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Pubblicazioni recenti - cardiopulmonary exercise
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Real-time exercise reduces impaired cardiac function in breast cancer patients undergoing chemotherapy: a randomized controlled trial.
Ann Phys Rehabil Med2021 Jan;():101485. doi: S1877-0657(21)00003-8.
Chung Wei-Pang, Yang Hsin-Lun, Hsu Ya-Ting, Hung Ching-Hsia, Liu Ping-Yen, Liu Yen-Wen, Chan Shih-Hung, Tsai Kun-Ling,
Abstract
BACKGROUND:
Previous studies have reported that chemotherapy results in substantial long-term risk of heart failure. Exercise ameliorates exercise responses and exercise tolerance in patients receiving chemotherapy. The cardioprotective effect of real-time exercise in breast cancer is still unclear.
OBJECTIVES:
The aim of the present study was to determine the effect of real-time moderate-to-high-intensity exercise training in women with breast cancer undergoing chemotherapy and to follow up on parameters of cardiac function and exercise capacity at different times. We hypothesized that early moderate-to-high-intensity exercise training has beneficial effects on cardiac function in women with breast cancer undergoing chemotherapy.
METHODS:
This was a randomized controlled study that included 32 women randomly allocated into the control or exercise group. Exercise began with the first cycle of chemotherapy, and the training program was maintained during chemotherapy with 2 to 3 sessions per week for 3 months. Patients were instructed to perform moderate-to-high-intensity training with aerobic and resistance training. Outcome measurements were echocardiography and cardiopulmonary exercise test. The primary outcome was the change in left ventricle ejection fraction (LVEF). The secondary outcome was peak oxygen consumption (peak VO).
RESULTS:
The control group showed lower cardiac systolic function than the exercise group [mean (SD) LVEF 62% (2) and 70% (5), p < 0.05], reduced cardiac diastolic function, and cardiac hypertrophy at 3, 6 and 12 months after chemotherapy. At 6 months after chemotherapy, the exercise group exhibited relatively higher exercise capacity than controls [mean (SD) VO 12.1 (2.2) and 13.6 (2.2) mL/kg/min, p < 0.05]. The main effect size of the study based on echocardiography outcomes was 0.25 (95% confidence interval 0.23 to 0.27), a medium effect size.
CONCLUSIONS:
Moderate-to-high-intensity exercise training in breast cancer patients undergoing chemotherapy may prevent impaired cardiac function.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
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The impact of aerobic exercise on cardiopulmonary responses and predictors of change in individuals with Parkinson's disease.
Arch Phys Med Rehabil2021 Jan;():. doi: S0003-9993(21)00006-X.
Penko Amanda L, Zimmerman Nicole M, Crawford Michael, Linder Susan M, Alberts Jay L,
Abstract
OBJECTIVE:
To determine the impact of aerobic exercise on maximal and submaximal cardiopulmonary responses and predictors of change in individuals with Parkinson's disease (PD).
DESIGN:
Single-center, parallel-group, rater-blind study.
SETTING:
Research laboratory PARTICIPANTS: Individual's with mild to moderate PD (N=100) INTERVENTION: Participants were enrolled in a trial evaluating the impact of cycling on PD and randomized to either voluntary exercise (VE), forced exercise (FE), or a no exercise, control group. The exercise groups were time and intensity matched and exercised 3x/week for eight weeks on a stationary cycle.
MAIN OUTCOME MEASURE:
Cardiopulmonary responses were collected via gas analysis during a maximal graded exercise test at baseline and post intervention.
RESULTS:
Exercise attendance, was 97% and 93% for the FE and VE group respectively. Average exercise HR reserve was 67% ± 11% for FE and 70% ± 10% for VE. No significant difference was present for change in VO post intervention, even though the FE group had a 5% increase in VO. Both the FE and VE groups had significantly higher %VO at VT then the control group compared to baseline values (p=0.04). Mean (95% CI) VO at VT was 5% (0.1%, 11%) higher in FE patients (p=0.04) and 7% (2%, 12%) higher in VE groups compared to controls. A stepwise linear regression model revealed that lower age, high exercise cadence, and lower baseline VO were most predictive of improved VO. The overall model was found to be significant, (p< 0.01).
CONCLUSION:
Peak and submaximal cardiopulmonary function may improve after aerobic exercise in individuals with PD. Lower age, higher exercise cadence, and lower baseline VO were most predictive of improved VO in this exercise cohort. The improvements observed in aerobic capacity were gained after a relatively short aerobic cycling intervention.
Copyright © 2021. Published by Elsevier Inc.
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Clinical improvement of cardiac function in a patient with systemic lupus erythematosus and heart failure with preserved ejection fraction treated with belimumab.
BMJ Case Rep2021 Jan;14(1):. doi: e237549.
