sciences, St Mary's University, Strawberry Hill, Twickenham, UK
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21
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Zeiger JS, Weiler JM. Special Considerations and Perspectives for Exercise-Induced Bronchoconstriction (EIB) in Olympic and Other Elite Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2194-2201. [PMID: 32006727 DOI: 10.1016/j.jaip.2020.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 12/11/2022]
Abstract
Diagnosing and treating elite and Olympic athletes with exercise-induced bronchoconstriction has been well established. However, a subset of elite and Olympic athletes with exercise-induced bronchoconstriction experience symptoms of breathlessness due to lack of adherence, improper medications, and/or generalized breathing dysfunction. A short review of traditional treatment plans for elite and Olympic athletes is presented along with the challenges of adherence, managing dysfunctional breathing, and measuring and treating mental skills deficits that may impact breathing. Elite and Olympic athletes may not respond to traditional treatment for exercise-induced bronchospasm, and we present some of the reasons why the athletes fail to respond. Furthermore, we present information on how to detect and treat elite and Olympic athletes with difficult-to-treat asthma. As part of this review we developed a flow diagram for medical providers to identify the reasons for lack of response to traditional treatment plans for exercise-induced bronchoconstriction with options for other treatment modalities.
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22
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Wouters EF, Posthuma R, Koopman M, Liu WY, Sillen MJ, Hajian B, Sastry M, Spruit MA, Franssen FM. An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2020; 14:149-161. [PMID: 31931636 DOI: 10.1080/17476348.2020.1700796] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Pulmonary rehabilitation (PR) is one of the core components in the management of patients with chronic obstructive pulmonary disease (COPD). In order to achieve the maximal level of independence, autonomy, and functioning of the patient, targeted therapies and interventions based on the identification of physical, emotional and social traits need to be provided by a dedicated, interdisciplinary PR team.Areas covered: The review discusses cardiopulmonary exercise testing in the selection of different modes of training modalities. Neuromuscular electrical stimulation as well as gait assessment and training are discussed as well as add-on therapies as oxygen, noninvasive ventilator support or endoscopic lung volume reduction in selected patients. The potentials of pulsed inhaled nitric oxide in patients with underlying pulmonary hypertension is explored as well as nutritional support. The impact of sleep quality on outcomes of PR is reviewed.Expert opinion: Individualized, comprehensive intervention based on thorough assessment of physical, emotional, and social traits in COPD patients forms a continuous challenge for health-care professionals and PR organizations in order to dynamically implement and adapt these strategies based on dynamic, more optimal understanding of underlying pathophysiological mechanisms.
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Affiliation(s)
- Emiel Fm Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Rein Posthuma
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands
| | - Maud Koopman
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Wai-Yan Liu
- CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Maurice J Sillen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Bita Hajian
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Manu Sastry
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Frits M Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
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23
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Koopman M, Spruit MA, Franssen FM, Delbressine J, Wouters EF, Mathew D, Vink A, Vanfleteren LE. Effects of Non-Invasive Ventilation Combined with Oxygen Supplementation on Exercise Performance in COPD Patients with Static Lung Hyperinflation and Exercise-Induced Oxygen Desaturation: A Single Blind, Randomized Cross-Over Trial. J Clin Med 2019; 8:jcm8112012. [PMID: 31752201 PMCID: PMC6912429 DOI: 10.3390/jcm8112012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022] Open
Abstract
The effects of non-invasive ventilation (NIV) in addition to supplemental oxygen on exercise performance in patients with chronic obstructive pulmonary disease (COPD) with hyperinflation and exercise-induced desaturation (EID) remain unclear. We hypothesized that these patients would benefit from NIV and that this effect would be an add-on to oxygen therapy. Thirteen COPD patients with a residual volume >150% of predicted, normal resting arterial oxygen pressure (PaO2) and carbon-dioxide pressure (PaCO2) and EID during a six-minute walk test were included. Patients performed four constant work-rate treadmill tests, each consisting of two exercise bouts with a recovery period in between, wearing an oronasal mask connected to a ventilator and oxygen supply. The ventilator was set to the following settings in fixed order with clockwise rotation: Sham (continuous positive airway pressure (CPAP) 2 cm H2O, FiO2 21%), oxygen (CPAP 2 cm H2O, FiO2 35%), NIV and oxygen (inspiratory positive airway pressure (IPAP) 14 cm H2O/expiratory positive airway pressure (EPAP) 6 cm H2O, inspired oxygen fraction (FiO2) 35%), intermittent (walking: Sham setting, recovery: NIV and oxygen setting). During the first exercise, bout patients walked further with the oxygen setting compared to the sham setting (225 ± 107 vs 120 ± 50 meters, p < 0.05), but even further with the oxygen/NIV setting (283 ± 128 meters; p < 0.05). Recovery time between two exercise bouts was shortest with NIV and oxygen. COPD patients with severe static hyperinflation and EID benefit significantly from NIV in addition to oxygen during exercise and recovery.
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Affiliation(s)
- Maud Koopman
- Department of Research & Development, CIRO, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (J.D.)
- Correspondence: ; Tel.: +31-4755-87653
| | - Martijn A. Spruit
- Department of Research & Development, CIRO, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (J.D.)
- NUTRIM, School of Nutrition and Translational Research in Metabolism, 6200 MD Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC), 6202 AZ Maastricht, The Netherlands
- REVAL—Rehabilitation Research Center, BIOMED—Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Frits M.E. Franssen
- Department of Research & Development, CIRO, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (J.D.)
- NUTRIM, School of Nutrition and Translational Research in Metabolism, 6200 MD Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC), 6202 AZ Maastricht, The Netherlands
| | - Jeannet Delbressine
- Department of Research & Development, CIRO, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (J.D.)
| | - Emiel F.M. Wouters
- Department of Research & Development, CIRO, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (J.D.)
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC), 6202 AZ Maastricht, The Netherlands
| | - Denny Mathew
- Philips Research, 5656 AE Eindhoven, The Netherlands; (D.M.); (A.V.)
| | - Anton Vink
- Philips Research, 5656 AE Eindhoven, The Netherlands; (D.M.); (A.V.)
| | - Lowie E.G.W. Vanfleteren
- Department of Research & Development, CIRO, Center of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (J.D.)
