Neunhäuserer D; Reich B; Mayr B; Kaiser B; Lamprecht B; Ermolao A; Studnicka M; Niebauer J;

Scandinavian journal of medicine & science in sports [Scand J Med Sci Sports] 2020 Nov 05. Date of Electronic Publication: 2020 Nov 05.

Functional impairment caused by chronic obstructive pulmonary disease (COPD) impacts on activities of daily living and quality of life. Indeed, patients’ submaximal exercise capacity is of crucial importance. It was the aim of this study to investigate the effects of an exercise training intervention with and without supplemental oxygen on submaximal exercise performance. This is a secondary analysis of a randomized, controlled, double-blind, crossover trial. 29 COPD patients (63.5±5.9 years; FEV ₁ 46.4±8.6%) completed two consecutive 6-week periods of high intensity interval cycling and strength training, which was performed three times/week with either supplemental oxygen or medical air (10 L/min). Submaximal exercise capacity as well as the cardiocirculatory, ventilatory and metabolic response were evaluated at isotime (point of termination in the shortest cardiopulmonary exercise test), at physical work capacity at 110 bpm of heart rate (PWC 110), at the anaerobic threshold (AT), and at the lactate-2 mmol/L threshold. After 12 weeks of exercise training, patients improved in exercise tolerance, shown by decreased cardiocirculatory (heart rate, blood pressure) and metabolic (respiratory exchange ratio, lactate) effort at isotime; ventilatory response was not affected. Submaximal exercise capacity was improved at PWC 110, AT and the lactate-2 mmol/L threshold, respectively. Although supplemental oxygen seems to affect patients’ work rate at AT and the lactate-2 mmol/L threshold, no other significant effects were found. The improved submaximal exercise capacity and tolerance might counteract patients’ functional impairment. Although cardiovascular and metabolic training adaptations were shown, ventilatory efficiency remained essentially unchanged. The impact of supplemental oxygen seems less important on submaximal training effects.

Sovová M; Sovová E; Nakládalová M; Pokorná T; Štégnerová L; Masný O; Moravcová K; Štěpánek L;

Central European journal of public health [Cent Eur J Public Health] 2020 Oct; Vol. 28 Suppl, pp. S53-S56.

Objectives: Low cardiorespiratory fitness (CRF) is related to higher risk of cardiovascular diseases, increase in all-cause mortality and higher risk of different tumors. The reverse is also true; improvement in CRF is related to decrease in mortality. Cardiopulmonary exercise testing (CPET) is a standard and also the most precise test for determination of CRF – the best possibility is the maximal test measuring different parameters including maximal oxygen consumption. Healthcare professionals throughout the developed world have markedly high rates of sickness absence, burnout, and distress compared to other sectors and this leads to higher risk factors. The study aimed to assess CRF in a group of nurses in a big hospital and compare it with population norms and available published results.
Methods: Nurses over 50 years of age working in one faculty hospital were gradually included in the study from the beginning of 2018. These nurses work in physically demanding positions. A CPET was carried out following the Bruce protocol.
Results: 90 nurses (84 females and 6 males), mean age 55.7 years, were evaluated by CPET. The resting blood pressure was within the norm in 58 persons (64.44%), maximal oxygen consumption in 61 persons (67.8%), W/kg in 25 persons (46.2%). We detected a hypertension reaction in 28 persons (31.1%), some types of arrhythmia in 17 persons (18.9%) and signs of ischaemia in 8 persons (8.9%). The result of CPET led to further examination in 42 persons (46.6%). Detailed examination resulted in change of medication in 21 nurses (23.3%). New diseases were diagnosed in 15 nurses (hypertension, atrial fibrillation, mitral valve prolapse indicated for cardiac surgery, coronary artery stenosis, and lipid disorders).
Conclusions: It was concluded that the usage of CPET during the regular medical check-ups significantly increases detection of hidden diseases and thus improves the care for nurses.

