DONA ORA
Pubblicazioni recenti - cardiopulmonary exercise
-
Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice.
Am J Nephrol2021 Apr;():1-15. doi: 10.1159/000515384.
Pella Eva, Boutou Afroditi, Theodorakopoulou Marieta P, Sarafidis Pantelis,
Abstract
BACKGROUND:
Chronic kidney disease (CKD) is often characterized by increased prevalence of cardiovascular risk factors and increased incidence of cardiovascular events and death. Reduced cardiovascular reserve and exercise intolerance are common in patients with CKD and are associated with adverse outcomes.
SUMMARY:
The gold standard for identifying exercise limitation is cardiopulmonary exercise testing (CPET). CPET provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic function during maximal or submaximal exercise. It is useful in clinical setting for differentiation of the causes of exercise intolerance, risk stratification, and assessment of response to relevant treatments. A number of recent studies have used CPET in patients with pre-dialysis CKD, aiming to assess the cardiovascular reserve of these individuals, as well as the effect of interventions such as exercise training programs on their functional capacity. This review provides an in-depth description of CPET methodology and an overview of studies that utilized CPET technology to assess cardiovascular reserve in patients with pre-dialysis CKD. Key Messages: CPET can delineate multisystem changes and offer comprehensive phenotyping of factors determining overall cardiovascular risk. Potential clinical applications of CPET in CKD patients range from objective diagnosis of exercise intolerance to preoperative and long-term risk stratification and providing intermediate endpoints for clinical trials. Future studies should delineate the association of CPET indexes, with cardiovascular and respiratory alterations and hard outcomes in CKD patients, to enhance its diagnostic and prognostic utility in this population.
© 2021 S. Karger AG, Basel.
Guarda su PubMed
-
Self-monitored versus supervised walking programs for older adults.
Medicine (Baltimore)2021 Apr;100(16):e25561. doi: 10.1097/MD.0000000000025561.
Hsu Ching-Yi, Wu Hsin-Hsien, Liao Hung-En, Liao Tai-Hsiang, Su Shin-Chang, Lin Pay-Shin,
Abstract
ABSTRACT:
Walking is an effective, well accepted, inexpensive, and functional intervention. This study compared the outcomes and changes in walking behavior of self-monitored (SM) and supervised (SU) walking interventions for older adults.Participants were assigned to SM (n?=?21) and SU (n?=?21) walking groups according to their place of residence. Both groups exercised and wore a pedometer for 3 months.The outcome measures were step count, body mass index (BMI), and physical function. Two-way repeated-measure ANOVA and independent t tests were used to compare the intervention effects. We also plotted the trends and analyzed the walking steps weekly.Only BMI exhibited a group?×?time interaction. The pre-posttest differences showed knee extension muscle strength (KEMS) and Timed Up and Go test were significantly improved in the SM group, whereas BMI, KEMS, 30-s sit-to-stand, functional reach were significantly improved, but 5-m gait speed significantly slower in the SU group. For participants attending ?50% of the sessions, those in the SM and SU groups had similar results for all variables, except for 2-min step (2MS) and daily walking step counts.Both self-monitored and supervised walking benefit older adults in most physical functions, especially lower-extremity performance, such as muscle strength, balance, and mobility. The effects of both programs do not differ significantly, except for BMI and 2MS (ie cardiopulmonary endurance). We recommend pedometer-assisted self-monitored walking for older adults because of its ability to cultivate exercise habits over the long term, whereas supervised walking to establish effective exercise intensity.
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Guarda su PubMed
-
Factors contributing to exercise capacity in chronic thromboembolic pulmonary hypertension with near-normal hemodynamics.
J Heart Lung Transplant2021 Mar;():. doi: S1053-2498(21)02222-1.
Tobita Kazuki, Goda Ayumi, Nishida Yuichiro, Takeuchi Kaori, Kikuchi Hanako, Inami Takumi, Kohno Takashi, Yamada Shin, Soejima Kyoko, Satoh Toru,
Abstract
BACKGROUND:
Despite improved survival for patients with chronic thromboembolic pulmonary hypertension (CTEPH) due to progressive medical and interventional treatment, impaired exercise capacity remains common due to poorly understood mechanisms. We aimed to clarify the exercise capacity of CTEPH patients with near-normal pulmonary hemodynamics and evaluate its determinants among the hemodynamic, peripheral (e.g., oxygen use by the peripheral tissues), and muscular (e.g., skeletal muscle strength) factors.
METHODS:
Three hundred and twenty-nine patients with CTEPH (mean age, 63 ± 12 years; men/women, 73/256) with a near-normal mean pulmonary artery pressure (?30 mm Hg) at rest were enrolled. We assessed exercise capacity by peak oxygen consumption (peak VO) using cardiopulmonary exercise testing with a right heart catheter. We also measured the 6-minute walk distance (6MWD) and quadriceps muscle strength.