Baniaamam Milad, Voskuyl Alexandre E, Nurmohamed Michael T, Handoko M Louis,
Abstract
We present a 51-year-old Caucasian woman, with a medical history of systemic lupus erythematosus (SLE) who had dyspnoea at exertion. The SLE was clinically quiescent but serologically active. Echocardiography showed preserved left ventricular (LV) systolic function, pseudonormal mitral inflow pattern (diastolic dysfunction grade III), absence of wall motion abnormalities and elevated E/e' at exercise. An exercise right heart catheterisation was performed, confirming the diagnosis of heart failure with preserved ejection fraction (HFpEF). In the absence of other possible causes, we assumed that HFpEF was mediated by systemic inflammation secondary to SLE. Based on the Paulus' paradigm, that systemic inflammation may lead to diastolic dysfunction, we decided to add belimumab (a biological agent against soluble B-lymphocyte stimulator protein). After 16?weeks of treatment, patient reported an improved condition. Also, cardiopulmonary exercise test and echocardiography results improved, confirming resolution of the underlying LV diastolic dysfunction. This case supports the idea that targeting inflammation has therapeutic potential in a subset of HFpEF-patients.
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Effect of self-tailored high-intensity interval training versus moderate-intensity continuous exercise on cardiorespiratory fitness after myocardial infarction: A randomized controlled trial.
Ann Phys Rehabil Med2021 Jan;():101490. doi: S1877-0657(21)00008-7.
Marcin Thimo, Trachsel Lukas D, Dysli Michelle, Schmid Jean Paul, Eser Prisca, Wilhelm Matthias,
Abstract
BACKGROUND:
Whether high-intensity interval training (HIIT) is more efficient than moderate-intensity continuous exercise (MICE) to increase cardiorespiratory fitness in patients with acute coronary syndrome at moderate-to-high cardiovascular risk is controversial. The best approach to guide training intensity remains to be determined.
OBJECTIVE:
We aimed to assess intensities achieved with self-tailored HIIT and MICE according to perceived exertion and to compare the effect on cardiorespiratory fitness in patients early after ST-elevation myocardial infarction (STEMI).
METHODS:
We included 69 males starting cardiac rehabilitation within 4 weeks after STEMI. After a 3-week run-in phase with MICE, 35 patients were randomized to 9 weeks of HIIT (2×HIIT and 1×MICE per week) and 34 patients to MICE (3×MICE). Training workload for MICE was initially set at the patients' first ventilatory threshold (VT). HIIT consisted of 4×4-min intervals with a workload above the second VT in high intervals. Training intensity was adjusted weekly to maintain the perceived exertion (Borg score 13-14 for MICE, ?15 for HIIT). Session duration was 38 min in both groups. Peak oxygen consumption (VO2) was measured by cardiopulmonary exercise testing pre- and post-intervention.
RESULTS:
Both groups improved peak VO2 (ml/kg/min) (HIIT +1.9, p<0.001; MICE +3.2, p<0.001, Cohen's d -0.4), but changes in VO2 were not significantly different between groups (p=0.104). Exercise regimes did not differ between groups in terms of energy expenditure or training time, but perceived exertion was higher with HIIT.
CONCLUSIONS:
Self-tailored HIIT was feasible in patients early after STEMI. It was more strenuous but not superior nor more time efficient than MICE in improving peak VO2.
Copyright © 2021. Published by Elsevier Masson SAS.
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The risks of applying normative values in paediatric cardiopulmonary exercise testing: a case report.
ERJ Open Res2020 Oct;6(4):. doi: 00333-2020.
Waterfall Jessica L, Burns Paul, Shackell Dawn, Pepke-Zaba Joanna, Oates Katrina E, Sylvester Karl P,
Abstract
https://bit.ly/36WgOSO.
Copyright ©ERS 2020.
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Diaphragmatic excursion correlates with exercise capacity and dynamic hyperinflation in COPD patients.
ERJ Open Res2020 Oct;6(4):. doi: 00589-2020.
Shiraishi Masashi, Higashimoto Yuji, Sugiya Ryuji, Mizusawa Hiroki, Takeda Yu, Fujita Shuhei, Nishiyama Osamu, Kudo Shintarou, Kimura Tamotsu, Chiba Yasutaka, Fukuda Kanji, Tohda Yuji,
Abstract
Background:
Although the pathophysiological mechanisms involved in the development of dyspnoea and poor exercise tolerance in patients with COPD are complex, dynamic lung hyperinflation (DLH) plays a central role. Diaphragmatic excursions can be measured by ultrasonography (US) with high intra- and interobserver reliability. The objective of this study was to evaluate the effect of diaphragmatic excursions as assessed by US on exercise tolerance and DLH in patients with COPD.
Methods:
Patients with COPD (n=20) and age-matched control subjects (n=20) underwent US, which was used to determine the maximum level of diaphragmatic excursion (DE). Ventilation parameters, including the change in inspiratory capacity (?IC), were measured in the subjects during cardiopulmonary exercise testing (CPET). We examined the correlations between DE and the ventilation parameters.
Results:
The DE of patients with COPD was significantly lower than that of the controls (45.0±12.8?mm 64.6±6.3?mm, respectively; p<0.01). The perception of peak dyspnoea (Borg scale) was significantly negatively correlated with DE in patients with COPD. During CPET, oxygen uptake/weight (' /) and minute ventilation (') were significantly positively correlated with DE, while '/' and '/carbon dioxide output (' ) were significantly negatively correlated with DE in patients with COPD. DE was also significantly positively correlated with ?IC, reflecting DLH, and with ' /, reflecting exercise capacity.
