Iniesta RR; Causer AJ; Arregui-Fresneda I; Connett G; Allenby MI; Daniels T; Carroll MP; Urquhart DS; Saynor ZL;

Journal of human nutrition and dietetics : the official journal of the British Dietetic Association [J Hum Nutr Diet] 2021 Apr 28. Date of Electronic Publication: 2021 Apr 28.

Background: 25-hydroxyvitamin D (25OHD) may exert immunomodulatory effects on respiratory health, which may translate to improvements in exercise physiology. Thus, we aimed to investigate whether plasma 25OHD is associated with lung function and aerobic fitness in people with cystic fibrosis (pwCF).
Methods: A multi-centre retrospective review of pwCF (>9 years old) attending the Royal Hospital for Sick Children (Edinburgh) or Wessex CF-Unit (Southampton) was performed between July 2017 to October 2019. Demographic and clinical data were collected. Plasma 25OHD measured closest in time to clinical cardiopulmonary exercise testing (CPET) and/or spirometry (forced expiratory volume FEV ₁ % predicted) was recorded. Pancreatic insufficiency was diagnosed based on faecal elastase of <100 µg/g. We performed multiple-regression analysis with aerobic fitness outcomes [peak oxygen uptake (VO ₂ peak)] and FEV ₁ % predicted as primary outcomes.
Results: Ninety pwCF [mean±SD age: 19.1±8.6 years, 54 (60%) children, 48 (53%) males and 88 (98%) Caucasian] were included. 25OHD deficiency and insufficiency was 15 (17%) and 44 (49%) respectively. 25OHD deficiency and insufficiency was significantly associated with pancreatic insufficiency (χ2(4.8); p = 0.02). Plasma 25OHD was not significantly associated with FEV ₁ % predicted [R ² = 0.06; p= 0.42; 95%; CI (-0.09 – 0.19)] or VO _2peak [R ² = 0.04; p= 0.07; 95% CI (-011 – 0.005)] in all pwCF. However, 25OHD was significantly associated with both FEV ₁ % [R ² = 0.15; p= 0.02; 95% CI (1.99 – 2.64)] and VO _2peak [R ² = 0.13; p= 0.05; 95% CI (-0.26 – (-0.005)] in the paediatric cohort.
Conclusion: We showed that 25OHD is associated with improved lung function and aerobic fitness in children and adolescents with CF. Mechanistic and high-quality prospective studies including both lung function and aerobic fitness as primary outcomes are now warranted.

Feasel CD; Sandroff BM; Motl RW;

Acta neurologica Scandinavica [Acta Neurol Scand] 2021 Apr 29. Date of Electronic Publication: 2021 Apr 29.

Objectives: Aerobic reserve capacity reflects the available energy for performing everyday life tasks, and it has been studied in older adult populations. This preliminary study examined proof of concept and measurement of aerobic reserve capacity in multiple sclerosis (MS).
Materials & Methods: Twenty-one fully ambulatory people with MS performed a maximal, cardiopulmonary exercise test (CPET). We calculated aerobic reserve capacity based on the difference between peak aerobic power (VO _2peak ) and first stage oxygen consumption (VO ₂ ). Participants completed assessments for disability (Expanded Disability Status Scale, EDSS), cognition (Symbol Digit Modalities Test, SDMT), mood (Beck Depression Inventory, BDI), walking endurance (six-minute walk distance, 6MWD), walking speed (Timed Twenty-Foot Walk, T25FW), impact of MS (Multiple Sclerosis Impact Scale, MSIS-29), and anthropometric measurements (height and weight).
Results: Aerobic reserve capacity was 9.3 ± 3.7 ml/kg/min. Aerobic reserve capacity was positively associated with VO _2peak (ρ = .67, p < .01), time to exhaustion (ρ = .63, p < .01), and SDMT (ρ = .51, p < .05). Aerobic reserve capacity was negatively associated with BMI (ρ = -.62, p < .01) and RHR (ρ = -0.47, p < .05).
Conclusion: We provide preliminary evidence that aerobic reserve capacity is a feasible outcome derived from maximal CPET (eg, modified Balke protocol) in MS. Aerobic reserve capacity was associated with clinically relevant outcomes and could become an important outcome for rehabilitation in future research.

Torres-Castro R; Gimeno-Santos E; Vilaró J; Roqué-Figuls M; Moisés J; Vasconcello-Castillo L; Orizaga T; Barberà JA; Blanco I;

European respiratory review : an official journal of the European Respiratory Society [Eur Respir Rev] 2021 Apr 29; Vol. 30 (160). Date of Electronic Publication: 2021 Apr 29 (Print Publication: 2021).

