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Burtscher J, Millet GP, Gatterer H, Vonbank K, Burtscher M. Does Regular Physical Activity Mitigate the Age-Associated Decline in Pulmonary Function? Sports Med 2022; 52:963-970. [PMID: 35113387 PMCID: PMC9023399 DOI: 10.1007/s40279-022-01652-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 01/24/2023]
Abstract
Whereas the negative effects of aging and smoking on pulmonary function are undisputed, the potential favorable effects of physical activity on the aging process of the otherwise healthy lung remain controversial. This question is of particular clinical relevance when reduced pulmonary function compromises aerobic exercise capacity (maximal oxygen consumption) and thus contributes to an increased risk of morbidity and mortality. Here, we discuss whether and when the aging-related decline in pulmonary function limits maximal oxygen consumption and whether, how, and to what extent regular physical activity can slow down this aging process and preserve pulmonary function and maximal oxygen consumption. Age-dependent effects of reduced pulmonary function (i.e., FEV1, the volume that has been exhaled after the first second of forced expiration) on maximal oxygen consumption have been observed in several cross-sectional and longitudinal studies. Complex interactions between aging-related cellular and molecular processes affecting the lung, and structural and functional deterioration of the cardiovascular and respiratory systems account for the concomitant decline in pulmonary function and maximal oxygen consumption. Consequently, if long-term regular physical activity mitigates some of the aging-related decline in pulmonary function (i.e., FEV1 decline), this could also prevent a steep fall in maximal oxygen consumption. In contrast to earlier research findings, recent large-scale longitudinal studies provide growing evidence for the beneficial effects of physical activity on FEV1. Although further confirmation of those effects is required, these findings provide powerful arguments to start and/or maintain regular physical activity.
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Affiliation(s)
- Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Karin Vonbank
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, A-6020, Innsbruck, Austria.
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Kusić D, Connolly J, Kainulainen H, Semenova EA, Borisov OV, Larin AK, Popov DV, Generozov EV, Ahmetov II, Britton SL, Koch LG, Burniston JG. Striated muscle-specific serine/threonine-protein kinase beta segregates with high versus low responsiveness to endurance exercise training. Physiol Genomics 2019; 52:35-46. [PMID: 31790338 DOI: 10.1152/physiolgenomics.00103.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Bidirectional selection for either high or low responsiveness to endurance running has created divergent rat phenotypes of high-response trainers (HRT) and low-response trainers (LRT). We conducted proteome profiling of HRT and LRT gastrocnemius of 10 female rats (body weight 279 ± 35 g; n = 5 LRT and n = 5 HRT) from generation 8 of selection. Differential analysis of soluble proteins from gastrocnemius was conducted by label-free quantitation. Genetic association studies were conducted in 384 Russian international-level athletes (age 23.8 ± 3.4 yr; 202 men and 182 women) stratified to endurance or power disciplines. Proteomic analysis encompassed 1,024 proteins, 76 of which exhibited statistically significant (P < 0.05, false discovery rate <1%) differences between HRT and LRT muscle. There was significant enrichment of enzymes involved in glycolysis/gluconeogenesis in LRT muscle but no enrichment of gene ontology phrases in HRT muscle. Striated muscle-specific serine/threonine-protein kinase-beta (SPEG-β) exhibited the greatest difference in abundance and was 2.64-fold greater (P = 0.0014) in HRT muscle. Coimmunoprecipitation identified 24 potential binding partners of SPEG-β in HRT muscle. The frequency of the G variant of the rs7564856 polymorphism that increases SPEG gene expression was significantly greater (32.9 vs. 23.8%; OR = 1.6, P = 0.009) in international-level endurance athletes (n = 258) compared with power athletes (n = 126) and was significantly associated (β = 8.345, P = 0.0048) with a greater proportion of slow-twitch fibers in vastus lateralis of female endurance athletes. Coimmunoprecipitation of SPEG-β in HRT muscle discovered putative interacting proteins that link with previously reported differences in transforming growth factor-β signaling in exercised muscle.