- COPD Center, Sahlgrenska University Hospital, Institute of Medicine, University of Gothenburg, SE-413 45 Gothenburg, Sweden
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24
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More Impaired Dynamic Ventilatory Muscle Oxygenation in Congestive Heart Failure than in Chronic Obstructive Pulmonary Disease. J Clin Med 2019; 8:jcm8101641. [PMID: 31591369 PMCID: PMC6832638 DOI: 10.3390/jcm8101641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/25/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) often have dyspnea. Despite differences in primary organ derangement and similarities in secondary skeletal muscle changes, both patient groups have prominent functional impairment. With similar daily exercise performance in patients with CHF and COPD, we hypothesized that patients with CHF would have worse ventilatory muscle oxygenation than patients with COPD. This study aimed to compare differences in tissue oxygenation and blood capacity between ventilatory muscles and leg muscles and between the two patient groups. Demographic data, lung function, and maximal cardiopulmonary exercise tests were performed in 134 subjects without acute illnesses. Muscle oxygenation and blood capacity were measured using frequency-domain near-infrared spectroscopy (fd-NIRS). We enrolled normal subjects and patients with COPD and CHF. The two patient groups were matched by oxygen-cost diagram scores, New York Heart Association functional classification scores, and modified Medical Research Council scores. COPD was defined as forced expired volume in one second and forced expired vital capacity ratio ≤0.7. CHF was defined as stable heart failure with an ejection fraction ≤49%. The healthy subjects were defined as those with no obvious history of chronic disease. Age, body mass index, cigarette consumption, lung function, and exercise capacity were different across the three groups. Muscle oxygenation and blood capacity were adjusted accordingly. Leg muscles had higher deoxygenation (HHb) and oxygenation (HbO2) and lower oxygen saturation (SmO2) than ventilatory muscles in all participants. The SmO2 of leg muscles was lower than that of ventilatory muscles because SmO2 was calculated as HbO2/(HHb+HbO2), and the HHb of leg muscles was relatively higher than the HbO2 of leg muscles. The healthy subjects had higher SmO2, the patients with COPD had higher HHb, and the patients with CHF had lower HbO2 in both muscle groups throughout the tests. The patients with CHF had lower SmO2 of ventilatory muscles than the patients with COPD at peak exercise (p < 0.01). We conclud that fd-NIRS can be used to discriminate tissue oxygenation of different musculatures and disease entities. More studies on interventions on ventilatory muscle oxygenation in patients with CHF and COPD are warranted.
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Welch JF, Kipp S, Sheel AW. Respiratory muscles during exercise: mechanics, energetics, and fatigue. CURRENT OPINION IN PHYSIOLOGY 2019. [DOI: 10.1016/j.cophys.2019.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Dempsey JA. Respiratory Determinants of Exercise Limitation: Focus on Phrenic Afferents and the Lung Vasculature. Clin Chest Med 2019; 40:331-342. [PMID: 31078213 DOI: 10.1016/j.ccm.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We examine 2 means by which the healthy respiratory system contributes to exercise limitation. These include the activation of respiratory and locomotor muscle afferent reflexes, which constrain blood flow and hasten fatigue in both sets of muscles, and the excessive increases in pulmonary vascular pressures at high cardiac outputs, which constrain O2 transport and precipitate maladaptive right ventricular remodeling in endurance-trained subjects.
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Affiliation(s)
- Jerome A Dempsey
- Department Population Health Sciences, University of Wisconsin-Madison, 707 WARF Building, 610 N. Walnut Street, WI 53726, USA.
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Dominelli PB, Katayama K, Vermeulen TD, Stuckless TJ, Brown CV, Foster GE, Sheel AW. Work of breathing influences muscle sympathetic nerve activity during semi-recumbent cycle exercise. Acta Physiol (Oxf) 2019; 225:e13212. [PMID: 30358142 DOI: 10.1111/apha.13212] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 02/06/2023]
Abstract
Reducing the work of breathing during exercise improves locomotor muscle blood flow and reduces diaphragm and locomotor muscle fatigue and is thought to be the result of a sympathetically mediated reflex. AIM The aim of this study was to assess muscle sympathetic nerve activity (MSNA) when the work of breathing is experimentally lowered during dynamic exercise. METHODS Healthy subjects (n = 12; age = 29 ± 9 years) performed semi-recumbent cycling trials at 40%, 60%, and 80% of peak workload. Exercise trials consisted of spontaneous breathing, reduced work of breathing (proportional assist ventilator), followed by further spontaneous breathing (post-ventilator). MSNA was recorded from the median nerve. RESULTS There was no difference in work of breathing between PAV and post-PAV at 40% peak work. At 60% peak work, the ventilator significantly (P < 0.05) reduced work of breathing (103 ± 39 vs 144 ± 47 J min-1 ), sympathetic nerve activity (35 ± 5 vs 42 ± 8 burst min-1 ), and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>˙</mml:mo></mml:mover> <mml:msub><mml:mi>O</mml:mi> <mml:mn>2</mml:mn></mml:msub> </mml:mrow> </mml:math> (2.4 ± 0.5 vs 2.6 ± 0.5 L min-1 ) without influencing ventilation (86 ± 9 vs 82 ± 10 L min-1 ; P > 0.05), for PAV and post-PAV respectively. During 80% peak work (n = 8), the ventilator significantly (P < 0.05) reduced work of breathing (235 ± 110 vs. 361 ± 150 J min-1 ), MSNA (48 ± 7 vs 54 ± 11 burst min-1 ), and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>˙</mml:mo></mml:mover> <mml:msub><mml:mi>O</mml:mi> <mml:mn>2</mml:mn></mml:msub> </mml:mrow> </mml:math> (2.9 ± 0.6 vs 3.2 ± 0.7 L min-1 ) but not ventilation (121 ± 20 vs 123 ± 20 L min-1 ; P > 0.05), for PAV and post-PAV respectively. There was a significant relationship between MSNA and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>˙</mml:mo></mml:mover> <mml:msub><mml:mi>O</mml:mi> <mml:mn>2</mml:mn></mml:msub> </mml:mrow> </mml:math> (P < 0.0001) with a significant interaction due to the ventilator (P < 0.05). CONCLUSION Lowering the normally occurring work of breathing during exercise results in commensurate reductions in MSNA. Our findings provide evidence of a sympathetically mediated vasoconstrictor effect emanating from respiratory muscles during exercise.
