Author Archives: Paul Older

Lean Mass Loss and Altered Muscular Aerobic Capacity after Bariatric Surgery.

Zhou N; Scoubeau C; Forton K; Loi P; Closset J; Deboeck G; Moraine JJ;
Klass M; Faoro V

Obesity Facts. 15(2):248-256, 2022.

INTRODUCTION: Patients undergoing weight loss surgery do not improve their
aerobic capacity or peak oxygen uptake (VO2peak) after bariatric surgery
and some still complain about asthenia and/or breathlessness. We
investigated the hypothesis that a post-surgery muscular limitation could
impact the ventilatory response to exercise by evaluating the post-surgery
changes in muscle mass, strength, and muscular aerobic capacity, measured
by the first ventilatory threshold (VT).

METHODS: Thirteen patients with obesity were referred to our university
exercise laboratory before and 6 months after bariatric surgery and were
matched by sex, age, and height to healthy subjects with normal weight.
All subjects underwent a clinical examination, blood sampling, and body
composition assessment by dual-energy X-ray absorptiometry, respiratory
and limb muscle strength assessments, and cardiopulmonary exercise testing
on a cyclo-ergometer.

RESULTS: Bariatric surgery resulted in a loss of 34% fat mass, 43%
visceral adipose tissue, and 12% lean mass (LM) (p < 0.001). Absolute
handgrip, quadriceps, or respiratory muscle strength remained unaffected,
while quadriceps/handgrip strength relative to LM increased (p < 0.05).
Absolute VO2peak or VO2peak/LM did not improve and the first VT was
decreased after surgery (1.4 +/- 0.3 vs. 1.1 +/- 0.4 L min-1, p < 0.05)
and correlated to the exercising LM (LM legs) (R = 0.84, p < 0.001).

CONCLUSIONS: Although bariatric surgery has numerous beneficial effects,
absolute VO2peak does not improve and the weight loss-induced LM reduction
is associated to an altered muscular aerobic capacity, as reflected by an
early VT triggering early exercise hyperventilation.

Ongoing Exercise Intolerance Following COVID-19: A Magnetic Resonance-Augmented Cardiopulmonary Exercise Test Study.

Brown JT; Saigal A; Karia N; Patel RK; Razvi Y; Constantinou N; Steeden
JA; Mandal S; Kotecha T; Fontana M; Goldring J; Muthurangu V; Knight DS

Journal of the American Heart Association. 11(9):e024207, 2022 May 03.

Background Ongoing exercise intolerance of unclear cause following
COVID-19 infection is well recognized but poorly understood. We
investigated exercise capacity in patients previously hospitalized with
COVID-19 with and without self-reported exercise intolerance using
magnetic resonance-augmented cardiopulmonary exercise testing.
Methods and Results Sixty subjects were enrolled in this single-center prospective
observational case-control study, split into 3 equally sized groups: 2
groups of age-, sex-, and comorbidity-matched previously hospitalized
patients following COVID-19 without clearly identifiable postviral
complications and with either self-reported reduced (COVIDreduced) or
fully recovered (COVIDnormal) exercise capacity; a group of age- and
sex-matched healthy controls. The COVID reduced group had the lowest peak
workload (79W [Interquartile range (IQR), 65-100] versus controls 104W
[IQR, 86-148]; P=0.01) and shortest exercise duration (13.3+/-2.8 minutes
versus controls 16.6+/-3.5 minutes; P=0.008), with no differences in these
parameters between COVIDnormal patients and controls. The COVIDreduced
group had: (1) the lowest peak indexed oxygen uptake (14.9 mL/minper kg
[IQR, 13.1-16.2]) versus controls (22.3 mL/min per kg [IQR, 16.9-27.6];
P=0.003) and COVIDnormal patients (19.1 mL/min per kg [IQR, 15.4-23.7];
P=0.04); (2) the lowest peak indexed cardiac output (4.7+/-1.2 L/min per
m2) versus controls (6.0+/-1.2 L/min per m2; P=0.004) and COVIDnormal
patients (5.7+/-1.5 L/min per m2; P=0.02), associated with lower indexed
stroke volume (SVi:COVIDreduced 39+/-10 mL/min per m2 versus COVIDnormal
43+/-7 mL/min per m2 versus controls 48+/-10 mL/min per m2; P=0.02). There
were no differences in peak tissue oxygen extraction or biventricular
ejection fractions between groups. There were no associations between
COVID-19 illness severity and peak magnetic resonance-augmented
cardiopulmonary exercise testing metrics. Peak indexed oxygen uptake,
indexed cardiac output, and indexed stroke volume all correlated with
duration from discharge to magnetic resonance-augmented cardiopulmonary
exercise testing (P<0.05).
Conclusions Magnetic resonance-augmented
cardiopulmonary exercise testing suggests failure to augment stroke volume
as a potential mechanism of exercise intolerance in previously
hospitalized patients with COVID-19. This is unrelated to disease severity
and, reassuringly, improves with time from acute illness.

