Carvedilol Does Not Improve Exercise Performance in Fontan Patients: Results of a Crossover Trial

Context:Although body cooling has both performance and safety benefits, knowledge on optimizing cooling during specific sport competition is limited.Objectives:To identify when, during sport competition, it is optimal for body cooling and to identify optimal body-cooling modalities to enhance safety and maximize sport performance.Evidence Acquisition:A comprehensive literature search was conducted to identify articles with specific context regarding body cooling, sport performance, and cooling modalities used during sport competition. A search of scientific peer-reviewed literature examining the effects of body cooling on exercise performance was done to examine the influence of body cooling on exercise performance. Subsequently, a literature search was done to identify effective cooling modalities that have been shown to improve exercise performance.Evidence Synthesis:The cooling modalities that are most effective in cooling the body during sport competition depend on the sport, timing of cooling, and feasibility based on the constraints of the sports rules and regulations. Factoring in the length of breaks (halftime substitutions, etc), the equipment worn during competition, and the cooling modalities that offer the greatest potential to cool must be considered in each individual sport.Conclusions:Scientific evidence supports using body cooling as a method of improving performance during sport competition. Developing a strategy to use cooling modalities that are scientifically evidence-based to improve performance while maximizing athlete’s safety warrants further investigation.

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Effect of a day-trip to altitude (2500 m) on exercise performance in pulmonary hypertension: randomised crossover trial

ERJ Open Research ◽

10.1183/23120541.00314-2021 ◽

2021 ◽

Vol 7 (4) ◽

pp. 00314-2021

Author(s):

Simon R. Schneider ◽

Laura C. Mayer ◽

Mona Lichtblau ◽

Charlotte Berlier ◽

Esther I. Schwarz ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Exercise Performance ◽

Crossover Trial ◽

Arterial Oxygen Tension ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Mean Difference ◽

Arterial Oxygen ◽

Peripheral Oxygen Saturation ◽

High Interindividual Variability ◽

Constant Work Rate

Question addressed by the studyTo investigate exercise performance and hypoxia-related health effects in patients with pulmonary hypertension (PH) during a high-altitude sojourn.Patients and methodsIn a randomised crossover trial in stable (same therapy for >4 weeks) patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) with resting arterial oxygen tension (PaO2) ≥7.3 kPa, we compared symptom-limited constant work-rate exercise test (CWRET) cycling time during a day-trip to 2500 m versus 470 m. Further outcomes were symptoms, oxygenation and echocardiography. For safety, patients with sustained hypoxaemia at altitude (peripheral oxygen saturation <80% for >30 min or <75% for >15 min) received oxygen therapy.Results28 PAH/CTEPH patients (n=15/n=13); 13 females; mean±sd age 63±15 years were included. After >3 h at 2500 m versus 470 m, CWRET-time was reduced to 17±11 versus 24±9 min (mean difference −6, 95% CI −10 to −3), corresponding to −27.6% (−41.1 to −14.1; p<0.001), but similar Borg dyspnoea scale. At altitude, PaO2 was significantly lower (7.3±0.8 versus 10.4±1.5 kPa; mean difference −3.2 kPa, 95% CI −3.6 to −2.8 kPa), whereas heart rate and tricuspid regurgitation pressure gradient (TRPG) were higher (86±18 versus 71±16 beats·min−1, mean difference 15 beats·min−1, 95% CI 7 to 23 beats·min−1) and 56±25 versus 40±15 mmHg (mean difference 17 mmHg, 95% CI 9 to 24 mmHg), respectively, and remained so until end-exercise (all p<0.001). The TRPG/cardiac output slope during exercise was similar at both altitudes. Overall, three (11%) out of 28 patients received oxygen at 2500 m due to hypoxaemia.ConclusionThis randomised crossover study showed that the majority of PH patients tolerate a day-trip to 2500 m well. At high versus low altitude, the mean exercise time was reduced, albeit with a high interindividual variability, and pulmonary artery pressure at rest and during exercise increased, but pressure–flow slope and dyspnoea were unchanged.

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