Oleksak F; Spakova B; Durdikova A; Durdik P; Kralova T; Igaz M; Molnar M;
Gura M; Murgas D

Respiratory Physiology & Neurobiology. 296:103790, 2022 02.

OBJECTIVE: The objective was to use CPET to estimate the usability of
anthropometric index (AI) in patients with pectus excavatum (PE) as a
marker of functional impairment caused by chest deformity.

METHODS: The study included 32 paediatric patients (28 males) with PE.
Patients underwent CPET using a breath-by-breath exhaled gas analysis
method and continuous monitoring of cardiac parameters.

RESULTS: In both groups, two (overall four) patients met criteria for
cardiogenic limitation (low VO2 and low O2Pulse). Mean VO2/WR was below
two standard deviations (2SD) in patients with less severe PE; other
observed parameters were within normal limits (Z-score +/- 2 SD). The AI
had no observed correlation with peak ventilation, VO2peak and peak
workload.

CONCLUSION: The obtained CPET data do not correlate well with the
severity of chest deformity expressed with AI. There were similar physical
activity limitations in both examined groups of patients and they did not
depend on the severity of the deformity.

von Gruenewaldt, Anna; Nylander, Eva; Hedman, Kristofer.

Physiological Reports. 10(4):e15197, 2022 02.

Reduced exercise capacity and several limiting symptoms during exercise
have been reported following severe acute respiratory syndrome
coronavirus-2 (SARS-CoV-2) infection. From clinical observations, we
hypothesized that an abnormal breathing pattern (BrP) during exercise may
be common in these patients and related to reduced exercise capacity. We
aimed to (a) evaluate a method to classify the BrP as normal/abnormal or
borderline in terms of inter-rater agreement; (b) determine the occurrence
of an abnormal BrP in patients with post-COVID; and (c) compare
characteristics of post-COVID patients with normal and abnormal BrP. In a
retrospective, cross-sectional study of patients referred for CPET due to
post-COVID April 2020-April 2021, we selected subjects without a history
of intensive care and with available medical records. Three raters
independently categorized patients’ BrP as normal, abnormal, or
borderline, using four traditional CPET plots (respiratory exchange ratio,
tidal volume over ventilation, ventilatory equivalent for oxygen, and
ventilation over time). Out of 20 patients (11 male), 10 were categorized
as having a normal, 7 an abnormal, and three a borderline BrP. Inter-rater
agreement was good (Fleiss’ kappa: 0.66 [0.66-0.67]). Subjects with an
abnormal BrP had lower peak ventilation, lower exercise capacity, similar
ventilatory efficiency and a similar level of dyspnea at peak exercise, as
did subjects with a normal BrP. Patients’ BrP was possible to classify
with good agreement between observers. A third of patients had an abnormal
BrP, associated with lower exercise capacity, which could possibly explain
exercise related symptoms in some patients with post-COVID syndrome.

Peterman JE; Arena R; Myers J; Marzolini S; Ades PA; Savage PD; Lavie CJ;
Kaminsky LA

Journal of the American Heart Association. 10(22):e022336, 2021 11 16.
VI 1

Background The importance of cardiorespiratory fitness for stratifying
risk and guiding clinical decisions in patients with cardiovascular
disease is well-established. To optimize the clinical value of
cardiorespiratory fitness, normative reference standards are essential.
The purpose of this report is to extend previous cardiorespiratory fitness
normative standards by providing updated cardiorespiratory fitness
reference standards according to cardiovascular disease category and
testing modality. Methods and Results The analysis included 15 045 tests
(8079 treadmill, 6966 cycle) from FRIEND (Fitness Registry and the
Importance of Exercise National Database). Using data from tests conducted
January 1, 1974, through March 1, 2021, percentiles of directly measured
peak oxygen consumption (VO2peak) were determined for each decade from 30
through 89 years of age for men and women with a diagnosis of coronary
artery bypass surgery, myocardial infarction, percutaneous coronary
intervention, or heart failure. There were significant differences between
sex and age groups for VO2peak (P<0.001). The mean VO2peak was 23% higher
for men compared with women and VO2peak decreased by a mean of 7% per
decade for both sexes. Among each decade, the mean VO2peak from treadmill
tests was 21% higher than the VO2peak from cycle tests. Differences in
VO2peak were observed among the age groups in both sexes according to
cardiovascular disease category. Conclusions This report provides
normative reference standards by cardiovascular disease category for both
men and women performing cardiopulmonary exercise testing on a treadmill
or cycle ergometer. These updated and enhanced reference standards can
assist with patient risk stratification and guide clinical care.