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Affiliation(s)
- Paolo B. Dominelli
- School of Kinesiology University of British Columbia Vancouver British Columbia Canada
- Department of Anaesthesiology Mayo Clinic Rochester Minnesota
| | - Keisho Katayama
- Research Center of Health, Physical Fitness and Sports, Graduate School of Medicine Nagoya University Nagoya Japan
| | - Tyler D. Vermeulen
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences University of British Columbia Kelowna British Columbia Canada
| | - Troy J.R. Stuckless
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences University of British Columbia Kelowna British Columbia Canada
| | - Courtney V. Brown
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences University of British Columbia Kelowna British Columbia Canada
| | - Glen E. Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences University of British Columbia Kelowna British Columbia Canada
| | - Andrew William Sheel
- School of Kinesiology University of British Columbia Vancouver British Columbia Canada
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Tiller NB, Turner LA, Taylor BJ. Pulmonary and respiratory muscle function in response to 10 marathons in 10 days. Eur J Appl Physiol 2018; 119:509-518. [PMID: 30467593 DOI: 10.1007/s00421-018-4037-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Marathon and ultramarathon provoke respiratory muscle fatigue and pulmonary dysfunction; nevertheless, it is unknown how the respiratory system responds to multiple, consecutive days of endurance exercise. METHODS Nine trained individuals (six male) contested 10 marathons in 10 consecutive days. Respiratory muscle strength (maximum static inspiratory and expiratory mouth-pressures), pulmonary function (spirometry), perceptual ratings of respiratory muscle soreness (Visual Analogue Scale), breathlessness (dyspnea, modified Borg CR10 scale), and symptoms of Upper Respiratory Tract Infection (URTI), were assessed before and after marathons on days 1, 4, 7, and 10. RESULTS Group mean time for 10 marathons was 276 ± 35 min. Relative to pre-challenge baseline (159 ± 32 cmH2O), MEP was reduced after day 1 (136 ± 31 cmH2O, p = 0.017), day 7 (138 ± 42 cmH2O, p = 0.035), and day 10 (130 ± 41 cmH2O, p = 0.008). There was no change in pre-marathon MEP across days 1, 4, 7, or 10 (p > 0.05). Pre-marathon forced vital capacity was significantly diminished at day 4 (4.74 ± 1.09 versus 4.56 ± 1.09 L, p = 0.035), remaining below baseline at day 7 (p = 0.045) and day 10 (p = 0.015). There were no changes in FEV1, FEV1/FVC, PEF, MIP, or respiratory perceptions during the course of the challenge (p > 0.05). In the 15-day post-challenge period, 5/9 (56%) runners reported symptoms of URTI, relative to 1/9 (11%) pre-challenge. CONCLUSIONS Single-stage marathon provokes acute expiratory muscle fatigue which may have implications for health and/or performance, but 10 consecutive days of marathon running does not elicit cumulative (chronic) changes in respiratory function or perceptions of dyspnea. These data allude to the robustness of the healthy respiratory system.
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Affiliation(s)
- Nicholas B Tiller
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, UK.
| | - Louise A Turner
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, UK
| | - Bryan J Taylor
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Vitacca M, Ambrosino N. Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review. Respiration 2018; 97:3-11. [PMID: 30380534 DOI: 10.1159/000493691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic ventilatory failure (CVF) may be associated with reduced exercise capacity. Long-term non-invasive ventilation (NIV) may reduce patients' symptoms, improve health-related quality of life and reduce mortality and hospitalisations. There is an increasing use of NIV during exercise training with the purpose to train patients at intensity levels higher than allowed by their pathophysiological conditions. OBJECTIVE This narrative review describes the possibility to train patients with CVF and NIV use as a tool to increase the benefits of exercise training. METHODS We searched papers published between 1985 and 2018 in (or with the summary in) English language in PubMed and Scopus databases using the keywords "chronic respiratory failure AND exercise," "non invasive ventilation AND exercise," "pulmonary rehabilitation" and "exercise training." RESULTS Exercise training is feasible and effective also in patients with CVF. Assisted ventilation can improve exercise tolerance in different clinical conditions. In patients under long-term home ventilatory support, NIV administered also during walking results in improved oxygenation, decreased dyspnoea and increased walking distance. Continuous positive airway pressure and different modalities of assisted ventilation have been delivered through different interfaces during exercise training programmes. Patients with CVF on long-term NIV may benefit from exercising with the same ventilators, interfaces and settings as used at home. CONCLUSION We need more randomised clinical trials to investigate the effects of NIV on exercise training in patients with CVF and define organisation and setting.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Pulmonary Rehabilitation, Institute of Lumezzane (BS), Lumezzane,
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Institute of Montescano (PV), Montescano, Italy
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Gloeckl R, Andrianopoulos V, Stegemann A, Oversohl J, Schneeberger T, Schoenheit‐Kenn U, Hitzl W, Dreher M, Koczulla AR, Kenn K. High‐pressure non‐invasive ventilation during exercise in COPD patients with chronic hypercapnic respiratory failure: A randomized, controlled, cross‐over trial. Respirology 2018; 24:254-261. [DOI: 10.1111/resp.13399] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Rainer Gloeckl
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Prevention, Rehabilitation and Sports MedicineTechnical University of Munich (TUM) Munich Germany
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
| | - Antje Stegemann
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
| | - Julian Oversohl
- Department of Internal MedicinePhilipps‐University of Marburg Marburg Germany
| | - Tessa Schneeberger
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Pulmonary RehabilitationPhilipps‐University of Marburg, German Center for Lung Research (DZL) Marburg Germany
| | - Ursula Schoenheit‐Kenn
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics)Paracelsus Medical University Salzburg Austria
- Department of Ophthalmology and OptometryParacelsus Medical University Salzburg Austria
| | - Michael Dreher
- Department of Pneumology and Intensive Care MedicineUniversity Hospital RWTH Aachen Germany
| | - A. Rembert Koczulla
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Pulmonary RehabilitationPhilipps‐University of Marburg, German Center for Lung Research (DZL) Marburg Germany
| | - Klaus Kenn
- Institute for Pulmonary Rehabilitation ResearchSchoen Klinik Berchtesgadener Land Schoenau am Koenigssee Germany
- Department of Pulmonary RehabilitationPhilipps‐University of Marburg, German Center for Lung Research (DZL) Marburg Germany
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31
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Dominelli PB, Ripoll JG, Cross TJ, Baker SE, Wiggins CC, Welch BT, Joyner MJ. Sex differences in large conducting airway anatomy. J Appl Physiol (1985) 2018; 125:960-965. [PMID: 30024341 DOI: 10.1152/japplphysiol.00440.2018] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Airway luminal area is the major determinant of resistance to airflow in the tracheobronchial tree. Women may have smaller central conducting airways than men; however, previous evidence is confounded by an indirect assessment of airway geometry and by subjects with prior smoking history. The purpose of this study was to examine the effect of sex on airway size in healthy nonsmokers. Using low-dose high-resolution computed tomography, we retrospectively assessed airway luminal area in healthy men ( n = 51) and women ( n = 73) of varying ages (19-86 yr). Subjects with a positive smoking history, cardiopulmonary disease, or a body mass index > 40 kg/m2 were excluded. Luminal areas of the trachea, right and left main bronchus, bronchus intermediate, left and right upper lobes, and the left lower lobe were analyzed at three discrete points. The luminal areas of the conducting airways were ~26%-35% smaller in women. The trachea had the largest differences in luminal area between men and women (298 ± 47 vs. 195 ± 28 mm2 or 35% smaller for men and women, respectively), whereas the left lower lobe had the smallest differences (57 ± 15 vs. 42 ± 9 mm2 or 26% smaller for men and women, respectively). When a subset of subjects was matched for height, the sex differences in airway luminal area persisted, with women being ~20%-30% smaller. With all subjects, there were modest relationships between height and airway luminal area ( r = 0.73-0.53, P < 0.05). Although there was considerable overlap between sexes, the luminal areas of the large conducting airways were smaller in healthy women than in men. NEW & NOTEWORTHY Previous evidence for sex differences in airway size has been confounded by indirect measures and/or cohorts with significant smoking histories or pathologies. We found that central airways in healthy women were significantly smaller (~26%-35%) than men. The significant sex-difference in airway size was attenuated (20%-30% smaller) but preserved in a subset of subjects matched for height. Over a range of ages, healthy women have smaller central airways than men.