Background: Pulmonary hypertension (PH) is a frequent complication in patients with COPD.
Objective: To determine if, in patients with COPD, the presence of PH decreases exercise tolerance.
Methods: We included studies that analysed exercise tolerance using a cardiopulmonary exercise test (CPET) in patients with COPD with PH (COPD-PH) and without PH (COPD-nonPH). Two independent reviewers analysed the studies, extracted the data and assessed the quality of the evidence.
Results: Of the 4915 articles initially identified, seven reported 257 patients with COPD-PH and 404 patients with COPD-nonPH. The COPD-PH group showed differences in peak oxygen consumption ( V ‘ _{O 2peak} ), -3.09 mL·kg ^-1 ·min ^-1 (95% CI -4.74 to -1.43, p=0.0003); maximum workload (W _max ), -20.5 W (95% CI -34.4 to -6.5, p=0.004); and oxygen pulse (O ₂ pulse), -1.24 mL·beat ^-1 (95% CI -2.40 to -0.09, p=0.03), in comparison to the group with COPD-nonPH. If we excluded studies with lung transplant candidates, the sensitivity analyses showed even bigger differences: V ‘ _{O 2} , -4.26 mL·min ^-1 ·kg ^-1 (95% CI -5.50 to -3.02 mL·kg ^-1 ·min ^-1 , p<0.00001); W _max , -26.6 W (95% CI -32.1 to -21.1 W, p<0.00001); and O ₂ pulse, -2.04 mL·beat ^-1 (95% CI -2.92 to -1.15 mL·beat ^-1 , p<0.0001).
Conclusion: Exercise tolerance was significantly lower in patients with COPD-PH than in patients with COPD-nonPH, particularly in nontransplant candidates.

Van Iterson EH; Cho L; Tonelli A; Finet JE; Laffin LJ;

ESC heart failure [ESC Heart Fail] 2021 May 01. Date of Electronic Publication: 2021 May 01.

Aims: In patients with heart failure and reduced ejection fraction (HFrEF), it remains unclear how exacerbated impairments in peak exercise oxygen uptake (V̇O _2peak ) caused by coexistent obstructive or restrictive ventilatory defects affect mortality risk. We evaluated in patients with HFrEF, whether demonstrating either an obstructive or restrictive-patterned ventilatory defect on spirometry affects V̇O _2peak to yield all-cause mortality risk predicted by V̇O _2peak that is spirometry pattern specific.
Methods and Results: We retrospectively analysed resting spirometry and treadmill cardiopulmonary exercise testing data of patients with HFrEF (left ventricular ejection fraction ≤ 40%). The study sample (N = 329) was grouped by spirometry pattern: normal [Group 1: N = 101; forced expiratory volume in 1 s (FEV ₁ )/forced vital capacity (FVC) ≥ 0.70; FVC ≥ 80% predicted], restrictive without airflow obstruction (Group 2: N = 104; FEV ₁ /FVC ≥ 0.70; FVC < 80% predicted), or obstructive (Group 3: N = 124; FEV ₁ /FVC < 0.70). Patients were followed up to 1 year for the endpoint of all-cause mortality. V̇O _2peak was higher in Group 1 versus Groups 2 and 3 (13.4 ± 4.0 vs. 12.1 ± 3.7 and 12.2 ± 3.3 mL/kg/min, respectively; P = 0.014). Over the 1 year follow-up, n = 9, n = 16, and n = 12 deaths occurred in Groups 1-3, respectively, with corresponding crude survival rates of 88%, 81%, and 92%, respectively (log-rank; P = 0.352). V̇O _2peak was associated with all-cause mortality (crude hazard ratio = 0.77; P < 0.001). In multivariate analyses, a significant V̇O _2peak -by-spirometry group interaction yielded 1.99 (95% confidence interval, 1.14-3.46) and 2.43 (95% confidence interval, 1.44-4.11) higher mortality risk associated with V̇O _2peak in Group 2 versus Groups 1 and 3, respectively.
Conclusions: Demonstrating a restrictive pattern on spirometry yields the severest mortality risk associated with V̇O _2peak . Using spirometry to screen patients with HFrEF for ventilatory defects has a potential role in improving risk stratification based on V̇O _2peak .

Duscha BD; Johnson JL; Bennett WC; Ball KN; Mae Fos LB; Reaves MA; Kraus WE

Current sports medicine reports [Curr Sports Med Rep] 2021 May 01; Vol. 20 (5), pp. 259-265.

Abstract: Cardiopulmonary exercise testing (CPX) is a valuable tool in both clinical practice and research settings. Therefore, it is advantageous for human performance laboratories to continue operating during the coronavirus disease 2019 (COVID-19) pandemic. All institutions should adhere to general COVID-19 guidelines provided by the Centers for Disease Control. Because of the testing environment, CPX laboratories must consider additional precautionary safety measures. This article provides recommendations for modifying the CPX protocol to ensure safety for all stakeholders during the pandemic. These modifications are universal across all populations, types of institutions and testing modalities. Preliminary measures include careful review of federal, local, and institutional mandates. The description outlines how to evaluate a testing environment and alter workflow. Guidelines are provided on what specific personal protective equipment should be acquired; as well as necessary actions before, during, and after the CPX test. These precautions will limit the possibility of both clients and staff from contracting or spreading the disease while maintaining testing volume in the laboratory.

