A comparison of methods used to quantify the work of breathing during exercise

The mechanical work of breathing (Wb) is an insightful tool used to assess respiratory mechanics during exercise. There are several different methods used to calculate the Wb, however - each approach having its own distinct advantages/disadvantages. To date, a comprehensive assessment of the differences in the components of Wb between these methods is lacking. We therefore sought to compare the values of Wb during graded exercise as determined via the 4 most popular methods: (i) pressure-volume integration; (ii) the Hedstrand diagram; (iii) the Otis diagram; and the (iv) modified Campbell diagram. Forty-two participants (30 ± 15 years; 16 women) performed graded cycling to volitional exhaustion. Oesophageal pressure-volume loops were obtained throughout exercise. These data were used to calculate the total Wb and, where possible, its subcomponents of inspiratory and expiratory, resistive and elastic Wb, using each of the 4 methods. Our results demonstrate that the components of Wb were indeed different between methods across the minute ventilations engendered by graded exercise (P < 0.05). Importantly, however, no systematic pattern in these differences could be observed. Our findings indicate that the values of Wb obtained during exercise are uniquely determined by the specific method chosen to compute its value - no two methods yield identical results. Because there is currently no "gold-standard" for measuring the Wb, it is emphasized that future investigators be cognizant of the limitations incurred by their chosen method, such that observations made by others may be interpreted with greater context, and transparency.

Feasibility of cardiopulmonary exercise testing in interstitial lung disease: the PETFIB study

IntroductionCardiopulmonary exercise testing (CPET) provides a series of biomarkers, such as peak oxygen uptake, which could assess the development of disease status in interstitial lung disease (ILD). However, despite use in research and clinical settings, the feasibility of CPET in this patient group has yet to be established.MethodsTwenty-six patients with ILD (19 male) were recruited to this study. Following screening for contraindications to maximal exercise, participants underwent an incremental CPET to volitional exhaustion. Feasibility of CPET was assessed by the implementation, practicality, acceptability and demand, thus providing clinical-driven and patient-driven information on this testing procedure.ResultsOf the 26 recruited participants, 24 successfully completed at least one CPET, with 67/78 prospective tests being completed. Contraindications included hypertension, low resting oxygen saturation and recent pulmonary embolism. Of the CPETs undertaken, 63% successfully reached volitional exhaustion, with 31% being terminated early by clinicians due to excessive desaturation. Quantitative and qualitative feedback from participants revealed a positive experience of CPET and desire for it to be included as a future monitoring tool.ConclusionCPET is feasible in patients with ILD. Identification of common clinical contraindications, and understanding of patient perspectives will allow for effective design of future studies utilising CPET as a monitoring procedure.

The Effect of Inspiratory Muscle Warm-Up on VO2 Kinetics during Submaximal Rowing

The aim of the study was to investigate the effect of an inspiratory muscle warm-up on the VO2 kinetics during submaximal intensity ergometer rowing. Ten competitive male rowers (age 23.1 ± 3.8 years; height 188.1 ± 6.3 cm; body mass 85.6 ± 6.6 kg) took part in this investigation. A submaximal constant intensity (90% PVO2max) rowing test to volitional exhaustion was carried out twice with the standard rowing warm-up (Test 1) and with the standard rowing warm-up with additional specific inspiratory muscle warm-up of two sets of 30 repetitions at 40% maximal inspiratory pressure (Test 2). We found a significant correlation between time constant (τ1) and the VO2 value at 400 s in Test 1 (r = 0.78; p < 0.05); however, no correlation was found between those parameters in Test 2. In addition, we found a positive association between VO2max from the incremental rowing test and τ1 from Test 1 (r = 0.71; p < 0.05), whereas VO2 did not correlate with τ1 from Test 2. Adding inspiratory muscle warm-up of 40% maximal inspiratory pressure to regular rowing warm-up had no significant effect on oxygen consumption kinetics during submaximal rowing tests.

