scholarly journals Effect of Six-Minute Walk Test and Incremental Exercise on Inspiratory Capacity, Ventilatory Constraints, Breathlessness and Exercise Performance in Sedentary Male Smokers without Airway Obstruction

2021 ◽  
Vol 18 (23) ◽  
pp. 12665
Author(s):  
Wassim Melliti ◽  
Rim Kammoun ◽  
Donies Masmoudi ◽  
Said Ahmaidi ◽  
Kaouthar Masmoudi ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Lung Volume ◽  
Maximal Exercise ◽  
Ventilatory Threshold ◽  
Minute Ventilation ◽  
Pulmonary Function Tests ◽  
Exercise Intolerance ◽  
Dynamic Hyperinflation ◽  
Walk Test ◽  
Inspiratory Capacity

We investigated physiological responses and exercise capacity in sedentary young smokers during sub-maximal and maximal test and its impact on dyspnea and exercise intolerance. Fifty sedentary male smokers and non-smokers (age: 24 ± 1 years., weight: 71 ± 9 kg, height: 177.3 ± 4.8 cm, body mass index: 22.6 ± 2.5 kg/m2) underwent two visits with pulmonary function tests, breathing pattern, and inspiratory capacity measurement at rest and during sub-maximal and maximal exercise. Smokers show reduced exercise capacity during six minutes walk test (6-MWT) with decreased walked distance (p < 0.001) and inspiratory capacity (p < 0.05). During cardiopulmonary exercise test (CPET), smokers had higher minute ventilation VE for a given submaximal intensity (p < 0.05) and lower minute ventilation at maximal exercise (p < 0.001). End expiratory lung volume was significantly lower in sedentary smokers at rest (p < 0.05), at ventilatory threshold during exercise (p < 0.05), but not during peak exercise. End inspiratory lung volume was significantly lower in smokers at rest (p < 0.05) and ventilatory threshold (p < 0.05). Cigarette smoking alters lung function during submaximal and maximal exercise. This alteration is manifested by the development of dynamic hyperinflation contributing to exercise capacity limitation.

Regulation of ventilatory capacity during exercise in asthmatics

1995 ◽  
Vol 79 (3) ◽  
pp. 892-901 ◽  
Author(s):  
B. D. Johnson ◽  
P. D. Scanlon ◽  
K. C. Beck
Keyword(s):  
Exercise Capacity ◽  
Lung Volume ◽  
Maximal Exercise ◽  
Minute Ventilation ◽  
Constant Load ◽  
Flow Limitation ◽  
Ventilatory Capacity ◽  
Ventilatory Reserve ◽  
Maximal Exercise Capacity ◽  
Bronchomotor Tone

In asthmatic and control subjects, we examined the changes in ventilatory capacity (VECap), end-expiratory lung volume (EELV), and degree of flow limitation during three types of exercise: 1) incremental, 2) constant load (50% of maximal exercise capacity; 36 min), and 3) interval (alternating between 60 and 40% of maximal exercise capacity; 6-min workloads for 36 min). The VECap and degree of flow limitation at rest and during the various stages of exercise were estimated by aligning the tidal breathing flow-volume (F-V) loops within the maximal expiratory F-V (MEFV) envelope using the measured EELV. In contrast to more usual estimates of VECap (i.e., maximal voluntary ventilation and forced expiratory volume in 1 s x 40), the calculated VECap depended on the existing bronchomotor tone, the lung volume at which the subjects breathed (i.e., EELV), and the tidal volume. During interval and constant-load exercise, asthmatic subjects experienced reduced ventilatory reserve, higher degrees of flow limitation, and had higher EELVs compared with nonasthmatic subjects. During interval exercise, the VECap of the asthmatic subjects increased and decreased with variations in minute ventilation, due in part to alterations in their MEFV curve as exercise intensity varied between 60 and 49% of maximal capacity. In conclusion, asthmatic subjects have a more variable VECap and reduced ventilatory reserve during exercise compared with nonasthmatic subjects. The variations in VECap are due in part to a more labile MEFV curve secondary to changes in bronchomotor tone. Asthmatics defend VECap and minimize flow limitation by increasing EELV.

scholarly journals Airway clearance physiotherapy improves ventilatory dynamics during exercise in patients with cystic fibrosis: a pilot study