RESULTS:
The mean pulmonary artery pressure was 19 ± 4 mmHg and mean cardiac output was 4.8 ± 1.5 L/min at rest. The mean 6MWD was 444 ± 101 m, while the mean peak VO was 14.4 ± 3.9 mL/min/kg. A multivariate model that predicted 6MWD included quadriceps strength (??=?0.45, p < 0.001) and peak arterial venous oxygen difference (??=?0.29, p < 0.001). In contrast, the peak VO was best correlated with mPAP-CO slope (??=?-0.30, p < 0.001), followed by quadriceps strength and peak arterial venous oxygen difference.
CONCLUSIONS:
The 6MWD performance may be significantly influenced by peripheral oxygen use and muscular factors, while peak VO is influenced by hemodynamic and peripheral factors in CTEPH patients with near-normal hemodynamics.
Copyright © 2021. Published by Elsevier Inc.
Guarda su PubMed
-
Aerobic Versus Resistance Training Effects on Ventricular-Arterial Coupling and Vascular Function in the STRRIDE-AT/RT Trial.
Front Cardiovasc Med2021 ;8():638929. doi: 10.3389/fcvm.2021.638929.
Lekavich Carolyn L, Allen Jason D, Bensimhon Daniel R, Bateman Lori A, Slentz Cris A, Samsa Gregory P, Kenjale Aarti A, Duscha Brian D, Douglas Pamela S, Kraus William E,
Abstract
The goal was studying the differential effects of aerobic training (AT) vs. resistance training (RT) on cardiac and peripheral arterial capacity on cardiopulmonary (CP) and peripheral vascular (PV) function in sedentary and obese adults. In a prospective randomized controlled trial, we studied the effects of 6 months of AT vs. RT in 21 subjects. Testing included cardiac and vascular ultrasoundography and serial CP for ventricular-arterial coupling (Ees/Ea), strain-based variables, brachial artery flow-mediated dilation (BAFMD), and peak VO (pVO mL/kg/min) and peak O-pulse (Op; mL/beat). Within the AT group ( = 11), there were significant increases in rVO of 4.2 mL/kg/min (SD 0.93) ( = 0.001); Op of 1.9 mL/beat (SD 1.3) ( = 0.008) and the brachial artery post-hyperemia peak diameter 0.18 mm (SD 0.08) ( = 0.05). Within the RT group ( = 10) there was a significant increase in left ventricular end diastolic volume 7.0 mL (SD 9.8; = 0.05) and percent flow-mediated dilation (1.8%) (SD 0.47) ( = 0.004). Comparing the AT and RT groups, post exercise, rVO 2.97, (SD 1.22), ( = 0.03), Op 0.01 (SD 1.3), ( = 0.01), peak hyperemic blood flow volume (1.77 mL) (SD 140.69) ( = 0.009), were higher in AT, but LVEDP 115 mL (SD 7.0) ( = 0.05) and Ees/Ea 0.68 mmHg/ml (SD 0.60) = 0.03 were higher in RT. The differential effects of AT and RT in this hypothesis generating study have important implications for exercise modality and clinical endpoints.
Copyright © 2021 Lekavich, Allen, Bensimhon, Bateman, Slentz, Samsa, Kenjale, Duscha, Douglas and Kraus.
Guarda su PubMed
-
Cardio-Ankle Vascular Index Reflects Impaired Exercise Capacity and Predicts Adverse Prognosis in Patients With Heart Failure.
Front Cardiovasc Med2021 ;8():631807. doi: 10.3389/fcvm.2021.631807.
Watanabe Koichiro, Yoshihisa Akiomi, Sato Yu, Hotsuki Yu, Anzai Fumiya, Ichijo Yasuhiro, Kimishima Yusuke, Yokokawa Tetsuro, Misaka Tomofumi, Sato Takamasa, Kaneshiro Takashi, Oikawa Masayoshi, Kobayashi Atsushi, Takeishi Yasuchika,
Abstract
We aimed to assess the associations of CAVI with exercise capacity in heart failure (HF) patients. In addition, we further examined their prognosis. We collected the clinical data of 223 patients who had been hospitalized for decompensated HF and had undergone both CAVI and cardiopulmonary exercise testing. For the prediction of an impaired peak oxygen uptake (VO) of < 14 mL/kg/min, receiver-operating characteristic curve demonstrated that the cutoff value of CAVI was 8.9. In the multivariate logistic regression analysis for predicting impaired peak VO, high CAVI was found to be an independent factor (odds ratio 2.343, = 0.045). We divided these patients based on CAVI: the low-CAVI group (CAVI < 8.9, = 145) and the high-CAVI group (CAVI ? 8.9, = 78). Patient characteristics and post-discharge cardiac events were compared between the two groups. The high-CAVI group was older (69.0 vs. 58.0 years old, < 0.001) and had lower body mass index (23.0 vs. 24.1 kg/m, = 0.013). During the post-discharge follow-up period of median 1,623 days, 58 cardiac events occurred. The Kaplan-Meier analysis demonstrated that the cardiac event rate was higher in the high-CAVI group than in the low-CAVI group (log-rank = 0.004). The multivariate Cox proportional hazard analysis revealed that high CAVI was an independent predictor of cardiac events (hazard ratio 1.845, = 0.035). High CAVI is independently associated with impaired exercise capacity and a high cardiac event rate in HF patients.
