Effects of Surgical Facemasks on Perceived Exertion During Submaximal Exercise in Healthy Children

BackgroundOnly a few data associated to wearability of facemask during exercise are available in children. The aim of the study was to evaluate the effect of wearing a facemask on perceived exertion (primary aim), dyspnea, physical performance, and cardiorespiratory response during a submaximal exercise test in children aged between 8 and 12 years. MethodThis study was performed in 2021 in healthy volunteer children from 8 to 12 years. They performed prospectively two one-minute sit-to-stand test (STST), with or without a surgical facemask. The perceived exertion (modified Borg scale), dyspnea (Dalhousie scale), heart rate and pulsed oxygen saturation were recorded before and after STST. The STST measured the submaximal performance. ResultsThirty-eight healthy children were recruited (8-9 years: n=19 and 10-11 years: n=19). After the STST, the perceived exertion increased with or without a facemask (8-9 years group: +1 [0.6; 1.4] and +1.6 [1.0; 2.1]) –10-11 years group: +1.3 [0.7; 1.8]) and +1.9 [1.3; 2.6]) and it was higher with the facemask. The difference between the two conditions in perceived exertion was not clinically relevant in any group (mBorgf: 0.56 pts and 0.68 pts, respectively). The different domains of dyspnea assessed with Dalhousie scale were not influenced by the facemask. The submaximal performance measured by the STST was not changed by the mask whatever the age group. The cardio-respiratory demand was not clinically modified.ConclusionThe surgical facemask had no impact on dyspnoea, cardiorespiratory parameters, and exercise performance during a short submaximal exercise in healthy children.

Influence of lung Hyperinflation on Respiratory Muscles Pressures During a Submaximal test in Patients with COPD: a Clinical Perspective

Background and objective:: Reduction of exercise tolerance is associated with expiratory flow-limitation (EFL) and lung hyperinflation; those are only partially reversible to bronchodilator. Lung hyperinflation lowers the diaphragm muscle provoking a mechanical disadvantage that, eventually, reduces maximal inspiratory (MIP) and expiratory (MEP) pressures. We aimed to assess the influence of the dynamic lung hyperinflation on respiratory pressures changes at rest and after a submaximal exercise test in COPD patients with and without bronchodilator. Methods:: We prospectively analyzed 16 COPD patients (FEV1 36.4±10% pred.; age 61.0±8 years, height 165±12 cm and BMI 25.9±6 kg/m2). MIP and MEP were measured before and after performing the six minutes walking test (6MWT) with and without bronchodilator (400 mcg of albuterol). Results:: Nine of 16 patients increased IC more than 150 ml after bronchodilator use. Right after the 6MWT accomplished without bronchodilator IC decreased 7.05% compared to the 6MWT baseline value (p<0.01). Nine patients decreased IC more than 150ml. After bronchodilator use patients performed the 6MWT without any IC significant reduction (p>0.05). Twelve patients increased the MIP (ranging from 70±11cmH2O to 77±10cmH2O, p = 0.0043) using 400mcg of albuterol. Thirteen patients reduced MIP after the 6MWT without bronchodilator use (p <0.007). There was no significant reduction (p> 0.05) in MIP when patients performed the 6MWT after bronchodilator use. We also found a significant correlation between MIP and inspiratory capacity (IC) and MEP and the IC before and after the 6MWT (r=0.61, p=0.0054; r=0.60, p=0.0031, respectively). Conclusions:: Dynamic pulmonary hyperinflation directly interferes with the ability of respiratory muscles to generate inspiratory and expiratory pressures. The previous use of bronchodilator in patients with COPD reduced dynamic hyperinflation when accomplishing a sub-maximal exercise.

Determining Safe Participation in Aerobic Exercise Early After Stroke Through a Graded Submaximal Exercise Test

Objective The benefits of aerobic exercise early after stroke are well known, but concerns about cardiovascular risk are a barrier to clinical implementation. Symptom-limited exercise testing with electrocardiography (ECG) is recommended but not always feasible. The purpose of this study was to determine the frequency of and corresponding exercise intensities at which ECG abnormalities occurred during submaximal exercise testing that would limit safe exercise prescription beyond those intensities. Methods This study was a retrospective analysis of ECGs from 195 patients who completed submaximal exercise testing during stroke rehabilitation. A graded submaximal exercise test was conducted with a 5- or 12-lead ECG and was terminated on the basis of predetermined endpoint criteria (heart rate, perceived exertion, signs, or symptoms). ECGs were retrospectively reviewed for exercise-induced abnormalities and their associated heart rates. Results The peak heart rate achieved was 65.4% (SD = 10.5%) of the predicted maximum heart rate or 29.1% (SD = 15.5%) of the heart rate reserve (adjusted for beta-blocker medications). The test was terminated more often because of perceived exertion (93/195) than because of heart rate limits (60/195). Four patients (2.1%) exhibited exercise-induced horizontal or downsloping ST segment depression of ≥1 mm. Except for 1 patient, the heart rate at test termination was comparable with the heart rate associated with the onset of the ECG abnormality. Conclusion A graded submaximal exercise test without ECG but with symptom monitoring and conservative heart rate and perceived exertion endpoints may facilitate safe exercise intensities early after stroke. Symptom-limited exercise testing with ECG is still recommended when progressing to higher intensity exercise. Impact Concerns about cardiovascular risk are a barrier to physical therapists implementing aerobic exercise in stroke rehabilitation. This study showed that, in the absence of access to exercise testing with ECG, submaximal testing with conservative heart rate and perceived exertion endpoints and symptom monitoring can support physical therapists in the safe prescription of aerobic exercise early after stroke. Lay Summary It is recommended that people with stroke participate in aerobic exercise as early as possible during their rehabilitation. A submaximal exercise test with monitoring of heart rate, perceived exertion, blood pressure, and symptoms can support physical therapists in safely prescribing that exercise.

A COMPARATIVE STUDY OF CARDIOVASCULAR RESPONSE IN TWO ACUTE SUBMAXIMAL TREADMILL EXERCISE TESTS AND ITS CORRELATION WITH ANTHROPOMETRIC VARIABLES

Aim: (i) To assess and compare the cardiovascular response in two sub-maximal exercise tests. (ii) to see correlation between cardiovascular response and anthropometric variables. Method: 125 males 18-25 years underwent first three stages of the original Bruce protocol in one session and exercise according to Treadmill jogging test in another session in randomised order. Heart rate, blood pressure and ECG were recorded before, during and after taking the treadmill test. Results: During the exercise heart rate and systolic BP rose and diastolic BP fell in both the tests. Correlation analysis showed highly significant positive correlation between BMI and pre-exercise systolic BP, post-exercise heart rate and post-exercise systolic BPin both the tests. ECG showed no significant ST/Tor rhythm changes during or after the exercise. Conclusion: Heart rate and BPchanges were more in Bruce submaximal exercise test as compared to treadmill jogging test. Higher BMI was found to be correlated with higher resting systolic BP, higher post-exercise heart rate as well as higher post-exercise systolic BP.