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Affiliation(s)
| | - Juan G Ripoll
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Troy J Cross
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Sarah E Baker
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Chad C Wiggins
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Kim S, Homestead EP, Byrnes WC. Breathing valve resistance alters physiological responses during a graded exercise test. Eur J Appl Physiol 2018; 118:1921-1929. [PMID: 29961231 DOI: 10.1007/s00421-018-3922-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/22/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the impact of breathing valve resistance on peak aerobic capacity ([Formula: see text]) and running economy (RE) in endurance-trained and recreationally active individuals. METHODS Ten endurance-trained males (ETM), 10 endurance-trained females (ETF), 10 recreationally active males (RAM), and 10 recreationally active females (RAF) participated in this study. On two separate occasions, subjects performed identical graded exercise treadmill protocols using either a Hans Rudolph 2700 (high resistance) or a Daniels' (low resistance) two-way non-rebreathing valve. Parameters obtained from these protocols included energy expenditure (EE), ventilation ([Formula: see text]), heart rate, respiratory exchange ratio, RE, [Formula: see text], and time to exhaustion (TTE). RESULTS When using the Daniels' valve, all groups had lower submaximal EE (- 2.4, - 3.4, - 2.7, and - 2.0% for ETM, ETF, RAM, and RAF) and better RE (- 2.7, - 3.5, - 1.9, and - 1.8% for ETM, ETF, RAM and RAF) across all submaximal speeds. Only the ET groups had lower submaximal [Formula: see text] (4.6 and 3.8% for ETM and ETF) when using the Daniels' valve. TTE increased when using the Daniels' valve for all groups (6.0, 10.9, 6.2 and 9.8% for ETM, ETF, RAM and RAF), but [Formula: see text] was unaltered. CONCLUSION Compared to the Daniels' valve, the Hans Rudolph 2700 valve altered the assessment of RE, submaximal EE, and TTE regardless of fitness level or sex, but did not change [Formula: see text]. Therefore, airflow resistance of a breathing valve must be considered when assessing and comparing EE, RE and TTE in the applied and research settings.
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Affiliation(s)
- Sewan Kim
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St., 354 UCB, Boulder, CO, 80309, USA.
| | - Eric P Homestead
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St., 354 UCB, Boulder, CO, 80309, USA
| | - William C Byrnes
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St., 354 UCB, Boulder, CO, 80309, USA
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Sheel AW, Boushel R, Dempsey JA. Competition for blood flow distribution between respiratory and locomotor muscles: implications for muscle fatigue. J Appl Physiol (1985) 2018; 125:820-831. [PMID: 29878876 DOI: 10.1152/japplphysiol.00189.2018] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Sympathetically induced vasoconstrictor modulation of local vasodilation occurs in contracting skeletal muscle during exercise to ensure appropriate perfusion of a large active muscle mass and to maintain also arterial blood pressure. In this synthesis, we discuss the contribution of group III-IV muscle afferents to the sympathetic modulation of blood flow distribution to locomotor and respiratory muscles during exercise. This is followed by an examination of the conditions under which diaphragm and locomotor muscle fatigue occur. Emphasis is given to those studies in humans and animal models that experimentally changed respiratory muscle work to evaluate blood flow redistribution and its effects on locomotor muscle fatigue, and conversely, those that evaluated the influence of coincident limb muscle contraction on respiratory muscle blood flow and fatigue. We propose the concept of a "two-way street of sympathetic vasoconstrictor activity" emanating from both limb and respiratory muscle metaboreceptors during exercise, which constrains blood flow and O2 transport thereby promoting fatigue of both sets of muscles. We end with considerations of a hierarchy of blood flow distribution during exercise between respiratory versus locomotor musculatures and the clinical implications of muscle afferent feedback influences on muscle perfusion, fatigue, and exercise tolerance.
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Affiliation(s)
- A William Sheel
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Robert Boushel
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Jerome A Dempsey
- Department of Population Health Sciences, John Rankin Laboratory of Pulmonary Medicine, School of Medicine and Public Health, University of Wisconsin , Madison, Wisconsin
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Tiller NB, Aggar TR, West CR, Romer LM. Exercise-induced diaphragm fatigue in a Paralympic champion rower with spinal cord injury. J Appl Physiol (1985) 2018; 124:805-811. [PMID: 29191982 DOI: 10.1152/japplphysiol.00870.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this case report was to determine whether maximal upper body exercise was sufficient to induce diaphragm fatigue in a Paralympic champion adaptive rower with low-lesion spinal cord injury (SCI). An elite arms-only oarsman (age: 28 yr; stature: 1.89 m; and mass: 90.4 kg) with motor-complete SCI (T12) performed a 1,000-m time trial on an adapted rowing ergometer. Exercise measurements comprised pulmonary ventilation and gas exchange, diaphragm EMG-derived indexes of neural respiratory drive, and intrathoracic pressure-derived indexes of respiratory mechanics. Diaphragm fatigue was assessed by measuring pre- to postexercise changes in the twitch transdiaphragmatic pressure (Pdi,tw) response to anterolateral magnetic stimulation of the phrenic nerves. The time trial (248 ± 25 W, 3.9 min) elicited a peak O2 uptake of 3.46 l/min and a peak pulmonary ventilation of 150 l/min (57% MVV). Breath-to-stroke ratio was 1:1 during the initial 400 m and 2:1 thereafter. The ratio of inspiratory transdiaphragmatic pressure to diaphragm EMG (neuromuscular efficiency) fell from rest to 600 m (16.0 vs. 3.0). Potentiated Pdi,tw was substantially reduced (-33%) at 15-20 min postexercise, with only partial recovery (-12%) at 30-35 min. This is the first report of exercise-induced diaphragm fatigue in SCI. The decrease in diaphragm neuromuscular efficiency during exercise suggests that the fatigue was partly due to factors independent of ventilation (e.g., posture and locomotion). NEW & NOTEWORTHY This case report provides the first objective evidence of exercise-induced diaphragm fatigue in spinal cord injury (SCI) and, for that matter, in any population undertaking upper body exercise. Our data support the notion that high levels of exercise hyperpnea and factors other than ventilation (e.g., posture and locomotion) are responsible for the fatigue noted after upper body exercise. The findings extend our understanding of the limits of physiological function in SCI.