Ramos RJ; Ladha KS; Cuthbertson BH; Shulman MA; Myles PS; Wijeysundera DN;

Canadian journal of anaesthesia = Journal canadien d’anesthesie [Can J Anaesth] 2021 Apr; Vol. 68 (4), pp. 514-529. Date of Electronic Publication: 2021 Jan 13.

Purpose: The six-minute walk test (6MWT) is a simple and valid test for assessing cardiopulmonary fitness. Nevertheless, the relationship between preoperative 6MWT distance and postoperative complications is uncertain. We conducted a secondary analysis of the 6MWT nested cohort substudy of the Measurement of Exercise Tolerance before Surgery study to determine if 6MWT distance predicts postoperative complications or death.
Methods: This analysis included 545 adults (≥ 40 yr) who were at elevated cardiac risk and had elective inpatient non-cardiac surgery at 15 hospitals in Canada, Australia, and New Zealand. Each participant performed a preoperative 6MWT and was followed for 30 days after surgery. The primary outcome was moderate or severe in-hospital complications. The secondary outcome was 30-day death or myocardial injury. Multivariable logistic regression modelling was used to characterize the adjusted association of 6MWT distance with these outcomes.
Results: Seven participants (1%) terminated their 6MWT sessions early because of lower limb pain, dyspnea, or dizziness. Eighty-one (15%) participants experienced moderate or severe complications and 69 (13%) experienced 30-day myocardial injury or death. Decreased 6MWT distance was associated with increased odds of moderate or severe complications (adjusted odds ratio, 1.32 per 100 m decrease; 95% confidence interval, 1.01 to 1.73; P = 0.045). There was no association of 6MWT distance with myocardial injury or 30-day death (non-linear association; P = 0.49).
Conclusion: Preoperative 6MWT distance had a modest association with moderate or severe complications after inpatient non-cardiac surgery. Further studies are needed to determine the optimal role of the 6MWT as an objective exercise test for informing preoperative risk stratification.

Nemoto S; Kasahara Y; Izawa KP; Watanabe S; Yoshizawa K; Takeichi N; Kamiya K; Suzuki N; Omiya K; Kida K; Matsunaga A; Akashi YJ

Journal of cardiopulmonary rehabilitation and prevention [J Cardiopulm Rehabil Prev] 2021 Apr 16. Date of Electronic Publication: 2021 Apr 16.

Purpose: It is recommended that patients with myocardial infarction (MI) be prescribed exercise by target heart rate (HR) at the anaerobic threshold (AT) via cardiopulmonary exercise testing (CPX). Although percent HR reserve using predicted HRmax (%HRRpred) is used to prescribe exercise if CPX or an exercise test cannot be performed, %HRRpred is especially difficult to use when patients take β-blockers. We devised a new formula to predict HR at AT (HRAT) that considers β-blocker effects in MI patients and validated its accuracy.
Methods: The new formula was created using the data of 196 MI patients in our hospital (derivation sample), and its accuracy was assessed using the data of 71 MI patients in other hospitals (validation sample). All patients underwent CPX 1 mo after MI onset, and resting HR, resting systolic blood pressure (SBP), and HRAT were measured during CPX.
Results: The results of multiple regression analysis in the derivation sample gave the following formula (R2 = 0.605, P < .001): predicted HRAT = 2.035 × (≥65 yr:-1, <65 yr:1) + 3.648 × (body mass index <18.5 kg/m2:-1, body mass index ≥18.5 kg/m2:1) + 4.284 × (β1-blocker(+):-1, β1-blocker(-):1) + 0.734 × (HRrest) + 0.078 × (SBPrest) + 36.812. This formula consists entirely of predictors that can be obtained at rest. HRAT and predicted HRAT with the new formula were not significantly different in the validation sample (mean absolute error: 5.5 ± 4.1 bpm).
Conclusions: The accuracy of the new formula appeared to be favorable. This new formula may be a practical method for exercise prescription in MI patients, regardless of their β-blocker treatment status, if CPX is unavailable.

Frazão M; Santos ADC; Araújo AA; Romualdo MP; de Mello BLC; Jerônimo GG; Paulino FP; Brasileiro-Santos MDS;

Respiratory physiology & neurobiology [Respir Physiol Neurobiol] 2021 Apr 16; Vol. 290, pp. 103673. Date of Electronic Publication: 2021 Apr 16.

