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Robson LS, Abulimiti A, Granados JZ, Zia AN, Balmain BN, Pawelczyk JA, Babb TG. Pediatric patients diagnosed as overweight and obese have an elevated risk of dyspnea. Respir Physiol Neurobiol 2024; 323:104230. [PMID: 38340972 PMCID: PMC10947832 DOI: 10.1016/j.resp.2024.104230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
We investigated whether pediatric patients with overweight and obesity are more likely to have dyspnea compared with those who are non-overweight. We collected de-identified data from TriNetX, a global federated multicenter research database, using both the UT Southwestern Medical Center and multinational Research Networks. Our analysis focused on patients aged 8-12 years. We identified overweight and obesity using ICD-10-CM codes E66 and dyspnea using code R06.0. Patients with overweight and obesity had a significantly higher risk of dyspnea compared with those who were non-overweight. This association was observed in both the UT Southwestern Network (risk ratio: 1.81, p < 0.001) and the Research Network (risk ratio: 2.70, p < 0.001). Furthermore, within the UT Southwestern Network, the risk was found to be higher in females compared with males (risk ratio: 2.17 vs. 1.67). These results have significant clinical implications, suggesting that clinicians should consider overweight and obesity as independent risk factors for dyspnea in pediatric patients after excluding other possible contributing factors.
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Affiliation(s)
- Lydia S Robson
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, USA
| | - Abidan Abulimiti
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas, USA
| | - Jorge Z Granados
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas, USA
| | - Ayesha N Zia
- Department of Pediatrics, University of Texas Southwestern Medical Center, USA
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas, USA
| | - James A Pawelczyk
- Noll Physiological Research Center, Department of Kinesiology, Penn State University, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas, USA.
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Goh JT, Balmain BN, Tomlinson AR, MacNamara JP, Sarma S, Ritz T, Wakeham DJ, Brazile TL, Hynan LS, Levine BD, Babb TG. Respiratory symptom perception during exercise in patients with heart failure with preserved ejection fraction. Respir Physiol Neurobiol 2024; 325:104256. [PMID: 38583744 DOI: 10.1016/j.resp.2024.104256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
We investigated whether central or peripheral limitations to oxygen uptake elicit different respiratory sensations and whether dyspnea on exertion (DOE) provokes unpleasantness and negative emotions in patients with heart failure with preserved ejection fraction (HFpEF). 48 patients were categorized based on their cardiac output (Q̇c)/oxygen uptake (V̇O2) slope and stroke volume (SV) reserve during an incremental cycling test. 15 were classified as centrally limited and 33 were classified as peripherally limited. Ratings of perceived breathlessness (RPB) and unpleasantness (RPU) were assessed (Borg 0-10 scale) during a 20 W cycling test. 15 respiratory sensations statements (1-10 scale) and 5 negative emotions statements (1-10) were subsequently rated. RPB (Central: 3.5±2.0 vs. Peripheral: 3.4±2.0, p=0.86), respiratory sensations, or negative emotions were not different between groups (p>0.05). RPB correlated (p<0.05) with RPU (r=0.925), "anxious" (r=0.610), and "afraid" (r=0.383). While DOE provokes elevated levels of negative emotions, DOE and respiratory sensations seem more related to a common mechanism rather than central and/or peripheral limitations in HFpEF.
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Affiliation(s)
- Josh T Goh
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew R Tomlinson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Denis J Wakeham
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tiffany L Brazile
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- The O'Donnell School of Public Health and Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Haverkamp HC, Balmain BN. Ventilatory Responses to Exercise by Age, Sex, and Health Status. Curr Sports Med Rep 2024; 23:79-85. [PMID: 38437493 DOI: 10.1249/jsr.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
ABSTRACT An understanding of the normal pulmonary responses to incremental exercise is requisite for appropriate interpretation of findings from clinical exercise testing. The purpose of this review is to provide concrete information to aid the interpretation of the exercise ventilatory response in both healthy and diseased populations. We begin with an overview of the normal exercise ventilatory response to incremental exercise in the healthy, normally trained young-to-middle aged adult male. The exercise ventilatory responses in two nonpatient populations (females, elderly) are then juxtaposed with the responses in healthy males. The review concludes with overviews of the exercise ventilatory responses in four patient populations (obesity, chronic obstructive pulmonary disease, asthma, congestive heart failure). Again, we use the normal response in healthy adults as the framework for interpreting the responses in the clinical groups. For each healthy and clinical population, recent, impactful research findings will be presented.
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Affiliation(s)
- Hans Christian Haverkamp
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University-Spokane Health Sciences, Spokane, WA
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Stickford JL, Bhammar DM, Balmain BN, Babb TG. Static respiratory mechanics are unaltered in males and females with obesity. J Appl Physiol (1985) 2023; 135:1255-1262. [PMID: 37881847 PMCID: PMC10979829 DOI: 10.1152/japplphysiol.00519.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023] Open
Abstract
We tested the hypothesis that independent of the obesity-related shift in lung volume subdivisions, obesity would not reduce the interrelationships of expiratory flow, lung volume, and static lung elastic recoil pressure in males and females. Simultaneous measurements of expiratory flow, volume, and transpulmonary pressure were continuously recorded while flow-volume loops of varying expiratory efforts were performed in a pressure-corrected, volume-displacement body plethysmograph in males and females with obesity. Static compliance curves were collected using the occlusion technique. Flow-volume, static pressure-volume, and static pressure-flow relationships were examined. Isovolume pressure-flow curves were constructed for the determination of the critical pressure for maximal flow. Data were compared with that collected in lean males and females. Individuals with obesity displayed a notable decrease in functional residual capacity. The interrelationships of flow, lung volume, static elastic recoil pressure, and the minimum pressure required for maximal expiratory flow in males and females with obesity were not different from that in lean males and females (all P > 0.05). Obesity does not alter the interrelationships of flow-volume-pressure of the lung in adult males and females (all P > 0.05). We further explored potential sex differences in static mechanics independent of obesity and observed that females have lower maximal expiratory flow due to a combination of smaller lungs and greater upstream flow resistance compared with males (all P ≤ 0.05).NEW & NOTEWORTHY The potential influence of obesity on the interrelationships between maximal expiratory flow, lung volume, and static lung elastic recoil pressure is unclear. These data show that the presence of obesity does not alter the relationship of flow and pressure across the mid-expiratory range in males and females. In addition, independent of obesity, females have smaller lungs and greater upstream flow resistance, which contributes to reduced maximal flow, when compared with males.
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Affiliation(s)
- Jonathon L Stickford
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, Texas, United States
| | - Dharini M Bhammar
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, Texas, United States
- Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, Texas, United States
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, Texas, United States
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Babb TG, Balmain BN, Tomlinson AR, Hynan LS, Levine BD, MacNamara JP, Sarma S. Ventilatory limitations in patients with HFpEF and obesity. Respir Physiol Neurobiol 2023; 318:104167. [PMID: 37758032 DOI: 10.1016/j.resp.2023.104167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/13/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) patients have an increased ventilatory demand. Whether their ventilatory capacity can meet this increased demand is unknown, especially in those with obesity. Body composition (DXA) and pulmonary function were measured in 20 patients with HFpEF (69 ± 6 yr;9 M/11 W). Cardiorespiratory responses, breathing mechanics, and ratings of perceived breathlessness (RPB, 0-10) were measured at rest, 20 W, and peak exercise. FVC correlated with %body fat (R2 =0.51,P = 0.0006), V̇O2peak (%predicted,R2 =0.32,P = 0.001), and RPB (R2 =0.58,P = 0.0004). %Body fat correlated with end-expiratory lung volume at rest (R2 =0.76,P < 0.001), 20 W (R2 =0.72,P < 0.001), and peak exercise (R2 =0.74,P < 0.001). Patients were then divided into two groups: those with lower ventilatory reserve (FVC<3 L,2 M/10 W) and those with higher ventilatory reserve (FVC>3.8 L,7 M/1 W). V̇O2peak was ∼22% less (p < 0.05) and RPB was twice as high at 20 W (p < 0.01) in patients with lower ventilatory reserve. Ventilatory reserves are limited in patients with HFpEF and obesity; indeed, the margin between ventilatory demand and capacity is so narrow that exercise capacity could be ventilatory limited in many patients.