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Affiliation(s)
- Denis Kusić
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | | | - Heikki Kainulainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Ekaterina A Semenova
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Oleg V Borisov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia.,Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Bonn, Germany
| | - Andrey K Larin
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Daniil V Popov
- Laboratory of Exercise Physiology, Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow, Russia
| | - Edward V Generozov
- Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia
| | - Ildus I Ahmetov
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.,Department of Molecular Biology and Genetics, Federal Research and Clinical Center of Physical-Chemical Medicine of Federal Medical Biological Agency, Moscow, Russia.,Laboratory of Molecular Genetics, Kazan State Medical University, Kazan, Russia
| | - Steven L Britton
- Department of Anaesthesiology, University of Michigan, Ann Arbor, Michigan.,Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan
| | - Lauren G Koch
- Department of Physiology and Pharmacology, The University of Toledo, Toledo, Ohio
| | - Jatin G Burniston
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, United Kingdom
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MacLean JE, DeHaan K, Fuhr D, Hariharan S, Kamstra B, Hendson L, Adatia I, Majaesic C, Lovering AT, Thompson RB, Nicholas D, Thebaud B, Stickland MK. Altered breathing mechanics and ventilatory response during exercise in children born extremely preterm. Thorax 2016; 71:1012-1019. [PMID: 27259338 PMCID: PMC5099182 DOI: 10.1136/thoraxjnl-2015-207736] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 05/03/2016] [Indexed: 11/05/2022]
Abstract
Background Extreme preterm birth confers risk of long-term impairments in lung function and exercise capacity. There are limited data on the factors contributing to exercise limitation following extreme preterm birth. This study examined respiratory mechanics and ventilatory response during exercise in a large cohort of children born extremely preterm (EP). Methods This cohort study included children 8–12 years of age who were born EP (≤28 weeks gestation) between 1997 and 2004 and treated in a large regionalised neonatal intensive care unit in western Canada. EP children were divided into no/mild bronchopulmonary dysplasia (BPD) (ie, supplementary oxygen or ventilation ceased before 36 weeks gestational age; n=53) and moderate/severe BPD (ie, continued supplementary oxygen or ventilation at 36 weeks gestational age; n=50). Age-matched control children (n=65) were born at full term. All children attempted lung function and cardiopulmonary exercise testing measurements. Results Compared with control children, EP children had lower airway flows and diffusion capacity but preserved total lung capacity. Children with moderate/severe BPD had evidence of gas trapping relative to other groups. The mean difference in exercise capacity (as measured by oxygen uptake (VO2)% predicted) in children with moderate/severe BPD was −18±5% and −14±5.0% below children with no/mild BPD and control children, respectively. Children with moderate/severe BPD demonstrated a potentiated ventilatory response and greater prevalence of expiratory flow limitation during exercise compared with other groups. Resting lung function did not correlate with exercise capacity. Conclusions Expiratory flow limitation and an exaggerated ventilatory response contribute to respiratory limitation to exercise in children born EP with moderate/severe BPD.