Rheumatoid arthritis T cell and muscle oxidative metabolism associate with exercise-induced changes in cardiorespiratory fitness.

Andonian BJ; Koss A; Koves TR; Hauser ER; Hubal MJ; Pober DM; Lord JM;MacIver NJ; St Clair EW; Muoio DM;
Kraus WE; Bartlett DB;Huffman KM;

Scientific reports [Sci Rep] 2022 May 06; Vol. 12 (1), pp. 7450.
Date of Electronic Publication: 2022 May 06.

Rheumatoid arthritis (RA) T cells drive autoimmune features via metabolic reprogramming that reduces oxidative metabolism. Exercise training improves cardiorespiratory fitness (i.e., systemic oxidative metabolism) and thus may impact RA T cell oxidative metabolic function. In this pilot study of RA participants, we took advantage of heterogeneous responses to a high-intensity interval training (HIIT) exercise program to identify relationships between improvements in cardiorespiratory fitness with changes in peripheral T cell and skeletal muscle oxidative metabolism. In 12 previously sedentary persons with seropositive RA, maximal cardiopulmonary exercise tests, fasting blood, and vastus lateralis biopsies were obtained before and after 10 weeks of HIIT. Following HIIT, improvements in RA cardiorespiratory fitness were associated with changes in RA CD4 + T cell basal and maximal respiration and skeletal muscle carnitine acetyltransferase (CrAT) enzyme activity. Further, changes in CD4 + T cell respiration were associated with changes in naïve CD4 + CCR7 + CD45RA + T cells, muscle CrAT, and muscle medium-chain acylcarnitines and fat oxidation gene expression profiles. In summary, modulation of cardiorespiratory fitness and molecular markers of skeletal muscle oxidative metabolism during exercise training paralleled changes in T cell metabolism. Exercise training that improves RA cardiorespiratory fitness may therefore be valuable in managing pathologically related immune and muscle dysfunction.

Trends of glucose, lactate and ketones during anaerobic and aerobic exercise in subjects with type 1 diabetes: The ACTION-1 Study.

De Ridder F; Ledeganck KJ; De Winter B; Braspenning R; Delbeke D; Renard E; Pozzilli P; Pieralice S; Vissers D;
De Block C;

Diabetes/metabolism research and reviews [Diabetes Metab Res Rev] 2022 May 09, pp. e3537.
Date of Electronic Publication: 2022 May 09.

Background: Exercise is part of type 1 diabetes (T1D) management due to its cardiovascular and metabolic benefits. However, despite using continuous glucose monitoring, many patients are reluctant to exercise because of fear for hypoglycaemia.
Aims: We assessed trends in glucose, lactate and ketones during anaerobic and aerobic exercise in people with T1D and compared incremental area under the curve (AUC) between both exercises.
Methods: Twenty-one men with T1D (median [IQR]: age 29 years [28-38], BMI 24.4 kg/m 2 [22.3-24.9], HbA1c 7.2% [6.7-7.8]), completed a cardiopulmonary exercise test (CPET) and a 60-minute aerobic exercise (AEX) at 60% VO 2 peak on an ergometer bicycle within a 6-week period. Subjects consumed a standardised breakfast (6 kcal/kg, 20.2g CHO/100ml) before exercise without pre-meal insulin and basal insulin for pump users.
Results: During CPET, glucose levels increased, peaking at 331mg/dL [257-392] 1-3h after exercise and reaching a nadir 6h after exercise at 176mg/dL [118-217]. Lactate levels peaked at 6.0mmol/L [5.0-6.6] (max 12.5mmol/L). During AEX, glucose levels also increased, peaking at 305mg/dL [245-336] 80 min after exercise and reaching a nadir 6h after exercise at 211mg/dL [116-222]. Lactate levels rose quickly to a median of 4.3mmol/L [2.7-6.7] after 10 min. Ketone levels were low during both tests (median ≤0.2mmol/L). Lactate, but not glucose or ketone AUC, was significantly higher in CPET compared to AEX (p=0.04).
Conclusions: Omitting pre-meal insulin and also basal insulin in pump users, did prevent hypoglycaemia but induced hyperglycaemia due to a too high carbohydrate ingestion. No ketosis was recorded during or after the exercises.