Conclusion:
Reduced mobility of the diaphragm was related to decreased exercise capacity and increased dyspnoea due to dynamic lung hyperinflation in COPD patients.
Copyright ©ERS 2020.
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Exercise-based interventions for Indigenous adults with chronic lung disease in Australia, Canada, New Zealand, and USA: a systematic review.
J Thorac Dis2020 Dec;12(12):7442-7453. doi: 10.21037/jtd-20-1904.
Meharg David P, Gwynne Kylie, Gilroy John, Alison Jennifer A,
Abstract
Indigenous peoples in Australia, New Zealand, Canada, and the United States of America (USA) have a higher burden of chronic lung disease than non-Indigenous people. Exercised-based interventions, such as pulmonary rehabilitation, are highly effective to manage chronic lung disease. The outcomes of these interventions for Indigenous people require evaluation. The aim of this review was to critically appraise the literature on the impact of exercise-based interventions on quality of life, exercise capacity and health care utilisation in Indigenous adults with chronic lung disease in Australia, New Zealand, Canada, and USA. The Cochrane Library, Medline, Embase, CINAHL, Scopus, Psychinfo, APAIS-Aboriginal Health and PEDro databases were searched for peer-reviewed and grey literature that evaluated exercise-based interventions, such as pulmonary rehabilitation for Indigenous adults with chronic lung disease in Australia, New Zealand, Canada, and USA. Two authors independently screened and reviewed titles and abstract and full texts of potentially eligible studies for inclusion. An Indigenous decolonisation methodological framework was also applied to evaluate Indigenous governance, involvement, and engagement in the studies. A total of 3,598 records were screened, nine full papers were reviewed, and one was study included, which was a cardiopulmonary rehabilitation program for Indigenous people in Australia. Participants with chronic respiratory or heart disease significantly improved functional exercise capacity and quality of life [six-minute walk distance mean change (95% CI) 79 metres (47 to 111); Chronic Respiratory Questionnaire Dyspnoea 0.9 points (0.2 to 1.5)]. Several items of the decolonisation framework were addressed. Only one study was able to be included in the review, highlighting the paucity of research about culturally safe exercise-based interventions for Indigenous adults with chronic lung disease. There is a need for further research with strong Indigenous governance, involvement, and engagement.
2020 Journal of Thoracic Disease. All rights reserved.
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Reduced skeletal muscle endurance and ventilatory efficiency during exercise in adult smokers without airflow obstruction.
J Appl Physiol (1985)2021 Jan;():. doi: 10.1152/japplphysiol.00762.2020.
Sadaka Ahmed Salama, Faisal Azmy, Khalil Yehia Mohamed, Mourad Sahar Mohamed, Zidan Mohamed Helmy, Polkey Michael I, Hopkinson Nicholas S,
Abstract
BACKGROUND:
Smokers without airflow obstruction have reduced exercise capacity, but the underlying physiological mechanisms are not fully understood.
AIM:
To compare quadriceps function assessed using non-volitional measures, and ventilatory requirements during exercise, between smokers without airway obstruction and never-smoker controls.
STUDY DESIGN AND METHODS:
Adult smokers (n=20) and never-smoker controls (n=16) aged 25-50 years with normal spirometry, underwent incremental cycle cardiopulmonary exercise testing to exhaustion with measurement of symptoms and dynamic lung volumes. Quadriceps strength and endurance were assessed non-volitionally using single and repetitive magnetic stimulation. Quadriceps bulk was assessed using ultrasound, as rectus-femoris cross-sectional area (Q-CSA). Physical activity level was quantified using the SenseWear armband worn for 5 days.
RESULTS:
Smokers had lower peak exercise workload, peak oxygen consumption and anaerobic threshold (AT) compared to controls (170+46 vs. 256+57 W; 2.20 ±0.56 vs. 3.18 ±0.72 L/min; 1.38±0.33 vs. 2.09±0.7 L/min, respectively; p<0.01 for all). Quadriceps endurance was lower in smokers (D force-time integral 54.9±14.7% vs. 40.4±14.7%; p=0.007), but physical activity, quadriceps strength and bulk were similar between groups. Smokers displayed higher ventilation (120W: 52.6±11.8 vs. 40.7±6.0 L/min; p<0.001), decreased ventilatory efficiency (higher ?/?CO) and were more breathless with greater leg fatigue at iso-workloads and iso-ventilation levels compared to never-smoker controls. Smokers showed no mechanical constraints on tidal volume expansion during exercise or ventilatory limitation at peak exercise.
CONCLUSION:
Adult smokers without airflow obstruction have reduced skeletal muscle endurance and ventilatory efficiency compared to never-smoker controls, despite similar daily physical activity levels, which contributed to reduced peak exercise capacity.
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Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial.
Ann Surg2021 Jan;():. doi: 10.1097/SLA.0000000000004702.