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Affiliation(s)
- Nicholas B Tiller
- Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Sheffield Hallam University , Sheffield , United Kingdom.,Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom
| | - Thomas R Aggar
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom
| | - Christopher R West
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom.,ICORD, Vancouver, British Columbia, Canada
| | - Lee M Romer
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London , Uxbridge , United Kingdom.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London , Uxbridge , United Kingdom
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35
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Archiza B, Welch JF, Geary CM, Allen GP, Borghi-Silva A, Sheel AW. Temporal characteristics of exercise-induced diaphragmatic fatigue. J Appl Physiol (1985) 2017; 124:906-914. [PMID: 29357497 DOI: 10.1152/japplphysiol.00942.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is evidence suggesting diaphragmatic fatigue (DF) occurs relatively early during high-intensity exercise; however, studies investigating the temporal characteristics of exercise-induced DF are limited by incongruent methodology. Eight healthy adult males (25 ± 5 yr) performed a maximal incremental exercise test on a cycle ergometer on day 1. A constant-load time-to-exhaustion (TTE) exercise test was conducted on day 2 at 60% delta between the calculated gas exchange threshold and peak work rate. Two additional constant-load exercise tests were performed at the same intensity on days 3 and 4 in a random order to either 50 or 75% TTE. DF was assessed on days 2, 3, and 4 by measuring transdiaphragmatic twitch pressure (Pdi,tw) in response to cervical magnetic stimulation. DF was present after 75 and 100% TTE (≥20% decrease in Pdi,tw). The magnitude of fatigue was 15.5 ± 5.7%, 23.6 ± 6.4%, and 35.0 ± 12.1% at 50, 75, and 100% TTE, respectively. Significant differences were found between 100 to 75 and 50% TTE (both P < 0.01), and 75 to 50% TTE ( P < 0.01). There was a significant relationship between the magnitude of fatigue and cumulative diaphragm force output ( r = 0.785; P < 0.001). Ventilation, the mechanical work of breathing (WOB), and pressure-time products were not different between trials ( P > 0.05). Our data indicate that exercise-induced DF presents a relatively late onset and is proportional to the cumulative WOB; thus the ability of the diaphragm to generate pressure progressively declines throughout exercise. NEW & NOTEWORTHY The notion that diaphragmatic fatigue (DF) occurs relatively early during exercise is equivocal. Our results indicate that DF occurs during high-intensity endurance exercise in healthy men and its magnitude is strongly related to the amount of pressure and work generated by respiratory muscles. Thus we conclude that the work of breathing is the major determinant of exercise-induced DF.
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Affiliation(s)
- Bruno Archiza
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada.,Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paolo, Brazil
| | - Joseph F Welch
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Caitlin M Geary
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Grayson P Allen
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Audrey Borghi-Silva
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paolo, Brazil
| | - A William Sheel
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
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36
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Tiller NB, Campbell IG, Romer LM. Influence of Upper-Body Exercise on the Fatigability of Human Respiratory Muscles. Med Sci Sports Exerc 2017; 49:1461-1472. [PMID: 28288012 PMCID: PMC5473371 DOI: 10.1249/mss.0000000000001251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose Diaphragm and abdominal muscles are susceptible to contractile fatigue in response to high-intensity, whole-body exercise. This study assessed whether the ventilatory and mechanical loads imposed by high-intensity, upper-body exercise would be sufficient to elicit respiratory muscle fatigue. Methods Seven healthy men (mean ± SD; age = 24 ± 4 yr, peak O2 uptake [V˙O2peak] = 31.9 ± 5.3 mL·kg−1·min−1) performed asynchronous arm-crank exercise to exhaustion at work rates equivalent to 30% (heavy) and 60% (severe) of the difference between gas exchange threshold and V˙O2peak. Contractile fatigue of the diaphragm and abdominal muscles was assessed by measuring pre- to postexercise changes in potentiated transdiaphragmatic and gastric twitch pressures (Pdi,tw and Pga,tw) evoked by supramaximal magnetic stimulation of the cervical and thoracic nerves, respectively. Results Exercise time was 24.5 ± 5.8 min for heavy exercise and 9.8 ± 1.8 min for severe exercise. Ventilation over the final minute of heavy exercise was 73 ± 20 L·min−1 (39% ± 11% maximum voluntary ventilation) and 99 ± 19 L·min−1 (53% ± 11% maximum voluntary ventilation) for severe exercise. Mean Pdi,tw did not differ pre- to postexercise at either intensity (P > 0.05). Immediately (5–15 min) after severe exercise, mean Pga,tw was significantly lower than pre-exercise values (41 ± 13 vs 53 ± 15 cm H2O, P < 0.05), with the difference no longer significant after 25–35 min. Abdominal muscle fatigue (defined as ≥15% reduction in Pga,tw) occurred in 1/7 subjects after heavy exercise and 5/7 subjects after severe exercise. Conclusions High-intensity, upper-body exercise elicits significant abdominal, but not diaphragm, muscle fatigue in healthy men. The increased magnitude and prevalence of fatigue during severe-intensity exercise is likely due to additional (nonrespiratory) loading of the thorax.
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Affiliation(s)
- Nicholas B Tiller
- 1Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, UNITED KINGDOM; 2Division of Sport, Health and Exercise Sciences, Brunel University London, London, UNITED KINGDOM; and 3School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UNITED KINGDOM
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Dominelli PB, Molgat-Seon Y, Griesdale DEG, Peters CM, Blouin JS, Sekhon M, Dominelli GS, Henderson WR, Foster GE, Romer LM, Koehle MS, Sheel AW. Exercise-induced quadriceps muscle fatigue in men and women: effects of arterial oxygen content and respiratory muscle work. J Physiol 2017; 595:5227-5244. [PMID: 28524229 DOI: 10.1113/jp274068] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/16/2017] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS High work of breathing and exercise-induced arterial hypoxaemia (EIAH) can decrease O2 delivery and exacerbate exercise-induced quadriceps fatigue in healthy men. Women have a higher work of breathing during exercise, dedicate a greater fraction of whole-body V̇O2 towards their respiratory muscles and develop EIAH. Despite a greater reduction in men's work of breathing, the attenuation of quadriceps fatigue was similar between the sexes. The degree of EIAH was similar between sexes, and regardless of sex, those who developed the greatest hypoxaemia during exercise demonstrated the most attenuation of quadriceps fatigue. Based on our previous finding that women have a greater relative oxygen cost of breathing, women appear to be especially susceptible to work of breathing-related changes in quadriceps muscle fatigue. ABSTRACT Reducing the work of breathing or eliminating exercise-induced arterial hypoxaemia (EIAH) during exercise decreases the severity of quadriceps fatigue in men. Women have a greater work of breathing during exercise, dedicate a greater fraction of whole-body V̇O2 towards their respiratory muscles, and demonstrate EIAH, suggesting women may be especially susceptible to quadriceps fatigue. Healthy subjects (8 male, 8 female) completed three constant load exercise tests over 4 days. During the first (control) test, subjects exercised at ∼85% of maximum while arterial blood gases and work of breathing were assessed. Subsequent constant load exercise tests were iso-time and iso-work rate, but with EIAH prevented by inspiring hyperoxic gas or work of breathing reduced via a proportional assist ventilator (PAV). Quadriceps fatigue was assessed by measuring force in response to femoral nerve stimulation. For both sexes, quadriceps force was equally reduced after the control trial (-27 ± 2% baseline) and was attenuated with hyperoxia and PAV (-18 ± 1 and -17 ± 2% baseline, P < 0.01, respectively), with no sex difference. EIAH was similar between the sexes, and regardless of sex, subjects with the lowest oxyhaemoglobin saturation during the control test had the greatest quadriceps fatigue attenuation with hyperoxia (r2 = 0.79, P < 0.0001). For the PAV trial, despite reducing the work of breathing to a greater degree in men (men: 60 ± 5, women: 75 ± 6% control, P < 0.05), the attenuation of quadriceps fatigue was similar between the sexes (36 ± 4 vs. 37 ± 7%). Owing to a greater relative V̇O2 of the respiratory muscles in women, less of a change in work of breathing is needed to reduce quadriceps fatigue.