Avram RL; Nechita AC; Popescu MN; Teodorescu M; Ghilencea LN; Turcu D; Lechea E; Maher S; Bejan GC;
Berteanu M;

Journal of medicine and life [J Med Life] 2022 Jan; Vol. 15 (1), pp. 58-64.

Lately, easier and shorter tests have been used in the functional evaluation of cardiac patients. Among these, walking speed (WS) and Timed Up and Go (TUG) tests are associated with all-cause mortality, mainly cardiovascular and the rate of re-hospitalization, especially in the elderly population. We prospectively analyzed a group of 38 patients admitted to the Cardiology Clinic from Elias Hospital, Romania, with chronic coronary syndrome (CCS) (n=22) and STEMI (n=16). We assessed the patients immediately after admission and before discharge with G-WALK between the 1 ^st and 30 ^th of September 2019. Our study group had a mean age of 62.7±12.1 years. Patients with a low WS were older (69.90±12.84 vs. 59.90±10.32 years, p=0.02) and had a lower serum hemoglobin (12.38±1.20 vs. 13.72±2.07 g/dl, p=0.02). The WS significantly improved during hospitalization (p=0.03) after optimal treatment. The TUG test performed at the time of admission had a longer duration in patients with heart failure (14.05 vs. 10.80 sec, p=0.02) and was influenced by patients’ age (r=0.567, p=0.02), serum creatinine (r=0.409, p=0.03) and dilation of right heart chambers (r=0.399, p=0.03). WS and TUG tests can be used in patients with CCS and STEMI, and are mainly influenced by age, thus having a greater value among the elderly.

von Gruenewaldt A; Nylander E; Hedman K;

Physiological reports [Physiol Rep] 2022 Feb; Vol. 10 (4), pp. e15197.

Reduced exercise capacity and several limiting symptoms during exercise have been reported following severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. From clinical observations, we hypothesized that an abnormal breathing pattern (BrP) during exercise may be common in these patients and related to reduced exercise capacity. We aimed to (a) evaluate a method to classify the BrP as normal/abnormal or borderline in terms of inter-rater agreement; (b) determine the occurrence of an abnormal BrP in patients with post-COVID; and (c) compare characteristics of post-COVID patients with normal and abnormal BrP. In a retrospective, cross-sectional study of patients referred for CPET due to post-COVID April 2020-April 2021, we selected subjects without a history of intensive care and with available medical records. Three raters independently categorized patients’ BrP as normal, abnormal, or borderline, using four traditional CPET plots (respiratory exchange ratio, tidal volume over ventilation, ventilatory equivalent for oxygen, and ventilation over time). Out of 20 patients (11 male), 10 were categorized as having a normal, 7 an abnormal, and three a borderline BrP. Inter-rater agreement was good (Fleiss’ kappa: 0.66 [0.66-0.67]). Subjects with an abnormal BrP had lower peak ventilation, lower exercise capacity, similar ventilatory efficiency and a similar level of dyspnea at peak exercise, as did subjects with a normal BrP. Patients’ BrP was possible to classify with good agreement between observers. A third of patients had an abnormal BrP, associated with lower exercise capacity, which could possibly explain exercise related symptoms in some patients with post-COVID syndrome.

Brotto AR; Phillips DB; Meah VL; Ross BA; Fuhr DP; Beaudry RI; van Diepen S; Stickland MK;

European journal of applied physiology [Eur J Appl Physiol] 2022 Mar; Vol. 122 (3), pp. 703-715.
Date of Electronic Publication: 2022 Jan 22.