Copyright © 2021 Watanabe, Yoshihisa, Sato, Hotsuki, Anzai, Ichijo, Kimishima, Yokokawa, Misaka, Sato, Kaneshiro, Oikawa, Kobayashi and Takeishi.
Guarda su PubMed
-
Impact of Exercise-Based Cardiac Rehabilitation on the Mid-Term Outcomes of Patients After Acute Myocardial Infarction Treated With Current Acute-Phase Management and Optimal Medical Therapy.
Heart Lung Circ2021 Apr;():. doi: S1443-9506(21)00380-2.
Kyuno Etsushi, Iso Yoshitaka, Tsujiuchi Miki, Maeda Atsuo, Miyazawa Ryo, Kowaita Hitoshi, Kitai Hitomi, Sato Tokutada, Ebato Mio, Sambe Takeyuki, Suzuki Hiroshi,
Abstract
BACKGROUND:
Early reported beneficial effects of cardiac rehabilitation (CR) have recently been disputed. The present study aimed to investigate the clinical impact of CR on the mid-term outcomes of patients following ST-segment elevation myocardial infarction (STEMI) treated with currently available management.
METHODS:
This study reviewed 145 consecutive patients who underwent primary coronary intervention and were discharged without any disability after STEMI during 2013-2015.
RESULTS:
Among the patients, 66 (45.5%) completed an outpatient CR program (CR group) and 79 were their non-CR counterparts or patients who dropped out of the program (N-D group). There were no between-group differences in patient demographics and clinical profiles, including door-to-balloon times and prescriptions. A total of 27 patients developed major adverse cardiac and cerebrovascular events (MACCE) during follow-up. The MACCE-free survival rates were 88% and 76% in the CR and N-D groups, respectively (log-rank, p=0.04). Cox proportional analysis demonstrated that inclusion in the N-D group was a significant predictor of MACCEs (HR, 2.36; 95% CI, 1.07-5.74; p=0.03). In the CR group, peak oxygen consumption and ventilatory efficiency determined by cardiopulmonary exercise testing significantly improved after the program (p<0.01).
CONCLUSIONS:
The impact of CR on the mid-term prognosis of patients with STEMI, even in the current myocardial infarction management era, was beneficial.
Copyright © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
Guarda su PubMed
-
Neuromuscular efficiency is impaired during exercise in COPD patients.
Respir Physiol Neurobiol2021 Apr;():103673. doi: S1569-9048(21)00058-6.
Frazão Murillo, da Cruz Santos Amilton, Araújo Alex Andrade, Romualdo Michel Platini, de Mello Brenda Lopes Cavalcanti, Jerônimo Géssica Gomes, Paulino Flávia Pinheiro, do Socorro Brasileiro-Santos Maria,
Abstract
AIM:
to analyze respiratory and peripheral neuromuscular efficiency during exercise in COPD.
METHODS:
COPD patients (VEF?=?39.25?±?13.1%) were paired with healthy subjects. It was performed cardiopulmonary exercise test with simultaneously electromyography (EMG). Respiratory neuromuscular efficiency was determined by relationship between tidal volume and diaphragm EMG. Peripheral neuromuscular efficiency was determined by relationship between power output and vastus lateralis EMG.
RESULTS:
Healthy subjects presented higher respiratory neuromuscular efficiency at moderate, heavy and maximum exercise intensities compared to COPD (p?
CONCLUSION:
COPD patients have lower respiratory neuromuscular efficiency at moderate exercise intensity and lower peripheral neuromuscular efficiency at light exercise intensity. Dynamic hyperinflation affects respiratory and peripheral neuromuscular efficiency.
Copyright © 2021. Published by Elsevier B.V.
Guarda su PubMed
-
Feasibility of semi-recumbent bicycle exercise Doppler echocardiography for the evaluation of the right heart and pulmonary circulation unit in different clinical conditions: the RIGHT heart international NETwork (RIGHT-NET).
Int J Cardiovasc Imaging2021 Apr;():. doi: 10.1007/s10554-021-02243-x.