Berkel Annefleur E M, Bongers Bart C, Kotte Hayke, Weltevreden Paul, de Jongh Frans H C, Eijsvogel Michiel M M, Wymenga A N Machteld, Bigirwamungu-Bargeman Marloes, van der Palen Job, van Det Marc J, van Meeteren Nico L U, Klaase Joost M,
Abstract
OBJECTIVE:
To assess the effects of a 3-week community-based exercise program on 30-day postoperative complications in high-risk patients scheduled for elective colorectal resection for (pre)malignancy.
SUMMARY BACKGROUND DATA:
Patients with a low preoperative aerobic fitness undergoing colorectal surgery have an increased risk of postoperative complications. It remains, however, to be demonstrated whether prehabilitation in these patients reduces postoperative complications.
METHODS:
This 2-center, prospective, single-blinded randomized clinical trial was carried out in 2 large teaching hospitals in the Netherlands. Patients (?60 years) with colorectal (pre)malignancy scheduled for elective colorectal resection and with a score ?7 metabolic equivalents on the veterans-specific activity questionnaire were randomly assigned to the prehabilitation group or the usual care group by using block-stratified randomization. An oxygen uptake at the ventilatory anaerobic threshold <11?mL/kg/min at the baseline cardiopulmonary exercise test was the final inclusion criterion. Inclusion was based on a power analysis. Patients in the prehabilitation group participated in a personalized 3-week (3 sessions per week, nine sessions in total) supervised exercise program given in community physical therapy practices before colorectal resection. Patients in the reference group received usual care. The primary outcome was the number of patients with one or more complications within 30 days of surgery, graded according to the Clavien-Dindo classification. Data were analyzed on an intention-to-treat basis.
RESULTS:
Between February 2014 and December 2018, 57 patients [30 males and 27 females; mean age 73.6 years (standard deviation 6.1), range 61-88 years] were randomized to either prehabilitation (n = 28) or usual care (n = 29). The rate of postoperative complications was lower in the prehabilitation group (n = 12, 42.9%) than in the usual care group (n = 21, 72.4%, relative risk 0.59, 95% confidence interval 0.37-0.96, P = 0.024).
CONCLUSIONS:
Exercise prehabilitation reduced postoperative complications in high-risk patients scheduled to undergo elective colon resection for (pre)malignancy. Prehabilitation should be considered as usual care in high-risk patients scheduled for elective colon, and probably also rectal, surgery.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Influence of iron manipulation on hypoxic pulmonary vasoconstriction and pulmonary reactivity during ascent and acclimatization to 5050 m.
J Physiol2021 Jan;():. doi: 10.1113/JP281114.
Willie Christopher K, Patrician Alexander, Hoiland Ryan L, Williams Alexandra M, Gasho Christopher, Subedi Prajan, Anholm James, Drane Aimee, Tymko Michael M, Nowak-Flück Daniela, Plato Sawyer, McBride Emily, Varoli Giovanfrancesco, Binsted Gordon, Eller Lindsay K, Reimer Raylene A, MacLeod David B, Stembridge Michael, Ainslie Philip N,
Abstract
KEY POINTS:
Iron acts as a cofactor in the stabilization of the hypoxic-inducible factor family, and likely plays an influential role in the modulation of hypoxic pulmonary vasoconstriction. It is uncertain whether iron regulation is altered in lowlanders during either 1) ascent to high altitude, or 2) following partial acclimatization, when compared to high-altitude adapted Sherpa. During ascent to 5050 m, the rise in pulmonary artery systolic pressure (PASP) was blunted in Sherpa, compared to lowlanders; however, upon arrival to 5050 m PASP levels were comparable in both groups, but the reduction in iron bioavailability was more prevalent in lowlanders, compared to Sherpa. Following partial acclimatization to 5050 m, there were differential influences of iron status manipulation (via iron infusion or chelation) at rest and during exercise between lowlanders and Sherpa on the pulmonary vasculature.
ABSTRACT:
To examine the adaptational role of iron bioavailability on the pulmonary vascular responses to acute and chronic hypobaric hypoxia, the hematological and cardiopulmonary profile of lowlanders and Sherpa were determined during: 1) a nine-day ascent to 5050m (20 lowlanders; 12 Sherpa), and 2) following partial acclimatization (11±4 days) to 5050m (18 lowlanders; 20 Sherpa), where both groups received either an i.v. infusion of iron (iron (iii)-hydroxide sucrose) or an iron chelator (desferrioxamine). During ascent, there were reductions in iron status in both lowlanders and Sherpa; however, Sherpa appeared to demonstrate a more efficient capacity to mobilize stored iron, compared to lowlanders, when expressed as a ?hepcidin per unit change in either body iron or the soluble transferrin receptor index, between 3400-5050m (p = 0.016 and p = 0.029 respectively). The rise in pulmonary artery systolic pressure (PASP) was blunted in Sherpa, compared to lowlanders during ascent; however, PASP was comparable in both groups upon arrival to 5050m. Following partial acclimatization, despite Sherpa demonstrating a blunted hypoxic ventilatory response and greater resting hypoxemia, they had similar hypoxic pulmonary vasoconstriction when compared to lowlanders at rest. Iron-infusion attenuated PASP in both groups at rest (p = 0.005), while chelation did not exaggerate PASP in either group at rest or during exaggerated hypoxemia (P O = 67 mmHg). During exercise at 25% peak wattage, PASP was only consistently elevated in Sherpa, which persisted following both iron infusion or chelation. These findings provide new evidence on the complex interplay of iron regulation on pulmonary vascular regulation during acclimatization and adaptation to high altitude. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Association of six-minute walk test distance with postoperative complications in non-cardiac surgery: a secondary analysis of a multicentre prospective cohort study.
