Intérêts et difficultés d’interprétation du coefficient de transfert du CO (TLCO/VA)

INTRODUCTION

Interpreting measurements of carbon monoxide can be problematic.

STATE OF THE ART

The transfer factor (TLCO) is usually calculated by multiplying the decrease in alveolar CO concentration between the beginning and the end of a 10 second breath hold (KCO) by the alveolar volume (VA). Thus a reduced TLCO may occur due to either a low KCO, a reduced VA, or a combination of both.

PERSPECTIVES

A careful examination of KCO and VA will usually suggest a specific explanation for a reduction in TLCO. In restrictive lung diseases from extrapulmonary origin, TLCO is low but TLCO/VA [[/INF 120% of the reference values. In interstitial lung disease, the value of TLCO/VA depends on whether the loss of lung units is diffuse or not, and probably also on the status of the microcirculation. In airflow obstruction, a low VA is caused by uneven distribution of inspired He/CO mixture within the breath-hold time.

CONCLUSIONS

The transfer factor for carbon monoxide is best interpreted in terms of its components, alveolar volume and carbon monoxide transfer coefficient.

Clinical experience with functional electrical stimulation-assisted gait with Parastep in spinal cord-injured patients

STUDY DESIGN

Clinical evaluation of the Parastep method, a six-channel transcutaneous functional electrical stimulation device, in spinal cord-injured patients.

OBJECTIVES

To investigate the motor performances of this new technique regarding energy expenditure and to evaluate its advantages and limitations, especially in social activities involving ambulation.

METHODS

This study was conducted in 15 thoracic spine-injured patients. The lesion was complete except in two patients. The gait ability and the functional use were judged clinically. Energy cost was evaluated from heart rate, peak oxygen uptake, and lactatemia.

RESULTS

Thirteen patients completed the training (mean: 20 sessions) and achieved independent ambulation with a walker. The mean walking distance, without rest, was 52.8 +/- 69 m, and the mean speed was 0.15 +/- 0.14 m/sec. One patient with incomplete lesion, who had been nonambulatory for 8 months after the injury, became able to walk without functional electrical stimulation after five sessions. The follow-up was 40 +/- 11 months. Five patients pursued using functional electrical stimulation-assisted gait as a means of physical exercise but not for ambulation in social activities. The patients experienced marked psychological benefits, with positive changes in their way of life. In three subjects, a comparison of physiologic responses to exercise between a progressive arm ergometer test and a walking test with the Parastep (Sigmedics, Inc., Northfield, IL) at a speed of 0.1 m/sec was performed, showing that the heart rate, the peak oxygen uptake, and lactatemia during gait were close to those obtained at the end of the maximal test on the ergometer.

CONCLUSIONS

In spite of its ease of operation and good cosmetic acceptance, the Parastep approach has very limited applications for mobility in daily life, because of its modest performance associated with high metabolic cost and cardiovascular strain. However, it can be proposed as a resource to keep physical and psychological fitness in patients with spinal cord injury.

Blood lactate concentrations during exercise: effect of sampling site and exercise mode

BACKGROUND

The purpose of the study was to compare blood lactate concentrations determined in blood sampled from three sites (finger capillary, ear-lobe capillary, and forearm vein) during exercise on three different ergometers (a cycle ergometer, a treadmill and an arm-crank ergometer).

METHODS

A total of 312 well-trained subjects performed either a six-minute steady-state exercise (n = 219) or an incremental exercise test until exhaustion (n = 93). Blood was sampled from two sites after each exercise test and at the end of each stage of the incremental protocol, 852 pairs of blood samples were analysed.

RESULTS

Results showed that, when exercise was performed on a cycle ergometer or a treadmill, no significant differences between venous and ear capillary samples were observed whereas finger capillary values were higher. On an arm-crank ergometer, venous and finger capillary lactate concentrations were usually higher than ear capillary values with some discrepancies depending on the times of sampling.

CONCLUSIONS

We conclude that lactate values may differ depending on the sampling site and the type of exercise mode. An ear capillary sample may be preferred because it is less affected by lactate release in the arms and easier to obtain.