Purpose: Previous work suggests that endurance-trained athletes have superior pulmonary vasculature function as compared to untrained individuals, which may contribute to their greater maximal oxygen uptake ([Formula: see text]O _2max ). Inhaled nitric oxide (iNO) reduces pulmonary vascular resistance in healthy individuals, which could translate into greater cardiac output and improved [Formula: see text]O _2max , particularly in untrained individuals. The purpose of the study was to examine whether iNO improved [Formula: see text]O _2max in endurance trained and untrained individuals.
Methods: Sixteen endurance-trained and sixteen untrained individuals with normal lung function completed this randomized double-blind cross-over study over four sessions. Experimental cardiopulmonary exercise tests were completed while breathing either normoxia (placebo) or 40 ppm of iNO, on separate days (order randomized). On an additional day, echocardiography was used to determine pulmonary artery systolic pressure at rest and during sub-maximal exercise (60 Watts) while participants breathed normoxia or iNO.
Results: Right ventricular systolic pressure was significantly reduced by iNO during exercise (Placebo: 34 ± 7 vs. iNO: 32 ± 7; p = 0.04). [Formula: see text]O _2max was greater in the endurance trained group (Untrained: 3.1 ± 0.7 vs. Endurance: 4.3 ± 0.9 L min ^-1 ; p < 0.01), however, there was no effect of condition (p = 0.79) and no group by condition interaction (p = 0.68). Peak cardiac output was also unchanged by iNO in either group.
Conclusion: Despite a reduction in right ventricular systolic pressure, the lack of change in [Formula: see text]O _2max with iNO suggests that the pulmonary vasculature does not limit [Formula: see text]O _2max in young healthy individuals, regardless of fitness level.

Marcin T; Trachsel LD; Dysli M; Schmid JP; Eser P; Wilhelm M

Annals of Physical & Rehabilitation Medicine. 65(1):101490, 2022 Jan.
VI 1

BACKGROUND: Whether high-intensity interval training (HIIT) is more
efficient than moderate-intensity continuous exercise (MICE) to increase
cardiorespiratory fitness in patients with acute coronary syndrome at
moderate-to-high cardiovascular risk is controversial. The best approach
to guide training intensity remains to be determined.

OBJECTIVE: We aimed to assess intensities achieved with self-tailored
HIIT and MICE according to perceived exertion and to compare the effect on
cardiorespiratory fitness in patients early after ST-elevation myocardial
infarction (STEMI).

METHODS: We included 69 males starting cardiac rehabilitation within 4
weeks after STEMI. After a 3-week run-in phase with MICE, 35 patients were
randomised to 9 weeks of HIIT (2xHIIT and 1xMICE per week) and 34 patients
to MICE (3xMICE). Training workload for MICE was initially set at the
patients’ first ventilatory threshold (VT). HIIT consisted of 4×4-min
intervals with a workload above the second VT in high intervals. Training
intensity was adjusted weekly to maintain the perceived exertion (Borg
score 13-14 for MICE, >=15 for HIIT). Session duration was 38min in both
groups. Peak oxygen consumption (VO2) was measured by cardiopulmonary
exercise testing pre- and post-intervention.

RESULTS: Both groups improved peak VO2 (ml/kg/min) (HIIT +1.9, P<0.001;
MICE +3.2, P<0.001, Cohen’s d -0.4), but changes in VO2 were not
significantly different between groups (P=0.104). Exercise regimes did not
differ between groups in terms of energy expenditure or training time, but
perceived exertion was higher with HIIT.

CONCLUSIONS: Self-tailored HIIT was feasible in patients early after
STEMI. It was more strenuous but not superior nor more time-efficient than
MICE in improving peak VO2.

Powell TA; Mysliwiec V; Brock MS; Morris MJ

Journal of Clinical Sleep Medicine. 18(1):279-288, 2022 01 01.
VI 1

The effects of untreated obstructive sleep apnea (OSA) on cardiopulmonary
function remain unclear. Cardiorespiratory fitness (CRF), commonly
reflected by VO2 max measured during cardiopulmonary exercise testing, has
gained popularity in evaluating numerous cardiopulmonary conditions and
may provide a novel means of identifying OSA patients with the most
clinically significant disease. This emerging testing modality provides
simultaneous assessment of respiratory and cardiovascular function with
results helping uncover evidence of evolving pathology in either organ
system. In this review, we highlight the current state of the literature
in regard to OSA and CRF with a specific focus on changes in
cardiovascular function that have been previously noted. While OSA does
not appear to limit respiratory function during exercise, studies seem to
suggest an abnormal cardiovascular exercise response in this population
including decreased cardiac output, a blunted heart rate response (ie,
chronotropic incompetence), and exaggerated blood pressure response.
Surprisingly, despite these observed changes in the cardiovascular
response to exercise, results involving VO2 max in OSA remain
inconclusive. This is reflected by VO2 max studies involving middle-aged
OSA patients showing both normal and reduced CRF. As prior studies have
not extensively characterized oxygen desaturation burden, we propose that
reductions in VO2 max may exist in OSA patients with only the most
significant disease (as reflected by nocturnal hypoxia). Further
characterizing this relationship remains important as some research
suggests that positive airway pressure therapy or aerobic exercise may
improve CRF in patients with OSA. In conclusion, while it likely that
severe OSA, via an abnormal cardiovascular response to exercise, is
associated with decreased CRF, further study is clearly warranted to
include determining if OSA with decreased CRF is associated with increased
morbidity or mortality.