Can J Anaesth2021 Jan;():. doi: 10.1007/s12630-020-01909-9.
Ramos Ryan J, Ladha Karim S, Cuthbertson Brian H, Shulman Mark A, Myles Paul S, Wijeysundera Duminda N, ,
Abstract
PURPOSE:
The six-minute walk test (6MWT) is a simple and valid test for assessing cardiopulmonary fitness. Nevertheless, the relationship between preoperative 6MWT distance and postoperative complications is uncertain. We conducted a secondary analysis of the 6MWT nested cohort substudy of the Measurement of Exercise Tolerance before Surgery study to determine if 6MWT distance predicts postoperative complications or death.
METHODS:
This analysis included 545 adults (? 40 yr) who were at elevated cardiac risk and had elective inpatient non-cardiac surgery at 15 hospitals in Canada, Australia, and New Zealand. Each participant performed a preoperative 6MWT and was followed for 30 days after surgery. The primary outcome was moderate or severe in-hospital complications. The secondary outcome was 30-day death or myocardial injury. Multivariable logistic regression modelling was used to characterize the adjusted association of 6MWT distance with these outcomes.
RESULTS:
Seven participants (1%) terminated their 6MWT sessions early because of lower limb pain, dyspnea, or dizziness. Eighty-one (15%) participants experienced moderate or severe complications and 69 (13%) experienced 30-day myocardial injury or death. Decreased 6MWT distance was associated with increased odds of moderate or severe complications (adjusted odds ratio, 1.32 per 100 m decrease; 95% confidence interval, 1.01 to 1.73; P = 0.045). There was no association of 6MWT distance with myocardial injury or 30-day death (non-linear association; P = 0.49).
CONCLUSION:
Preoperative 6MWT distance had a modest association with moderate or severe complications after inpatient non-cardiac surgery. Further studies are needed to determine the optimal role of the 6MWT as an objective exercise test for informing preoperative risk stratification.
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Impact of aerobic exercise on cognitive function in patients with schizophrenia during daily nursing: A protocol for systematic review and meta-analysis.
Medicine (Baltimore)2021 Jan;100(1):e23876. doi: 10.1097/MD.0000000000023876.
Chen Chunmian, Yang Yafang, Ye Xinwu, Jin Yulian, Cai Ziyao, Zheng Jie,
Abstract
OBJECTIVES:
To assess the effect of aerobic exercise (AE) on cognition function in people with schizophrenia (SZ) during daily nursing.
METHODS:
The literature search will be conducted via PubMed, Embase, Cochrane Library, and Web of Science. Weighted mean difference (WMD) or standardized mean difference (SMD) and 95% confidence intervals (CIs) will be adopted to calculate the association between AE and cognitive function in patients with SZ. Publication bias will be performed by Begg test. When there is publication bias, "cut-and-fill method" will be adopted to adjust publication bias. Sensitivity analysis will be used to test the stability of the result. When the heterogeneity is large (I2???50%), meta regression will be used to explore the source of inter-study heterogeneity. When the heterogeneity is large (I2???50%) and the results are statistically significant (P?
CONCLUSION:
This meta-analysis will evaluate the impact of aerobic exercise on cognitive function in patients with SZ during daily nursing on the basis of existing evidence.
OSF REGISTRATION NUMBER:
10.17605/OSF.IO/C8ABX.
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
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Inhaled nitric oxide improves ventilatory efficiency and exercise capacity in patients with mild COPD: A randomized-control crossover trial.
J Physiol2021 Jan;():. doi: 10.1113/JP280913.
Phillips Devin B, Brotto Andrew R, Ross Bryan A, Bryan Tracey L, Wong Eric Y L, Meah Victoria L, Fuhr Desi P, van Diepen Sean, Stickland Michael K,
Abstract
KEY POINTS:
Patients with mild chronic obstructive pulmonary disease (COPD) have an elevated ventilatory equivalent to CO production (V? /V?CO ) during exercise, secondary to increased dead space ventilation. The reason for the increased dead space is unclear, however, pulmonary microvascular dysfunction and the corresponding capillary hypoperfusion is a potential mechanism. Despite emerging evidence that mild COPD is associated with pulmonary microvascular dysfunction, limited research has focused on experimentally modulating the pulmonary microvasculature during exercise in mild COPD. The current study sought to examine the effect of inhaled nitric oxide (iNO), a selective pulmonary vasodilator, on V? /V?CO , dyspnoea and exercise capacity in patients with mild COPD. Experimental iNO increased peak oxygen uptake in mild COPD, secondary to reduced V? /V?CO and dyspnoea. This is the first study to demonstrate that experimental manipulation of the pulmonary circulation alone, can positively impact dyspnoea and exercise capacity in mild COPD.