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Affiliation(s)
- Paolo B Dominelli
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Yannick Molgat-Seon
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Donald E G Griesdale
- Division of Critical Care Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Carli M Peters
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Mypinder Sekhon
- Division of Critical Care Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Giulio S Dominelli
- Division of Respiratory Medicine, University of British Columbia, Kelowna, BC, Canada
| | - William R Henderson
- Division of Critical Care Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Glen E Foster
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Lee M Romer
- Centre for Human Performance, Exercise and Rehabilitation, Division of Sport, Health and Exercise Sciences, Brunel University London, Uxbridge, UK
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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Bajema A, Swinbourne AL, Gray M, Leicht AS. Effect of portable non-invasive ventilation & environmental conditions on everyday activities. Respir Physiol Neurobiol 2017; 243:55-59. [PMID: 28554818 DOI: 10.1016/j.resp.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
The current study examined the effect of non-invasive ventilation (NIV) within environments of differing temperature and humidity on several physiological and perceptual responses while performing six activities of daily living (i.e. putting on shirt/shoes/trousers, vacuuming, hanging towels, and walking on a treadmill). Sixteen healthy participants completed the activities of varying difficulty within four experimental conditions: with and without NIV; and in temperate (22°C, 40% relative humidity) and hot-humid environments (32°C, 70% relative humidity). Comparisons of physiological responses between conditions were examined via repeated measures ANOVAs. Overall, NIV resulted in similar physiological and perceptual responses within all environmental conditions for healthy participants. Further, NIV use increased heart rate during the most strenuous task (29.5±12.7 vs. 22.8±12.0bpm, p=0.008) indicating NIV use may stress cardiovascular functioning during moderate-high intensity activities. Tropical conditions did not alter physiological or perceptual responses during everyday tasks with NIV use by healthy adults. Future investigations examining the independent and combined impacts of task intensity, extreme environments and NIV use will clarify the benefits of NIV for healthy and clinical populations.
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Affiliation(s)
- Anna Bajema
- Psychology, James Cook University, Townsville, Australia
| | | | - Marion Gray
- Cluster for Health Improvement, University of the Sunshine Coast, Sippy Downs, Australia
| | - Anthony S Leicht
- Sport and Exercise Science, James Cook University, Townsville, Queensland 4811, Australia.
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Mauri T, Turrini C, Eronia N, Grasselli G, Volta CA, Bellani G, Pesenti A. Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure. Am J Respir Crit Care Med 2017; 195:1207-1215. [DOI: 10.1164/rccm.201605-0916oc] [Citation(s) in RCA: 262] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Tommaso Mauri
- Department of Anesthesia, Critical Care and Emergency, IRCCS (Institute for Treatment and Research) Ca’ Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Cecilia Turrini
- Department of Anesthesia, Critical Care and Emergency, IRCCS (Institute for Treatment and Research) Ca’ Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Nilde Eronia
- Department of Emergency, San Gerardo Hospital, Monza, Italy; and
| | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, IRCCS (Institute for Treatment and Research) Ca’ Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Giacomo Bellani
- Department of Emergency, San Gerardo Hospital, Monza, Italy; and
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, IRCCS (Institute for Treatment and Research) Ca’ Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Abstract
Non-invasive ventilation (NIV) is increasingly used in addition to exercise training in patients with chronic obstructive pulmonary disease with the purpose to allow them to train at higher intensities. Different modalities of assisted ventilation have been used with benefits for relief of dyspnoea and increase in exercise capacity. Nevertheless there are some potential problems with the use of NIV in pulmonary rehabilitation programmes. Despite promising results, a generalised use of NIV during exercise training programmes is unlikely to have a role in routine settings. The use of NIV during exercise training as a component of pulmonary rehabilitation should be reserved to individual cases.
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Affiliation(s)
| | - Lixin Xie
- b Department of Pulmonary and Critical Care Medicine , Chinese PLA General Hospital , Beijing , China
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Arend M, Mäestu J, Kivastik J, Rämson R, Jürimäe J. Effect of inspiratory muscle warm-up on submaximal rowing performance. J Strength Cond Res 2015; 29:213-8. [PMID: 25028992 DOI: 10.1519/jsc.0000000000000618] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Performing inspiratory muscle warm-up might increase exercise performance. The aim of this study was to investigate the impact of inspiratory muscle warm-up to submaximal rowing performance and to find if there is an effect on lactic acid accumulation and breathing parameters. Ten competitive male rowers aged between 19 and 27 years (age, 23.1 ± 3.8 years; height, 188.1 ± 6.3 cm; body mass, 85.6 ± 6.6 kg) were tested 3 times. During the first visit, maximal inspiratory pressure (MIP) assessment and the incremental rowing test were performed to measure maximal oxygen consumption and maximal aerobic power (Pamax). A submaximal intensity (90% Pamax) rowing test was performed twice with the standard rowing warm-up as test 1 and with the standard rowing warm-up and specific inspiratory muscle warm-up as test 2. During the 2 experimental tests, distance, duration, heart rate, breathing frequency, ventilation, peak oxygen consumption, and blood lactate concentration were measured. The only value that showed a significant difference between the test 1 and test 2 was breathing frequency (52.2 ± 6.8 vs. 53.1 ± 6.8, respectively). Heart rate and ventilation showed a tendency to decrease and increase, respectively, after the inspiratory muscle warm-up (p < 0.1). Despite some changes in respiratory parameters, the use of 40% MIP intensity warm-up is not suggested if the mean intensity of the competition is at submaximal level (at approximately 90% maximal oxygen consumption). In conclusion, the warm-up protocol of the respiratory muscles used in this study does not have a significant influence on submaximal endurance performance in highly trained male rowers.