Gender effect on the relationship of time limit at 100% VO2max with other bioenergetic characteristics

The aim of this study was to investigate the influence of gender on the possible contribution of tlim at Va max (minimal speed that elicits VO2max) in performance speeds. The male and female elite middle-distance runners had similar performance (IAAF scores). Fourteen female and fifteen male (25.2 +/- 3.6 and 25.1 +/- 4.2 yr old; VO2max = 63.2 +/- 4.2 and 77.7 +/- 6.4 ml.kg-1 min-1; Va max = 17.3 +/- 0.7 and 20.8 +/- 1.1 km.h-1, respectively) performed three exercise tests on a treadmill (3 degrees slope) within a 2-wk period: an incremental test to determine VO2max, Va max and the velocity at the onset of blood lactate accumulation (VOBLA); an exhaustive constant velocity test to determine tlim at Va max; and an exhaustive constant velocity test at 110% Va max to determine the accumulated oxygen deficit (AOD). There were no effects of gender, i.e., no significant differences were observed between female and male for tlim at Va max (421 +/- 129 vs 367 +/- 118 s respectively; P = 0.24), VOBLA as % Va max (88.4 +/- 2.7 vs 90.4 3% of Va max; P = 0.07), AOD (40.1 +/- 14.9 vs 48.9 +/- 21.3 ml.O2.kg-1; P = 0.22), running economy at the same absolute speed, i.e., 14 km.h-1 (53.4 +/- 2.6 vs 52.7 +/- 4.1 ml.O2.min-1.kg-1; P = 0.64) nor for gross oxygen cost of running (CR) at the same relative velocity (75% Va max) (0.214 +/- 0.001 vs 0.214 +/- 0.002 ml.O2.kg-1.m-1; P = 0.94). However, an effect of gender was found on the relationship between the bioenergetic parameters and performance. For male, v1500 was predicted by Va max, VOBLA, tlim at 110% of Va max, and CR (R2 = 0.96). For female, no bioenergetic parameters were strongly correlated with v1500 m. The inverse relationship found between Va max and tlim at Va max in previous literature was confirmed by the 29 runners in this study and for the subset of male only.

Energy consumption of paraplegic locomotion using reciprocating gait orthosis

The energy cost of walking using a reciprocating gait orthosis (RGOII) with functional electrical stimulation (FES) was assessed in 14 patients with spastic complete paraplegia from six rehabilitation centres. Before and after training asing RGOII with FES, the subjects performed a progressive maximal test on an arm-crank ergometer to obtain their laboratory peak oxygen uptake (LVO2peak), heart rate (HR) and blood lactate concentration changes. At the end of the training session, oxygen uptake (VO2) was measured during a walking test with orthosis at different speeds (6 min steady state at 0.1 m.s-1, followed by 2-min stages at progressively increasing speeds up to exhaustion). Of the subjects 4 repeated this test using orthosis without FES. At a speed of 0.1 m.s-1, VO2 represented 47 (SD 23)% of LVO2peak, mean HR was 137 (SD 21) beats.min-1 and mean blood lactate concentration 2.4. (SD 1.4) mmol.l-1. Maximal speed ranged from 0.23 to 0.5 m.s-1. At maximal speed, VO2 was 91 (SD 18)% of LVO2peak, mean HR reached 96 (SD 7)% and mean blood lactate concentration only 52 (SD 19)% of the maximal values measured during the laboratory test. Walking without electrical stimulation induced an increase in HR but there was no difference in VO2 and blood lactate compared to walking with stimulation. The training period did not result in any improvement in maximal physiological data. We concluded that the free cadence walking speed with orthosis remains much lower than that of able-bodied people or wheelchair users. The metabolic cost at a given speed is much higher even if, using a stimulation device, the cardiovascular stress is reduced.

Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicenter controlled study. II: Physiological evaluation

We have investigated physiological changes in 21 patients with a spinal cord injury who were fitted with the RGO-II hybrid orthosis. All parameters were measured before and after a training programme in order to evaluate the benefit of gait rehabilitation, cardiovascular adaptation, constipation, spasticity and osteoporosis. A tendency for the improvement in cardiovascular function was noticed, and a segmental decrease in right colonic transit time was observed. However there was no reproducible change in spasticity, and no gain in bone mineral density. These data suggest that the physiological benefits which occur when patients walk with the aid of a hybrid orthosis only correct the effects of immobility. In addition, we did not find any physiological improvement regarding the neurological lesion (spasticity or osteoporosis).