The effect of breathing an oxygen-enriched mixture on tissue saturation in obese women.

Zawada AE; Juchacz A; Palutka R; Zaleśna K; Drużdż A; Dobrowolska A;Domaszewska K;

Advances in clinical and experimental medicine : official organ Wroclaw Medical University [Adv Clin Exp Med] 2022 May 11. Date of Electronic Publication: 2022 May 11.

Background: Physical activity undertaken in the treatment process additionally increases the oxygen demand of the working muscles. It seems interesting to see whether a delivery of an enriched respiratory mixture can have an impact on lower acidification of working muscles and oxygenation of tissues.
Objectives: To assess tissue saturation and the level of acidification at rest and during exercise while breathing atmospheric air or an oxygen-enriched mixture.
Material and Methods: Tissue saturation and lactate concentration at rest and during exercise were assessed in 18 females with an average body mass index (BMI) of 42 kg/m2. The study regimen was as follows: day 1 – cardiopulmonary exercise testing (CPET) – determination of the threshold load; day 2 – 20 min of physical effort on a cycloergometer (threshold load, breathing atmospheric air); day 3 – 20 min of physical effort on a cycloergometer (threshold load, breathing mixture enriched with oxygen). Saturation measurements were performed in 3 places on the patient’s body by measuring absorbance via near-infrared spectroscopy (NIRS).
Results: A significant decrease in heart rate (HR) at rest was found when using the oxygen-enriched air mixture (Z = 2.1339, p = 0.0328 (effect size (ES) = 0.478)). During the exercise, a significant decrease in saturation was shown only for the midpoint of the quadriceps muscles (Z = 2.1572, p = 0.309 (ES = 0.600)). Medium effect sizes were shown by the difference in resting and exercising lactate concentration change between the experimental models studied (Z = 2.5041, p = 0.0122 (ES = 0.707)). In the experimental models studied, different medium effect sizes were demonstrated in the resting and exercising lactate concentration change.
Conclusions: Oxygen-enriched air mixture contributes to reducing hypoxia in working muscles of obese people. Oxygen supplementation can result in higher physical fitness levels. The implementation of oxygen-enriched air mixture is a promising therapeutic strategy for obese patients who exhibit high lactate concentrations after exercise.

Determinants of exercise capacity in children and adolescents with severe therapy-resistant asthma.

Schindel CS; Schiwe D; Heinzmann-Filho JP; Gheller MF; Campos NE; Pitrez PM; Donadio MVF

Journal of Asthma. 59(1):115-125, 2022 01.

OBJECTIVE: To evaluate the exercise capacity of children and adolescents
with severe therapy resistant asthma (STRA) aiming to identify its main
determinants.

METHODS: Cross-sectional study including individuals aged 6-18 years with
a diagnosis of STRA. Clinical (age and gender), anthropometric (weight,
height and body mass index) and disease control data were collected. Lung
function (spirometry), cardiopulmonary exercise testing (CPET) and
exercise-induced bronchoconstriction (EIB) test were performed.

RESULTS: Twenty-four patients aged 11.5 +/- 2.6 years were included. The
mean forced expiratory volume in one second (FEV1) was 91.3 +/- 9.2%. EIB
occurred in 54.2% of patients. In CPET, the peak oxygen uptake (VO2peak)
was 34.1 +/- 7.8 mL kg-1 min-1. A significant correlation between
ventilatory reserve and FEV1 (r = 0.57; p = 0.003) was found. Similarly,
there was a significant correlation between CPET and percent of FEV1 fall
in the EIB test for both VE/VO2 (r = 0.47; p = 0.02) and VE/VCO2 (r =
0.46; p = 0.02). Patients with FEV1<80% had lower ventilatory reserve (p =
0.009). In addition, resting heart rate correlated with VO2peak (r=-0.40;
p = 0.04), VE/VO2 (r = 0.46; p = 0.02) and VE/VCO2 (r = 0.48; p = 0.01).