Ferrara Francesco, Gargani Luna, Naeije Robert, Rudski Lawrence, Armstrong William F, Wierzbowska-Drabik Karina, Argiento Paola, Bandera Francesco, Cademartiri Filippo, Citro Rodolfo, Cittadini Antonio, Cocchia Rosangela, Contaldi Carla, D'Alto Michele, D'Andrea Antonello, Grünig Ekkehard, Guazzi Marco, Kolias Theodore John, Limongelli Giuseppe, Marra Alberto Maria, Mauro Ciro, Moreo Antonella, Ranieri Brigida, Saggar Rajan, Salzano Andrea, Stanziola Anna Agnese, Vriz Olga, Vannan Mani, Kasprzak Jaroslaw D, Bossone Eduardo, ,
Abstract
Exercise Doppler echocardiography (EDE) is a well-validated tool in ischemic and valvular heart diseases. However, its use in the assessment of the right heart and pulmonary circulation unit (RH-PCU) is limited. The aim of this study is to assess the semi-recumbent bicycle EDE feasibility for the evaluation of RH-PCU in a large multi-center population, from healthy individuals and elite athletes to patients with overt or at risk of developing pulmonary hypertension (PH). From January 2019 to July 2019, 954 subjects [mean age 54.2?±?16.4 years, range 16-96, 430 women] underwent standardized semi-recumbent bicycle EDE with an incremental workload of 25 watts every 2 min, were prospectively enrolled among 7 centers participating to the RIGHT Heart International NETwork (RIGHT-NET). EDE parameters of right heart structure, function and pressures were obtained according to current recommendations. Right ventricular (RV) function at peak exercise was feasible in 903/940 (96%) by tricuspid annular plane systolic excursion (TAPSE), 667/751 (89%) by tissue Doppler-derived tricuspid lateral annular systolic velocity (S') and 445/672 (66.2%) by right ventricular fractional area change (RVFAC). RV-right atrial pressure gradient [RV-RA gradient?=?4?×?tricuspid regurgitation velocity (TRV)] was feasible in 894/954 patients (93.7%) at rest and in 816/954 (85.5%) at peak exercise. The feasibility rate in estimating pulmonary artery pressure improved to more than 95%, if both TRV and/or right ventricular outflow tract acceleration time (RVOT AcT) were considered. In high specialized echocardiography laboratories semi-recumbent bicycle EDE is a feasible tool for the assessment of the RH-PCU pressure and function.
Guarda su PubMed
-
Exercise intolerance in pulmonary arterial hypertension: insight into central and peripheral pathophysiological mechanisms.
Eur Respir Rev2021 Jun;30(160):. doi: 200284.
Malenfant Simon, Lebret Marius, Breton-Gagnon Émilie, Potus François, Paulin Roxane, Bonnet Sébastien, Provencher Steeve,
Abstract
Exercise intolerance is a cardinal symptom of pulmonary arterial hypertension (PAH) and strongly impacts patients' quality of life (QoL). Although central cardiopulmonary impairments limit peak oxygen consumption ( ) in patients with PAH, several peripheral abnormalities have been described over the recent decade as key determinants in exercise intolerance, including impaired skeletal muscle (SKM) morphology, convective O transport, capillarity and metabolism indicating that peripheral abnormalities play a greater role in limiting exercise capacity than previously thought. More recently, cerebrovascular alterations potentially contributing to exercise intolerance in patients with PAH were also documented. Currently, only cardiopulmonary rehabilitation has been shown to efficiently improve the peripheral components of exercise intolerance in patients with PAH. However, more extensive studies are needed to identify targeted interventions that would ultimately improve patients' exercise tolerance and QoL. The present review offers a broad and comprehensive analysis of the present literature about the complex mechanisms and their interactions limiting exercise in patients and suggests several gaps in knowledge that need to be addressed in the future for a better understanding of exercise intolerance in patients with PAH.
Copyright ©ERS 2021.
Guarda su PubMed
-
Minute ventilation/carbon dioxide production in patients with dysfunctional breathing.
Eur Respir Rev2021 Jun;30(160):. doi: 200182.
Watson Matthew, Ionescu Maria Florina, Sylvester Karl, Fuld Jonathan,
Abstract
Dysfunctional breathing refers to a multi-dimensional condition that is characterised by pathological changes in an individual's breathing. These changes lead to a feeling of breathlessness and include alterations in the biomechanical, psychological and physiological aspects of breathing. This makes dysfunctional breathing a hard condition to diagnose, given the diversity of aspects that contribute to the feeling of breathlessness. The disorder can debilitate individuals without any health problems, but may also be present in those with underlying cardiopulmonary co-morbidities. The ventilatory equivalent for CO ( ) is a physiological parameter that can be measured using cardiopulmonary exercise testing. This review will explore how this single measurement can be used to aid the diagnosis of dysfunctional breathing. A background discussion about dysfunctional breathing will allow readers to comprehend its multidimensional aspects. This will then allow readers to understand how can be used in the wider diagnosis of dysfunctional breathing. Whilst cannot be used as a singular parameter in the diagnosis of dysfunctional breathing, this review supports its use within a broader algorithm to detect physiological abnormalities in patients with dysfunctional breathing. This will allow for more individuals to be accurately diagnosed and appropriately managed.
