CHRISTOPHER B. COOPER, WILLIAM L. BEAVER, DAN M. COOPER
AND KARLMAN WASSERMAN
Experimental Physiology (1992), 77, 51-64

The V VO (alveolar CO2 output-alveolar 02 uptake) relationship ( V-slope) during increasing
work rate (r-amp) cycle ergometer exercise has two approximately linear components: a lower
component slope (S,) with a value of about 0-95 and a steeper, upper component (S2). We
examined the effect of muscle glycogen depletion (protocol 1) and the rate of increase in work
rate (ramp rate) without muscle glycogen depletion (protocol 2) on S1 and S2. In protocol 1,
ten healthy men with a mean age of 31 4 years (S.D. 6-2) were studied on each of 3 days (days
I and 3 were control days). They performed a ramp exercise test to maximum tolerance and
steady-state tests at rest, during unloaded pedalling and at two constant work rates below their
anaerobic threshold (AT). To deplete muscle glycogen before the test on day 2, the subjects
performed 2 h of very heavy cycle exercise on the preceding day and fasted overnight. Si was
reduced on day 2 (0 79 compared with 0 95, P < 0 001), as was the VC0 -VO slope derived
from steady-state measurements (0 81 compared with 0 99, P < 0 001), but AT and the slope
difference (S2 -S5) were unchanged. In protocol 2, seven healthy men with a mean age of 20 6
years (S.D. 2-4) performed ramp tests at three different rates of increasing work rate (1 5, 30 and
60 W min’), each ramp rate being performed twice in random sequence. The ramp rate did not
affect Si but S2 was steeper with the faster rates of work rate increase (127, 143 and 163,
respectively, P < 0 01). Our findings support the concept that the lower component of the Vslope
plot (below AT) represents muscle substrate respiratory quotient (RQ) while the
difference between Si and S2 reflects ‘excess CO2’ derived from bicarbonate buffering of lactic
acid.

CHRISTOPHER B. COOPER, WILLIAM L. BEAVER, DAN M. COOPER
AND KARLMAN WASSERMAN

The V VO (alveolar CO2 output-alveolar 02 uptake) relationship ( V-slope) during increasing
work rate (r-amp) cycle ergometer exercise has two approximately linear components: a lower
component slope (S,) with a value of about 0-95 and a steeper, upper component (S2). We
examined the effect of muscle glycogen depletion (protocol 1) and the rate of increase in work
rate (ramp rate) without muscle glycogen depletion (protocol 2) on S1 and S2. In protocol 1,
ten healthy men with a mean age of 31 4 years (S.D. 6-2) were studied on each of 3 days (days
I and 3 were control days). They performed a ramp exercise test to maximum tolerance and
steady-state tests at rest, during unloaded pedalling and at two constant work rates below their
anaerobic threshold (AT). To deplete muscle glycogen before the test on day 2, the subjects
performed 2 h of very heavy cycle exercise on the preceding day and fasted overnight. Si was
reduced on day 2 (0 79 compared with 0 95, P < 0 001), as was the VC0 -VO slope derived
from steady-state measurements (0 81 compared with 0 99, P < 0 001), but AT and the slope
difference (S2 -S5) were unchanged. In protocol 2, seven healthy men with a mean age of 20 6
years (S.D. 2-4) performed ramp tests at three different rates of increasing work rate (1 5, 30 and
60 W min’), each ramp rate being performed twice in random sequence. The ramp rate did not
affect Si but S2 was steeper with the faster rates of work rate increase (127, 143 and 163,
respectively, P < 0 01). Our findings support the concept that the lower component of the Vslope
plot (below AT) represents muscle substrate respiratory quotient (RQ) while the
difference between Si and S2 reflects ‘excess CO2’ derived from bicarbonate buffering of lactic acid.

BARSTOW, THOMAS J., DAN M. COOPER, ERIC M. SOBEL,
ELLIOT M. LANDAW, AND SAM EPSTEIN.

Am. J. Phvsiol. 259 (Regulatory Integrative Comp. Physiol. 28): Rl63-
Rl?l, 1990.-

The effect of changes in metabolic rate on the
dynamics of CO, exchange among its various compartments in
the human body is not well understood. We examined COz
dynamics in six healthy male subjects using an intravenous
bolus of [ “‘Clbicarbonate. Subjects were studied while resting,
during light exercise [50% of the lactate threshold (LT), 3-4
times resting 0, uptake (VOW)], and during moderate exercise
(95% of the LT, 6 times resting VO,). The sum of three
exponential terms well described the washout of 1’3C02 in exhaled
breath both at rest and during each exercise level despite
substantial increases in metabolic rate accompanying the exercise
studies. Average recovery of “‘C label rose from 67%
during rest to 80% during light and moderate exercise (P <
0.01). The estimate of CO, elimination (ho2) calculated from
the washout parameters and corrected for recovery was in very
good agreement with the VCO~ directly measured simultaneously
breath by breath (r = 0.993, SE for VCO~ = 0.079 l/min).
By use of a three-compartment mammillary model, the quantity
of CO, in the central pool (Q1) doubled from rest to light
exercise (233 & 60 to 479 t 76 mmol, P < 0.01) but did not
change further with moderate exercise (458 & 74 mmol). Rate
constants for exchange between pools and for irreversible loss
from the system tended to increase with metabolic rate, but
there was large variation in the responses. We conclude that
the compartmental dynamics of CO, transport and storage are
very sensitive to changes in metabolic rate induced by exercise.