ABSTRACT:
Patients with mild chronic obstructive pulmonary disease (COPD) have an exaggerated ventilatory response to exercise, contributing to dyspnoea and exercise intolerance. Previous research in mild COPD has demonstrated an elevated ventilatory equivalent to CO production (V? /V?CO ) during exercise, secondary to increased dead space ventilation. The reason for the increased dead space is unclear, however, pulmonary microvascular dysfunction and the corresponding capillary hypoperfusion is a potential mechanism. The current study tested the hypothesis that inhaled nitric oxide (iNO), a selective pulmonary vasodilator, would lower V? /V?CO and dyspnoea, and improve exercise capacity in patients with mild COPD. In this multi-group randomized-control crossover study, fifteen patients with mild COPD (FEV = 89 ± 11%predicted) and fifteen healthy controls completed symptom-limited cardiopulmonary exercise tests while breathing normoxic gas or 40 ppm iNO. Compared with placebo, iNO significantly increased peak oxygen uptake (1.80 ± 0.14 versus 1.53 ± 0.10 L·min , p<0.001) in COPD, while no effect was observed in controls. At an equivalent work rate of 60 Watts, iNO reduced V? /V?CO by 3.8 ± 4.2 units (p = 0.002) and dyspnoea by 1.1 ± 1.2 Borg units (p<0.001) in COPD, while no effect was observed in controls. Operating lung volumes and oxygen saturation were unaffected by iNO in both groups. iNO increased peak oxygen uptake in COPD, secondary to reduced V? /V?CO and dyspnoea. These data suggest that mild COPD patients demonstrate pulmonary microvascular dysfunction that contributes to increased V? /V?CO , dyspnoea and exercise intolerance. This is the first study to demonstrate that experimental manipulation of the pulmonary circulation alone, can positively impact dyspnoea and exercise capacity in mild COPD. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Glutathione Peroxidase Activity is Altered in Vascular Cognitive Impairment-No Dementia and Is a Potential Marker for Verbal Memory Performance.
J Alzheimers Dis2021 Jan;():. doi: 10.3233/JAD-200754.
Ahmed Mehnaz, Herrmann Nathan, Chen Jinghan Jenny, Saleem Mahwesh, Oh Paul I, Andreazza Ana C, Kiss Alexander, Lanctôt Krista L,
Abstract
BACKGROUND:
Coronary artery disease (CAD) increases risk for vascular cognitive impairment-no dementia (VCIND), a precursor to dementia, potentially through persistent oxidative stress.
OBJECTIVE:
This study assessed peripheral glutathione peroxidase activity (GPX), which is protective against oxidative stress, in VCIND versus cognitively normal CAD controls (CN). GPX activity was also evaluated as a biomarker of cognition, particularly verbal memory.
METHODS:
120 CAD patients with VCIND (1SD below norms on executive function or verbal memory (VM)) or without (CN) participated in exercise rehabilitation for 24 weeks. Neurocognitive and cardiopulmonary fitness (VO2peak) assessments and plasma were collected at baseline and 24-weeks.
RESULTS:
GPX was higher in VCIND compared to CN (F1,119?=?3.996, p?=?0.048). Higher GPX was associated with poorer baseline VM (?=?-0.182, p?=?0.048), and longitudinally with VM decline controlling for sex, body mass index, VO2peak, and education (b[SE]?=?-0.02[0.01], p?=?0.004). Only CN participants showed improved VM performance with increased fitness (b[SE]?=?1.30[0.15], p?< ?0.005).
CONCLUSION:
GPX was elevated in VCIND consistent with a compensatory response to persistent oxidative stress. Increased GPX predicted poorer cognitive outcomes (verbal memory) in VCIND patients despite improved fitness.
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Heart rate kinetics during standard cardiopulmonary exercise testing in heart transplant recipients: a longitudinal study.
ESC Heart Fail2021 Jan;():. doi: 10.1002/ehf2.13102.
Schumacher Oliver, Trachsel Lukas D, Herzig David, Mohacsi Paul, Sigurdardottir Vilborg, Wilhelm Matthias, Eser Prisca,
Abstract
AIMS:
Heart transplantation (HTx) results in complete autonomic denervation of the donor heart, causing resting tachycardia and abnormal heart rate (HR) responses to exercise. We determined the time course of suggestive cardiac reinnervation post HTx and investigated its clinical significance.
METHODS AND RESULTS:
Heart rate kinetics during standard cardiopulmonary exercise testing at 2.5-5 years after HTx was assessed in 58 patients. According to their HR increase 30 s after exercise onset, HTx recipients were classified as denervated (slow responders: <5 beats per minute [b.p.m.]) or potentially reinnervated (fast responders: ?5 b.p.m.). Additionally, in 30 patients, longitudinal changes of maximal oxygen consumption and HR kinetics were assessed during the first 15 post-operative years. At 2.5-5 years post HTx, 38% of our study population was potentially reinnervated. Fast responders were significantly younger (41 ± 15 years) than slow responders (53 ± 13 years, P = 0.003) but did not differ with regard to donor age, immunosuppressive regime, cardiovascular risk factors, endomyocardial biopsy, or vasculopathy parameters. While HR reserve (56 ± 20 vs. 39 ± 15 b.p.m., P = 0.002) and HR recovery after 60 s (15 ± 11 vs. 5 ± 6 b.p.m., P < 0.001) were greater in fast responders, resting HR, peak HR of predicted, and peak oxygen consumption of predicted were comparable.