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Affiliation(s)
- Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew R Tomlinson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Peter O'Donnell Jr. School of Public Health and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Goh JT, Balmain BN, Wilhite DP, Granados J, Sandy LL, Liu YL, Pawelczyk JA, Babb TG. Elevated risk of dyspnea in adults with obesity. Respir Physiol Neurobiol 2023; 318:104151. [PMID: 37673304 DOI: 10.1016/j.resp.2023.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 09/08/2023]
Abstract
We investigated whether older adults (OA) with obesity are more likely to have dyspnea compared with OA without obesity, and whether OA with obesity are at a greater risk of having dyspnea compared with middle-aged (MA) and younger adults (YA) with obesity. We obtained de-identified data from the TriNetX UT Southwestern Medical Center database. We identified obesity and dyspnea using ICD-10-CM codes E66 and R06.0, respectively. Patients were separated into three age groups: OA, (65-75 y.o.), MA (45-55 y.o.), and YA (25-35 y.o). Within these groups, those with and without obesity or dyspnea were identified for analysis. The risk of dyspnea was greater in OA (risk ratio: 3.64), MA (risk ratio: 3.52), and YA (risk ratio: 2.76) with obesity compared with age-matched patients without obesity (all p < 0.01). The risk of dyspnea was greater in OA and MA with obesity compared with YA with obesity (both p < 0.001 vs. YA). These findings suggest that clinicians should consider obesity as an independent risk factor for dyspnea.
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Affiliation(s)
- Josh T Goh
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel P Wilhite
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jorge Granados
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lydia L Sandy
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yu-Lun Liu
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James A Pawelczyk
- Noll Laboratory, Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Balmain BN, Tomlinson AR, MacNamara JP, Hynan LS, Wakeham DJ, Levine BD, Sarma S, Babb TG. Reducing Pulmonary Capillary Wedge Pressure During Exercise Exacerbates Exertional Dyspnea in Patients With Heart Failure With Preserved Ejection Fraction: Implications for V˙/Q˙ Mismatch. Chest 2023; 164:686-699. [PMID: 37030529 PMCID: PMC10548458 DOI: 10.1016/j.chest.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND The primary cause of dyspnea on exertion in heart failure with preserved ejection fraction (HFpEF) is presumed to be the marked rise in pulmonary capillary wedge pressure during exercise; however, this hypothesis has never been tested directly. Therefore, we evaluated invasive exercise hemodynamics and dyspnea on exertion in patients with HFpEF before and after acute nitroglycerin (NTG) treatment to lower pulmonary capillary wedge pressure. RESEARCH QUESTION Does reducing pulmonary capillary wedge pressure during exercise with NTG improve dyspnea on exertion in HFpEF? STUDY DESIGN AND METHODS Thirty patients with HFpEF performed two invasive 6-min constant-load cycling tests (20 W): one with placebo (PLC) and one with NTG. Ratings of perceived breathlessness (0-10 scale), pulmonary capillary wedge pressure (right side of heart catheter), and arterial blood gases (radial artery catheter) were measured. Measurements of V˙/Q˙ matching, including alveolar dead space (Vdalv; Enghoff modification of the Bohr equation) and the alveolar-arterial Po2 difference (A-aDO2; alveolar gas equation), were also derived. The ventilation (V˙e)/CO2 elimination (V˙co2) slope was also calculated as the slope of the V˙e and V˙co2 relationship, which reflects ventilatory efficiency. RESULTS Ratings of perceived breathlessness increased (PLC: 3.43 ± 1.94 vs NTG: 4.03 ± 2.18; P = .009) despite a clear decrease in pulmonary capillary wedge pressure at 20 W (PLC: 19.7 ± 8.2 vs NTG: 15.9 ± 7.4 mm Hg; P < .001). Moreover, Vdalv (PLC: 0.28 ± 0.07 vs NTG: 0.31 ± 0.08 L/breath; P = .01), A-aDO2 (PLC: 19.6 ± 6.7 vs NTG: 21.1 ± 6.7; P = .04), and V˙e/V˙co2 slope (PLC: 37.6 ± 5.7 vs NTG: 40.2 ± 6.5; P < .001) all increased at 20 W after a decrease in pulmonary capillary wedge pressure. INTERPRETATION These findings have important clinical implications and indicate that lowering pulmonary capillary wedge pressure does not decrease dyspnea on exertion in patients with HFpEF; rather, lowering pulmonary capillary wedge pressure exacerbates dyspnea on exertion, increases V˙/Q˙ mismatch, and worsens ventilatory efficiency during exercise in these patients. This study provides compelling evidence that high pulmonary capillary wedge pressure is likely a secondary phenomenon rather than a primary cause of dyspnea on exertion in patients with HFpEF, and a new therapeutic paradigm is needed to improve symptoms of dyspnea on exertion in these patients.
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Affiliation(s)
- Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrew R Tomlinson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Linda S Hynan
- The O'Donnell School of Public Health and Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Denis J Wakeham
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Jaffery MF, Balmain BN, Wilhite DP, Babb TG, Crandall CG. Six Months of Exercise Training Improves Ventilatory Responses during Exercise in Adults with Well-Healed Burn Injuries. Med Sci Sports Exerc 2023; 55:765-776. [PMID: 36729937 PMCID: PMC10106361 DOI: 10.1249/mss.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Pulmonary function is lower after a severe burn injury, which could influence ventilatory responses during exercise. It is unclear whether exercise training improves pulmonary function or ventilatory responses during exercise in adults with well-healed burn injuries. Therefore, we tested the hypothesis that exercise training improves pulmonary function and ventilatory responses during exercise in adults with well-healed burn injuries. METHODS Thirty-nine adults (28 with well-healed burn injuries and 11 non-burn-injured controls) completed 6 months of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we performed comprehensive pulmonary function testing and measured ventilatory responses during cycling exercise. We compared variables using two-way ANOVA (group-time; i.e., preexercise/postexercise training (repeated factor)). RESULTS Exercise training did not increase percent predicted spirometry, lung diffusing capacity, or airway resistance measures (time: P ≥ 0.14 for all variables). However, exercise training reduced minute ventilation ( V̇E ; time: P ≤ 0.05 for 50 and 75 W) and the ventilatory equivalent for oxygen ( V̇E /V̇O 2 ; time: P < 0.001 for 75 W) during fixed-load exercise for both groups. The ventilatory equivalent for carbon dioxide ( V̇E /V̇CO 2 ) during exercise at 75 W was reduced after exercise training (time: P = 0.04). The percentage of age-predicted maximum heart rate at the ventilatory threshold was lower in adults with well-healed burn injuries before ( P = 0.002), but not after ( P = 0.22), exercise training. Lastly, exercise training increased V̇E and reduced V̇E /V̇O 2 during maximal exercise (time: P = 0.005 for both variables). CONCLUSIONS These novel findings demonstrate that exercise training can improve ventilatory responses during exercise in adults with well-healed burn injuries.
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Affiliation(s)
- Joseph C. Watso
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX
| | - Steven A. Romero
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, TX
| | - Gilbert Moralez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mu Huang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX
- Office of Science, Medicine, and Health, American Heart Association, Dallas, TX
| | - Matthew N. Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Manall F. Jaffery
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Bryce N. Balmain
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Daniel P. Wilhite
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Tony G. Babb
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
| | - Craig G. Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX
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Foster J, Balmain BN, Wilhite DP, Watso JC, Babb TG, Cramer MN, BelvaL LN, Crandall CG. Inhibiting regional sweat evaporation modifies the ventilatory response to exercise: interactions between core and skin temperature. J Appl Physiol (1985) 2023; 134:1011-1021. [PMID: 36892886 PMCID: PMC10110718 DOI: 10.1152/japplphysiol.00597.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
In humans, elevated body temperatures can markedly increase the ventilatory response to exercise. However, the impact of changing the effective body surface area (BSA) for sweat evaporation (BSAeff) on such responses is unclear. Ten healthy adults (9 males, 1 female) performed eight exercise trials cycling at 6 W/kg of metabolic heat production for 60 min. Four conditions were used where BSAeff corresponded to 100%, 80%, 60%, and 40% of BSA using vapor-impermeable material. Four trials (one at each BSAeff) were performed at 25°C air temperature, and four trials (one at each BSAeff) at 40°C air temperature, each with 20% humidity. The slope of the relation between minute ventilation and carbon dioxide elimination (V̇E/V̇co2 slope) assessed the ventilatory response. At 25°C, the V̇E/V̇co2 slope was elevated by 1.9 and 2.6 units when decreasing BSAeff from 100 to 80 and to 40% (P = 0.033 and 0.004, respectively). At 40°C, V̇E/V̇co2 slope was elevated by 3.3 and 4.7 units, when decreasing BSAeff from 100 to 60 and to 40% (P = 0.016 and P < 0.001, respectively). Linear regression analyses using group average data from each condition demonstrated that end-exercise mean body temperature (integration of core and mean skin temperature) was better associated with the end-exercise ventilatory response, compared with core temperature alone. Overall, we show that impeding regional sweat evaporation increases the ventilatory response to exercise in temperate and hot environmental conditions, and the effect is mediated primarily by increases in mean body temperature.NEW & NOTEWORTHY Exercise in the heat increases the slope of the relation between minute ventilation and carbon dioxide elimination (V̇E/V̇co2 slope) in young healthy adults. An indispensable role for skin temperature in modulating the ventilatory response to exercise is noted, contradicting common belief that internal/core temperature acts independently as a controller of ventilation during hyperthermia.