Suter B; Kay WA; Kuhlenhoelter AM; Ebenroth ES;

Cardiology in the young [Cardiol Young] 2020 Oct 21, pp. 1-7. Date of Electronic Publication: 2020 Oct 21.

Background: Cardiopulmonary exercise testing performance has been shown to be a predictor of morbidity, mortality, and quality of life in patients with Fontan physiology; however, the role of exercise performance along with other diagnostics is not fully understood. We evaluated the hypothesis that reduced exercise performance correlates with poorer quality of life in Fontan patients as they continue to age.
Methods: Chart review was performed on patients 12 years and older with Fontan who had completed cardiopulmonary exercise testing and age-appropriate quality of life surveys. Quality of life outcomes were analysed against exercise performance and other descriptive data.
Results: For the younger cohort (n = 22), exercise performance predicted quality of life with different measures across domains and had a stronger correlation than echocardiographic parameters. For the older cohort (n = 34), exercise performance did not predict quality of life.
Conclusions: Objective exercise performance was a useful marker for general, physical, emotional, social, and school quality of life in a younger cohort but less helpful in older adults. This is perhaps due to older patients accommodating to their conditions over time. The role of exercise performance and objective data in predicting quality of life in patients with Fontan physiology is incompletely understood and additional prospective evaluation should be undertaken.

Strozza D; ; Wilhite DP; Babb TG; Bhammar DM

Medicine and science in sports and exercise [Med Sci Sports Exerc] 2020 Nov; Vol. 52 (11), pp. 2310-2319.

Purpose: Thoracic gas compression and exercise-induced bronchodilation can influence the assessment of expiratory flow limitation (EFL) during cardiopulmonary exercise tests. The purpose of this study was to examine the effect of thoracic gas compression and exercise-induced bronchodilation on the assessment of EFL in children with and without obesity.
Methods: Forty children (10.7 ± 1.0 yr; 27 obese; 15 with EFL) completed pulmonary function tests and incremental exercise tests. Inspiratory capacity maneuvers were performed during the incremental exercise test for the placement of tidal flow volume loops within the maximal expiratory flow volume (MEFV) loops, and EFL was calculated as the overlap between the tidal and the MEFV loops. MEFV loops were plotted with volume measured at the lung using plethysmography (MEFVp), with volume measured at the mouth using spirometry concurrent with measurements in the plethysmograph (MEFVm), and from spirometry before (MEFVpre) and after (MEFVpost) the incremental exercise test. Only the MEFVp loops were corrected for thoracic gas compression.
Results: Not correcting for thoracic gas compression resulted in incorrect diagnosis of EFL in 23% of children at peak exercise. EFL was 26% ± 15% VT higher for MEFVm compared with MEFVp (P < 0.001), with no differences between children with and without obesity (P = 0.833). The difference in EFL estimation using MEFVpre (37% ± 30% VT) and MEFVpost (31% ± 26% VT) did not reach statistical significance (P = 0.346).
Conclusions: Not correcting the MEFV loops for thoracic gas compression leads to the overdiagnosis and overestimation of EFL. Because most commercially available metabolic measurement systems do not correct for thoracic gas compression during spirometry, there may be a significant overdiagnosis of EFL in cardiopulmonary exercise testing. Therefore, clinicians must exercise caution while interpreting EFL when the MEFV loop is derived through spirometry.

Martin-Rincon M; Calbet JAL;

Frontiers in physiology [Front Physiol] 2020 Sep 03; Vol. 11, pp. 1070. Date of Electronic Publication: 2020 Sep 03 (Print Publication: 2020).