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Affiliation(s)
- J E MacLean
- Faculty of Medicine and Dentistry, Departments of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Faculty of Medicine and Dentistry, Women & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - K DeHaan
- Faculty of Medicine and Dentistry, Departments of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - D Fuhr
- Faculty of Medicine and Dentistry, Departments of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - S Hariharan
- Faculty of Medicine and Dentistry, Departments of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Faculty of Medicine and Dentistry, Women & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - B Kamstra
- Faculty of Medicine and Dentistry, Departments of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Faculty of Medicine and Dentistry, Women & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - L Hendson
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - I Adatia
- Faculty of Medicine and Dentistry, Departments of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Faculty of Medicine and Dentistry, Women & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - C Majaesic
- Faculty of Medicine and Dentistry, Departments of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - A T Lovering
- Department of Human Physiology, University of Oregon, Eugene, Oregon, USA
| | - R B Thompson
- Faculty of Medicine and Dentistry, Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - D Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - B Thebaud
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - M K Stickland
- Faculty of Medicine and Dentistry, Women & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Abstract
OBJECTIVES The objective of this review is to present a case-based clinical discussion on this topic. METHODS The article represents part of the proceedings of the Occupational and Environmental Lung Disease conference held by the American College of Chest Physicians at Toronto, Ontario, Canada, in 2013, and is based upon a nonsystematic review of the current literature by the author. RESULTS Although the American Medical Association Guides to the Evaluation of Permanent Impairment is the mainstay for evaluating respiratory impairment, many other impairment schemata are currently available in the United States. Impairment evaluation for a case with chronic respiratory disease and a separate case with asthma is discussed. CONCLUSIONS Pulmonary function tests are the cornerstone for evaluating respiratory impairment. Impairment values differ between various impairment schemata. Impairment evaluation for asthma may be particularly difficult.
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Affiliation(s)
- Akshay Sood
- From the University of New Mexico Health Sciences Center School of Medicine, Albuquerque, NM
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Bertens LC, Reitsma JB, van Mourik Y, Lammers JWJ, Moons KG, Hoes AW, Rutten FH. COPD detected with screening: impact on patient management and prognosis. Eur Respir J 2014; 44:1571-8. [DOI: 10.1183/09031936.00074614] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is uncertain whether screening of older persons for chronic obstructive pulmonary disease (COPD) is worthwhile because the effects on patient management and prognosis are unknown.We aimed to assess the short-term consequences of detecting COPD in frail elderly subjects with dyspnoea, considering pulmonary drug use, hospitalisations and all-cause mortality.Community-dwelling frail elderly subjects, aged 65 years and older, with dyspnoea, participating in a screening study on COPD and heart failure were included. Final diagnoses were assigned by an expert panel based on all data from the screening strategy, including spirometry. Follow-up data were collected from the general practitioners.Of the 386 patients, 84 (21.8%) were received a new diagnosis of COPD. Overall, changes in pulmonary drug prescription during 6 months of follow-up were infrequent (n = 53, 13.7%; among new cases of COPD, 15 (17.9%) out of 84). Of all participants, 25.9% were hospitalised in the first year of follow-up, with the highest rate in patients with newly detected COPD (32.1%).Many new cases of COPD could be detected by screening frail elderly subjects with dyspnoea, but the impact on patient management seems limited. Our study underlines the importance of obtaining follow-up data to assess the true impact of a (screen-detected) diagnosis of COPD on patient management and outcome.
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Neuromuscular Electrical Stimulation and Inspiratory Muscle Training as Potential Adjunctive Rehabilitation Options for Patients With Heart Failure. J Cardiopulm Rehabil Prev 2010; 30:209-23. [DOI: 10.1097/hcr.0b013e3181c56b78] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Resting lung function in the assessment of the exercise capacity in patients with chronic heart failure. Am J Med Sci 2010; 339:210-5. [PMID: 20220330 DOI: 10.1097/maj.0b013e3181c78540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the lung involvement in patients with chronic heart failure (CHF), the significance of lung function abnormalities to functional status in these patients is still controversial. We postulated that in patients with CHF, resting lung function assessment may provide information of clinical relevance on exercise capacity, expressed as peak oxygen uptake (VO2) and ventilatory response to CO2 production (VE/VCO2) during a maximal exercise. METHODS We studied 49 clinically stable patients with CHF (38 men, age range: 25-78 years) (New York Heart Association class range: I-IV) with left ventricular ejection fraction <40%. Patients with chronic obstructive pulmonary disease were excluded. Patients performed pulmonary function tests and maximal incremental exercise test. RESULTS Resting spirometry was related to the exercise capacity (P < 0.05), expressed as peak VO2. By means of receiver operating characteristic curve analysis, the forced expiratory volume at first second (FEV1) cutoff point, which better identified patients with a peak VO2 < or =14 mL/kg/min, was <79% of predicted value (0.79 sensitivity and 0.73 specificity). Resting lung diffusion capacity for carbon monoxide and end-tidal pressure of CO2 (PETCO2) were inversely correlated to VE/VCO2 (P < 0.01). The lung diffusion capacity for carbon monoxide and PETCO2 cutoff points, which better identified patients with VE/VCO2 value >34, were <58% of predicted (0.92 sensitivity and 0.42 specificity) and <33 mm Hg (0.67 sensitivity and 0.92 specificity), respectively. CONCLUSIONS In patients with CHF, resting lung function, including spirometry, lung diffusion capacity, and PETCO2, can provide clinically useful information on exercise capacity, by predicting peak VO2 and VE/VCO2 slope. The results of this study highlight the role of resting lung function in the assessment of the functional status of cardiac patients.