Copyright ©ERS 2021.
Guarda su PubMed
-
Ventilation/carbon dioxide output relationships during exercise in health.
Eur Respir Rev2021 Jun;30(160):. doi: 200160.
Ward Susan A,
Abstract
"Ventilatory efficiency" is widely used in cardiopulmonary exercise testing to make inferences regarding the normality (or otherwise) of the arterial CO tension ( ) and physiological dead-space fraction of the breath (/) responses to rapid-incremental (or ramp) exercise. It is quantified as: 1) the slope of the linear region of the relationship between ventilation (') and pulmonary CO output (' ); and/or 2) the ventilatory equivalent for CO at the lactate threshold ('/' [Formula: see text]) or its minimum value ('/' min), which occurs soon after [Formula: see text] but before respiratory compensation. Although these indices are normally numerically similar, they are not equally robust. That is, high values for '/' [Formula: see text] and '/' min provide a rigorous index of an elevated / when is known (or can be assumed) to be regulated. In contrast, a high '-' slope on its own does not, as account has also to be taken of the associated normally positive and small ' intercept. Interpretation is complicated by factors such as: the extent to which is actually regulated during rapid-incremental exercise (as is the case for steady-state moderate exercise); and whether '/' [Formula: see text] or '/' min provide accurate reflections of the true asymptotic value of '/' , to which the '-' slope approximates at very high work rates.
Copyright ©ERS 2021.
Guarda su PubMed
-
Lifestle and rehabilitation during the COVID-19 pandemic: guidance for health professionals and support for exercise and rehabilitation programs.
Expert Rev Anti Infect Ther2021 Apr;():. doi: 10.1080/14787210.2021.1917994.
Goulart Cássia da Luz, Silva Rebeca Nunes, Oliveira Murilo Rezende, Guizilini Solange, Rocco Isadora Salvador, Mendez Vanessa Marques Ferreira, Bonjorno José Carlos, Caruso Flavia Rossi, Arena Ross, Borghi-Silva Audrey,
Abstract
INTRODUCTION:
The coronavirus disease 2019 (COVID-19) is a highly contagious respiratory viral disease for both the general population and health care professionals caring for infected patients. Of particular concern is the potential for significant respiratory, cardiovascular, physical, and psychological dysfunctions.
AREAS COVERED:
In this context, the current review will focus on the following areas: 1) staying physically active during the COVID-19 pandemic; 2) highlighting the importance of understanding COVID-19 mechanisms; 3) preventing infections for healthcare workers by using personal protective equipment; 4) highlighting importance of respiratory care and physical therapy during hospitalization in patients with COVID-19; and 5) facilitating referral to a rehabilitation program in patients recovering from COVID-19.
EXPERT OPINION:
We recommend daily physical exercise, outdoors or at home, as physical exercise increases the synthesis of anti-inflammatory cytokines; Patients with COVID-19 may develop severe acute respiratory syndrome, hypoxemia, diffuse alveolar damage, ACE2 reduction in the cardiovascular system and muscle weakness acquired through a prolonged hospital stay; The role of the physiotherapist in the hospital environment is of fundamental importance-early mobilization is highly recommended in severe cases of COVID-19.
Guarda su PubMed
-
A Comprehensive Functional Analysis in Patients after Atrial Switch Surgery.
Thorac Cardiovasc Surg2021 Dec;69(S 03):e32-e40. doi: 10.1055/s-0041-1726307.
Hornung Andreas, Vollmer Daniela, Wiegand Gesa, Apitz Christian, Latus Heiner, Hofbeck Michael, Sieverding Ludger,
Abstract
BACKGROUND:
?Long-term course after atrial switch operation is determined by increasing right ventricular (RV) insufficiency. The aim of our study was to investigate subtle functional parameters by invasive measurements with conductance technique and noninvasive examinations with cardiac magnetic resonance imaging (CMR).
METHODS:
?We used invasive (pressure-volume loops under baseline conditions and dobutamine) and noninvasive techniques (CMR with feature tracking [FT] method) to evaluate RV function. All patients had cardiopulmonary exercise testing (CPET).
RESULTS:
?From 2011 to 2013, 16 patients aged 28.2?±?7.3 (22-50) years after atrial switch surgery (87.5% Senning and 12.5% Mustard) were enrolled in this prospective study. All patients were in New York Heart Association (NYHA) class I to II and presented mean peak oxygen consumption of 30.1?±?5.7 (22.7-45.5) mL/kg/min. CMR-derived end-diastolic volume was 110?±?22 (78-156) mL/m and RV ejection fraction 41?±?8% (25-52%). CMR-FT revealed lower global systolic longitudinal, radial, and circumferential strain for the systemic RV compared with the subpulmonary left ventricle. End-systolic elastance (Ees) was overall reduced (compared with data from the literature) and showed significant increase under dobutamine (0.80?±?0.44 to 1.89?±?0.72?mm Hg/mL, ? 0.001), whereas end-diastolic elastance (Eed) was not significantly influenced (0.11?±?0.70 to 0.13?±?0.15?mm Hg/mL, ?=?0.454). We found no relevant relationship between load-independent conductance indices and strain or CPET parameters. Conductance analysis revealed significant mechanical dyssynchrony, higher during diastole (mean 30?±?4% baseline, 24?±?6% dobutamine) than during systole (mean 17?±?6% baseline, 19?±?7% dobutamine).