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Affiliation(s)
- Josh Foster
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Bryce N Balmain
- Pulmonary Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Daniel P Wilhite
- Pulmonary Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Joseph C Watso
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Cardiovascular and Applied Physiology Laboratory, Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Tony G Babb
- Pulmonary Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Matthew N Cramer
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Luke N BelvaL
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Craig G Crandall
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
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10
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Sarma S, MacNamara JP, Balmain BN, Hearon CM, Wakeham DJ, Tomlinson AR, Hynan LS, Babb TG, Levine BD. Challenging the Hemodynamic Hypothesis in Heart Failure With Preserved Ejection Fraction: Is Exercise Capacity Limited by Elevated Pulmonary Capillary Wedge Pressure? Circulation 2023; 147:378-387. [PMID: 36524474 PMCID: PMC9892242 DOI: 10.1161/circulationaha.122.061828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Exercise intolerance is a defining characteristic of heart failure with preserved ejection fraction (HFpEF). A marked rise in pulmonary capillary wedge pressure (PCWP) during exertion is pathognomonic for HFpEF and is thought to be a key cause of exercise intolerance. If true, acutely lowering PCWP should improve exercise capacity. To test this hypothesis, we evaluated peak exercise capacity with and without nitroglycerin to acutely lower PCWP during exercise in patients with HFpEF. METHODS Thirty patients with HFpEF (70±6 years of age; 63% female) underwent 2 bouts of upright, seated cycle exercise dosed with sublingual nitroglycerin or placebo control every 15 minutes in a single-blind, randomized, crossover design. PCWP (right heart catheterization), oxygen uptake (breath × breath gas exchange), and cardiac output (direct Fick) were assessed at rest, 20 Watts (W), and peak exercise during both placebo and nitroglycerin conditions. RESULTS PCWP increased from 8±4 to 35±9 mm Hg from rest to peak exercise with placebo. With nitroglycerin, there was a graded decrease in PCWP compared with placebo at rest (-1±2 mm Hg), 20W (-5±5 mm Hg), and peak exercise (-7±6 mm Hg; drug × exercise stage P=0.004). Nitroglycerin did not affect oxygen uptake at rest, 20W, or peak (placebo, 1.34±0.48 versus nitroglycerin, 1.32±0.46 L/min; drug × exercise P=0.984). Compared with placebo, nitroglycerin lowered stroke volume at rest (-8±13 mL) and 20W (-7±11 mL), but not peak exercise (0±10 mL). CONCLUSIONS Sublingual nitroglycerin lowered PCWP during submaximal and maximal exercise. Despite reduction in PCWP, peak oxygen uptake was not changed. These results suggest that acute reductions in PCWP are insufficient to improve exercise capacity, and further argue that high PCWP during exercise is not by itself a limiting factor for exercise performance in patients with HFpEF. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04068844.
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Affiliation(s)
- Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
- University of Texas Southwestern Medical Center, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
- University of Texas Southwestern Medical Center, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
- University of Texas Southwestern Medical Center, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
- University of Texas Southwestern Medical Center, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
| | - Denis J Wakeham
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
- University of Texas Southwestern Medical Center, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
| | - Andrew R Tomlinson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
- University of Texas Southwestern Medical Center, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
| | - Linda S Hynan
- Peter O'Donnell Jr School of Public Health and Department of Psychiatry (L.S.H.)
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
- University of Texas Southwestern Medical Center, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
- University of Texas Southwestern Medical Center, Dallas (S.S., J.P.M., B.N.B., C.M.H., D.J.W., A.R.T., T.G.B., B.D.L.)
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11
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Balmain BN, Tomlinson AR, MacNamara JP, Hynan LS, Levine BD, Sarma S, Babb TG. Alveolar Dead Space Is Augmented During Exercise in Patients With Heart Failure With Preserved Ejection Fraction. Chest 2022; 162:1349-1359. [PMID: 35753384 PMCID: PMC10403624 DOI: 10.1016/j.chest.2022.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with heart failure with preserved ejection fraction (HFpEF) exhibit many cardiopulmonary abnormalities that could result in V˙/Q˙ mismatch, manifesting as an increase in alveolar dead space (VDalveolar) during exercise. Therefore, we tested the hypothesis that VDalveolar would increase during exercise to a greater extent in patients with HFpEF compared with control participants. RESEARCH QUESTION Do patients with HFpEF develop VDalveolar during exercise? STUDY DESIGN AND METHODS Twenty-three patients with HFpEF and 12 control participants were studied. Gas exchange (ventilation [V˙E], oxygen uptake [V˙o2], and CO2 elimination [V˙co2]) and arterial blood gases were analyzed at rest, twenty watts (20W), and peak exercise. Ventilatory efficiency (evaluated as the V˙E/V˙co2 slope) also was measured from rest to 20W in patients with HFpEF. The physiologic dead space (VDphysiologic) to tidal volume (VT) ratio (VD/VT) was calculated using the Enghoff modification of the Bohr equation. VDalveolar was calculated as: (VD / VT × VT) - anatomic dead space. Data were analyzed between groups (patients with HFpEF vs control participants) across conditions (rest, 20W, and peak exercise) using a two-way repeated measures analysis of variance and relationships were analyzed using Pearson correlation coefficient. RESULTS VDalveolar increased from rest (0.12 ± 0.07 L/breath) to 20W (0.22 ± 0.08 L/breath) in patients with HFpEF (P < .01), whereas VDalveolar did not change from rest (0.01 ± 0.06 L/breath) to 20W (0.06 ± 0.13 L/breath) in control participants (P = .19). Thereafter, VDalveolar increased from 20W to peak exercise in patients with HFpEF (0.37 ± 0.16 L/breath; P < .01 vs 20W) and control participants (0.19 ± 0.17 L/breath; P = .03 vs 20W). VDalveolar was greater in patients with HFpEF compared with control participants at rest, 20W, and peak exercise (main effect for group, P < .01). Moreover, the increase in VDalveolar correlated with the V˙E/V˙co2 slope (r = 0.69; P < .01), which was correlated with peak V˙o2peak (r = 0.46; P < .01) in patients with HFpEF. INTERPRETATION These data suggest that the increase in V˙/Q˙ mismatch may be explained by increases in VDalveolar and that increases in VDalveolar worsens ventilatory efficiency, which seems to be a key contributor to exercise intolerance in patients with HFpEF.
