Le JN; Zhou R; Tao R; Dharmavaram N; Dhingra R; Runo J; Forfia P; Raza F;

Journal of cardiac failure [J Card Fail] 2022 Oct 12.
Date of Electronic Publication: 2022 Oct 12.

Background: While cardiopulmonary exercise testing (CPET) can identify mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF), exercise modalities with different body positions (e.g. recumbent ergometer, treadmill) are broadly utilized. In this study, we aim to determine if body position affects CPET parameters in patients with HFpEF.
Methods: Subjects with stable HFpEF (n=23) underwent non-invasive treadmill CPET, followed by an invasive recumbent cycle ergometer CPET within three months. A comparison group, undergoing similar studies, included: healthy subjects (n=5) and pulmonary arterial hypertension (n=6).
Results: The peak oxygen consumption (VO ₂ peak) and peak heart rate were significantly lower in recumbent versus upright position (10.1 vs 13.1 ml/kg/min [Δ – 3 ml/kg/min], p < 0.001; and 95 vs 113 bpm [Δ – 18 bpm], p < 0.001, respectively). No significant differences were found with V _E /VCO ₂ , ETCO ₂ , and RER. A similar pattern was observed in the comparison groups.
Conclusions: Compared to recumbent ergometer, treadmill CPET revealed higher VO ₂ peak and peak heart rate response. While determining chronotropic incompetence to adjust beta blockers in HFpEF, body position should be taken into account.

Hao X; He H; Tao L; Wang H; Zhao L; Ren Y; Wang P;

Diabetes, metabolic syndrome and obesity : targets and therapy [Diabetes Metab Syndr Obes] 2022 Oct 19; Vol. 15, pp. 3195-3203.
Date of Electronic Publication: 2022 Oct 19 (Print Publication: 2022).

Purpose: This study investigated blood pressure and ventilation efficiency by cardiopulmonary exercise test (CPX) in different types of obesity aged 40-60 years.
Material and Methods: The inclusion criteria of this cross-sectional study were adults aged 40-60 years underwent health checks. CPX was measured according to the relevant standards. According to different body mass index (BMI), there were 3 groups, BMI<24 (kg/m ² ), 24≤BMI<28 (kg/m ² ) and BMI≥28 (kg/m ² ). There were two groups in male, waist circumference≥90 (cm) and waist circumference<90 (cm). Similarly, there were two groups in female, waist circumference≥85 (cm) and waist circumference<85 (cm).
Results: There were 543 individuals (64.6% male and 35.4% female) aged 40-60 years in this study. The resting blood pressure (BP) and peak BP have the significant differences in different BMI groups (p < 0.001) and male or female groups (p < 0.001). However, the resting DBP (77.70±9.45 vs 81.16±8.80, p < 0.001) and peak DBP (85.67±10.21 vs 89.03±9.94, p = 0.002) have the significant differences in different male waist circumference groups, and the resting BP (SBP 113.76±14.29 vs 121.86±15.54, p = 0.001, DBP 71.95±10.83 vs 77.27±11.42, p = 0.005) has the significant differences in different female waist circumference groups. Carbon dioxide Ventilation equivalent (VE/VCO ₂ ) has the significant differences in different male waist circumference groups (26.84±3.10 vs 27.68±2.93, p = 0.009), but it has not the significant differences in different BMI groups and different female waist circumference groups. The oxygen pulse (VO ₂ /HR) is slightly higher in female group than male group (0.93±0.15 vs 0.89±0.15, p = 0.001). Breathing reserve has the statistical significance in BMI ≥28 group compared with the BMI <24 group (0.52±0.13 vs 0.46±0.17, ηp ² =0.021).
Conclusion: We found that the blood pressure and ventilation efficiency of CPX were different between the obesity and normal. This will provide a basis for accurate cardiopulmonary assessment of obesity.