Goulart CDL; Caruso FR; de Araújo ASG; de Moura SCG; Catai AM; Agostoni P; Mendes RG; Arena R; Borghi-Silva A

Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Jan 31; Vol. 8, pp. 772650.
Date of Electronic Publication: 2022 Jan 31 (Print Publication: 2021).

Aim: To evaluate the effect of non-invasive positive pressure ventilation (NIPPV) on (1) metabolic, ventilatory, and hemodynamic responses; and (2) cerebral (Cox), respiratory, and peripheral oxygenation when compared with SHAM ventilation during the high-intensity exercise in patients with coexisting chronic obstructive pulmonary disease (COPD) and heart failure (HF).
Methods and Results: On separate days, patients performed incremental cardiopulmonary exercise testing and two constant-work rate tests receiving NIPPV or controlled ventilation (SHAM) (the bilevel mode-Astral 150) in random order until the limit of tolerance (Tlim). During exercise, oxyhemoglobin (OxyHb+Mb) and deoxyhemoglobin (DeoxyHb+Mb) were assessed using near-infrared spectroscopy (Oxymon, Artinis Medical Systems, Einsteinweg, The Netherlands). NIPPV associated with high-intensity exercise caused a significant increase in exercise tolerance, peak oxygen consumption (V·O2in mlO ₂ ·kg ^-1 ·min ^-1 ), minute ventilation peak (V·Ein ml/min), peak peripheral oxygen saturation (SpO ₂ , %), and lactate/tlim (mmol/s) when compared with SHAM ventilation. In cerebral, respiratory, and peripheral muscles, NIPPV resulted in a lower drop in OxyHb+Mb ( p < 0.05) and an improved deoxygenation response DeoxyHb+Mb ( p < 0.05) from the half of the test (60% of Tlim) when compared with SHAM ventilation.
Conclusion: Non-invasive positive pressure ventilation during constant work-rate exercise led to providing the respiratory muscle unloading with greater oxygen supply to the peripheral muscles, reducing muscle fatigue, and sustaining longer exercise time in patients with COPD-HF.

Wiecha S; Price S; Cieśliński I; Kasiak PS; Tota Ł; Ambroży T; Śliż D;

International journal of environmental research and public health [Int J Environ Res Public Health] 2022 Feb 06; Vol. 19 (3). Date of Electronic Publication: 2022 Feb 06.

Cardiopulmonary exercise testing (CPET) on a treadmill (TE) or cycle ergometry (CE) is a common method in sports diagnostics to assess athletes’ aerobic fitness and prescribe training. In a triathlon, the gold standard is performing both CE and TE CPET. The purpose of this research was to create models using CPET results from one modality to predict results for the other modality. A total of 152 male triathletes (age = 38.20 ± 9.53 year; BMI = 23.97 ± 2.10 kg·m ^-2 ) underwent CPET on TE and CE, preceded by body composition (BC) analysis. Speed, power, heart rate (HR), oxygen uptake (VO ₂ ), respiratory exchange ratio (RER), ventilation (VE), respiratory frequency (fR), blood lactate concentration (LA) (at the anaerobic threshold (AT)), respiratory compensation point (RCP), and maximum exertion were measured. Random forests (RF) were used to find the variables with the highest importance, which were selected for multiple linear regression (MLR) models. Based on R ² and RF variable selection, MLR equations in full, simplified, and the most simplified forms were created for VO _2AT , HR _AT , VO _2RCP , HR _RCP , VO _2max , and HR _max for CE (R ² = 0.46-0.78) and TE (R ² = 0.59-0.80). By inputting only HR and power/speed into the RF, MLR models for practical HR calculation on TE and CE (both R ² = 0.41-0.75) were created. BC had a significant impact on the majority of CPET parameters. CPET parameters can be accurately predicted between CE and TE testing. Maximal parameters are more predictable than submaximal. Only HR and speed/power from one testing modality could be used to predict HR for another. Created equations, combined with BC analysis, could be used as a method of choice in comprehensive sports diagnostics.