CONCLUSIONS:
Signs of reinnervation occurred mainly in younger patients. Maximal oxygen consumption was independent of HR kinetics.
©2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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An integrated mathematical model of the cardiovascular and respiratory response to exercise: Model-building and comparison with reported models.
Am J Physiol Heart Circ Physiol2021 Jan;():. doi: 10.1152/ajpheart.00074.2020.
Sarmiento Carlos Andrés, Hernandez Alher Mauricio, Serna Higuita Leidy Yanet, Mañanas Miguel Ángel,
Abstract
The use of physiological models in medicine allows the evaluation of new hypotheses, development of diagnosis and clinical treatment applications, development of training and medical education tools, as well as medical device design. Although several mathematical models of physiological systems have been presented in the literature, few of them are able to predict the human cardiorespiratory response under physical exercise stimulus adequately. This paper aims to present the building and comparison of an integrated cardiorespiratory model focused on the prediction of the healthy human response under rest and aerobic exercise. The model comprises cardiovascular circulation, respiratory mechanics, gas exchange system, as well as cardiovascular and respiratory controllers. Every system is based on previously reported physiological models and incorporates reported mechanisms related to the aerobic exercise dynamics. Experimental data of thirty healthy male volunteers undergoing a cardiopulmonary exercise test and simulated data from two of the most current and complete cardiorespiratory models were used to evaluate the performance of the presented model. Experimental design, processing, and exploratory analysis are described in detail. The simulation results were compared against the experimental data in steady-state and in transient regime. The predictions of the proposed model closely mimic the experimental data, showing in overall the lowest prediction error (10.35%), the lowest settling times for cardiovascular and respiratory variables, and in general, the fastest and similar responses in transient regime. These results suggest that the proposed model is suitable to predict the cardiorespiratory response of healthy adult humans under rest and aerobic exercise conditions.
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Sudden cardiac death in sports: could we save Pheidippides?
Acta Cardiol2021 Jan;():1-15. doi: 10.1080/00015385.2020.1867388.
Deligiannis Asterios, Kouidi Evangelia,
Abstract
Hereditary diseases under the age of 35 are the most common underlying heart disease, leading to sudden cardiac death (SCD) in competitive sports, while in older people, atherosclerotic coronary artery disease (CAD) is the main cause. The following preventive measures are recommended: (a) The pre-participation cardiovascular screening, (b) the genetic testing, (c) the use of implantable cardioverter-defibrillator (ICD), (d) the prohibition of doping in sports, (e) the prevention of 'exercise-induced' cardiac complications, (f) the reduction of high-risk factors for CAD, and (g) the use of cardiopulmonary resuscitation. The cost-effectiveness of the electrocardiograms in the pre-participation screening programs remains questionable. Genetic testing is recommended in borderline cases and positive family history. Athletes with ICD can, under certain conditions, participate in competitive sports. Excessive endurance exercise appears to harm the endothelium, promotes inflammatory processes and leads to fibrosis in the myocardium, and calcium deposition in the coronary vessels. Cardiac arrest may be reversed if cardiopulmonary resuscitation is performed and a defibrillator is immediately used. Thus, equipping all fields with automatic external defibrillators are recommended.
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Effects of Drop-Set and Pyramidal Resistance Training Systems on Microvascular Oxygenation: A Near-Infrared Spectroscopy Approach.
Int J Exerc Sci2020 ;13(2):1549-1562.
Angleri Vitor, DE Oliveira Ramon, Biazon Thais M P C, Damas Felipe, Borghi-Silva Audrey, Barroso Renato, Libardi Cleiton A,
Abstract
Metabolic stress is a primary mechanism of muscle hypertrophy and is associated with microvascular oxygenation and muscle activation. Considering that drop-set (DS) and crescent pyramid (CP) resistance training systems are recommended to modulate these mechanisms related to muscle hypertrophy, we aimed to investigate if these resistance training systems produce a different microvascular oxygenation status and muscle activation from those observed in traditional resistance training (TRAD). Twelve volunteers had their legs randomized in an intra-subject cross-over design in TRAD (3 sets of 10 repetitions at 75% 1-RM), DS (3 sets of ?50-75% 1-RM) and CP (3 sets of 6-10 repetitions at 75-85% 1-RM). Vastus medialis microvascular oxygenation and muscle activation were respectively assessed by non-invasive near-infrared spectroscopy and surface electromyography techniques during the resistance training sessions in the leg-extension exercise. Total hemoglobin area under the curve (AUC) (TRAD: -1653.5 ± 2866.5; DS: -3069.2 ± 3429.4; CP: -1196.6 ± 2675.3) and tissue oxygen saturation (TRAD: 19283.1 ± 6698.0; DS: 23995.5 ± 15604.9; CP: 16109.1 ± 8553.1) increased without differences between protocols (>0.05). Greater decreases in oxygenated hemoglobin AUC and hemoglobin differentiated AUC were respectively found for DS (-4036.8 ± 2698.1; -5004.4 ± 2722.9) compared with TRAD (-1951.8 ± 1720.0; -2250.3 ± 1305.7) and CP (-1814.4 ± 2634.3; 2432.2 ± 2891.4) (<0.03). Higher increases of hemoglobin deoxygenated AUC were found for DS (1426.7 ± 1320.7) compared with TRAD (316.0 ± 1164.9) only (=0.04). No differences were demonstrated in electromyographic amplitudes between TRAD (69.0 ± 34.4), DS (61.3 ± 26.7) and CP (60.9 ± 38.8) (>0.05). Despite DS produced lower microvascular oxygenation levels compared with TRAD and CP, all protocols produced similar muscle activation levels.