CONCLUSIONS: Exercise capacity is impaired in approximately 30% of
children and adolescents with STRA. The results indicate that different
aspects of aerobic fitness are influenced by distinct determinants,
including lung function and EIB.

Interactive Video Games as a Method to Increase Physical Activity Levels in Children Treated for Leukemia.

Kowaluk A; Woźniewski M;

Healthcare (Basel, Switzerland) [Healthcare (Basel)] 2022 Apr 06; Vol. 10 (4).
Date of Electronic Publication: 2022 Apr 06.

Despite the beneficial effect of exercise, children treated for cancer do not engage in sufficient physical activity. It is necessary to search for attractive forms of physical activity, including interactive video games (IVGs). The aim of this study was to verify the effectiveness of the rehabilitation model developed by the authors based on the use of IVGs in children undergoing leukemia treatment. The study included a group of 21 children aged 7-13 years (12 boys, 9 girls) undergoing treatment for acute lymphoblastic leukemia (ALL) ( n = 13) and acute myeloid leukemia (AML) ( n = 8). The children were randomly assigned to an intervention group and a control group. To assess the level of cardiorespiratory fitness (CRF), each child participated in a Cardiopulmonary Exercise Test. Daily physical activity was assessed using the HBSC questionnaire. The study also used the Children’s Effort Rating Table Scale (CERT) to assess the intensity of physical effort. The children in the intervention group participated in 12 sessions of. The study participants managed to complete all stages of a progressive training program, which confirmed the feasibility of such physical effort by patients with cancer. Pediatric patients reported that the IVG training required a light to moderate physical effort despite high values of energy expenditure (EE).

Sex-Based Differences in Peak Exercise Blood Pressure Indexed to Oxygen Consumption Among Competitive Athletes.

Petek BJ; Gustus SK; Churchill TW; Guseh JS; Loomer G; VanAtta C; BaggishAL; Wasfy MM

Clinical Therapeutics. 44(1):11-22.e3, 2022 01.

PURPOSE: Although exercise testing guidelines define cutoffs for an
exaggerated exercise systolic blood pressure (SBP) response, SBPs above
these cutoffs are not uncommon in athletes given their high exercise
capacity. Alternately, guidelines also specify a normal SBP response that
accounts for metabolic equivalents (METs; mean [SD] of 10 [2] mm Hg per
MET or 3.5 mL/kg/min oxygen consumption [Vo2]). SBP and Vo2 increase less
during exercise in females than males. It is not clear if sex-based
differences in exercise SBP are related to differences in Vo2 or if
current recommendations for normal increase in SBP per MET produce
reasonable estimates using measured METs (ie, Vo2) in athletes. We
therefore examined sex-based differences in exercise SBP indexed to Vo2 in
athletes with the goal of defining normative values for exercise SBP that
account for fitness and sex.

METHODS: Using prospectively collected data from a single sports
cardiology program, normotensive athlete patients were identified who had
no relevant cardiopulmonary disease and had undergone cardiopulmonary
exercise testing with cycle ergometry or treadmill. The relationship
between DELTASBP (peak – rest) and DELTAVo2 (peak – rest) was examined in
the total cohort and compared between sexes.

FINDINGS: A total of 413 athletes (mean [SD] age, 35.5 [14] years; 38%
female; mean [SD] peak Vo2, 46.0 [10.2] mL/kg/min, 127% [27%] predicted)
met the inclusion criteria. The DELTASBP correlated with unadjusted
DELTAVo2 (cycle: R2 = 0.18, treadmill: R2 = 0.12; P < 0.0001). Female
athletes had lower mean (SD) peak SBP (cycle: 161 [15] vs 186 [24] mm Hg;
treadmill: 165 [17] vs 180 [20] mm Hg; P < 0.05) than male athletes.
Despite lower peak SBP, mean (SD) DELTASBP relative to unadjusted DELTAVo2
was higher in female than male athletes (cycle: 25.6 [7.2] vs 21.1 [7.3]
mm Hg/L/min; treadmill: 21.6 [7.2] vs 17.0 [6.2] mm Hg/L/min; P < 0.05).
When Vo2 was adjusted for body size and converted to METs, female and male
athletes had similar mean (SD) DELTASBP /DELTAMET (cycle: 6.0 [2.1] vs 5.8
[2.0] mm Hg/mL/kg/min; treadmill: 4.7 [1.8] vs 4.8 [1.7] mm Hg/mL/kg/min).