The maximal oxygen uptake ( V.O_2max ) is the primary determinant of endurance performance in heterogeneous populations and has predictive value for clinical outcomes and all-cause mortality. Accurate and precise measurement of V.O_2max requires the adherence to quality control procedures, including combustion testing and the use of standardized incremental exercise protocols with a verification phase preceded by an adequate familiarization. The data averaging strategy employed to calculate the V.O_2max from the breath-by-breath data can change the V.O_2max value by 4-10%. The lower the number of breaths or smaller the number of seconds included in the averaging block, the higher the calculated V.O_2max value with this effect being more prominent in untrained subjects. Smaller averaging strategies in number of breaths or seconds (less than 30 breaths or seconds) facilitate the identification of the plateau phenomenon without reducing the reliability of the measurements. When employing metabolic carts, averaging intervals including 15-20 breaths or seconds are preferable as a compromise between capturing the true V.O_2max and identifying the plateau. In training studies, clinical interventions and meta-analysis, reporting of V.O_2max in absolute values and inclusion of protocols and the averaging strategies arise as imperative to permit adequate comparisons. Newly developed correction equations can be used to normalize V.O_2max to similar averaging strategies. A lack of improvement of V.O_2max with training does not mean that the training program has elicited no adaptations, since peak cardiac output and mitochondrial oxidative capacity may be increased without changes in V.O_2max .

Fleenor BS; Carlini NA; Kaminsky LA; Whaley MH; Peterman JE; Harber MP

Journal of cardiopulmonary rehabilitation and prevention [J Cardiopulm Rehabil Prev] 2020 Oct 05. Date of Electronic Publication: 2020 Oct 05.

Background: Healthy vascular aging (HVA) and cardiorespiratory fitness (CRF) are each independently associated with lower cardiovascular disease-related mortality. It is unknown, however, whether the CRF-related reductions in cardiovascular disease risk are related to HVA. We hypothesized that HVA would be associated with higher CRF in men and women from the Ball State Adult Fitness Longitudinal Lifestyle STudy (BALL ST).
Methods: Apparently healthy men and women ≥50 yr of age from the BALL ST cohort (n = 101) who underwent a maximal cardiopulmonary exercise test to assess CRF (VO2peak) were included in the study. Participants were divided into either HVA, defined as brachial systolic blood pressure <140/90 mm Hg without taking medications and carotid-femoral pulse wave velocity <7.6 m/sec, or no HVA for subjects with SBP >140/90 mm Hg and/or PWV >7.6 m/sec.
Results: Participants with HVA had a higher age- and sex-adjusted CRF percentile (62 ± 5 vs 47 ± 3, P < .05), with women having a greater prevalence of HVA than men (36% vs 15%, P < .05). Both carotid-femoral pulse wave velocity (r =-0.27, P < .05) and brachial systolic blood pressure (r =-0.23, P < .05) were independently and inversely associated with CRF for the entire cohort. Men and women with HVA were younger having a lower body fat percentage and higher low-density lipoprotein cholesterol (P < .05, all).
Conclusions: These data demonstrate that HVA is associated with higher CRF, which may partially explain the preventative cardioprotective effects of CRF.

Pugliese NR; De Biase N; Conte L; Gargani L; Mazzola M; Fabiani I; Natali A; Dini FL; Frumento P; Rosada J;
Taddei S; Borlaug BA; Masi S;

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography [J Am Soc Echocardiogr] 2020 Oct 06. Date of Electronic Publication: 2020 Oct 06.