CONCLUSIONS:
?Functional assessment of a deteriorating systemic RV remains demanding. Conductance indices as well as the CMR-derived strain parameters showed overall reduced values, but a significant relationship was not present (including CPET). Our conductance analysis revealed intraventricular and predominantly diastolic RV dyssynchrony.
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Guarda su PubMed
-
Effects of wearing a cloth face mask on performance, physiological and perceptual responses during a graded treadmill running exercise test.
Br J Sports Med2021 Apr;():. doi: bjsports-2020-103758.
Driver Simon, Reynolds Megan, Brown Katelyn, Vingren Jakob L, Hill David W, Bennett Monica, Gilliland Taylor, McShan Evan, Callender Librada, Reynolds Erin, Borunda Nate, Mosolf John, Cates Casey, Jones Alan,
Abstract
OBJECTIVES:
To (1) determine if wearing a cloth face mask significantly affected exercise performance and associated physiological responses, and (2) describe perceptual measures of effort and participants' experiences while wearing a face mask during a maximal treadmill test.
METHODS:
Randomised controlled trial of healthy adults aged 18-29 years. Participants completed two (with and without a cloth face mask) maximal cardiopulmonary exercise tests (CPETs) on a treadmill following the Bruce protocol. Blood pressure, heart rate, oxygen saturation, exertion and shortness of breath were measured. Descriptive data and physical activity history were collected pretrial; perceptions of wearing face masks and experiential data were gathered immediately following the masked trial.
RESULTS:
The final sample included 31 adults (age=23.2±3.1 years; 14 women/17 men). Data indicated that wearing a cloth face mask led to a significant reduction in exercise time (-01:39±01:19 min/sec, p<0.001), maximal oxygen consumption (VOmax) (-818±552 mL/min, p<0.001), minute ventilation (-45.2±20.3 L/min), maximal heart rate (-8.4±17.0 beats per minute, p<0.01) and increased dyspnoea (1.7±2.9, p<0.001). Our data also suggest that differences in SpO and rating of perceived exertion existed between the different stages of the CPET as participant's exercise intensity increased. No significant differences were found between conditions after the 7-minute recovery period.
CONCLUSION:
Cloth face masks led to a 14% reduction in exercise time and 29% decrease in VOmax, attributed to perceived discomfort associated with mask-wearing. Compared with no mask, participants reported feeling increasingly short of breath and claustrophobic at higher exercise intensities while wearing a cloth face mask. Coaches, trainers and athletes should consider modifying the frequency, intensity, time and type of exercise when wearing a cloth face mask.
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Guarda su PubMed
-
Cardiopulmonary exercise test. More than a simple exercise test, but cautious how to interpret.
Hellenic J Cardiol -
Post-Traumatic Stress Disorder is Associated with a Decrease in Anaerobic Threshold, O-Pulse, and Maximal Oxygen Uptake.
Chest2021 Apr;():. doi: S0012-3692(21)00674-7.
McMahon Michael J, Holley Aaron B, Warren Whittney A, Collen Jacob F, Sherner John H, Zeman Joseph E, Morris Michael J,
Abstract
BACKGROUND:
Post-traumatic stress disorder (PTSD) has been linked to respiratory symptoms and functional limitations, but the mechanism(s) leading to this association are poorly defined.
RESEARCH QUESTION:
What is the relationship between PTSD, lung function, and the cardiopulmonary response to exercise in combat veterans presenting with chronic respiratory symptoms?
STUDY DESIGN:
and Methods: We prospectively enrolled military service members with respiratory symptoms following deployment to southwest Asia (SWA). All participants underwent a comprehensive evaluation to include pulmonary function (PFT) and cardiopulmonary exercise (CPET) testing. We compared PFT variables and cardiopulmonary response to exercise in subjects with and without PTSD using multivariable linear regression to adjust for confounders.
RESULTS:
303 participants were included (PTSD =70; Non-PTSD =233). Those with PTSD had a greater frequency of current respiratory complaints. There were no differences in measures for airway disease or lung volumes, but patients with PTSD had a reduction in diffusing capacity (DLCO) that was eliminated after adjustment for differences in hemoglobin levels. Participants with PTSD had a lower anaerobic threshold (AT) (23.9 vs 26.4 cc/kg/min; p =0.004), peak oxygen pulse (19.7 vs 18.5 cc/beat; p=0.03) and peak oxygen uptake (peakVO) (34.5 cc/kg/min vs 38.8 cc/kg/min, p <0.001). No significant difference was observed in gas-exchange, respiratory reserve, or effort at peak exercise between participants with and without PTSD.