F. Schwendinger, R. Knaier, T. Radtke and A. Schmidt-Trucksass

Sports Med 2022 ;17 September
https://pubmed.ncbi.nlm.nih.gov/36115933/

Patients recovering from COVID-19 often report symptoms of exhaustion, fatigue and dyspnoea and present with exercise intolerance persisting for months post-infection. Numerous studies investigated these sequelae and their possible underlying mechanisms using cardiopulmonary exercise testing. We aimed to provide an in-depth discussion as well as an overview of the contribution of selected organ systems to exercise intolerance based on the Wasserman gears. The gears represent the pulmonary system, cardiovascular system, and periphery/musculature and mitochondria. Thirty-two studies that examined adult patients post-COVID-19 via cardiopulmonary exercise testing were included. In 22 of 26 studies reporting cardiorespiratory fitness (herein defined as peak oxygen uptake-VO2peak), VO2peak was < 90% of predicted value in patients. VO2peak was notably below normal even in the long-term. Given the available evidence, the contribution of respiratory function to low VO2peak seems to be only minor except for lung diffusion capacity. The prevalence of low lung diffusion capacity was high in the included studies. The cardiovascular system might contribute to low VO2peak via subnormal cardiac output due to chronotropic incompetence and reduced stroke volume, especially in the first months post-infection. Chronotropic incompetence was similarly present in the moderate- and long-term follow-up. However, contrary findings exist. Peripheral factors such as muscle mass, strength and perfusion, mitochondrial function, or arteriovenous oxygen difference may also contribute to low VO2peak. More data are required, however. The findings of this review do not support deconditioning as the primary mechanism of low VO2peak post-COVID-19. Post-COVID-19 sequelae are multifaceted and require individual diagnosis and treatment

Tomovic M; Toliopoulos A; Koutlianos N; Dalkiranis A; Bubanj S; Deligiannis A; Kouidi E;

International journal of environmental research and public health [Int J Environ Res Public Health] 2022 Sep 27; Vol. 19 (19).
Date of Electronic Publication: 2022 Sep 27.

Background: Running is a common recreational activity, and the number of long-distance-race participants is continuously growing. It is well-established that regular physical activity can prevent and manage non-communicable diseases and benefit public health. Training for a long-distance race requires development of specific aerobic abilities and should generate the desired race performance. The purpose of this study was to support the training design and motivation of recreational endurance runners, by investigating whether a 14.5 km race performance of long-distance runners correlates with their cardiopulmonary indices measured in the laboratory.
Methods: To examine the relationships of a 14.5 km running performance with the cardiopulmonary parameters of amateur runners, a cross-sectional study design was applied. Fifteen (eleven men and four women) recreational long-distance runners (aged 41.3 ± 9.2 years) from Northern Greece were included in the study and were evaluated in the laboratory within one week before an endurance running race-the 14.5 km Philip Road race, in Greece. The laboratory-based examinations of the athletes consisted of a comprehensive medical pre-participation screening and maximal cardiopulmonary exercise testing.
Results: The results showed that the 14.5 km race performance time (73.8 ± 9.7 min) significantly correlated with the cardiopulmonary-exercise-testing speed-related indices at specific submaximal and maximal workloads ( p &lt; 0.01, p &lt; 0.05), while the cardiopulmonary indices of oxygen uptake did not reliably predict race running time ( p &gt; 0.05).
Conclusions: There is a better correlation of the 14.5 km running performance of recreational long-distance runners with the cardiopulmonary-exercise-testing speed-related indices at specific workloads than with the indices of oxygen uptake, running economy or respiratory economy. When preparing a training strategy, amateur long-distance runners should mostly rely on specific running-speed-related laboratory data rather than on oxygen-uptake values.

Reljic D; Eichhorn A; Herrmann HJ; Neurath MF; Zopf Y;

International journal of environmental research and public health [Int J Environ Res Public Health] 2022 Sep 28; Vol. 19 (19).
Date of Electronic Publication: 2022 Sep 28.