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Affiliation(s)
- Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Andrew R Tomlinson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Linda S Hynan
- Department of Population and Data Sciences (Biostatistics) & Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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12
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Balmain BN, Tomlinson AR, MacNamara JP, Sarma S, Morris M, Moran R, Payne M, Samels M, Lee D, Levine BD, Babb TG. Nitroglycerin Increases Alveolar Dead Space During Exercise In Patients With Heart Failure With Preserved Ejection Fraction. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000876328.03999.b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Jaffery MF, Balmain BN, Wilhite DP, Babb T, Crandall CG. Pulmonary Function After Six Months Of Progressive Exercise Training In Adult Burn-injury Survivors. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000878548.56816.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Bhammar DM, Balmain BN, Babb TG, Bernhardt V. Sex differences in the ventilatory responses to exercise in mild-moderate obesity. Exp Physiol 2022; 107:965-977. [PMID: 35771362 PMCID: PMC9357174 DOI: 10.1113/ep090309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of the study? What are the sex differences in ventilatory responses during exercise in adults with obesity. What is the main finding and its importance? Tidal volume and expiratory flows are lower in females when compared with males at higher levels of ventilation despite small increases in end-expiratory lung volumes. Since dyspnea on exertion is a frequent complaint, particularly in females with obesity, careful attention should be paid to unpleasant respiratory symptoms and mechanical ventilatory constraints before prescribing exercise. ABSTRACT Obesity is associated with altered ventilatory responses, which may be exacerbated in females due to the functional consequences of sex-related morphological differences in the respiratory system. This study examined sex differences in ventilatory responses during exercise in adults with obesity. Healthy adults with obesity (n = 73; 48 females) underwent pulmonary function testing, underwater weighing, magnetic resonance imaging, a graded exercise test to exhaustion, and two constant work rate exercise tests; one at a fixed work rate (60W for females and 105W for males) and one at a relative intensity (50% of peak oxygen uptake, V̇O2peak ). Metabolic, respiratory, and perceptual responses were assessed during exercise. Compared with males, females used a smaller proportion of their ventilatory capacity at peak exercise (69.13 ± 14.49 vs. 77.41 ± 17.06 % maximum voluntary ventilation, P = 0.0374). Females also utilized a smaller proportion of their forced vital capacity (FVC) at peak exercise (tidal volume: 48.51±9.29 vs. 54.12±10.43 %FVC, P = 0.0218). End-expiratory lung volumes were 2-4% higher in females compared with males during exercise (P<0.05), while end-inspiratory lung volumes were similar. Since the males were initiating inspiration from a lower lung volume, they experienced greater expiratory flow limitation during exercise. Ratings of perceived breathlessness during exercise were similar between females and males at comparable levels of ventilation. In summary, sex differences in the manifestations of obestity-related mechanical ventilatory constraints were observed. Since dyspnea on exertion is a common complaint in patients with obesity, particularly in females, exercise prescriptions should be tailored with the goal of minimizing unpleasant respiratory sensations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dharini M Bhammar
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA.,Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA
| | - Vipa Bernhardt
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA.,Department of Health & Human Performance, Texas A&M University - Commerce, Commerce, TX, USA
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15
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Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Jaffery MF, Balmain BN, Wilhite DP, Babb TG, Crandall CG. Adults with well-healed burn injuries have lower pulmonary function values decades after injury. Physiol Rep 2022; 10:e15264. [PMID: 35581737 PMCID: PMC9114657 DOI: 10.14814/phy2.15264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/25/2022] [Indexed: 06/15/2023] Open
Abstract
Sub-acute (e.g., inhalation injury) and/or acute insults sustained during a severe burn injury impairs pulmonary function. However, previous work has not fully characterized pulmonary function in adults with well-healed burn injuries decades after an injury. Therefore, we tested the hypothesis that adults with well-healed burn injuries have lower pulmonary function years after recovery. Our cohort of adults with well-healed burn-injuries (n = 41) had a lower forced expiratory volume in one second (Burn: 93 ± 16 vs. Control: 103 ± 10%predicted, mean ± SD; d = 0.60, p = 0.04), lower maximal voluntary ventilation (Burn: 84 [71-97] vs. Control: 105 [94-122] %predicted, median [IQR]; d = 0.84, p < 0.01), and a higher specific airway resistance (Burn: 235 ± 80 vs. Control: 179 ± 40%predicted, mean ± SD; d = 0.66, p = 0.02) than non-burned control participants (n = 12). No variables were meaningfully influenced by having a previous inhalation injury (d ≤ 0.44, p ≥ 0.19; 13 of 41 had an inhalation injury), the size of the body surface area burned (R2 ≤ 0.06, p ≥ 0.15; range of 15%-88% body surface area burned), or the time since the burn injury (R2 ≤ 0.04, p ≥ 0.22; range of 2-50 years post-injury). These data suggest that adults with well-healed burn injuries have lower pulmonary function decades after injury. Therefore, future research should examine rehabilitation strategies that could improve pulmonary function among adults with well-healed burn injuries.
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Affiliation(s)
- Joseph C. Watso
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- Department of Applied Clinical ResearchSchool of Health ProfessionsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Steven A. Romero
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- Department of Physiology & AnatomyUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Gilbert Moralez
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- Department of Applied Clinical ResearchSchool of Health ProfessionsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Mu Huang
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
- Department of Applied Clinical ResearchSchool of Health ProfessionsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Matthew N. Cramer
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Manall F. Jaffery
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Bryce N. Balmain
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Daniel P. Wilhite
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Tony G. Babb
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
| | - Craig G. Crandall
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Institute for Exercise and Environmental MedicineTexas Health Presbyterian Hospital DallasDallasTexasUSA
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16
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Balmain BN, Tomlinson AR, MacNamara JP, Sarma S, Levine BD, Hynan LS, Babb TG. Physiological dead space during exercise in patients with heart failure with preserved ejection fraction. J Appl Physiol (1985) 2022; 132:632-640. [PMID: 35112932 PMCID: PMC8897014 DOI: 10.1152/japplphysiol.00786.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is associated with cardiopulmonary abnormalities that may increase physiological dead space to tidal volume (VD/VT) during exercise. However, studies have not corrected VD/VT for apparatus mechanical dead space (VDM), which may confound the accurate calculation of VD/VT. We evaluated whether calculating physiological dead space with (VD/VTVDM) and without (VD/VT) correcting for VDM impacts the interpretation of gas exchange efficiency during exercise in HFpEF. Fifteen HFpEF (age: 69 ± 6 yr; V̇o2peak: 1.34 ± 0.45 L/min) and 12 controls (70 ± 3 yr; V̇o2peak: 1.70 ± 0.51 L/min) were studied. Pulmonary gas exchange and arterial blood gases were analyzed at rest, submaximal (20 W for HFpEF and 40 W for controls), and peak exercise. VD/VT was calculated as [Formula: see text] - [Formula: see text]/[Formula: see text]. VD/VTVDM was calculated as [Formula: see text] - [Formula: see text]/[Formula: see text] - VDM/VT. VD/VT decreased from rest (HFpEF: 0.54 ± 0.07; controls: 0.32 ± 0.07) to submaximal exercise (HFpEF: 0.46 ± 0.07; controls: 0.25 ± 0.06) in both groups (P < 0.05), but remained stable (P > 0.05) thereafter to peak exercise (HFpEF: 0.46 ± 0.09; controls: 0.22 ± 0.05). In HFpEF, VD/VTVDM did not change (P = 0.58) from rest (0.29 ± 0.07) to submaximal exercise (0.29 ± 0.06), but increased (P = 0.02) thereafter to peak exercise (0.33 ± 0.06). In controls, VD/VTVDM remained stable such that no change was observed (P > 0.05) from rest (0.17 ± 0.06) to submaximal exercise (0.14 ± 0.06), or thereafter to peak exercise (0.14 ± 0.05). Calculating physiological dead space with and without a VDM correction yields quantitively and qualitatively different results, which could have impact on the interpretation of gas exchange efficiency in HFpEF. Further investigation is required to uncover the clinical consequences and the mechanism(s) explaining the increase in VD/VTVDM during exercise in HFpEF.NEW & NOTEWORTHY Calculating VD/VT with and without correcting for VDM yields quantitively and qualitatively different results, which could have an important impact on the interpretation of V/Q mismatch in HFpEF. The finding that V/Q mismatch and gas exchange efficiency worsened, as reflected by an increase in VD/VTVDM during exercise, has not been previously demonstrated in HFpEF. Thus, further studies are needed to investigate the mechanisms explaining the increase in VD/VTVDM during exercise in patients with HFpEF.