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Matthews IL, Fredriksen PM, Bjørnstad PG, Thaulow E, Gronn M. Reduced pulmonary function in children with the Fontan circulation affects their exercise capacity. Cardiol Young 2006; 16:261-7. [PMID: 16725065 DOI: 10.1017/s1047951106000345] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2005] [Indexed: 11/07/2022]
Abstract
Most children with functionally univentricular hearts nowadays are treated surgically by creating a total cavopulmonary connection. In the resulting Fontan circulation, the venous return and the pulmonary arterial bed are coupled in series, bypassing the heart. This gives the potential for interaction between the abnormal circulation and function of the lungs. In this study, we investigated the pattern of impairment of pulmonary function, and its relation to decreased exercise capacity. We performed spirometry in 33 (85 percent) of 39 eligible Norwegian children, aged from 8 to 16, with a total cavopulmonary connection, along with whole body plethysmography, the carbon monoxide single breath test, and a peak treadmill exercise test. The single breath test showed a mean corrected diffusing capacity of 66.5 percent of predicted, giving a z score of minus 2.88. The mean residual volume measured by whole body plethysmography was 146.8 percent, equivalent to a z score of 2.46, whereas the mean residual volume measured by the single breath test was 102.4 percent of predicted, this being the same as a z score of 0.43. The mean peak treadmill exercise test was 70.0 percent of predicted, equivalent with a z score of minus 3.07. Mean forced vital capacity was 85.7 percent of predicted, the equivalent z score being minus 0.92. Lung function correlated with the peak treadmill exercise test. We have shown, therefore, that children with the Fontan circulation have reduced diffusing capacity, possibly caused by the abnormal circulation through the lungs. The difference between residual volume measured by plethysmography and the single breath test implies trapping of air. The correlation of parameters for lung function with peak consumption of oxygen during exercise indicates that the abnormalities of pulmonary function may affect physical capacity.
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Affiliation(s)
- Iren Lindbak Matthews
- Paediatric Department, Paediatric Pulmonology and Allergology Unit, Rikshospitalet University Hospital, Oslo, Norway.
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Ingle L, Shelton RJ, Cleland JGF, Clark AL. Poor Relationship Between Exercise Capacity and Spirometric Measurements in Patients With More Symptomatic Heart Failure. J Card Fail 2005; 11:619-23. [PMID: 16230266 DOI: 10.1016/j.cardfail.2005.06.430] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Revised: 06/02/2005] [Accepted: 06/06/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND The origin of exercise limitation in patients with chronic heart failure (CHF) is multifactorial, and the relative contributions of different abnormalities may vary with severity of heart failure symptoms. The aim of the current study was to determine the extent to which spirometric indices predict peak exercise capacity in patients with differing severity of symptoms. METHODS AND RESULTS A total of 340 patients with left ventricular systolic dysfunction underwent spirometry, and a ramped, maximal exercise treadmill test with metabolic gas exchange measurements. For comparative purposes, a group of 174 aged-matched controls with no major structural heart disease (MSHD) was also included. In a stepwise linear regression model, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were independent predictors of peak oxygen uptake (pVO2) in controls (r2= 18-25%; P = .001) and New York Heart Association (NYHA) I-II patients (r2= 16-18%; P = .001). No association between spirometric indices (FEV1/FVC) and pVO2 (r2= 1-2%; P > .05) was found in NYHA III-IV patients. CONCLUSION In aged-matched controls with no MSHD, spirometric variables (FEV1/FVC) explain 18% to 25% of the variance in pVO2, and 16% to 18% of the variance in patients with NYHA class I-II symptoms. As symptoms worsen, the influence of spirometric variables on peak exercise capacity diminishes, and there is no such relation in the NYHA class III-IV patients.