Aim: to analyze respiratory and peripheral neuromuscular efficiency during exercise in COPD.
Methods: COPD patients (VEF ₁  = 39.25 ± 13.1 %) were paired with healthy subjects. It was performed cardiopulmonary exercise test with simultaneously electromyography (EMG). Respiratory neuromuscular efficiency was determined by relationship between tidal volume and diaphragm EMG. Peripheral neuromuscular efficiency was determined by relationship between power output and vastus lateralis EMG.
Results: Healthy subjects presented higher respiratory neuromuscular efficiency at moderate, heavy and maximum exercise intensities compared to COPD (p < 0.05). Healthy subjects presented higher peripheral neuromuscular efficiency at light, moderate, heavy and maximum exercise intensities compared to COPD (p < 0.001). Dynamic hyperinflation presented correlation with respiratory and peripheral neuromuscular efficiency (r = -0.73 and r = -0.76, p < 0.001).
Conclusion: COPD patients have lower respiratory neuromuscular efficiency at moderate exercise intensity and lower peripheral neuromuscular efficiency at light exercise intensity. Dynamic hyperinflation affects respiratory and peripheral neuromuscular efficiency.

Kanegusuku H; Peçanha T; Silva-Batista C; Miyasato RS; Silva Júnior NDD; Mello MT; Piemonte MEP;
Ugrinowitsch C; Forjaz CLM;

Einstein (Sao Paulo, Brazil) [Einstein (Sao Paulo)] 2021 Apr 19; Vol. 19, pp. eAO5940. Date of Electronic Publication: 2021 Apr 19 (Print Publication: 2021).

Objective: To evaluate the effects of resistance training on metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson’s disease.
Methods: Twenty-four patients with Parkinson’s disease (modified Hoehn and Yahr stages 2 to 3) were randomly assigned to one of two groups: Control or Resistance Training. Patients in the Resistance Training Group completed an exercise program consisting of five resistance exercises (two to four sets of six to 12 repetitions maximum per set) twice a week. Patients in the Control Group maintained their usual lifestyle. Oxygen uptake, systolic blood pressure and heart rate were assessed at rest and during cycle ergometer-based maximal cardiopulmonary exercise testing at baseline and at 12 weeks. Assessments during exercise were conducted at absolute submaximal intensity (slope of the linear regression line between physiological variables and absolute workloads), at relative submaximal intensity (anaerobic threshold and respiratory compensation point) and at maximal intensity (maximal exercise). Muscle strength was also evaluated.
Results: Both groups had similar increase in peak oxygen uptake after 12 weeks of training. Heart rate and systolic blood pressure measured at absolute and relative submaximal intensities and at maximal exercise intensity did not change in any of the groups. Muscle strength increased in the Resistance Training but not in the Control Group after 12 weeks.
Conclusion: Resistance training increases muscle strength but does not change metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson’s disease without cardiovascular comorbidities.

Van Ryckeghem L;Franssen WMA; Verbaanderd E; Indesteege J; De Vriendt F; Verwerft J;Dendale P; Bito V;
Hansen D;

Canadian journal of diabetes [Can J Diabetes] 2021 Jan 23. Date of Electronic Publication: 2021 Jan 23.

Objectives: Cardiovascular diseases and exercise intolerance elevate mortality in type 1 diabetes (T1D). Left ventricular systolic and diastolic function are already affected in T1DM adolescents, displaying poor glycemic control (glycated hemoglobin [A1C]>7.5%) and exercise intolerance. We investigated to the extent to which left ventricular function is affected by disease severity/duration and whether this is related to exercise capacity.
Methods: Transthoracic echocardiography was performed in 19 T1DM adolescents (14.8±1.9 years old, A1C 7.4±0.9%) and 19 controls (14.4±1.3 years old, A1C 5.3±0.2%), matched for age and Tanner stage. Diastolic and systolic (ejection fraction [EF]) function were assessed. Cardiopulmonary exercise testing was used to evaluate exercise capacity, as measured by peak oxygen uptake (VO _2peak ).
Results: VO _2peak and left ventricular systolic and diastolic function were similar in both groups. Within the T1D group, EF was negatively associated with disease duration (r=-0.79 corrected for age, standardized body mass index, glucose variability and VO _2peak ; p=0.011). Regression analyses revealed that 37.6% of the variance in EF could be attributed to disease duration.
Conclusions: Although left ventricular systolic and diastolic function are preserved in T1D with adequate exercise capacity, disease duration negatively affects EF. The detrimental effects of T1D seem to be driven by disease duration, rather than by disease severity, at least during adolescence. Young T1D patients may, therefore, benefit from cardiovascular evaluation in order to detect cardiovascular abnormalities early in the disease course, and therefore, improve long-term cardiovascular health.