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Affiliation(s)
- Bryce N. Balmain
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew R. Tomlinson
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James P. MacNamara
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Satyam Sarma
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin D. Levine
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Linda S. Hynan
- 3Department of Population and Data Sciences (Biostatistics) & Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tony G. Babb
- 1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas,2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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17
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Balmain BN, Tomlinson AR, MacNamara JP, Sarma S, Levine BD, Hynan LS, Babb TG. Estimating exercise Pa CO2 in patients with heart failure with preserved ejection fraction. J Appl Physiol (1985) 2022; 132:36-45. [PMID: 34762529 PMCID: PMC8721897 DOI: 10.1152/japplphysiol.00474.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/25/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023] Open
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) exhibit cardiopulmonary abnormalities that could affect the predictability of exercise [Formula: see text] from the Jones corrected partial pressure of end-tidal CO2 (PJCO2) equation (PJCO2 = 5.5 + 0.9 × [Formula: see text] - 2.1 × VT). Since the dead space to tidal volume (VD/VT) calculation also includes [Formula: see text] measurements, estimates of VD/VT from PJCO2 may also be affected. Because using noninvasive estimates of [Formula: see text] and VD/VT could save patient discomfort, time, and cost, we examined whether partial pressure of end-tidal CO2 ([Formula: see text]) and PJCO2 can be used to estimate [Formula: see text] and VD/VT in 13 patients with HFpEF. [Formula: see text] was measured from expired gases measured simultaneously with radial arterial blood gases at rest, constant-load (20 W), and peak exercise. VD/VT[art] was calculated using the Enghoff modification of the Bohr equation, and estimates of VD/VT were calculated using [Formula: see text] (VD/VT[ET]) and PJCO2 (VD/VT[J]) in place of [Formula: see text]. [Formula: see text] was similar to [Formula: see text] at rest (-1.46 ± 2.63, P = 0.112) and peak exercise (0.66 ± 2.56, P = 0.392), but overestimated [Formula: see text] at 20 W (-2.09 ± 2.55, P = 0.020). PJCO2 was similar to [Formula: see text] at rest (-1.29 ± 2.57, P = 0.119) and 20 W (-1.06 ± 2.29, P = 0.154), but underestimated [Formula: see text] at peak exercise (1.90 ± 2.13, P = 0.009). VD/VT[ET] was similar to VD/VT[art] at rest (-0.01 ± 0.03, P = 0.127) and peak exercise (0.01 ± 0.04, P = 0.210), but overestimated VD/VT[art] at 20 W (-0.02 ± 0.03, P = 0.025). Although VD/VT[J] was similar to VD/VT[art] at rest (-0.01 ± 0.03, P = 0.156) and 20 W (-0.01 ± 0.03, P = 0.133), VD/VT[J] underestimated VD/VT[art] at peak exercise (0.03 ± 0.04, P = 0.013). Exercise [Formula: see text] and VD/VT[ET] provides better estimates of [Formula: see text] and VD/VT[art] than PJCO2 and VD/VT[J] does at peak exercise. Thus, estimates of [Formula: see text] and VD/VT should only be used if sampling arterial blood during CPET is not feasible.NEW & NOTEWORTHY [Formula: see text] provides a better estimate of [Formula: see text] than PJCO2 at peak exercise, and VD/VT[ET] provides a better estimate of VD/VT[art] than VD/VT[J] at peak exercise. Although we reported significant correlations, we did not find an identity between [Formula: see text] and estimates of [Formula: see text], nor did we find an identity between VD/VT[art] and estimates of VD/VT[art]. Thus, caution should be taken and estimates of [Formula: see text] and VD/VT should only be used if sampling arterial blood during CPET is not feasible.
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Affiliation(s)
- Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew R Tomlinson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Linda S Hynan
- Department of Population and Data Sciences (Biostatistics) & Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas
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18
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Bernhardt V, Stickford JL, Bhammar DM, Balmain BN, Babb TG. Repeatability of dyspnea measurements during exercise in women with obesity. Respir Physiol Neurobiol 2021; 297:103831. [PMID: 34922000 DOI: 10.1016/j.resp.2021.103831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/10/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022]
Abstract
While the 0-10 Borg scale to rate perceived breathlessness (RPB) is widely used to assess dyspnea on exertion, the repeatability of RPB in women with obesity is unknown. We examined the repeatability of RPB in women with obesity during submaximal constant-load cycling following at least 10 weeks of normal daily life. Seventeen women (37 ± 7 yr; 34.6 ± 4.5 kg/m2) who rated their breathlessness as 3 on the Borg scale (i.e., "moderate") during 60 W submaximal cycling repeated the same test following 19 ± 9 weeks of normal living. Mean body weight (93.8 ± 16.1 vs. 93.6 ± 116.8 kg, p = 0.94) and RPB (3.0 ± 0.0 vs. 3.1 ± 1.4, p = 0.80) did not differ between pre- and post-normal living periods. We demonstrate that subjective ratings of breathlessness are repeatable for the majority of subjects and can be used to accurately assess DOE during submaximal constant-load cycling in women with obesity.
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Affiliation(s)
| | | | | | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA.
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19
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Abstract
Obesity alters chest wall mechanics, reduces lung volumes, and increases airway resistance. In addition, the luminal area of the larger conducting airways is smaller in women than in men when matched for lung size. We examined whether differences in pulmonary mechanics with obesity and sex were associated with the dysanapsis ratio (DR), an estimate of airway size when the expiratory flow is maximal, in men and women with and without obesity. In addition, we examined the ability to estimate DR using predicted versus measured static recoil pressure at 50% forced vital capacity (FVC; Pst50FVC). Participants completed pulmonary function testing and measurements of pulmonary mechanics. Flow, volume, and transpulmonary pressure were recorded while completing forced vital capacity (FVC) maneuvers in a body plethysmograph. Static compliance curves were collected using the occlusion technique. DR was calculated using measured values of forced midexpiratory flow and Pst50FVC. DR was also calculated using Pst predicted from previously reported data. There was no significant group (lean vs. obese) by sex interaction or main effect of group on DR. However, women displayed significantly larger DR compared with men. Predicted Pst50FVC was significantly greater than measured Pst50FVC. DR calculated from measured Pst was significantly greater than when using predicted Pst. In conclusion, although obesity does not appear to alter airway size, women may have larger airways compared with men when midexpiratory flow is maximal. In addition, DR estimated using predicted Pst should be used with caution.NEW & NOTEWORTHY It is unclear whether obesity in combination with sex influences the dysanapsis ratio (DR). These data indicate that DR is unaltered in adults with obesity and is greater in women than in men but similar between sexes when matched for lung volume. We also report a significant difference between predicted and measured static recoil pressure. Thus, we caution against predicting static recoil pressure in the calculation of DR.
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Affiliation(s)
- Jonathon L Stickford
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,Exercise and Respiratory Physiology Laboratory, Department of Health and Exercise Science, Appalachian State University, Boone, North Carolina
| | - Daniel P Wilhite
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Dharini M Bhammar
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
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20
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Spencer MD, Balmain BN, Bernhardt V, Wilhite DP, Babb TG. Dyspnea during exercise and voluntary hyperpnea in women with obesity. Respir Physiol Neurobiol 2021; 287:103638. [PMID: 33581294 DOI: 10.1016/j.resp.2021.103638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/23/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Temporal responses of ratings of perceived breathlessness (RBP) during constant-load and incremental exercise, and during voluntary hyperpnea (EVH) were examined in women with obesity. Following 6 min of constant-load (60W) cycling, 34 women rated RPB≥4 (+DOE) and 22 women rated RPB≤2 (-DOE). Both groups completed an incremental cycling test and an EVH test at 40 and 60L/min; RPB was assessed each minute of incremental cycling and at the end of each EVH trial. RPB increased with ventilation during constant-load (+DOE: R2=0.86; -DOE: R2=0.82) and incremental (+DOE: R2=0.91; -DOE: R2=0.92) exercise, but + DOE had a greater y-intercept than -DOE (60W: -0.16±1.53 vs. -0.73±0.55; incremental: -0.50±1.40 vs. -1.71±0.84). Despite matching ventilation, RPB was greater in + DOE at baseline (0.97±1.14 vs. 0.14±0.28), 40L/min (2.50±1.43 vs. 0.98±0.91), and 60L/min (3.94±2.19 vs. 2.07±1.32) during EVH. These findings show that despite linear associations between RPB and ventilation during exercise and voluntary hyperpnea, breathlessness perception at a given ventilatory demand is heightened in +DOE compared with -DOE.
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Affiliation(s)
- Matthew D Spencer
- Centre for Research in Occupational Safety and Health, Laurentian University, ON, Canada
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vipa Bernhardt
- Texas A&M University Commerce, Department of Health and Human Performance, Commerce, TX, USA
| | - Daniel P Wilhite
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA.
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21
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Wilhite DP, Bhammar DM, Balmain BN, Martinez-Fernandez T, Babb TG. Inhaled albuterol increases estimated ventilatory capacity in nonasthmatic children without and with obesity. Respir Physiol Neurobiol 2020; 285:103597. [PMID: 33301965 DOI: 10.1016/j.resp.2020.103597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/05/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Forced mid-expiratory flow (i.e., isoFEF25-75) may increase with a short-acting β2-agonist in nonasthmatic children without bronchodilator responsiveness. This could also increase estimated ventilatory capacity along mid-expiration (V̇Ecap25-75), especially in vulnerable children with obesity who exhibit altered breathing mechanics. We estimated V̇Ecap25-75 pre- and post-albuterol treatment in 8-12yo children without (n = 28) and with (n = 46) obesity. A two-way ANOVA was performed to determine effects of an inhaled bronchodilator (pre-post) and obesity (group) on isoFEF25-75 and V̇Ecap25-75. There was no group by bronchodilator interaction or main group effect on outcome variables. However, a significant main effect of the bronchodilator was detected in spirometry parameters, including a substantial increase in isoFEF25-75 (17.1 ± 18.0 %) and only a slight (non-clinical) but significant increase in FEV1 (2.4 ± 4.3 %). V̇Ecap25-75 significantly increased with albuterol (+11.7 ± 10.6 L/min; +15.8 ± 13.9 %). These findings imply potentially important increases in ventilatory reserve with a bronchodilator in nonasthmatic children without and with obesity, which could potentially influence respiratory function at rest and during exercise.