Copyright © 2021. Published by Elsevier Inc.
Guarda su PubMed
-
Intercept of minute ventilation versus carbon dioxide output relationship as an index of ventilatory inefficiency in chronic obstructive pulmonary disease.
J Thorac Dis2021 Mar;13(3):1553-1563. doi: 10.21037/jtd-20-2725.
Lin Fang, Nie Shan, Zhao Ranran, Cao Min, Yuan Wei, Li Yunxiao, Tan Chunting, Xu Bo, Wang Haoyan,
Abstract
Background:
Ventilatory inefficiency contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). The intercept of the minute ventilation (V) carbon dioxide output (V CO) plot is a key ventilatory inefficiency parameter. However, its relationships with lung hyperinflation (LH) and airflow limitation are not known. This study aimed to evaluate correlations between the V/V CO intercept and LH and airflow limitation to determine its physiological interpretation as an index of functional impairment in COPD.
Methods:
We conducted a retrospective analysis of data from 53 COPD patients and 14 healthy controls who performed incremental cardiopulmonary exercise tests (CPETs) and resting pulmonary function assessment. Ventilatory inefficiency was represented by parameters reflecting the V/V CO nadir and slope (linear region) and the intercept of V/V CO plot. Their correlations with measures of LH and airflow limitation were evaluated.
Results:
Compared to control, the slope (30.58±3.62, P<0.001) and intercept (4.85±1.11 L/min, P<0.05) were higher in COPD, leading to a higher nadir (31.47±4.47, P<0.01). Despite an even higher intercept in COPD (7.16±1.41, P<0.001), the slope diminished with disease progression (from 30.58±3.62 in COPD to 26.84±4.96 in COPD, P<0.01). There was no difference in nadir among COPD groups and higher intercepts across all stages. The intercept was correlated with peak V/maximal voluntary ventilation (MVV) (r=0.489, P<0.001) and peak V O/Watt (r=0.354, P=0.003). The intercept was positively correlated with residual volume (RV) % predicted (r=0.571, P<0.001), RV/total lung capacity (TLC) (r=0.588, P<0.001), peak tidal volume (V)/FEV (r=0.482, P<0.001) and negatively correlated with rest inspiratory capacity (IC)/TLC (r=-0.574, P<0.001), peak V/TLC (r=-0.585, P<0.001), airflow limitation forced expiratory volume in 1 s (FEV) % predicted (r=-0.606, P<0.001), and FEV/forced vital capacity (FVC) (r=-0.629, P<0.001).
Conclusions:
V/V CO intercept was consistently correlated with worsening static and dynamic LH, pulmonary gas exchange, and airflow limitation in COPD. The V/V CO intercept emerged as a useful index of ventilatory inefficiency in COPD patients.
2021 Journal of Thoracic Disease. All rights reserved.
Guarda su PubMed
-
Combined Chair-Based Exercises Improve Functional Fitness, Mental Well-Being, Salivary Steroid Balance, and Anti-microbial Activity in Pre-frail Older Women.
Front Psychol2021 ;12():564490. doi: 10.3389/fpsyg.2021.564490.
Furtado Guilherme Eustáquio, Letieri Rubens Vinícius, Silva-Caldo Adriana, Trombeta Joice C S, Monteiro Clara, Rodrigues Rafael Nogueira, Vieira-Pedrosa Ana, Barros Marcelo Paes, Cavaglieri Cláudia Regina, Hogervorst Eef, Teixeira Ana Maria, Ferreira José Pedro,
Abstract
Introduction:
Regular exercise has long been shown to positively impact the immune system responsiveness and improve mental well-being (MWB). However, the putative links between biomarkers of mental health and immune efficiency in exercising subjects have been scarcely investigated. The aim of this study was to verify the effect of a 14-week combined chair-based exercise program (CEP) on salivary steroid hormones and anti-microbial proteins, functional fitness, and MWB indexes in pre-frail older women.
Methods:
The participant women (82.8 4.6 years old; = 32) were randomly divided into the exercising group (CEP, = 17) and the non-exercising control group (CG, = 15). The pre/post assessment included: (1) salivary anti-microbial proteins lysozyme; (Lys) and immunoglobulin-A (IgA); (2) salivary steroid hormones of testosterone (TT) and cortisol (COR); (3) functional fitness (gait speed, hand grip strength, and static balance); (4) MWB questionnaires (happiness, depression state, satisfaction with life, and stress).