2018 ◽  
Vol 104 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Fernanda Maria Vendrusculo ◽  
Zoe Johnstone ◽  
Elaine Dhouieb ◽  
Márcio V F Donadio ◽  
Steven Cunningham ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pilot Study ◽  
Exercise Capacity ◽  
Ventilatory Threshold ◽  
Minute Ventilation ◽  
Cardiopulmonary Exercise Testing ◽  
Airflow Limitation ◽  
Dynamic Hyperinflation ◽  
Airway Clearance ◽  
Significant Difference

BackgroundAirflow limitation and dynamic hyperinflation may limit exercise capacity in patients with cystic fibrosis (CF). The aim was to investigate whether the undertaking of airway clearance physiotherapy (ACT) prior to cardiopulmonary exercise testing (CPET) results in improvements in exercise capacity.MethodsA prospective randomised, cross-over pilot study was performed in children aged >9 years. Spirometry, plethysmography and CPET were performed on two separate occasions—one test with ACT prior to CPET and the other without.Results12 patients with CF were included in the study with a mean (SD) age of 12.83 (1.85) years. No significant difference in peak oxygen uptake (VO2) was found between the tests. However, lower minute ventilation (VE) and ventilatory equivalents (VEVO2 and VEVCO2) at ventilatory threshold (VT) were noted when ACT was undertaken prior to CPET. The mean(SD) VE (L/min) at VT was 26.67 (5.49) vs 28.92 (6.3) (p=0.05), VEVO2 (L/min) at VT was 24.5 (1.75) vs 26.05 (2.5) (p=0.03) and VEVCO2 (L/min) at VT was 26.58 (2.41) vs 27.98 (2.11) (p=0.03).ConclusionsThese pilot data suggest that ACT prior to exercise may lead to improved ventilatory dynamics during exercise in individuals with CF.

Expiratory muscle activity in the awake and sleeping human during lung inflation and hypercapnia

1992 ◽  
Vol 72 (3) ◽  
pp. 881-887 ◽  
Author(s):  
Y. Wakai ◽  
M. M. Welsh ◽  
A. M. Leevers ◽  
J. D. Road
Keyword(s):  
Lung Volume ◽  
Muscle Activity ◽  
Ventilatory Threshold ◽  
Minute Ventilation ◽  
Abdominal Muscle ◽  
Transversus Abdominis ◽  
Abdominal Muscles ◽  
Lung Inflation ◽  
Expiratory Muscle ◽  
Intramuscular Electrodes

Expiratory muscle activity has been shown to occur in awake humans during lung inflation; however, whether this activity is dependent on consciousness is unclear. Therefore we measured abdominal muscle electromyograms (intramuscular electrodes) in 13 subjects studied in the supine position during wakefulness and non-rapid-eye-movement sleep. Lung inflation was produced by nasal continuous positive airway pressure (CPAP). CPAP at 10–15 cmH2O produced phasic expiratory activity in two subjects during wakefulness but produced no activity in any subject during sleep. During sleep, CPAP to 15 cmH2O increased lung volume by 1,260 +/- 215 (SE) ml, but there was no change in minute ventilation. The ventilatory threshold at which phasic abdominal muscle activity was first recorded during hypercapnia was 10.3 +/- 1.1 l/min while awake and 13.8 +/- 1 l/min while asleep (P less than 0.05). Higher lung volumes reduced the threshold for abdominal muscle recruitment during hypercapnia. We conclude that lung inflation alone over the range that we studied does not alter ventilation or produce recruitment of the abdominal muscles in sleeping humans. The internal oblique and transversus abdominis are activated at a lower ventilatory threshold during hypercapnia, and this activation is influenced by state and lung volume.

scholarly journals Ventilatory response to exercise in subjects breathing CO2 or HeO2

1997 ◽  
Vol 82 (3) ◽  
pp. 746-754 ◽  
Author(s):  
T. G. Babb
Keyword(s):  
Maximal Exercise ◽  
Respiratory Mechanics ◽  
Ventilatory Threshold ◽  
Ventilatory Response ◽  
Minute Ventilation ◽  
Normal Lung ◽  
Normal Lung Function ◽  
Older Subjects ◽  
Breathing Room ◽  
Response To Exercise