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Affiliation(s)
- Daniel P Wilhite
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, United States
| | - Dharini M Bhammar
- Department of Kinesiology and Nutrition Sciences, University of Nevada-Las Vegas, Las Vegas, NV, United States
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, United States
| | | | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, United States.
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22
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Balmain BN, Sabapathy S, Yamada A, Shiino K, Chan J, Haseler LJ, Kavanagh JJ, Morris NR, Stewart GM. Cardiac perturbations after high-intensity exercise are attenuated in middle-aged compared with young endurance athletes: diminished stress or depleted stimuli? Am J Physiol Heart Circ Physiol 2020; 320:H159-H168. [PMID: 33124881 DOI: 10.1152/ajpheart.00427.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Strenuous exercise elicits transient functional and biochemical cardiac imbalances. Yet, the extent to which these responses are altered owing to aging is unclear. Accordingly, echocardiograph-derived left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) and high-sensitivity cardiac troponin I (hs-cTnI) were assessed before (pre) and after (post) a 60-min high-intensity cycling race intervention (CRIT60) in 11 young (18-30 yr) and 11 middle-aged (40-65 yr) highly trained male cyclists, matched for cardiorespiratory fitness. LV and RV GLS were measured at rest and during a semirecumbent exercise challenge performed at the same intensity (young: 93 ± 10; middle-aged: 85 ± 11 W, P = 0.60) pre- and post-CRIT60. Augmentation (change from rest-to-exercise challenge) of LV GLS (pre: -2.97 ± 0.65; post: -0.82 ± 0.48%, P = 0.02) and RV GLS (pre: -2.08 ± 1.28; post: 3.08 ± 2.02%, P = 0.01) was attenuated and completely abolished, in the young following CRIT60, while augmentation of LV GLS (pre: -3.21 ± 0.41; post: -3.99 ± 0.55%, P = 0.22) and RV GLS (pre: -3.47 ± 1.44; post: -1.26 ± 1.00%, P = 0.27) was preserved in middle-aged following CRIT60. While serum hs-cTnI concentration increased followingCRIT60 in the young (pre: 7.3 ± 1.6; post: 17.7 ± 1.6 ng/L, P < 0.01) and middle-aged (pre: 4.5 ± 0.6; post: 10.7 ± 2.0 ng/L, P < 0.01), serum hs-cTnI concentration increased to a greater extent in the young than in the middle-aged following CRIT60 (P < 0.01). These findings suggest that functional and biochemical cardiac perturbations induced by high-intensity exercise are attenuated in middle-aged relative to young individuals. Further study is warranted to determine whether acute exercise-induced cardiac perturbations alter the adaptive myocardial remodeling response.NEW & NOTEWORTHY High-intensity endurance exercise elicits acute cardiac imbalances that may be an important stimulus for adaptive cardiac remodeling. This study highlights that following a bout of high-intensity exercise that is typical of routine day-to-day cycling training, exercise-induced autonomic, biochemical, and functional cardiac imbalances are attenuated in middle-aged relative to young well-trained cyclists. These findings suggest that aging may alter exercise-induced stress stimulus response that initiates cardiac remodeling in athlete's heart.
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Affiliation(s)
- Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas.,Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | | | - Akira Yamada
- Department of Cardiology, Fujita Health University, Nagoya, Japan
| | - Kenji Shiino
- Department of Cardiology, Fujita Health University, Nagoya, Japan
| | - Jonathan Chan
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,Cardiology Division, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Luke J Haseler
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Justin J Kavanagh
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Norman R Morris
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Glenn M Stewart
- Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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23
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Balmain BN, Wilhite DP, Bhammar DM, Peck A, Payne M, Martinez-Fernandez T, Babb TG. External Dead Space Explains Sex-differences In The Exercise Ventilatory Response In Obese And Nonobese Children. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000684476.95811.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Balmain BN, Wilhite DP, Bhammar DM, Babb TG. External dead space explains sex-differences in the ventilatory response to submaximal exercise in children with and without obesity. Respir Physiol Neurobiol 2020; 279:103472. [PMID: 32512232 DOI: 10.1016/j.resp.2020.103472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
We compared the exercise ventilatory response (slope of the ventilation, V̇E and carbon dioxide production, V̇CO2 relationship) in boys and girls with and without obesity. 46 children with obesity (BMI percentile: 97.7 ± 1.4) and 27 children without obesity (BMI percentile: 55.1 ± 22.2) were included and divided into groups by sex (with obesity: 17 girls and 29 boys; without obesity: 13 girls and 14 boys). A 6 min constant load cycling test at 45 % of peak work rate was performed. The V̇E/V̇CO2 slope was similar (p = 0.67) between children with (32.7 ± 4.3) and without (32.2 ± 6.1) obesity; however, it was higher (p = 0.02) in girls (35.4 ± 5.6) than boys (32.6 ± 4.9). We also examined a corrected V̇E/V̇CO2 slope for the effects of mechanical dead space (VDM), by subtracting V̇DM from V̇E (V̇Ecorr/V̇CO2 slope). The V̇Ecorr/V̇CO2 slope remained similar (p = 0.37) between children with (26.8 ± 3.2) and without obesity (26.1 ± 3.1); however, no sex differences were observed (p = 0.13). Therefore, VDM should be accounted for before evaluating the V̇E/V̇CO2 slope, particularly when making between-sex comparisons.
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Affiliation(s)
- Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, UT Southwestern Medical Center. Dallas, TX, USA
| | - Daniel P Wilhite
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, UT Southwestern Medical Center. Dallas, TX, USA
| | - Dharini M Bhammar
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, UT Southwestern Medical Center. Dallas, TX, USA.
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25
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Sheel AW, Scheinowitz M, Iannetta D, Murias JM, Keir DA, Balmain BN, Wilhite DP, Babb TG, Toffoli G, Silva BM, da Silva GSF, Gruet M, Romain AJ, Pageaux B, Sousa FAB, Rodrigues NA, de Araujo GG, Bossi AH, Hopker J, Brietzke C, Pires FO, Angius L. Commentaries on Viewpoint: Time to reconsider how ventilation is regulated above the respiratory compensation point during incremental exercise. J Appl Physiol (1985) 2020; 128:1450-1455. [PMID: 32412390 DOI: 10.1152/japplphysiol.00259.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Andrew William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Danilo Iannetta
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Juan M. Murias
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel A. Keir
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Bryce N. Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas Texas
| | - Daniel P. Wilhite
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas Texas
| | - Tony G. Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas Texas
| | | | - Bruno M. Silva
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | - Glauber S. F. da Silva
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Mathieu Gruet
- Unité de Recherche Impact de l’Activité Physique sur la Santé, Université de Toulon, Toulon, France
| | - Ahmed Jérôme Romain
- École de kinésiologie et des sciences de l’activité physique (EKSAP), Faculté de médecine, Université de Montréal, Montreal Canada
| | - Benjamin Pageaux
- École de kinésiologie et des sciences de l’activité physique (EKSAP), Faculté de médecine, Université de Montréal, Montreal Canada,Centre de recherche de l’institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
| | - Filipe A. B. Sousa
- Laboratory of Applied Sciences do Sport (LACAE), Institute of Physical Education and Sport (IEFE), Federal University of Alagoas (UFAL), Alagoas, Brazil
| | - Natalia A. Rodrigues
- Laboratory of Applied Sciences do Sport (LACAE), Institute of Physical Education and Sport (IEFE), Federal University of Alagoas (UFAL), Alagoas, Brazil
| | - Gustavo G. de Araujo
- Laboratory of Applied Sciences do Sport (LACAE), Institute of Physical Education and Sport (IEFE), Federal University of Alagoas (UFAL), Alagoas, Brazil
| | - Arthur Henrique Bossi
- School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, Chatham, Kent, United Kingdom
| | - James Hopker
- School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, Chatham, Kent, United Kingdom
| | - Cayque Brietzke
- Exercise Psychophysiology Research Group, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil,Human Movement Science and Rehabilitation Program, Federal University of São Paulo, Santos, Brazil
| | - Flávio Oliveira Pires
- Exercise Psychophysiology Research Group, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil,Human Movement Science and Rehabilitation Program, Federal University of São Paulo, Santos, Brazil
| | - Luca Angius
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Costalat G, Godin B, Balmain BN, Moreau C, Brotherton E, Billaut F, Lemaitre F. Autonomic regulation of the heart and arrhythmogenesis in trained breath-hold divers. Eur J Sport Sci 2020; 21:439-449. [PMID: 32223533 DOI: 10.1080/17461391.2020.1749313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractBreath-hold divers are known to develop cardiac autonomic changes and brady-arrthymias during prolonged breath-holding (BH). The effects of BH-induced hypoxemia were investigated upon both cardiac autonomic status and arrhythmogenesis by comparing breath-hold divers (BHDs) to non-divers (NDs). Eighteen participants (9 BHDs, 9 NDs) performed a maximal voluntary BH with face immersion. BHDs were asked to perform an additional BH at water surface to increase the degree of hypoxemia. Beat-to-beat changes in heart rate (HR), short-term fractal scaling exponent (DFAα1), the number of arrhythmic events [premature ventricular contractions (PVCs), premature atrial contractions (PACs)] and peripheral oxygen saturation (SpO2) were recorded during and immediately following BH. The corrected QT-intervals (QTc) were analyzed pre- and post-acute BH. A regression-based model was used to split BH into a normoxic (NX) and a hypoxemic phase (HX). During the HX phase of BH, BHDs showed a progressive decrease in DFAα1 during BH with face immersion (p < 0.01) and BH with whole-body immersion (p < 0.01) whereas NDs did not (p > 0.05). In addition, BHDs had more arrhythmic events during the HX of BH with whole-body immersion when compared to the corresponding NX phase (5.9 ± 6.7 vs 0.4 ± 1.3; p < 0.05; respectively). The number of PVCs was negatively correlated with SpO2 during BH with whole-body immersion (r = -0.72; p < 0.05). The hypoxemic stage of voluntary BH is concomitant with significant cardiac autonomic changes toward a synergistic sympathetic and parasympathetic stimulation. Co-activation led ultimately to increased bradycardic response and cardiac electrophysiological disturbances.