Effect of Acute Sodium Bicarbonate Intake on Sprint-Intermittent Performance and Blood Biochemical Responses in Well-Trained Sprinters

The present study was designed to determine the acute effect of sodium bicarbonate (NaHCO3) on the number of sprint repetitions during sprint high-intensity intermittent testing. In addition, blood biochemical (pH, HCO3-, and lactate) responses measured in three occasions were investigated. Thirteen male well-trained sprinters (24.65±3.44 yrs) performed two consecutive trials (7 days apart). Athletes were assigned randomly either to ingest a single dose of NaHCO3 (0.3 g/kg) 1 h prior to exercise or placebo using a double-blind crossover design. The intermittent sprint test consisted of 60 s treadmill sprints (90% of maximal work done) and 30-s recovery repeated intermittently until volitional exhaustion. Blood samples were collected from all athletes before exercise, after 1 h of dose intake, and after exercise in each trial. Paired sample t-testing showed that athletes complete significantly more sprint repetitions (p=0.036) during the intermittent sprint test with NaHCO3 (6.846±3.114) than with the placebo (5.538±3.872). Data also revealed no differences between trials in all blood responses at pre-exercise. After 1 h of dose consumption, however, blood pH and HCO3- were higher with NaHCO3 than with placebo (p<0.05), but no differences were noted in lactate between trials (p>0.05). After completion of the test, all blood responses were significantly higher with NaHCO3 than with placebo (p<0.05). In conclusion, intake of 0.3 g/kg of NaHCO3 1 h prior to treadmill sprint-intermittent performance increased sprint repetitions in well-trained sprinters, probably due to activated glycolysis caused by intracellular protons efflux into the blood.

Effectiveness of caffeine intake on maximal and sub-maximal physiological markers of exercise intensity among wheelchair users compared to able-bodied individuals

The aim of the current study was to assess the effect of caffeine intake on maximal and sub-maximal physiological markers of exercise intensity and whether group (able-bodied and wheelchair users) moderated these findings. Ten able-bodied men (20.3±2.4 years, length 174.3±5.1 cm, 76.4±9.4 kg) and 9 wheelchair users (29.9±7.1 years, length 164±13 cm, 78.6±20.6 kg) participated in the study. Each participant performed 4 exercise tests. Two ramp exercise tests were used to assess the effect of caffeine intake on maximal values of power output (PO), oxygen uptake (VO2), heart rate (HR), lactate and rate of perceived exertion (RPE): one performed with 6 mg/kg body mass of caffeine ingestion as gelatine capsules, and the second one with placebo. Two constant-load exercise tests at 70% POpeak to volitional exhaustion were used to assess the effect caffeine intake on sub-maximal values of VO2, HR, lactate and RPE: one performed with 6 mg/kg body mass of caffeine ingestion as gelatine capsules, and the second one with placebo. Two way ANOVA revealed that caffeine intake does not affect maximal values of VO2, HR, lactate and RPE (P>0.05). Caffeine intake reduced sub-maximal RPE at 5 min (P<0.05) and 10 min of exercise. Sub-maximal HR at 70% POpeak was higher in caffeine than placebo among wheelchair users (P<0.05). Time to exhaustion at 70% POpeak was significantly longer in caffeine than placebo (P<0.05). VO2max and POpeak were significantly higher among able-bodied than wheelchair users (P<0.05). Caffeine has an effect on sub-maximal RPE and time to volitional exhaustion. Closed-loop exercise mode should be employed in future studies. Greater dosage of caffeine could be used but should not exceed the permitted amount of 12 mg/kg body mass. Wheelchair users should exercise and do more physical activity to enhance VO2max and POpeak.

P6341Impact of left-ventricular hemodynamics on treadmill exercise intolerance in conscious rats: pilot evaluation in animals with diastolic dysfunction