Babb, T. G. Ventilatory response to exercise in subjects breathing CO2 or HeO2. J. Appl. Physiol. 82(3): 746–754, 1997.—To investigate the effects of mechanical ventilatory limitation on the ventilatory response to exercise, eight older subjects with normal lung function were studied. Each subject performed graded cycle ergometry to exhaustion once while breathing room air; once while breathing 3% CO2-21% O2-balance N2; and once while breathing HeO2 (79% He and 21% O2). Minute ventilation (V˙e) and respiratory mechanics were measured continuously during each 1-min increment in work rate (10 or 20 W). Data were analyzed at rest, at ventilatory threshold (VTh), and at maximal exercise. When the subjects were breathing 3% CO2, there was an increase ( P < 0.001) inV˙e at rest and at VTh but not during maximal exercise. When the subjects were breathing HeO2,V˙e was increased ( P < 0.05) only during maximal exercise (24 ± 11%). The ventilatory response to exercise below VTh was greater only when the subjects were breathing 3% CO2( P < 0.05). Above VTh, the ventilatory response when the subjects were breathing HeO2 was greater than when breathing 3% CO2( P < 0.01). Flow limitation, as percent of tidal volume, during maximal exercise was greater ( P < 0.01) when the subjects were breathing CO2 (22 ± 12%) than when breathing room air (12 ± 9%) or when breathing HeO2 (10 ± 7%) ( n = 7). End-expiratory lung volume during maximal exercise was lower when the subjects were breathing HeO2 than when breathing room air or when breathing CO2( P < 0.01). These data indicate that older subjects have little reserve for accommodating an increase in ventilatory demand and suggest that mechanical ventilatory constraints influence both the magnitude of V˙eduring maximal exercise and the regulation ofV˙e and respiratory mechanics during heavy-to-maximal exercise.

scholarly journals Exercise Capacity, Ventilatory Response, and Gas Exchange in COPD Patients With Mild to Severe Obstruction Residing at High Altitude

2021 ◽  
Vol 12 ◽  
Author(s):  
Mauricio Gonzalez-Garcia ◽  
Margarita Barrero ◽  
Dario Maldonado
Keyword(s):  
Gas Exchange ◽  
High Altitude ◽  
Sea Level ◽  
Exercise Capacity ◽  
Oxygen Pressure ◽  
Exercise Intolerance ◽  
Arterial Oxygen ◽  
Dynamic Hyperinflation ◽  
Copd Patients ◽  
Inspired Oxygen

BackgroundExercise intolerance, desaturation, and dyspnea are common features in patients with chronic obstructive pulmonary disease (COPD). At altitude, the barometric pressure (BP) decreases, and therefore the inspired oxygen pressure and the partial pressure of arterial oxygen (PaO2) also decrease in healthy subjects and even more in patients with COPD. Most of the studies evaluating ventilation and arterial blood gas (ABG) during exercise in COPD patients have been conducted at sea level and in small populations of people ascending to high altitudes. Our objective was to compare exercise capacity, gas exchange, ventilatory alterations, and symptoms in COPD patients at the altitude of Bogotá (2,640 m), of all degrees of severity.MethodsMeasurement during a cardiopulmonary exercise test of oxygen consumption (VO2), minute ventilation (VE), tidal volume (VT), heart rate (HR), ventilatory equivalents of CO2 (VE/VCO2), inspiratory capacity (IC), end-tidal carbon dioxide tension (PETCO2), and ABG. For the comparison of the variables between the control subjects and the patients according to the GOLD stages, the non-parametric Kruskal–Wallis test or the one-way analysis of variance test was used.ResultsEighty-one controls and 525 patients with COPD aged 67.5 ± 9.1 years were included. Compared with controls, COPD patients had lower VO2 and VE (p &lt; 0.001) and higher VE/VCO2 (p = 0.001), A-aPO2, and VD/VT (p &lt; 0.001). In COPD patients, PaO2 and saturation decreased, and delta IC (p = 0.004) and VT/IC increased (p = 0.002). These alterations were also seen in mild COPD and progressed with increasing severity of the obstruction.ConclusionThe main findings of this study in COPD patients residing at high altitude were a progressive decrease in exercise capacity, increased dyspnea, dynamic hyperinflation, restrictive mechanical constraints, and gas exchange abnormalities during exercise, across GOLD stages 1–4. In patients with mild COPD, there were also lower exercise capacity and gas exchange alterations, with significant differences from controls. Compared with studies at sea level, because of the lower inspired oxygen pressure and the compensatory increase in ventilation, hypoxemia at rest and during exercise was more severe; PaCO2 and PETCO2 were lower; and VE/VO2 was higher.