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Affiliation(s)
- Guillaume Costalat
- Faculty of Sport Sciences, APERE laboratory, EA 3300, University of Picardie Jules Verne, France
| | | | - Bryce N Balmain
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Clara Moreau
- CHU Sainte Justine - Brain and Child Development, University of Montreal, Canada
| | - Emily Brotherton
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Francois Billaut
- Département de kinésiologie, Faculté de Médecine, Université Laval, Québec, Canada
| | - Frederic Lemaitre
- Faculty of Sport Sciences, CETAPS laboratory, EA 3832, Normandy University, France
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Stewart GM, Chan J, Kane GC, Johnson BD, Balmain BN, Yamada A, Shiino K, Haseler LJ, Sabapathy S. Marked Disparity in Regional and Transmural Cardiac Mechanics in the Athlete's Heart. Med Sci Sports Exerc 2020; 52:1908-1914. [PMID: 32175971 DOI: 10.1249/mss.0000000000002336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Regional heterogeneity of the human heart plays an important role in left ventricular (LV) and right ventricular (RV) function and may contribute to enhanced myocardial efficiency in the athlete's heart. PURPOSE This study comprehensively characterized regional and transmural myocardial tissue deformation (strain) in recreationally active (RA) and endurance-trained (ET) men to determine if regional nonuniformity evolves alongside morphological adaptations associated with endurance training. METHODS Echocardiography was used to measure LV and RV global, regional (apical, mid, basal) and transmural (endocardial, epicardial) longitudinal strain in 30 endurance-trained (ET) (age, 31 ± 2 yr; body mass index, 23.1 ± 0.5 kg·m; V˙O2peak, 60.2 ± 6.5 mL·kg·min) and 30 RA (age: 29 ± 2 yr; body mass index, 23.4 ± 0.4 kg·m; V˙O2peak: 42.6 ± 4.6 mL·kg·min). Nonuniformity was characterized using apex-to-base and transmural (endocardial-to-epicardial) strain gradients. RESULTS Global longitudinal strain was similar in ET and RA in the left (-17.4% ± 0.4% vs -17.8% ± 0.5%, P = 0.662) and right ventricle (-25.8% ± 0.8% vs 26.4% ± 1.0%, P = 0.717). The apex-to-base strain gradient was greater in ET than RA in the left (-6.5% ± 0.7% vs -2.7% ± 0.8%, P = 0.001) and right ventricle (-9.6% ± 1.8% vs -3.0% ± 1.6%, P = 0.010). The LV transmural strain gradient was greater than RV in both groups, but similar in ET and RA (-4.7% ± 0.2% vs -4.7% ± 0.2%, P = 0.850), whereas RV transmural strain gradient was greater in ET than RA (-3.4% ± 0.3% vs -1.6% ± 0.4%, P = 0.003). RV apex-to-base and transmural strain gradients correlated with RV end-diastolic area (R = 0.536 & 0.555, respectively, P < 0.01) and V˙O2peak (R = 0.415 & 0.677, respectively, P < 0.01). CONCLUSIONS Transmural nonuniformity is more pronounced in the left ventricle than the RV free wall; however, RV functional nonuniformity develops markedly after endurance training. Differences in myocardial architecture and exercise-induced wall stress in the left and right ventricles are possible explanations for the marked functional nonuniformity throughout the myocardium and in response to endurance exercise training.
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Affiliation(s)
| | | | - Garvan C Kane
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Bryce N Balmain
- School of Allied Health Sciences, Griffith University, Gold Coast, AUSTRALIA
| | - Akira Yamada
- Department of Cardiology, Fujita Health University, Nagoya, JAPAN
| | - Kenji Shiino
- Department of Cardiology, Fujita Health University, Nagoya, JAPAN
| | - Luke J Haseler
- School of Physiotherapy and Exercise Science, Curtin University, Perth, AUSTRALIA
| | - Surendran Sabapathy
- School of Allied Health Sciences, Griffith University, Gold Coast, AUSTRALIA
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28
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Affiliation(s)
- Eric J Stöhr
- Cardiff Metropolitan University Cardiff UNITED KINGDOM Columbia University New York, NY Griffith University, Gold Coast Queensland, AUSTRALIA
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29
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Balmain BN, Seale H, Harris J, Hall K, Lin AC, Sabapathy S, Morris NR. Relating exercise-induced desaturation and gas-exchange in pulmonary artery hypertension. Respir Physiol Neurobiol 2019; 259:58-62. [DOI: 10.1016/j.resp.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
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Balmain BN, Jay O, Morris NR, Shiino K, Stewart GM, Jayasinghe R, Chan J, Sabapathy S. Thermoeffector Responses at a Fixed Rate of Heat Production in Heart Failure Patients. Med Sci Sports Exerc 2018; 50:417-426. [PMID: 29040221 DOI: 10.1249/mss.0000000000001455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Heart failure (HF) patients seem to exhibit altered thermoregulatory responses during exercise in the heat. However, the extent to which these responses are altered due to physiological impairments independently of biophysical factors associated with differences in metabolic heat production (Hprod), evaporative heat balance requirements (Ereq), and/or body size is presently unclear. Therefore, we examined thermoregulatory responses in 10 HF patients and 10 age-matched controls (CON) similar in body size during exercise at a fixed rate of Hprod and therefore Ereq in a 30°C environment. METHODS Rectal temperature, local sweat rate, and cutaneous vascular conductance were measured throughout 60 min of cycle ergometry. Whole-body sweat rate was estimated from pre-post nude body weight corrected for fluid intake. RESULTS Despite exercising at the same rate of Hprod (HF, 338 ± 43 W; CON, 323 ± 31 W; P = 0.25), the rise in rectal temperature was greater (P < 0.01) in HF (0.81°C ± 0.16°C) than in CON (0.49°C ± 0.27°C). In keeping with a similar Ereq (HF, 285 ± 40 W; CON, 274 ± 28 W; P = 0.35), no differences in whole-body sweat rate (HF, 0.45 ± 0.11 L·h; CON, 0.41 ± 0.07 L·h; P = 0.38) or local sweat rate (HF, 0.96 ± 0.17 mg·cm·min; CON, 0.79 ± 0.15 mg·cm·min; P = 0.50) were observed between groups. However, the rise in cutaneous vascular conductance was lower in HF than in CON (HF, 0.83 ± 0.42 au·mm Hg; CON, 2.10 ± 0.79 au·mm Hg; P < 0.01). In addition, the cumulative body heat storage estimated from partitional calorimetry was similar between groups (HF, 154 ± 106 kJ; CON, 196 ± 174 kJ; P = 0.44). CONCLUSIONS Collectively, these findings demonstrate that HF patients exhibit a blunted skin blood flow response, but no differences in sweating. Given that HF patients had similar body heat storage to that of CON at the same Hprod, their greater rise in core temperature can be attributed to a less uniform internal distribution of heat between the body core and periphery.