Mendes, Fernanda de Souza Nogueira Sardinha; Sousa, Andréa
Silvestre; Souza, Fernando Cesar de Castro; Pinto, Vivian Liane Mattos;
Silva, Paula Simplicio; Saraiva, Roberto Magalhães; Xavier, Sergio
Salles; Veloso, Henrique Horta; Holanda, Marcelo; Costa, Andréa;
Carneiro, Fernanda Martins; Silva, Gilberto; Borges, Juliana Pereira;
Tibirica, Eduardo; Pinheiro, Roberta Olmo; Lara, Flávio Alves;
Hasslocher-Moreno, Alejandro Marcel; Brasil, Pedro; Mediano, Mauro
Felippe Felix.

Trials, December 2016, Vol. 17 Issue: Number 1 p1-11,
11p;

Abstract: The effects of exercise training on Chagas heart disease
are still unclear. This study aimed to evaluate the effect of exercise
training over functional capacity, cardiac function, quality of life,
and biomarkers in Chagas heart disease.                   The PEACH
study is a superiority randomized clinical trial which will include
subjects who meet the following criteria: Chagas heart disease with a
left ventricular ejection fraction below 45 % with or without heart
failure symptoms; clinical stability in the last 3 months; adherence to
clinical treatment; and age above 18 years. The exclusion criteria are:
pregnancy; neuromuscular limitations; smoking; evidence of non-chagasic
heart disease; systemic conditions that limit exercise practice or
cardiopulmonary exercise test; unavailability to attend the center
three times a week during the intervention period; and practitioners of
regular exercise. The intervention group will perform an exercise
training intervention three times per week during 6 months and will be
compared to the control group without exercise. Both groups will
undergo the same monthly pharmaceutical and nutritional counseling as
well as standard medical treatment according to the Brazilian consensus
on Chagas disease. The primary outcome is functional capacity based on
peak exercise oxygen consumption during cardiopulmonary exercise
testing. Secondary outcomes are: cardiac function; body composition;
muscle respiratory strength; microvascular reactivity; cardiac rhythm
abnormalities; autonomic function; biochemical; oxidative stress and
inflammatory biomarkers; and quality of life. Subjects will be
evaluated at baseline, and at 3 and 6 months after randomization.
Thirty patients will be randomly assigned into exercise or control
groups at a ratio of 1:1.                   Findings of the present
study will be useful to determine if physical exercise programs should
be included as an important additional therapy in the treatment of
patients with Chagas heart disease.

West, M.; Loughney, L.;  Ambler, G.; Dimitrov, B.; Kelly, J.; Mythen, M.; Sturgess, R.;
Calverley, P.; Kendrick, A.; Grocott, M.; Jack, S..

BMC Cancer, December 2016, Vol. 16 Issue: Number 1 p1-8, 8p;

Abstract: In 2014 approximately 21,200 patients were diagnosed with oesophageal and
gastric cancer in England and Wales, of whom 37 % underwent planned
curative treatments. Potentially curative surgical resection is
associated with significant morbidity and mortality. For operable
locally advanced disease, neoadjuvant chemotherapy (NAC) improves
survival over surgery alone. However, NAC carries the risk of toxicity
and is associated with a decrease in physical fitness, which may in
turn influence subsequent clinical outcome. Lower levels of physical
fitness are associated with worse outcome following major surgery in
general and Upper Gastrointestinal Surgery (UGI) surgery in particular.
Cardiopulmonary exercise testing (CPET) provides an objective
assessment of physical fitness. The aim of this study is to test the
hypothesis that NAC prior to upper gastrointestinal cancer surgery is
associated with a decrease in physical fitness and that the magnitude
of the change in physical fitness will predict mortality 1 year
following surgery.                   This study is a multi-centre,
prospective, blinded, observational cohort study of participants with
oesophageal and gastric cancer scheduled for neoadjuvant cancer
treatment (chemo- and chemoradiotherapy) and surgery. The primary
endpoints are physical fitness (oxygen uptake at lactate threshold
measured using CPET) and 1-year mortality following surgery; secondary
endpoints include post-operative morbidity (Post-Operative Morbidity
Survey (POMS)) 5 days after surgery and patient related quality of life
(EQ-5D-5 L).                   The principal benefits of this study, if
the underlying hypothesis is correct, will be to facilitate better
selection of treatments (e.g. NAC, Surgery) in patients with
oesophageal or gastric cancer. It may also be possible to develop new
treatments to reduce the effects of neoadjuvant cancer treatment on
physical fitness. These results will contribute to the design of a
large, multi-centre trial to determine whether an in-hospital
exercise-training programme that increases physical fitness leads to
improved overall survival.