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Affiliation(s)
- Lee Ingle
- Department of Academic Cardiology, Castle Hill Hospital, Castle Road, Cottingham, Hull, United Kingdom
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Nanas S, Nanas J, Papazachou O, Kassiotis C, Papamichalopoulos A, Milic-Emili J, Roussos C. Resting lung function and hemodynamic parameters as predictors of exercise capacity in patients with chronic heart failure. Chest 2003; 123:1386-93. [PMID: 12740252 DOI: 10.1378/chest.123.5.1386] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to examine the role of resting pulmonary function and hemodynamic parameters as predictors of exercise capacity in patients with chronic heart failure. MEASUREMENTS AND RESULTS Fifty-one patients with chronic heart failure underwent resting pulmonary function testing, including inspiratory capacity (IC) and symptom-limited, treadmill cardiopulmonary exercise testing (CPET). Right-heart catheterization and radionuclide ventriculography were performed within 2 days of CPET. Mean (+/- SD) left ventricular ejection fraction was 31 +/- 12% and cardiac index was 2.34 +/- 0.77 L/min/m(2). Percentage of predicted FEV(1) was 92 +/- 14%, percentage of predicted FVC was 94 +/- 15%, FEV(1)/FVC was 81 +/- 4%, and percentage of predicted IC was 84 +/- 18%. Mean peak oxygen uptake (peak O(2)) was 17.9 +/- 5.4 mL/kg/min. Analysis of variance among the three functional Weber classes showed statistically significant differences for pulmonary capillary wedge pressure (PCWP) and IC. Specifically, the more severe the exercise intolerance, the lower was IC and the higher was PCWP. In a multivariate stepwise regression analysis, using peak O(2) (liters per minute) as the dependent variable and the pulmonary function test measurements as independent variables, the only significant predictor selected was IC (r = 0.71, p < 0.0001). In a final stepwise regression analysis including all the independent variables of the resting pulmonary function tests and hemodynamic measurements, the two predictors selected were IC and PCWP (r(2) = 0.58). CONCLUSIONS In patients with chronic heart failure, IC is inversely related to PCWP and is a strong independent predictor of functional capacity.
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Affiliation(s)
- Serafim Nanas
- Pulmonary and Critical Care Medicine Department, National and Kapodestrian University, Montreal, Canada.
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Abstract
Published data indicate that exercise in COPD is more often limited by leg effort than breathlessness. This casts some doubt on the classical belief that inability to ventilate limits exercise performance. In fact, symptoms limiting exercise appear to be essentially the same in COPD and in health or congestive heart failure, where exercise is limited by inadequate energy supply to locomotor muscles. In COPD, impaired O2 delivery to locomotor muscles is suggested by: (1) the O2 cost (VO2) of breathing may be approximately 50% of whole body VO2; (2) decreasing the work of breathing improves performance and VO2 of locomotor muscles, and (3) locomotor muscle VO2 is greater when it is the only muscle exercising than during whole body exercise. Excessive expiratory pressures when expiratory flow is limited may lead to decreased venous return and contribute importantly to exercise limitation.