Results:
Significant differences with large Cohen's () effect sizes were found on increased salivary TT ( < 0.05; = 0.60) after exercise intervention. The results revealed a decrease in IgA levels after CEP ( < 0.01, = 0.30). The increase in subjective happiness levels ( < 0.05, = 0.30) and decrease of stress perception ( < 0.01, = 2.60) and depressive state ( < 0.05, = 0.30) were found after intervention in the CEP group. Robust statistical differences in gait speed ( < 0.05; = 0.60) and balance tests ( < 0.05; = 0.80) were also found in the CEP group. In control, COR increased moderately ( < 0.05; = 0.65) while no changes were found for the other indicators. Correlation analyses showed inter-dependence between pre-post variations of MWB, biochemical indexes, and fitness function (e.g., COR inverse correlation with hand grip strength and balance tests).
Conclusion:
The CEP program was able to improve functional-fitness performance, decrease feelings of stress, and increase happiness. The CEP also induced clinically relevant hormonal and immune responses, which suggests that chair exercises that combine muscular strength, balance, and gait speed training are promising interventions to improve physical and mental health of older pre-frail adults.
Copyright © 2021 Furtado, Letieri, Silva-Caldo, Trombeta, Monteiro, Rodrigues, Vieira-Pedrosa, Barros, Cavaglieri, Hogervorst, Teixeira and Ferreira.
Guarda su PubMed
-
Reversal of cardiopulmonary exercise intolerance in patients with post-thrombotic obstruction of the inferior vena cava.
Thromb Res2021 Apr;():. doi: S0049-3848(21)00129-8.
Sebastian Tim, Barco Stefano, Kreuzpointner Robert, Konstantinides Stavros, Kucher Nils,
Abstract
BACKGROUND:
It is unclear whether cardiopulmonary exercise intolerance in patients with chronic obstruction of the inferior vena cava (IVC) is reversible following endovascular IVC reconstruction.
METHODS:
In 17 patients (mean age 45 ± 15 years, 71% men) with post-thrombotic syndrome due to IVC obstruction and preserved left ventricular ejection fraction (mean 58 ± 3%), we performed cardiopulmonary exercise testing before and 3 months after IVC reconstruction (mean 4.1 ± 1.5 implanted stents). The median time from latest episode of deep vein thrombosis to intervention was 150 (interquartile range 102-820) days.
RESULTS:
At baseline, 12 (71%) patients reported New York Heart Association (NYHA) class II or III symptoms, 76% did not achieve >85% of predicted oxygen uptake at peak exercise (mean 61.8 ± 13.7%). After IVC reconstruction, the following changes were observed at anaerobic threshold: work rate increased by 14.6 W, 95%CI (-0.7; 30.0), oxygen uptake increased by 1.8 ml/kg, 95%CI (0.3; 3.3). Oxygen pulse increased by 1.95 ml per beat, 95%CI (1.12; 2.78), corresponding to a mean relative increase of 22.5%, 95%CI (12.4; 32.7) (p < 0.001). The following changes were observed at peak exercise: work rate increased by 48.1 W, 95%CI (27.8; 68.4), oxygen uptake increased by 6.4 ml/kg, 95%CI (3.8; 9.1). Oxygen pulse increased by 2.68 ml per beat, 95%CI (1.60; 3.76), corresponding to a mean relative increase of 29.4%, 95%CI (17.7; 41.2) (p < 0.001). At follow-up, 5 (29%) patients remained in NYHA class II.
CONCLUSIONS:
In patients with chronic IVC obstruction, cardiopulmonary exercise intolerance as a result of impaired cardiac filling is at least partially reversible following endovascular IVC reconstruction.
STUDY REGISTRATION:
URL: https://clinicaltrials.gov. Unique identifier: NCT02433054.
Copyright © 2021 Elsevier Ltd. All rights reserved.
Guarda su PubMed
-
Traditional Chinese exercise potential role as prevention and adjuvant therapy in patients with COVID-19.
Complement Ther Clin Pract2021 Apr;43():101379. doi: S1744-3881(21)00078-5.
Yang Sha, Liu Tianyu, Xiong Jing, Teng Yuke, Guo Yuyi, Yu Shuguang, Zeng Fang,
Abstract
The epidemic situation of COVID-19 is a great public health emergency worldwide characterized by fastest spreading, widest infection range and the mostly difficult to prevent and control in recent years. According to medical experience, traditional Chinese exercises (TCE) have been applied for COVID-19 prevention, adjuvant treatment or rehabilitation, and achieved some curative effects. They can enhance the body immunity, improve the function of organs, especially cardiopulmonary function, promote physical and mental rehabilitation by adjusting the body, regulating the breath, regulating the mind. This paper aims to investigate the potential value of TCE for health preservation in the prevention and adjuvant treatment for COVID-19 according to an overview of application and analysis of existing evidence. On this basis, this review proposed the TCE plan by visiting clinical and practice experts, so as to provide some references for the prevention and treatment of COVID-19 with TCE in the world.
Copyright © 2021 Elsevier Ltd. All rights reserved.
Guarda su PubMed