Initially, we aimed to investigate the impact of a one-year worksite low-volume, high-intensity interval training (LOW-HIIT) on cardiometabolic health in 114 sedentary office workers. Due to the COVID-19 pandemic outbreak, LOW-HIIT was discontinued after 6 months and participants were followed up for 6 months to analyze physical activity/exercise behavior and outcome changes during lockdown. Health examinations, including cardiopulmonary exercise testing and the assessment of cardiometabolic markers were performed baseline (T-1), after 6 months (T-2, termination of worksite LOW-HIIT) and 12 months (T-3, follow-up). Cycle ergometer LOW-HIIT (5 × 1 min at 85-95% HR _max ) was performed 2×/week. For follow-up analyses, participants were classified into three groups: HIIT-group (continued home-based LOW-HIIT), EX-group (continued other home-based exercises), and NO-EX-group (discontinued LOW-HIIT/exercise). At T-2, VO _2max (+1.5 mL/kg/min, p = 0.002), mean arterial blood pressure (MAB, -4 mmHg, p &lt; 0.001), HbA _1c (-0.2%, p = 0.005) and self-reported quality of life (QoL, +5 points, p &lt; 0.001) were improved. At T-3, HIIT-group maintained VO _2max and QoL and further improved MAB. EX-group maintained MAB and QoL but experienced a VO _2max decrease. In NON-EX, VO _2max , MAB and QoL deteriorated.
We conclude that LOW-HIIT can be considered a promising option to improve cardiometabolic health in real-life conditions and to mitigate physical inactivity-related negative health impacts during lockdowns.

Durstenfeld MS; Sun K; Tahir P; Peluso MJ; Deeks SG; Aras MA; Grandis DJ; Long CS; Beatty A; Hsue PY

JAMA network open [JAMA Netw Open] 2022 Oct 03; Vol. 5 (10), pp. e2236057.
Date of Electronic Publication: 2022 Oct 03.

Importance: Reduced exercise capacity is commonly reported among individuals with COVID-19 symptoms more than 3 months after SARS-CoV-2 infection (long COVID-19 [LC]). Cardiopulmonary exercise testing (CPET) is the criterion standard to measure exercise capacity and identify patterns of exertional intolerance.
Objectives: To estimate the difference in exercise capacity among individuals with and without LC symptoms and characterize physiological patterns of limitations to elucidate possible mechanisms of LC.
Data Sources: A search of PubMed, EMBASE, Web of Science, preprint servers, conference abstracts, and cited references was performed on December 20, 2021, and again on May 24, 2022. A preprint search of medrxiv.org, biorxiv.org, and researchsquare.com was performed on June 9, 2022.
Study Selection: Studies of adults with SARS-CoV-2 infection more than 3 months earlier that included CPET-measured peak oxygen consumption (V̇o2) were screened independently by 2 blinded reviewers; 72 (2%) were selected for full-text review, and 35 (1%) met the inclusion criteria. An additional 3 studies were identified from preprint servers.
Data Extraction and Synthesis: Data extraction was performed by 2 independent reviewers according to the PRISMA reporting guideline. Data were pooled using random-effects models.
Main Outcomes and Measures: Difference in peak V̇o2 (in mL/kg/min) among individuals with and without persistent COVID-19 symptoms more than 3 months after SARS-CoV-2 infection.
Results: A total of 38 studies were identified that performed CPET on 2160 individuals 3 to 18 months after SARS-CoV-2 infection, including 1228 with symptoms consistent with LC. Most studies were case series of individuals with LC or cross-sectional assessments within posthospitalization cohorts. Based on a meta-analysis of 9 studies including 464 individuals with LC symptoms and 359 without symptoms, the mean peak V̇o2 was -4.9 (95% CI, -6.4 to -3.4) mL/kg/min among those with symptoms with a low degree of certainty. Deconditioning and peripheral limitations (abnormal oxygen extraction) were common, but dysfunctional breathing and chronotropic incompetence were also described. The existing literature was limited by small sample sizes, selection bias, confounding, and varying symptom definitions and CPET interpretations, resulting in high risk of bias and heterogeneity.
Conclusions and Relevance: The findings of this systematic review and meta-analysis study suggest that exercise capacity was reduced more than 3 months after SARS-CoV-2 infection among individuals with symptoms consistent with LC compared with individuals without LC symptoms, with low confidence. Potential mechanisms for exertional intolerance other than deconditioning include altered autonomic function (eg, chronotropic incompetence, dysfunctional breathing), endothelial dysfunction, and muscular or mitochondrial pathology.