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Affiliation(s)
- A Aliverti
- Dipartimento di Bioingegneria, Politecnico di Milano, and Centro di Bioingegneria of the Fondazione Don Gnocchi ONLUS-IRCCS and Politecnico di Milano, Italia.
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Faggiano P, D'Aloia A, Gualeni A, Giordano A. Relative contribution of resting haemodynamic profile and lung function to exercise tolerance in male patients with chronic heart failure. Heart 2001; 85:179-84. [PMID: 11156669 PMCID: PMC1729632 DOI: 10.1136/heart.85.2.179] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To clarify the relative contribution of resting haemodynamic profile and pulmonary function to exercise capacity in patients with heart failure. SETTING Cardiology department and cardiac rehabilitation unit in a tertiary centre. DESIGN 161 male patients (mean (SD) age 59 (9) years) with heart failure (New York Heart Association class II-IV, left ventricular ejection fraction 23 (7)%) underwent spirometry, alveolar capillary diffusing capacity (DLCO), and mouth inspiratory and expiratory pressures (MIP, MEP, respectively, in 100 patients). Right heart catheterisation and a symptom limited cardiopulmonary exercise test were performed in 137 patients within 3-4 days. RESULTS Mean peak exercise oxygen consumption (VO(2)) was 13 (3.9) ml/kg/min. Among resting haemodynamic variables only cardiac index showed a significant correlation with peak VO(2). There were no differences in haemodynamic variables between patients with peak VO(2) </= or > 14 ml/kg/min. There was a moderate correlation (p < 0.05) between several pulmonary function variables and peak VO(2). Forced vital capacity (3.5 (0.9) v 3.2 (0.8) l, p < 0.05) and DLCO (21.6 (6.9) v 17.7 (5.5) ml/mm Hg/min, p < 0.05) were higher in patients with peak VO(2) > 14 ml/kg/min than in those with peak VO(2) </= 14 ml/kg/min. Using a stepwise regression analysis, the respiratory and haemodynamic variables which correlated significantly with peak VO(2) were DLCO, MEP, and cardiac index, with an overall R value of 0.63. CONCLUSIONS The data confirm previous studies showing a poor correlation between resting indices of cardiac function and exercise capacity in heart failure. However, several pulmonary function variables were related to peak exercise VO(2). In particular, lung diffusing capacity and respiratory muscle function seem to affect exercise tolerance during heart failure.
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Affiliation(s)
- P Faggiano
- Cardiac Rehabilitation Division, S Maugeri Foundation, Gussago, Italy.
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Chauhan A, Sridhar G, Clemens R, Krishnan B, Marciniuk DD, Gallagher CG. Role of respiratory function in exercise limitation in chronic heart failure. Chest 2000; 118:53-60. [PMID: 10893359 DOI: 10.1378/chest.118.1.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To test the hypothesis that respiratory function contributes to limit maximal exercise performance in patients with chronic heart failure by using the technique of dead space loading during exercise. DESIGN Blinded subjects underwent two maximal incremental exercise tests in random order on an upright bicycle ergometer: one with and one without added dead space. SETTING : Tertiary-care university teaching hospital. SUBJECTS Seven patients with stable chronic heart failure (mean +/- SEM left ventricular ejection fraction, 27 +/- 3%). RESULTS Subjects were able to significantly increase their peak minute ventilation during exercise with added dead space when compared with control exercise (57.4 +/- 5.9 vs 50.0 +/- 5.6 L/min; p < 0.05). Peak oxygen uptake, workload, heart rate, and exercise duration were not significantly different between the added dead space and control tests. Breathing pattern was significantly deeper and slower at matched levels of ventilation during exercise with added dead space. CONCLUSION Because patients with chronic heart failure had significant ventilatory reserve at the end of exercise and were able to further increase their maximal minute ventilation, we conclude that respiratory function does not contribute to limitation of exercise in patients with chronic heart failure.
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Affiliation(s)
- A Chauhan
- Division of Respiratory Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Dublin, Ireland
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