Use of oxygen uptake recovery curve to predict peak oxygen uptake in upper body exercise

A group of 18 well-trained white-water kayakers performed maximal upper body exercise in the laboratory and during a field test. Laboratory direct peak oxygen uptake (VO2) values were compared, firstly by a VO2 backward extrapolation estimation and secondly by an estimation calculated from VO2 measured during the first 20 s of exercise recovery. Direct peak VO2 correlated with VO2 backward extrapolation (r = 0.89), but the results of this study showed that the backward extrapolation method tended to overestimate significantly peak VO2 by [0.57 (SD 0.31) l.min-1 in the laboratory, and 0.66 (SD 0.33) l.min-1 in the field, P < 0.001]. The VO2 measured during the first 20 s of recovery, whether the exercise was performed in the laboratory or in the field, correlated well with the laboratory direct peak VO2 (r = 0.92 and r = 0.91, respectively). The use of the regression equation obtained from field data (VO2F20s), that is peak VO2 = 0.23 + 1.08 VO2F20s, gave an estimated peak VO2, the mean difference of which compared with direct peak VO2 was 0.22 (SD 0.13) l.min-1. In conclusion, we propose the use of a regression equation to estimate peak VO2 from a single sample of the gas expired during the first 20 s of recovery after maximal exercise involving the upper part of the body.

Effects of captopril chronic intake on the aerobic performance and muscle strength of normotensive trained subjects

Fifteen normotensive athletes specializing in dynamic sports took part in a randomized double-blind and cross-over study: captopril (50 mg/24 h) vs placebo. Each treatment lasted one month. Maximal exercise tests on cycle ergometer were performed at the end of each period. No significant differences were observed in the maximal values of oxygen uptake, power, heart rate or blood lactate value. The anaerobic threshold, defined as the exercise intensity which corresponded to a 4 mmol.l-1 blood lactate level was unchanged. With captopril, the end-of-exercise systolic and diastolic BP were slightly altered (NS). Lower limb muscle strength, as explored with a Cybex isokinetic system, was not modified by captopril intake. The results indicate that maximal aerobic performance and isokinetic strength of the lower limbs are not altered by captopril chronic administration (50 mg/day) in normotensive trained subjects.

Isokinetic investigation of knee extensors and knee flexors in young French soccer players

The knee extensor and knee flexor muscle groups in three groups of young soccer players were tested with a Cybex II isokinetic dynamometer and compared with adults. Muscle strength increased with age. The largest gain was observed in young players aged 16-17 years whose quadriceps was the most modified muscle group giving the lowest H/Q ratio. Analysis of the regression equations obtained for torque values at 30 degrees s-1 and 180 degrees s-1 revealed that there were two distinct groups: under 16 and over 16. After reaching 16 years of age, the increase in muscle strength is greater at low velocity than at high velocity.

Ventilatory and occlusion-pressure responses to exercise in trained and untrained children

Pattern of breathing and mouth occlusion pressure were investigated during an incremental and exhaustive ergocycle test in untrained and trained 11 to 13 year old boys. At each level of exercise, the trained group had lower ventilation, a lower respiratory equivalent, and a lower respiratory rate. These results suggest that trained subjects have more efficient ventilation. Lower ventilation coincided with a smaller mean inspiratory flow (VT/TI), while the ratio of inspiratory to total breath (TI/TTOT) was unchanged. In contrast, mouth occlusion pressure and the index of neuromuscular inspiratory drive were the same up to 60 W for the two groups, and tended to be slightly lower in the trained boys above this level.

Extent of lactic anaerobic metabolism in handballers

The authors investigated lactic anaerobic metabolism in handball players during practice games. Seven players aged 18-21, belonging to second division league clubs, took part in the study. In the laboratory, VO2 max and the onset of blood lactate accumulation (OBLA) were determined with progressive maximal ergocycle tests. On the field, video recordings, cardiotelemetry, and rectal temperature measurements made during the first half of the game were used to quantify exertion. An intravenous catheter worn permanently was used to draw blood for lactate measurements at the 5th, 10th, 15th, 20th, and 30th min of play and after a 10-min rest period. The results confirmed earlier observations showing the need for an excellent maximal aerobic power and capacity in handballers. However, the maximal lactate levels observed (4-9 mmol X l-1) were above those that could be expected from samples drawn only at the end of play. These findings indicate that players must be trained to tolerate high lactate levels to preserve their maximal efficiency throughout the game. Finally, lactate production increased with player exertion and with increasing OBLA.