Kornuijt A; Bongers BC; G J Marcellis R;Lenssen AF;

Physiotherapy theory and practice [Physiother Theory Pract] 2022 Oct 07, pp. 1-14.
Date of Electronic Publication: 2022 Oct 07.

Objective: To investigate the feasibility of submaximal cardiopulmonary exercise testing (CPET) in patients with knee osteoarthritis (OA) scheduled for primary total knee arthroplasty (TKA) surgery. Secondly, to assess their preoperative aerobic capacity.
Methods: In this observational, single-center study, participants performed a submaximal CPET 3-6 weeks before surgery. To examine their experiences, participants completed a questionnaire and one week later they were contacted by telephone. CPET was deemed feasible when five feasibility criteria were met. Aerobic capacity was evaluated by determining the oxygen uptake (VO ₂ ) at the ventilatory anaerobic threshold (VAT) and oxygen uptake efficiency slope (OUES). OUES values were compared with two sets of normative values.
Results: All feasibility criteria were met as 14 representative participants were recruited (recruitment rate: 60.9%), and all participants were able to perform the test and reached the VAT. No adverse events occurred, and all participants were positive toward submaximal CPET. The median VO ₂ at the VAT was 12.8 mL/kg/min (IQR 11.3-13.6). The median OUES/kg was 23.1 (IQR 20.2-28.9), 106.4% and 109.4% of predicted.
Conclusion: Submaximal CPET using cycle ergometry seems feasible in patients with knee OA scheduled for TKA surgery to evaluate preoperative aerobic capacity.

Simon W; Maria P; Mahabadi AA; Tienush R; Peter L;

International journal of cardiology [Int J Cardiol] 2022 Oct 08.
Date of Electronic Publication: 2022 Oct 08.

Background: Beta blockers (BB) reduce chronotropic response and exercise capacity in heart failure with preserved ejection fraction (HFpEF). To analyze the influence of BB on exercise performance and O 2 pulse increase as a surrogate for stroke volume in HFpEF.
Methods: We retrospectively analyzed the influence of BB intake (yes: n = 48/no: n = 51) on peak oxygen uptake (VO 2peak), oxygen uptake efficiency slope (OUES), and increase of O 2 pulse in HFpEF patients undergoing cardiopulmonary exercise testing (CPET). Associations of outcome variables and risk category of the algorithm of the Heart Failure Association of the European Society of Cardiology (HFA-PEFF score) were calculated.
Results: Patients on BB showed lower VO 2peak (p = .003) and OUES (p = .002), with a dominant effect in the high-risk (p = .020; 0.002), but not in the low risk-group (p = .434; p = .499). In the intermediate group BB showed a trend towards lower VO 2peak (p = .078) and lower values for OUES (p = .020). Patients on BB also demonstrated a lower increase of O 2 pulse during exercise (p = .002), without differences between HFA-PEFF risk groups (low: p = .322, intermediate: p = .269, high: p = .313).
Conclusions: BB reduce exercise capacity and O 2 pulse increase in HFpEF patients. Direct quantification of O 2 pulse increase may help to improve the discrimination of HFpEF patients.

Zannoni J; Guazzi MMilani V; Bandera F; Alfonzetti E; Arena R;

International journal of cardiology [Int J Cardiol] 2022 Oct 10.
Date of Electronic Publication: 2022 Oct 10.