IMPLICATIONS: In this cohort of athletes without known cardiopulmonary
disease, observed sex-based differences in peak exercise SBP were in part
related to the differences in DELTAVo2 between male and female athletes.
Despite lower peak SBP, DELTASBP/unadjusted DELTAVo2 was paradoxically
higher in female athletes. Future work should define whether this finding
reflects sex-based differences in the peripheral vascular response to
exercise. In this athletic cohort, DELTASBP/DELTAMET was similar between
sexes and much lower than the ratio that has been proposed by guidelines
to define a normal SBP response. Our observed DELTASBP/DELTAMET, based on
measured rather than estimated METs, provides a clinically useful estimate
for normal peak SBP range in athletes.

 

Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation.

de Assumpcao CRA; do Prado DML; Jordao CP; Dourado LOC; Vieira MLC;
Montenegro CGSP; Negrao CE; Gowdak LHW; De Matos LDNJ

Clinics (Sao Paulo, Brazil). 77:100003, 2022.

OBJECTIVE: To evaluate the exercise capacity of children and adolescents
with severe therapy resistant asthma (STRA) aiming to identify its main
determinants.

METHODS: Cross-sectional study including individuals aged 6-18 years with
a diagnosis of STRA. Clinical (age and gender), anthropometric (weight,
height and body mass index) and disease control data were collected. Lung
function (spirometry), cardiopulmonary exercise testing (CPET) and
exercise-induced bronchoconstriction (EIB) test were performed.

RESULTS: Twenty-four patients aged 11.5 +/- 2.6 years were included. The
mean forced expiratory volume in one second (FEV1) was 91.3 +/- 9.2%. EIB
occurred in 54.2% of patients. In CPET, the peak oxygen uptake (VO2peak)
was 34.1 +/- 7.8 mL kg-1 min-1. A significant correlation between
ventilatory reserve and FEV1 (r = 0.57; p = 0.003) was found. Similarly,
there was a significant correlation between CPET and percent of FEV1 fall
in the EIB test for both VE/VO2 (r = 0.47; p = 0.02) and VE/VCO2 (r =
0.46; p = 0.02). Patients with FEV1<80% had lower ventilatory reserve (p =
0.009). In addition, resting heart rate correlated with VO2peak (r=-0.40;
p = 0.04), VE/VO2 (r = 0.46; p = 0.02) and VE/VCO2 (r = 0.48; p = 0.01).

CONCLUSIONS: Exercise capacity is impaired in approximately 30% of
children and adolescents with STRA. The results indicate that different
aspects of aerobic fitness are influenced by distinct determinants,
including lung function and EIB.

Dissociation Between Minimum Minute Ventilation/Carbon Dioxide Production and Minute Ventilation vs. Carbon Dioxide Production Slope.

Murata M; Kobayashi Y; Adachi H

Circulation Journal. 86(1):79-86, 2021 12 24.

BACKGROUND: Minute ventilation/carbon dioxide production (VE/VCO2) is a
variable of cardiopulmonary exercise testing (CPET), which is evaluated by
arterial CO2pressure and ventilation-perfusion mismatch via invasive
methods. This study evaluated substitute non-invasively obtained variables
for minimum VE/VCO2(Min) and VE vs. VCO2slope (Slope) and the relationship
between Min and Slope.
Methods and Results: This study enrolled 1,052
patients with heart disease who underwent CPET and impedance cardiography
simultaneously. At first, the correlations between the end-tidal
CO2pressure (PETCO2), tidal volume/respiratory rate (TV/RR) ratio, VE and
VCO2Y-intercept (Y-int), and cardiac index (CI) and the Min and Slope were
investigated. Second, the correlation between Min and Slope was
investigated. PETCO2showed the largest correlation value among the 4
variables. These 4 variables could reveal 84.2% and 81.9% of Min and
Slope, respectively. Although Slope correlated with Min (R=0.868) and
predicted 78.9% of Min, considering these 4 variables, Slope+Y-int was
more strongly correlated with Min (R=0.940); the Slope+Y-int revealed
90.6% of the Min relationship in the multiple regression analysis.
CONCLUSIONS: Over 80% of the Min and Slope values were revealed with the
above-mentioned 4 variables collected non-invasively. The formula,
MinSlope+Y-int, can reveal >90% of the Min/Slope relationships, and the
Y-int may be a crucial factor to clarify the relationship between Min and
Slope.