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Affiliation(s)
- Bryce N Balmain
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Ollie Jay
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Norman R Morris
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Kenji Shiino
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Glenn M Stewart
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Rohan Jayasinghe
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Jonathan Chan
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
| | - Surendran Sabapathy
- Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA.,Menzies Health Institute Queensland, Gold Coast, QLD, AUSTRALIA
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Balmain BN, Sabapathy S, Louis M, Morris NR. Aging and Thermoregulatory Control: The Clinical Implications of Exercising under Heat Stress in Older Individuals. Biomed Res Int 2018; 2018:8306154. [PMID: 30155483 PMCID: PMC6098859 DOI: 10.1155/2018/8306154] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 01/27/2023]
Abstract
Climate change is predicted to bring about a greater variability in weather patterns with an increase in extreme weather events such as sustained heat waves. This change may have a direct impact on population health since heat waves can exceed the physiological limit of compensability of vulnerable individuals. Indeed, many clinical reports suggest that individuals over the age of 60 years are consistently the most vulnerable, experiencing significantly greater adverse heat-related health outcomes than any other age cohort during environmental heat exposure. There is now evidence that aging is associated with an attenuated physiological ability to dissipate heat and that the risk of heat-related illness in these individuals is elevated, particularly when performing physical activity in the heat. The purpose of this review is to discuss mechanisms of thermoregulatory control and the factors that may increase the risk of heat-related illness in older individuals. An understanding of the mechanisms responsible for impaired thermoregulation in this population is of particular importance, given the current and projected increase in frequency and intensity of heat waves, as well as the promotion of regular exercise as a means of improving health-related quality of life and morbidity and mortality. As such, the clinical implications of this work in this population will be discussed.
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Affiliation(s)
- Bryce N. Balmain
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Surendran Sabapathy
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Menaka Louis
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Norman R. Morris
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
- Metro North Hospital and Health Service, Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
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Balmain BN, Jay O, Morris NR, Stewart GM, Shiino K, McFarland AJ, Jayasinghe R, Chan J, Sabapathy S. Folic acid supplementation improves vascular endothelial function, yet not skin blood flow during exercise in the heat, in patients with heart failure. Am J Physiol Regul Integr Comp Physiol 2018; 315:R810-R819. [PMID: 29975566 DOI: 10.1152/ajpregu.00132.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure (HF) patients are susceptible to heat strain during exercise, secondary to blunted skin blood flow (SkBF) responses, which may be explained by impaired nitric oxide (NO)-dependent vasodilation. Folic acid improves vascular endothelial function and SkBF through NO-dependent mechanisms in healthy older individuals and patients with cardiovascular disease. We examined the effect of folic acid supplementation (5 mg/day for 6 wk) on vascular function [brachial artery flow-mediated dilation (FMD)] and SkBF responses [cutaneous vascular conductance (CVC)] during 60 min of exercise at a fixed metabolic heat production (300 ẆHprod) in a 30°C environment in 10 patients with HF (New York Heart Association Class I-II) and 10 healthy controls (CON). Serum folic acid concentration increased in HF [preintervention (pre): 1.4 ± 0.2; postintervention (post): 8.9 ± 6.7 ng/ml, P = 0.01] and CON (pre: 1.3 ± 0.6; post: 5.2 ± 4.9 ng/ml, P = 0.03). FMD improved by 2.1 ± 1.3% in HF ( P < 0.01), but no change was observed in CON postintervention ( P = 0.20). During exercise, the external workload performed on the cycle ergometer to attain the fixed level of heat production for exercise was similar between groups (HF: 60 ± 13; CON: 65 ± 20 external workload, P = 0.52). Increases in CVC during exercise were similar in HF (pre: 0.89 ± 0.43; post: 0.83 ± 0.45 au/mmHg, P = 0.80) and CON (pre: 2.01 ± 0.79; post: 2.03 ± 0.72 au/mmHg, P = 0.73), although the values were consistently lower in HF for both pre- and postintervention measurement intervals ( P < 0.05). These findings demonstrate that folic acid improves vascular endothelial function in patients with HF but does not enhance SkBF during exercise at a fixed metabolic heat production in a warm environment.
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Affiliation(s)
- Bryce N Balmain
- School of Allied Health Sciences, Griffith University , Gold Coast , Australia
| | - Ollie Jay
- Charles Perkins Centre, University of Sydney , Australia.,Thermal Ergonomics Laboratory, Exercise and Sport Science, Faculty of Health Sciences, University of Sydney , Sydney , Australia
| | - Norman R Morris
- School of Allied Health Sciences, Griffith University , Gold Coast , Australia.,Metro North Hospital and Health Service, Allied Health Research Collaborative, The Prince Charles Hospital , Brisbane , Australia
| | - Glenn M Stewart
- Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Kenji Shiino
- School of Allied Health Sciences, Griffith University , Gold Coast , Australia
| | - Amelia J McFarland
- School of Pharmacy and Pharmacology, Griffith University , Gold Coast , Australia
| | - Rohan Jayasinghe
- Cardiology, Gold Coast University Hospital , Gold Coast , Australia
| | - Jonathan Chan
- Cardiology, Gold Coast University Hospital , Gold Coast , Australia
| | - Surendran Sabapathy
- School of Allied Health Sciences, Griffith University , Gold Coast , Australia
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Sabapathy S, Balmain BN, Jay O, Shiino K, Stewart GM, Jayasinghe R, Chan J, Morris NR. Heart Failure Modulates Thermoregulatory Control Independently Of Differences In Physical Characteristics And Metabolic Heat Production. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000537137.53727.2d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Balmain BN, Jay O, Morris NR, McFarland AJ, Shiino K, Stewart GM, Jayasinghe R, Chan J, Sabapathy S. Folic Acid Improves Vascular Function, But Not Skin Blood Flow, In Heart Failure Patients. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536220.12269.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Balmain BN, Sabapathy S, Jay O, Adsett J, Stewart GM, Jayasinghe R, Morris NR. Heart Failure and Thermoregulatory Control: Can Patients With Heart Failure Handle the Heat? J Card Fail 2017; 23:621-627. [DOI: 10.1016/j.cardfail.2017.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 12/28/2022]
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Balmain BN, Jay O, Sabapathy S, Royston D, Stewart GM, Jayasinghe R, Morris NR. Altered thermoregulatory responses in heart failure patients exercising in the heat. Physiol Rep 2016; 4:e13022. [PMID: 27905297 PMCID: PMC5112500 DOI: 10.14814/phy2.13022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/03/2016] [Accepted: 10/09/2016] [Indexed: 01/11/2023] Open
Abstract
Heart failure (HF) patients appear to exhibit impaired thermoregulatory capacity during passive heating, as evidenced by diminished vascular conductance. Although some preliminary studies have described the thermoregulatory response to passive heating in HF, responses during exercise in the heat remain to be described. Therefore, the aim of this study was to compare thermoregulatory responses in HF and controls (CON) during exercise in the heat. Ten HF (NYHA classes I-II) and eight CON were included. Core temperature (Tc), skin temperature (Tsk), and cutaneous vascular conductance (CVC) were assessed at rest and during 1 h of exercise at 60% of maximal oxygen uptake. Metabolic heat production (Hprod) and the evaporative requirements for heat balance (Ereq) were also calculated. Whole-body sweat rate was determined from pre-post nude body mass corrected for fluid intake. While Hprod (HF: 3.9 ± 0.9; CON: 6.4 ± 1.5 W/kg) and Ereq (HF: 3.3 ± 0.9; CON: 5.6 ± 1.4 W/kg) were lower (P < 0.01) for HF compared to CON, both groups demonstrated a similar rise in Tc (HF: 0.9 ± 0.4; CON: 1.0 ± 0.3°C). Despite this similar rise in Tc, Tsk (HF: 1.6 ± 0.7; CON: 2.7 ± 1.2°C), and the elevation in CVC (HF: 1.4 ± 1.0; CON: 3.0 ± 1.2 au/mmHg) was lower (P < 0.05) in HF compared to CON Additionally, whole-body sweat rate (HF: 0.36 ± 0.15; CON: 0.81 ± 0.39 L/h) was lower (P = 0.02) in HF compared to CON Patients with HF appear to be limited in their ability to manage a thermal load and distribute heat content to the body surface (i.e., skin), secondary to impaired circulation to the periphery.
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Affiliation(s)
- Bryce N Balmain
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Surendran Sabapathy
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Danielle Royston
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Glenn M Stewart
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Rohan Jayasinghe
- Menzies Health Institute, Gold Coast, Queensland, Australia
- Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Norman R Morris
- Menzies Health Institute, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
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