Introduction: Cardiorespiratory fitness (CRF) is now considered a vital sign. Cardiopulmonary exercise testing (CPET) is the gold-standard assessment of CRF; peak oxygen consumption (VO ₂ ) and the minute ventilation/carbon dioxide production (VE/VCO ₂ ) slope are considered primary CPET measures of CRF. More work is needed to determine the role of this exercise assessment in the primary care setting.
Methods: 695 subjects (mean age: 62 ± 13 years, body mass index: 28.9 ± 5.3 kg/m ² , 375 female and 320 male) underwent CPET using a cycle ergometer. 95% of the cohort had one or more major cardiovascular risk factor (i.e., obesity, smoking, dyslipidemia, hypertension, diabetes); no subject was diagnosed with cardiovascular disease (CVD) at the time of CPET. Subjects were tracked for the composite endpoint of cardiovascular mortality or hospital admission.
Results: Mean peak VO ₂ , VE/VCO ₂ slope and peak respiratory exchange ratio were 17.8 ± 5.8 mlO ₂ •kg ^-1 •min ^-1 , 26.7 ± 4.1, and 1.18 ± 0.13, respectively. There were 42 composite events during the 64 ± 18 month tracking period. Both peak VO ₂ (Chi-square 16.3, p < 0.001) and the VE/VCO ₂ slope (Chi-square 14.9, p < 0.001) were significant univariate predictors of the composite endpoint. The VE/VCO ₂ slope added significant predictive value to peak VO ₂ and was retained in the multivariate regression (residual Chi-square 7.0, p = 0.008).
Discussion: These results support the prognostic value of CPET prior to a CVD diagnosis. The prognostic value of the VE/VCO ₂ slope, not commonly the focus of CPET trials in patients with one or more major cardiovascular risk factors but without a confirmed CVD diagnosis, is a particularly novel finding in the current study.

Haque A; Wisely N; McCollum C;

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2022 Jul 16.
Date of Electronic Publication: 2022 Jul 16.

Objective: Ruptured abdominal aortic aneurysm (AAA) carries a mortality rate of up to 80%. Elective repair prevents rupture, but peri-operative mortality remains at 2% – 3%. This mortality rate and long term survival rate are associated with impaired peak oxygen uptake (peak VO ₂ ), oxygen uptake at anaerobic threshold (AT) and ventilatory equivalent for CO ₂ (VECO ₂ ) at AT on cardiopulmonary exercise testing (CPET). Improving fitness to optimise these variables could improve peri-operative and long term survival, but the required exercise training suitable for patients with AAA has yet to be established. This randomised controlled trial aimed to evaluate the effectiveness of 24 week, patient directed, community based exercise on CPET measured fitness in AAA surveillance patients.
Methods: This was a prospective randomised controlled trial in a tertiary UK vascular centre conducted using CONSORT guidelines. Patients on AAA surveillance (n = 56) were randomly assigned to either (1) a 24 week community exercise programme (CEP) with choice of gym or home exercises, or (2) standard clinical care including advice on weight loss and exercise. The primary outcome was change in peak VO ₂ at 24 weeks, with secondary outcomes including AT, VECO ₂ , cardiovascular biomarkers (lipid profile, pro-B-type natriuretic peptide, and high sensitivity C reactive protein, body mass index, and HRQoL. Follow up was at eight, 16, 24, and 36 weeks to evaluate duration of benefit. All analyses were performed on an intention to treat basis.
Results: CEP patients (n = 28) achieved mean (95% confidence interval [CI]) improvements from baseline in peak VO ₂ of 1.5 (95% CI 0.5 – 2.5), 2.1 (95% CI 1.1 – 3.2), 2.3 (95% CI 1.2 – 3.3), and 2.2 (95% CI 1.1, 3.3) mL/kg/min at 8, 16, 24, and 36 weeks, respectively. These changes in CEP patients were significantly greater than those seen in control patients at 16 (p = .002), 24 (p = .031), and 36 weeks (p < .001). There were also significant improvements in AT, triglyceride levels, and HRQoL in CEP patients.
Conclusion: This CEP significantly improved those CPET parameters associated with impaired peri-operative and long term survival in patients following AAA repair. These improvements were maintained at 12 weeks following the end of the programme