scholarly journals Intensity and quality of exertional dyspnoea in patients with stable pulmonary hypertension

2019 ◽  
Vol 55 (2) ◽  
pp. 1802108 ◽  
Author(s):  
Athénaïs Boucly ◽  
Capucine Morélot-Panzini ◽  
Gilles Garcia ◽  
Jason Weatherald ◽  
Xavier Jaïs ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Minute Ventilation ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Dynamic Hyperinflation ◽  
Exertional Dyspnoea ◽  
Work Effort ◽  
Inspiratory Capacity ◽  
Thromboembolic Pulmonary Hypertension ◽  
Pulmonary Arterial ◽  
The Impact

Dynamic hyperinflation is observed during exercise in 60% of patients with clinically stable pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), intensifying exertional dyspnoea. The impact of dynamic changes in respiratory mechanics during exercise on qualitative dimensions of dyspnoea in these patients has not been evaluated.26 patients (PAH n=17; CTEPH n=9) performed an incremental symptom-limited cycle exercise test. Minute ventilation (V′E), breathing pattern, operating lung volumes and dyspnoea intensity were assessed throughout exercise. Dyspnoea quality was serially assessed during exercise using a three-item questionnaire (dyspnoea descriptors). The inflection point of tidal volume (VT) relative to V′E was determined for each incremental test. Changes in inspiratory capacity during exercise defined two groups of patients: hyperinflators (65%) and non-hyperinflators (35%). Multidimensional characterisation of dyspnoea was performed after exercise using the Multidimensional Dyspnea Profile.In hyperinflators, inspiratory capacity decreased progressively throughout exercise by 0.36 L, while remaining stable in non-hyperinflators. The “work/effort” descriptor was most frequently selected throughout exercise in both types of patients (65% of all responses). At the VT/V′E inflection, work/effort plateaued while “unsatisfied inspiration” descriptors became selected predominantly only in hyperinflators (77% of all responses). In the affective domain, the emotion most frequently associated with dyspnoea was anxiety.In pulmonary hypertension patients who develop hyperinflation during exercise, dyspnoea descriptors referring to unsatisfied inspiration become predominant following the VT/V′E inflection. As these descriptors are generally associated with more negative emotional experiences, delaying or preventing the VT/V′E inflection may have important implications for symptom management in patients with pulmonary hypertension.

scholarly journals Changes in dynamic lung mechanics after lung volume reduction coil treatment of severe emphysema

Thorax ◽  
2017 ◽  
Vol 73 (6) ◽  
pp. 584-586 ◽  
Author(s):  
Demosthenes Makris ◽  
Sylvie Leroy ◽  
Johana Pradelli ◽  
Jonathan Benzaquen ◽  
Hervé Guenard ◽  
...  
Keyword(s):  
Lung Volume ◽  
Lung Compliance ◽  
Lung Mechanics ◽  
Dynamic Hyperinflation ◽  
Positive End Expiratory Pressure ◽  
Lung Volume Reduction ◽  
Inspiratory Capacity ◽  
Endurance Time ◽  
Significant Attenuation ◽  
Dynamic Lung Compliance

We assessed the relationships between changes in lung compliance, lung volumes and dynamic hyperinflation in patients with emphysema who underwent bronchoscopic treatment with nitinol coils (coil treatment) (n=11) or received usual care (UC) (n=11). Compared with UC, coil treatment resulted in decreased dynamic lung compliance (CLdyn) (p=0.03) and increased endurance time (p=0.010). The change in CLdyn was associated with significant improvement in FEV1 and FVC, with reduction in residual volume and intrinsic positive end-expiratory pressure, and with increased inspiratory capacity at rest/and at exercise. The increase in end-expiratory lung volume (EELV) during exercise (EELVdyn-ch=EELVisotime EELVrest) demonstrated significant attenuation after coil treatment (p=0.02).