Background: Cardiopulmonary exercise testing (CPET) represents the gold standard to estimate peak oxygen consumption (VO ₂ ) noninvasively. To improve the analysis of the mechanisms behind effort intolerance, we examined whether exercise stress echocardiography measurements relate to directly measured peak VO ₂ during exercise in a large cohort of patients within the heart failure (HF) spectrum.
Methods: We performed a symptom-limited graded ramp bicycle CPET exercise stress echocardiography in 30 healthy controls and 357 patients: 113 at risk of developing HF (American College of Cardiology/American Heart Association stage A-B) and 244 in HF stage C with preserved (HFpEF, n = 101) or reduced ejection fraction (HFrEF, n = 143).
Results: Peak VO ₂ significantly decreased from controls (23, 21.7-29.7 mL/kg/minute; median, interquartile range) to stage A-B (18, 15.4-20.7 mL/kg/minute) and stage C (HFpEF: 13.6, 11.8-16.8 mL/kg/minute; HFrEF: 14.2, 10.7-17.5 mL/kg/minute). A regression model to predict peak VO ₂ revealed that peak left ventricular (LV) systolic annulus tissue velocity (S’), peak tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (right ventricle-pulmonary artery coupling), and low-load left atrial (LA) reservoir strain/E/e’ (LA compliance) were independent predictors, in addition to peak heart rate, stroke volume, and workload (adjusted R ²  = 0.76, P < .0001). The model was successfully tested in subjects with atrial fibrillation (n = 49) and with (n = 224) and without (n = 163) beta-blockers (all P < .01). Peak S’ showed the highest accuracy in predicting peak VO ₂  < 10 mL/kg/minute (cut point ≤ 7.5 cm/sec, area under the curve = 0.92, P < .0001) and peak VO ₂  > 20 mL/kg/minute (cut point > 12.5 cm/sec, area under the curve = 0.84, P < .0001) in comparison with the other cardiac variables of the model (P < .05).
Conclusions: Peak VO ₂ is directly related to measures of LV systolic function, LA compliance, and right ventricle-pulmonary artery coupling, in addition to heart rate and stroke volume and independently of workload, age, and sex. The evaluation of cardiac mechanics may provide more insights into the causes of effort intolerance in subjects from HF stages A-C.

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

The Journal of asthma : official journal of the Association for the Care of Asthma [J Asthma] 2020 Oct 07, pp. 1-13. Date of Electronic Publication: 2020 Oct 07.

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 to 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 (FEV ₁ ) was 91.3 ± 9.2%. EIB occurred in 54.2% of patients. In CPET, the peak oxygen uptake (VO ₂ peak) was 34.1 ± 7.8 mL.kg ^-1 .min ^-1 . A significant correlation between ventilatory reserve and FEV ₁ (r = 0.57; p  = 0.003) was found. Similarly, there was a significant correlation between CPET and percent of FEV ₁ fall in the EIB test for both V _E /VO ₂ (r = 0.47; p  = 0.02) and V _E /VCO ₂ (r = 0.46; p  = 0.02). Patients with FEV ₁ <80% had lower ventilatory reserve ( p  = 0.009). In addition, resting heart rate correlated with VO ₂ peak (r=-0.40; p  = 0.04), V _E /VO ₂ (r = 0.46; p  = 0.02) and V _E /VCO ₂ (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.

Jen R; Orr JE; Gilbertson D; Fine J; Li Y; Wong D; Hopkins SR; Raisingani A; Malhotra A;

Respiratory physiology & neurobiology [Respir Physiol Neurobiol] 2020 Oct 01, pp. 103557. Date of Electronic Publication: 2020 Oct 01.

Rationale: OSA has been associated with reduced exercise capacity. Endothelial dysfunction and exercise-induced pulmonary hypertension (ePH) may be mediators of this impairment. We hypothesized that OSA severity would be associated with impaired exercise performance, endothelial dysfunction, and ePH.
Methods: Subjects with untreated OSA were recruited. Subjects underwent endothelial function, and cardiopulmonary exercise testing with an echocardiogram immediately before and following exercise.
Results: 22 subjects were recruited with mean age 56 ± 8 years, 74 % male, BMI 29 ± 3 kg/m ² , and AHI 22 ± 12 events/hr. Peak V˙O ₂ did not differ from normal (99.7 ± 17.3 % predicted; p = 0.93). There was no significant association between OSA severity (as AHI, ODI) and exercise capacity, endothelial function, or pulmonary artery pressure. However, ODI, marker of RV diastolic dysfunction, and BMI together explained 59.3 % of the variability of exercise performance (p < 0.001) via our exploratory analyses.
Conclusions: Exercise capacity was not impaired in this OSA cohort. Further work is needed to elucidate mechanisms linking sleep apnea, obesity, endothelial dysfunction and exercise impairment.