Lamb, Benjamin Wilfrid; Tan, Wei Shen; Eneje, Philip; Bruce, David;
Jones, Amy; Ahmad, Imran; Sridhar, Ashwin; Baker, Hilary; Briggs, Tim
P.; Hines, John E.; Nathan, Senthil; Martin, Daniel; Stephens, Robert
C.; Kelly, John D..

Urologic Oncology, September 2016, Vol. 34 Issue:
Number 9 p417.e17-417.e23, 7p;

Abstract: Patients undergoing radical
cystectomy have associated comorbidities resulting in reduced
cardiorespiratory fitness. Preoperative cardiopulmonary exercise
testing (CPET) measures including anaerobic threshold (AT) can predict
major adverse events (MAE) and hospital length of stay (LOS) for
patients undergoing open and robotic cystectomy with extracorporeal
diversion. Our objective was to determine the relationship between CPET
measures and outcome in patients undergoing robotic radical cystectomy
and intracorporeal diversion (intracorporeal robotic assisted radical
cystectomy [iRARC]).

Broch, Kaspar; Urheim, Stig; Massey, Richard; Stueflotten, Wenche; Fosså, Kristian; Hopp,
Einar; Aakhus, Svend; Gullestad, Lars.

International Journal of Cardiology, November 2016, Vol. 223 Issue: Number 1 p688-692, 5p;
Abstract: In patients with chronic, hemodynamically significant aortic
regurgitation (AR), a long period of left ventricular remodeling
usually occurs prior to the development of symptoms or left ventricular
dysfunction. The value of cardiopulmonary exercise testing in patients
with asymptomatic AR is not established.

Cornelis, Nils; Buys, Roselien.

International Journal of Cardiology, November
2016, Vol. 222 Issue: Number 1 p538-547, 10p;

Abstract: Cardiopulmonary
exercise testing (CPET) has become part of screening and evaluation in
cardiology. The exercise modalities most often used in CPET are the
treadmill (TM) and upright bicycle (UB). Nowadays, also the supine
bicycle (SB) is becoming more often used, especially when combined with
cardiac imaging

Kato, Yuko;
Suzuki, Shinya; Uejima, Tokuhisa; Semba, Hiroaki; Nagayama, Osamu;
Hayama, Etsuko; Yamashita, Takeshi.

European Journal of Preventive
Cardiology, September 2016, Vol. 23 Issue: Number 13 p1429-1436, 8p;

Abstract: Background  Resting heart rate is a surrogate marker
associated with achieved exercise capacity, which has been observed in
patients with sinus rhythm. The aim of this study was to examine and
compare the relationships between resting heart rate and peak oxygen
consumption in atrial fibrillation and sinus rhythm.Methods and results
A total of 2160 consecutive patients undergoing cardiopulmonary
exercise testing in our single-hospital cohort were divided into two
groups according to rhythm status: an atrial fibrillation group
(N= 320) and a sinus rhythm group (N= 1840). In the total cohort and
sinus rhythm group, resting heart rate was negatively correlated with
percentage of predicted peak oxygen consumption (Ptrend< 0.0001); in
atrial fibrillation patients, this correlation was apparently positive
(Ptrend= 0.032). Multivariate analysis of the total cohort showed a
significant interaction between resting heart rate and rhythm status
for peak oxygen consumption after adjustments for age, sex, ejection
fraction, structural heart diseases and heart rate-lowering drugs. In
the sinus rhythm group, resting heart rate was an independent, negative
contributing factor for peak oxygen consumption, even after the
adjustments for patient background. However, in the atrial fibrillation
group, resting heart rate was a weak positive or non-independent
contributing factor for peak oxygen consumption after the same
adjustments.Conclusions  The impact of resting heart rate on exercise
capacity differed completely between atrial fibrillation and sinus
rhythm, suggesting that heart rate control may need to be managed
differently for atrial fibrillation and sinus rhythm, in light of
exercise capacity that is related to quality of life and prognosis.

Müller, Jan; Meyer, Joanna; Elmenhorst, Julia;
Oberhoffer, Renate.

The Journal of Clinical Hypertension, August 2016,
Vol. 18 Issue: Number 8 p762-765, 4p;

Abstract: Cardiopulmonary fitness
benefits cardiovascular health. Various studies have shown a strong
negative correlation between exercise capacity and arterial stiffness
in adults. However, evidence for this connection in children and
adolescents is scarce. About 320 healthy children and adolescents (252
male, 14.0±2.1 years) were evaluated with regard to their demographic,
anthropometric and hemodynamic parameters, and their peak oxygen
uptake. Peripheral and central systolic blood pressures were measured
with patients in a supine position using an oscillometric device. Peak
oxygen uptake was assessed by cardiopulmonary exercise testing. In
multivariate regression, only peripheral systolic blood pressure
(β=0.653, P<.001) and body weight (β=0.284, P<.001) emerged as
independent determinants for central systolic blood pressure. Body
weight therefore determines central systolic blood pressure in children
and adolescents rather than measures of cardiorespiratory fitness. The
prevention of overweight in childhood is necessary to reduce stiffening
of the arteries and delay the onset of cardiovascular disease.