Effect of mild-to-moderate airflow limitation on exercise capacity

1991 ◽  
Vol 70 (1) ◽  
pp. 223-230 ◽  
Author(s):  
T. G. Babb ◽  
R. Viggiano ◽  
B. Hurley ◽  
B. Staats ◽  
J. R. Rodarte
Keyword(s):  
Exercise Capacity ◽  
Vital Capacity ◽  
Maximal Exercise ◽  
Minute Ventilation ◽  
Airflow Limitation ◽  
Maximal Heart Rate ◽  
Lung Capacity ◽  
Close Relationship ◽  
Response To Exercise ◽  
Maximal Exercise Capacity

To determine the effect of mild-to-moderate airflow limitation on exercise tolerance and end-expiratory lung volume (EELV), we studied 9 control subjects with normal pulmonary function [forced expired volume in 1 s (FEV1) 105% pred; % of forced vital capacity expired in 1 s (FEV1/FVC%) 81] and 12 patients with mild-to-moderate airflow limitation (FEV1 72% pred; FEV1/FVC % 58) during progressive cycle ergometry. Maximal exercise capacity was reduced in patients [69% of pred maximal O2 uptake (VO2max)] compared with controls (104% pred VO2max, P less than 0.01); however, maximal expired minute ventilation-to-maximum voluntary ventilation ratio and maximal heart rate were not significantly different between controls and patients. Overall, there was a close relationship between VO2max and FEV1 (r2 = 0.62). Resting EELV was similar between controls and patients [53% of total lung capacity (TLC)], but at maximal exercise the controls decreased EELV to 45% of TLC (P less than 0.01), whereas the patients increased EELV to 58% of TLC (P less than 0.05). Overall, EELV was significantly correlated to both VO2max (r = -0.71, P less than 0.001) and FEV1 (r = -0.68, P less than 0.001). This relationship suggests a ventilatory influence on exercise capacity; however, the increased EELV and associated pleural pressures could influence cardiovascular function during exercise. We suggest that the increase in EELV should be considered a response reflective of the effect of airflow limitation on the ventilatory response to exercise.

Effect of obesity on respiratory mechanics during rest and exercise in COPD

2011 ◽  
Vol 111 (1) ◽  
pp. 10-19 ◽  
Author(s):  
Josuel Ora ◽  
Pierantonio Laveneziana ◽  
Karin Wadell ◽  
Megan Preston ◽  
Katherine A. Webb ◽  
...  
Keyword(s):  
Muscle Function ◽  
Respiratory Muscle ◽  
Pulmonary Function Tests ◽  
Forced Expiratory Volume ◽  
Normal Weight ◽  
Exercise Intolerance ◽  
Chronic Obstructive ◽  
Inspiratory Capacity ◽  
Respiratory Muscle Function ◽  
Gastric Pressure

The presence of obesity in COPD appears not to be a disadvantage with respect to dyspnea and weight-supported cycle exercise performance. We hypothesized that one explanation for this might be that the volume-reducing effects of obesity convey mechanical and respiratory muscle function advantages. Twelve obese chronic obstructive pulmonary disease (COPD) (OB) [forced expiratory volume in 1 s (FEV1) = 60%predicted; body mass index (BMI) = 32 ± 1 kg/m2; mean ± SD] and 12 age-matched, normal-weight COPD (NW) (FEV1 = 59%predicted; BMI = 23 ± 2 kg/m2) subjects were compared at rest and during symptom-limited constant-work-rate exercise at 75% of their maximum. Measurements included pulmonary function tests, operating lung volumes, esophageal pressure, and gastric pressure. OB vs. NW had a reduced total lung capacity (109 vs. 124%predicted; P < 0.05) and resting end-expiratory lung volume (130 vs. 158%predicted; P < 0.05). At rest, there was no difference in respiratory muscle strength but OB had greater ( P < 0.05) static recoil and intra-abdominal pressures than NW. Peak ventilation, oxygen consumption, and exercise endurance times were similar in OB and NW. Pulmonary resistance fell ( P < 0.05) at the onset of exercise in OB but not in NW. Resting inspiratory capacity, dyspnea/ventilation plots, and the ratio of respiratory muscle effort to tidal volume displacement were similar, as was the dynamic performance of the respiratory muscles including the diaphragm. In conclusion, the lack of increase in dyspnea and exercise intolerance in OB vs. NW could not be attributed to improvement in respiratory muscle function. Potential contributory factors included alterations in the elastic properties of the lungs, raised intra-abdominal pressures, reduced lung hyperinflation, and preserved inspiratory capacity.

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