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The impact of additional resistance and balance training in exercise-based cardiac rehabilitation in older patients after valve surgery or intervention: randomized control trial.
BMC Geriatr2021 Jan;21(1):23. doi: 10.1186/s12877-020-01964-3.
Tamulevi?i?t?-Prascien? Egle, Beigien? Aurelija, Thompson Mark James, Baln? Kristina, Kubilius Raimondas, Bjarnason-Wehrens Birna,
Abstract
BACKGROUND:
To evaluate the short- and mid-term effect of a specially tailored resistance and balance training provided in addition to usual cardiac rehabilitation (CR) care program in older patients after valve surgery/intervention.
METHODS:
Single-center (inpatient CR clinic in Lithuania) randomized controlled trial. Two hundred fifty-two patients were assessed for eligibility on the first day of admittance to CR early after (14.5?±?5.9?days) valve surgery/intervention between January 2018 and November 2019. Participants were coded centrally in accordance with randomization 1:1 using a computerized list. Control group (CG) patients were provided with usual care phase-II-CR inpatient multidisciplinary CR program, while intervention group (IG) patients received additional resistance and balance training (3 d/wk). Patients participated in a 3-month follow-up. Main outcome measures were functional capacity (6?min walk test (6MWT, meters), cardiopulmonary exercise testing), physical performance (Short Physical Performance Battery (SPPB, score) and 5-m walk test (5MWT, meters/second)), strength (one repetition maximum test for leg press), physical frailty (SPPB, 5MWT).
RESULTS:
One hundred sixteen patients (76.1?±?6.7?years, 50% male) who fulfilled the study inclusion criteria were randomized to IG (n?=?60) or CG (n?=?56) and participated in CR (18.6?±?2.7?days). As a result, 6MWT (IG 247?±?94.1 vs. 348?±?100.1, CG 232?±?102.8 vs. 333?±?120.7), SPPB (IG 8.31?±?2.21 vs. 9.51?±?2.24, CG 7.95?±?2.01 vs. 9.08?±?2.35), 5MWT (IG 0.847?±?0.31 vs. 0.965?±?0.3, CG 0.765?±?0.24 vs 0.879?±?0.29) all other outcome variables and physical frailty level improved significantly (p?
CONCLUSION:
Exercise-based CR improves functional and exercise capacity, physical performance, and muscular strength, and reduces physical frailty levels in patients after valve surgery/intervention in the short and medium terms. SPPB score and 5MWT were useful for physical frailty assessment, screening and evaluation of outcomes in a CR setting. Additional benefit from the resistance and balance training could not be confirmed.
TRIAL REGISTRATION:
NCT04234087 , retrospectively registered 21 January 2020.
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A Pilot Study on the Association of Mitochondrial Oxygen Metabolism and Gas Exchange During Cardiopulmonary Exercise Testing: Is There a Mitochondrial Threshold?
Front Med (Lausanne)2020 ;7():585462. doi: 10.3389/fmed.2020.585462.
Baumbach Philipp, Schmidt-Winter Christiane, Hoefer Jan, Derlien Steffen, Best Norman, Herbsleb Marco, Coldewey Sina M,
Abstract
Mitochondria are the key players in aerobic energy generation via oxidative phosphorylation. Consequently, mitochondrial function has implications on physical performance in health and disease ranging from high performance sports to critical illness. The protoporphyrin IX-triplet state lifetime technique (PpIX-TSLT) allows measurements of mitochondrial oxygen tension (mitoPO). Hitherto, few data exist on the relation of mitochondrial oxygen metabolism and ergospirometry-derived variables during physical performance. This study investigates the association of mitochondrial oxygen metabolism with gas exchange and blood gas analysis variables assessed during cardiopulmonary exercise testing (CPET) in aerobic and anaerobic metabolic phases. Seventeen volunteers underwent an exhaustive CPET (graded multistage protocol, 50 W/5 min increase), of which 14 were included in the analysis. At baseline and for every load level PpIX-TSLT-derived mitoPO measurements were performed every 10 s with 1 intermediate dynamic measurement to obtain mitochondrial oxygen consumption and delivery (mito O, mito O). In addition, variables of gas exchange and capillary blood gas analyses were obtained to determine ventilatory and lactate thresholds (VT, LT). Metabolic phases were defined in relation to VT1 and VT2 (aerobic:
Copyright © 2020 Baumbach, Schmidt-Winter, Hoefer, Derlien, Best, Herbsleb and Coldewey.
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