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Affiliation(s)
- Mati Arend
- Departments of 1Sports and Exercise Coaching and 2Physiology, University of Tartu, Tartu, Estonia
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Kurti SP, Smith JR, Emerson SR, Castinado KM, Harms CA. Absence of Respiratory Muscle Fatigue in High-Intensity Continuous or Interval Cycling Exercise. J Strength Cond Res 2015; 29:3171-6. [DOI: 10.1519/jsc.0000000000000974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ohya T, Hagiwara M, Suzuki Y. Inspiratory muscle warm-up has no impact on performance or locomotor muscle oxygenation during high-intensity intermittent sprint cycling exercise. SPRINGERPLUS 2015; 4:556. [PMID: 26435902 PMCID: PMC4586185 DOI: 10.1186/s40064-015-1355-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/20/2015] [Indexed: 12/03/2022]
Abstract
The purpose of this study was to investigate the effect of inspiratory muscle (IM) warm-up on performance and locomotor muscle oxygenation during high-intensity intermittent sprint cycling exercise. Ten subjects performed identical exercise tests (10 × 5 s with 25-s recovery on a cycle ergometer) after performing one of two different IM warm-up protocols. The IM warm-up consisted of two sets of 30 inspiratory efforts against a pressure-threshold load equivalent to 15 % (PLA) or 40 % (IMW) of maximal inspiratory pressure (MIP). MIP was measured with a portable autospirometer. Peak power and percent decrease in power were determined. Oxyhemoglobin (O2Hb) was measured using near-infrared spectroscopy. The MIP increased relative to baseline after IMW (115 ± 21 vs. 123 ± 17 cmH2O, P = 0.012, ES = 0.42), but not after PLA (115 ± 20 vs. 116 ± 17 cmH2O). Peak power (PLA: 10.0 ± 0.6 vs. IMW: 10.2 ± 0.5 W kg−1), percent decrease in power (PLA: 13.4 ± 5.6 vs. IMW: 13.2 ± 5.5 %), and changes in O2Hb levels (PLA: −10.8 ± 4.8 vs. −10.7 ± 4.1 μM) did not differ between the trials. IM function was improved by IMW. However, this did not enhance performance or locomotor muscle oxygenation during high-intensity intermittent sprint cycling exercise in untrained healthy males.
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Affiliation(s)
- Toshiyuki Ohya
- Department of Sports Science, Japan Institute of Sports Sciences, 3-15-1 Nishigaoka, Kita-ku, Tokyo, 115-0056 Japan
| | - Masahiro Hagiwara
- Department of Sports Science, Japan Institute of Sports Sciences, 3-15-1 Nishigaoka, Kita-ku, Tokyo, 115-0056 Japan
| | - Yasuhiro Suzuki
- Department of Sports Science, Japan Institute of Sports Sciences, 3-15-1 Nishigaoka, Kita-ku, Tokyo, 115-0056 Japan
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Exercise Tolerance Can Be Enhanced through a Change in Work Rate within the Severe Intensity Domain: Work above Critical Power Is Not Constant. PLoS One 2015; 10:e0138428. [PMID: 26407169 PMCID: PMC4583487 DOI: 10.1371/journal.pone.0138428] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/29/2015] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The characterization of the hyperbolic power-time (P-tlim) relationship using a two-parameter model implies that exercise tolerance above the asymptote (Critical Power; CP), i.e. within the severe intensity domain, is determined by the curvature (W') of the relationship. PURPOSES The purposes of this study were (1) to test whether the amount of work above CP (W>CP) remains constant for varied work rate experiments of high volatility change and (2) to ascertain whether W' determines exercise tolerance within the severe intensity domain. METHODS Following estimation of CP (208 ± 19 W) and W' (21.4 ± 4.2 kJ), 14 male participants (age: 26 ± 3; peak VO2: 3708 ± 389 ml.min(-1)) performed two experimental trials where the work rate was initially set to exhaust 70% of W' in 3 ('THREE') or 10 minutes ('TEN') before being subsequently dropped to CP plus 10 W. RESULTS W>CP for TEN (104 ± 22% W') and W' were not significantly different (P>0.05) but lower than W>CP for THREE (119 ± 17% W', P<0.05). For both THREE (r = 0.71, P<0.01) and TEN (r = 0.64, P<0.01), a significant bivariate correlation was found between W' and tlim. CONCLUSION W>CP and tlim can be greater than predicted by the P-tlim relationship when a decrement in the work rate of high-volatility is applied. Exercise tolerance can be enhanced through a change in work rate within the severe intensity domain. W>CP is not constant.
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Ambrosino N, Cigni P. Non invasive ventilation as an additional tool for exercise training. Multidiscip Respir Med 2015; 10:14. [PMID: 25874110 PMCID: PMC4396167 DOI: 10.1186/s40248-015-0008-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/23/2015] [Indexed: 11/10/2022] Open
Abstract
Recently, there has been increasing interest in the use of non invasive ventilation (NIV) to increase exercise capacity. In individuals with COPD, NIV during exercise reduces dyspnoea and increases exercise tolerance. Different modalities of mechanical ventilation have been used non-invasively as a tool to increase exercise tolerance in COPD, heart failure and lung and thoracic restrictive diseases. Inspiratory support provides symptomatic benefit by unloading the ventilatory muscles, whereas Continuous Positive Airway Pressure (CPAP) counterbalances the intrinsic positive end-expiratory pressure in COPD patients. Severe stable COPD patients undergoing home nocturnal NIV and daytime exercise training showed some benefits. Furthermore, it has been reported that in chronic hypercapnic COPD under long-term ventilatory support, NIV can also be administered during walking. Despite these results, the role of NIV as a routine component of pulmonary rehabilitation is still to be defined.
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Affiliation(s)
- Nicolino Ambrosino
- Pulmonary Rehabilitation and Weaning Center, Auxilium Vitae, Borgo S.Lazzaro 5, Volterra, PI Italy
| | - Paolo Cigni
- Pulmonary Rehabilitation and Weaning Center, Auxilium Vitae, Borgo S.Lazzaro 5, Volterra, PI Italy
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Wilkie SS, Dominelli PB, Sporer BC, Koehle MS, Sheel AW. Heliox breathing equally influences respiratory mechanics and cycling performance in trained males and females. J Appl Physiol (1985) 2015; 118:255-64. [PMID: 25429095 PMCID: PMC4312847 DOI: 10.1152/japplphysiol.00400.2014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 11/25/2014] [Indexed: 11/22/2022] Open
Abstract
In this study we tested the hypothesis that inspiring a low-density gas mixture (helium-oxygen; HeO2) would minimize mechanical ventilatory constraints and preferentially increase exercise performance in females relative to males. Trained male (n = 11, 31 yr) and female (n = 10, 26 yr) cyclists performed an incremental cycle test to exhaustion to determine maximal aerobic capacity (V̇o2max; male = 61, female = 56 ml·kg(-1)·min(-1)). A randomized, single-blinded crossover design was used for two experimental days where subjects completed a 5-km cycling time trial breathing humidified compressed room air or HeO2 (21% O2:balance He). Subjects were instrumented with an esophageal balloon for the assessment of respiratory mechanics. During the time trial, we assessed the ability of HeO2 to alleviate mechanical ventilatory constraints in three ways: 1) expiratory flow limitation, 2) utilization of ventilatory capacity, and 3) the work of breathing. We found that HeO2 significantly reduced the work of breathing, increased the size of the maximal flow-volume envelope, and reduced the fractional utilization of the maximal ventilatory capacity equally between men and women. The primary finding of this study was that inspiring HeO2 was associated with a statistically significant performance improvement of 0.7% (3.2 s) for males and 1.5% (8.1 s) for females (P < 0.05); however, there were no sex differences with respect to improvement in time trial performance (P > 0.05). Our results suggest that the extent of sex-based differences in airway anatomy, work of breathing, and expiratory flow limitation is not great enough to differentially affect whole body exercise performance.