Introduction Exercise intolerance is a clinical hallmark of patients with hypertrophic cardiomyopathy and/or impaired diastolic function. Elevated LV filling pressures, particularly in response to acute exercise bouts, are thought to play a role limiting exercise capacity in ventricles with abnormal relaxation/compliance. However, it is experimentally difficult to obtain in vivo hemodynamic measures necessary for the evaluation of centrally mediated dysfunction. Leveraging radio-telemetry, we evaluated central hemodynamic parameters as mediators of exercise intolerance in obese ZSF1 rats with diabetes, hypertension, and diastolic dysfunction. Methods Both ZSF1 (637+12g, n=8) and age-matched (28 weeks) healthy control (CTRL, 543+14g, n=4, P<0.05) rats were instrumented for telemetric left-ventricular pressure (LVP) recordings. Following surgical recovery rats were familiarized to treadmill running and subsequently challenged with an exercise protocol aimed at increasing heart rate by 200 beats/min (5° incline, 15 m/min, increased by 3 m/min every 2-min) until volitional exhaustion. LV pressures were collected continuously during cage resting, treadmill resting, and post-exercise until heart rate returned to baseline. Additionally, resting echocardiographic and blood glucose measures were collected. Results At rest, ZSF1 rats had preserved ejection fraction (73+6 vs 79+9%), elevated (P<0.05) blood glucose (237+83 vs 94+23 mg/dL), end-systolic (147+18 vs 103+13 mmHg), and end-diastolic pressures (16+3 vs 9+3 mmHg), with preserved indexed end-diastolic volumes (670+95 vs 741+89 μL/kg), suggesting impaired diastolic compliance. ZSF1 rats terminated exercise prematurely (8:26+1:20 vs 10:27+1:18 min, P<0.05), indicating a limitation in exercise capacity. This early volitional exhaustion was noted while end-diastolic pressures were not further increased (17+7 mmHg), suggesting that other pathological derangement may play a role modulating exercise capacity. For instance, ZSF1 rats tended to have a blunted increase in the systolic index dP/dt40 (+2589+1450 vs +3938+749 mmHg/s, P<0.1) despite achieving comparable increases in HR (193+34 vs 196+38 bpm) with exercise. Conclusion This pilot study demonstrates the feasibility for evaluation of left-ventricular hemodynamics during exercise in rodents with diastolic dysfunction, establishing a platform to evaluate both the mechanisms of exercise intolerance as well as potential therapeutic approaches to rescue exercise capacity. Acknowledgement/Funding MyoKardia

Energy Cost of Running Under Hypogravity in Well-Trained Runners and Triathletes: A Biomechanical Perspective

Hypogravity treadmills have become a popular training tool in distance running and triathlon. Counter-intuitively, tibial acceleration load is not attenuated by hypogravity unloading during running, while, equally surprisingly, leaps become flatter instead of higher. To explain these effects from a biomechanical perspective, Polet, Schroeder, and Bertram (2017) recently developed an energetic model for hypogravity running and validated it with recreational athletes at a constant jogging speed. The present study was conducted to refine that model for competitive athletes at relevant running speeds of 12–22 km h−1 and gravity levels of 100 %, 80 % and 60 %. Based on new experimental data on 15 well-trained runners in treadmill tests until volitional exhaustion, the enhanced semi-empirical model well describes energy expenditure and the observed biomechanical effects of hypogravity running. Remarkably, anaerobic contributions led to an increase in energy cost per meter for speeds above 16–18 km h−1 (p < 0.001), irrespective of hypogravity unloading. Moreover, some converging trends were observed that might reflect general adaptations in running motor control for optimization of efficiency. In essence, the outcome of this research might help sports scientists and practitioners to design running programs for specific training stimuli, e.g. conditioning of anaerobic energy metabolism.

Effect of a maximal treadmill test on intraocular pressure and ocular perfusion pressure: The mediating role of fitness level

Objectives: We compared the impact of a maximal treadmill test on intraocular pressure and ocular perfusion pressure between trained and untrained individuals. Methods: Based on the maximal aerobic capacity (relative VO2 max), 31 military helicopter pilots were divided into groups of trained (n = 16; VO2 max = 57.06 ± 1.66) and untrained (n = 15; VO2 max = 43.42 ± 1.19) individuals. Intraocular pressure and blood pressure were collected before effort, just after volitional exhaustion and after 5 and 15 min of recovery. Results: The maximal treadmill test induced significant changes on intraocular pressure (p < 0.001, η2 = 0.52) and ocular perfusion pressure (p < 0.001, η2 = 0.60). Intraocular pressure and ocular perfusion pressure increased just after volitional exhaustion (effect size = 0.88 and 1.59, respectively), and these values returned to baseline levels after 5 (effect size = 0.87 and 1.26, respectively) and 15 (effect size = 1.23 and 1.91, respectively) min of recovery. The untrained group exhibited higher intraocular pressure and ocular perfusion pressure values in comparison with the trained group just after volitional exhaustion (effect size = 1.43 and 0.11 for intraocular pressure and effect size = 2.81 and 0.96 for ocular perfusion pressure). Five minutes of recovery was insufficient to reach baseline intraocular pressure and ocular perfusion pressure values only for the untrained group (effect size = 0.91 and 0.72, respectively). Conclusion: Our findings reveal that fitness level modulates the intraocular pressure and ocular perfusion pressure responses to a maximal treadmill test, being high fitness levels desirable in order to attenuate the impact of maximal efforts on these indices. These outcomes may be of clinical relevance for the management of glaucoma patients or those at risk, although future studies are needed to test these results in a clinical population.