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Affiliation(s)
- Sabrina S Wilkie
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Paolo B Dominelli
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Benjamin C Sporer
- Division of Sports Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada; and Canada Sport Institute Pacific, Vancouver, Canada
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, Vancouver, Canada; Division of Sports Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada; and
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, Canada;
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Acute respiratory muscle unloading by normoxic helium-O₂ breathing reduces the O₂ cost of cycling and perceived exertion in obese adolescents. Eur J Appl Physiol 2014; 115:99-109. [PMID: 25213005 DOI: 10.1007/s00421-014-2993-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In obesity, an increased work of breathing contributes to a higher O2 cost of exercise and negatively affects exercise tolerance. The purpose of the study was to determine whether, in obese adolescents, acute respiratory muscle unloading via normoxic helium-O2 breathing reduces the O2 cost of cycling and perceived exertion. METHODS Nine males [age 16.8 ± 1.6 (x ± SD) years, body mass 109.9 ± 15.0 kg] performed on a cycle ergometer, breathing room air (AIR) or a 21 % O2-79 % helium mixture (He-O2): an incremental exercise, for determination of [Formula: see text]O2 peak and gas exchange threshold (GET); 12 min constant work rate (CWR) exercises at 70 % of GET (<GET) and 120 % of GET (>GET) determined in AIR. RESULTS [Formula: see text]O2 peak was not different in the two conditions. From the 3rd to the 12th minute of exercise (both during CWR < GET and CWR > GET), [Formula: see text]O2 was lower in He-O2 vs. AIR (end-exercise values: 1.40 ± 0.14 vs. 1.57 ± 0.22 L min(-1) <GET, and 2.23 ± 0.31 vs. 2.54 ± 0.27 L min(-1) >GET). During CWR > GET in AIR, [Formula: see text]O2 linearly increased from the 3rd to the 12th minute of exercise, whereas no substantial increase was observed in He-O2. The O2 cost of cycling was ~10 % (<GET) and ~15 % (>GET) lower in He-O2 vs. AIR. Heart rate and ratings of perceived exertion for dyspnea/respiratory discomfort and leg effort were lower in He-O2. CONCLUSIONS In obese adolescents, acute respiratory muscle unloading via He-O2 breathing lowered the O2 cost of cycling and perceived exertion during submaximal moderate- and heavy-intensity exercise.
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Dominelli PB, Render JN, Molgat-Seon Y, Foster GE, Sheel AW. Precise mimicking of exercise hyperpnea to investigate the oxygen cost of breathing. Respir Physiol Neurobiol 2014; 201:15-23. [PMID: 24981705 DOI: 10.1016/j.resp.2014.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/13/2014] [Accepted: 06/17/2014] [Indexed: 11/25/2022]
Abstract
The oxygen cost of exercise hyperpnea (V˙(O2 RM)) has been quantified using a variety of techniques with inconsistent findings. Between-study variation relates to poor control of breathing patterns and lung mechanics. We developed a methodology allowing precise matching of exercising WOB in order to estimate V˙(O2 RM). Thirteen healthy young subjects (7 male) completed an incremental cycle exercise test, familiarization and experimental days where exercise hyperpnea was mimicked. On experimental days, feedback of exercise flow, volume and the respiratory pressures were provided while end-tidal CO2 was kept at exercise levels during each 5-min trial. Minute ventilation levels between 50 and 100% maximum were mimicked 3-5 times. The r(2) between exercise and mimic trails was 0.99 for frequency, tidal volume and minute ventilation; 0.86 for esophageal pressure swings and 0.93 for WOB. The coefficient of variation for (V˙(O2) averaged 4.3, 4.4 and 5.7% for 50, 75 and 100% ventilation trials. When WOB and other respiratory parameters are tightly controlled, the V˙(O2 RM) can be consistently estimated.
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Affiliation(s)
- P B Dominelli
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.
| | - J N Render
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Y Molgat-Seon
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - G E Foster
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada; Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - A W Sheel
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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49
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Wüthrich TU, Eberle EC, Spengler CM. Locomotor and diaphragm muscle fatigue in endurance athletes performing time-trials of different durations. Eur J Appl Physiol 2014; 114:1619-33. [DOI: 10.1007/s00421-014-2889-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/06/2014] [Indexed: 01/19/2023]
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50
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Lorenzo S, Babb TG. Ventilatory responses at peak exercise in endurance-trained obese adults. Chest 2014; 144:1330-1339. [PMID: 23722607 DOI: 10.1378/chest.12-3022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Alterations in respiratory mechanics predispose healthy obese individuals to low lung volume breathing, which places them at risk of developing expiratory flow limitation (EFL). The high ventilatory demand in endurance-trained obese adults further increases their risk of developing EFL and increases their work of breathing. The objective of this study was to investigate the prevalence and magnitude of EFL in fit obese (FO) adults via measurements of breathing mechanics and ventilatory dynamics during exercise. METHODS Ten (seven women and three men) FO (mean ± SD, 38 ± 5 years, 38% ± 5% body fat) and 10 (seven women and three men) control obese (CO) (38 ± 5 years, 39% ± 5% body fat) subjects underwent hydrostatic weighing, pulmonary function testing, cycle exercise testing, and the determination of the oxygen cost of breathing during eucapnic voluntary hyperpnea. RESULTS There were no differences in functional residual capacity (43% ± 6% vs 40% ± 9% total lung capacity [TLC]), residual volume (21% ± 4% vs 21% ± 4% TLC), or FVC (111% ± 13% vs 104% ± 15% predicted) between FO and CO subjects, respectively. FO subjects had higher FEV1 (111% ± 13% vs 99% ± 11% predicted), TLC (106% ± 14% vs 94% ± 7% predicted), peak expiratory flow (123% ± 14% vs 106% ± 13% predicted), and maximal voluntary ventilation (128% ± 15% vs 106% ± 13% predicted) than did CO subjects. Peak oxygen uptake (129% ± 16% vs 86% ± 15% predicted), minute ventilation (128 ± 35 L/min vs 92 ± 25 L/min), and work rate (229 ± 54 W vs 166 ± 55 W) were higher in FO subjects. Mean inspiratory (4.65 ± 1.09 L/s vs 3.06 ± 1.21 L/s) and expiratory (4.15 ± 0.95 L/s vs 2.98 ± 0.76 L/s) flows were greater in FO subjects, which yielded a greater breathing frequency (51 ± 8 breaths/min vs 41 ± 10 breaths/min) at peak exercise in FO subjects. Mechanical ventilatory constraints in FO subjects were similar to those in CO subjects despite the greater ventilatory demand in FO subjects. CONCLUSION FO individuals achieve high ventilations by increasing breathing frequency, matching the elevated metabolic demand associated with high fitness. They do this without developing meaningful ventilatory constraints. Therefore, endurance-trained obese individuals with higher lung function are not limited by breathing mechanics during peak exercise, which may allow healthy obese adults to participate in vigorous exercise training.
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Affiliation(s)
- Santiago Lorenzo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and The University of Texas Southwestern Medical Center, Dallas, TX
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and The University of Texas Southwestern Medical Center, Dallas, TX.
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