Aspinall SP; Hill DM; Mackintosh KA; McNarry MA;

Respiratory medicine case reports [Respir Med Case Rep] 2020 Jul 23; Vol. 31, pp. 101173. Date of Electronic Publication: 2020 Jul 23 (Print Publication: 2020).

Although aerobic capacity has been identified as an important predictor of mortality in Cystic Fibrosis (CF) individuals, many remain insufficiently active. As a ‘ lack of time ‘ is a commonly cited barrier to exercise, reduced-exertion high-intensity interval training (REHIT) may provide a truly time-effective method to increase aerobic capacity. Six-weeks of REHIT in a CF individual was assessed by a cardiopulmonary exercise test (CPET) and individual perceptions described using a self-report narrative. Peak oxygen uptake ( V˙O ₂ peak) increased by 6% whilst pulmonary function remained unchanged. Qualitative data indicated social support and low-time commitment positively influenced adherence with fatigue and lack of enjoyment noted as a significant barriers. REHIT was demonstrated as a viable, manageable option for a CF individual with moderate-severe pulmonary limitation. Further research is needed to determine the efficacy of REHIT in a large representative sample to ascertain whether it represents an alternative treatment strategy.

Aburub A; Ledger SJ; Sim J; Hunter SM;

Movement disorders clinical practice [Mov Disord Clin Pract] 2020 Jul 25; Vol. 7 (6), pp. 599-606. Date of Electronic Publication: 2020 Jul 25 (Print Publication: 2020).

Background: Cardiorespiratory impairments are considered the main cause of mortality in the late stages of Parkinson’s. Aerobic exercise has been shown to improve pulmonary function in asthmatic patients and in healthy people. However, effects of aerobic exercise on cardiopulmonary function in people with Parkinson’s have not been investigated. Therefore, this study aimed to review the effects of aerobic exercise on cardiopulmonary function in people with Parkinson’s.
Methods: A systematic search was conducted using MEDLINE, AMED, CINHAL Plus, and relevant associated keywords, from January 1970 to January 2020. Inclusion criteria for the studies were: aerobic exercise as part of the intervention, pulmonary function test, and/or cardiopulmonary exercise test as outcome measures.
Results: In total, 329 citations were identified from the search, of which nine were included in this review. In general, aerobic exercise was found to have positive effects on cardiac function for people with Parkinson’s, but there is a lack of studies on the effects of aerobic exercise on pulmonary function.
Conclusion: People with early stages of Parkinson’s may experience positive effects of aerobic exercise on cardiac fitness. Further research is needed in this area, particularly into the effects of aerobic exercise on pulmonary function in early stages of the disease.

Ashikaga K; Itoh H; Maeda T et al;

Journal of cardiology [J Cardiol] 2020 Aug 04. Date of Electronic Publication: 2020 Aug 04.

Background: The current understanding of ventilator efficiency variables during ramp exercise testing in the normal Japanese population is insufficient, and the responses of tidal volume (VT) and minute ventilation (V̇E) to the ramp exercise test in the normal Japanese population are not known.
Methods: A total of 529 healthy Japanese subjects aged 20-78 years underwent cardiopulmonary exercise testing using a cycle ergometer with ramp protocols. VT and V̇E at rest, at anaerobic threshold, and at peak exercise were determined. The slope of V̇E versus carbon dioxide (V̇CO ₂ ) (V̇E vs. V̇CO ₂ slope), minimum V̇E/V̇CO ₂ , and oxygen uptake efficiency slope (OUES) were determined.
Results: For males and females in their 20 s, peak VT (VTpeak) was 2192 ± 376 and 1509 ± 260 mL (p < 0.001), peak V̇E (V̇Epeak) was 80.6 ± 18.7 and 57.7 ± 13.9 L/min (sex differences p < 0.001), the V̇E vs. V̇CO ₂ slope was 24.4 ± 3.2 and 25.7 ± 3.2 (p = 0.035), the minimum V̇E/V̇CO ₂ was 24.2 ± 2.3 and 27.0 ± 2.8 (p < 0.001), and the OUES was 2452 ± 519 and 1991 ± 315 (p < 0.001), respectively. VTpeak and V̇Epeak decreased with age and increased with weight and height. The V̇E vs. V̇CO ₂ slope and minimum V̇E/V̇CO ₂ increased with age, while conversely, the OUES decreased with age.
Conclusions: We have established the normal range of VT and V̇E responses, the V̇E vs. V̇CO ₂ slope, the minimum V̇E/V̇CO ₂ , and the OUES for a healthy Japanese population. Some of these parameters were influenced by weight, height, sex, and age. These results provide useful reference values for interpreting the results of cardiopulmonary exercise testing in cardiac patients.

Rato J; Mendes SC; Sousa A; Lemos M; Martins DS; Anjos R;

Pediatric cardiology [Pediatr Cardiol] 2020 Aug 08. Date of Electronic Publication: 2020 Aug 08.

Speckle-tracking echocardiography has been used to assess atrial function. This analysis is feasible in univentricular hearts. The aim of this study was to characterize the relationship between atrial strain and functional capacity in the Fontan circulation. Apical four-chamber echocardiographic loops of 39 Fontan patients were reviewed. The dominant atrium was assessed for active (ε _act ), conduit (ε _con ), and reservoir (ε _res ) strain and ε _act /ε _res ratio. Cardiopulmonary exercise test was performed on the same day and oxygen uptake (VO ₂ ) at ventilatory threshold (VT) and peak VO ₂ were chosen as the dependent variables. Statistical analysis was performed using SPSS ^® version 23. Unpaired t test was used for binomial and continuous variable correlation; single and multivariable linear regression were used for continuous variable correlation. Statistical significance was defined as p value < 0.05. VO ₂ at VT as a percentage of predicted VO ₂ was 36.8% (SD 10.7). Peak VO ₂ was 64.7% (SD 18.9) of the predicted value. In univariate analysis, both were associated with age, atrioventricular regurgitation, ejection fraction, ε _res , ε _con , and ε _act /ε _res . In multivariate regression, higher VO ₂ at VT and peak VO ₂ were associated with younger age (p = 0.003 and p = 0.001, respectively) and higher ε _con (p = 0.026 and p = 0.020). Evaluation of heart function is difficult in the Fontan circulation, hindered by complex ventricular morphology and lack of normative data. VO ₂ provides a good surrogate. Atrial strain parameters are compromised in these patients and associated with VO ₂ . Therefore, whenever possible, atrial strain should be measured as it may provide a new method of risk stratification.

Kondo T, Okumura T, Oishi H, Arao Y, Kato H, Yamaguchi S, Kuwayama T, Haga T, Yokoi , Hiraiwa H, Fukaya K, Sawamura A, Morimoto R, Mutsuga M, Fujimoto K, Usui A, Murohara T.

Int J Artif Organs. 2020 Aug 12:391398820949888. doi: 10.1177/0391398820949888. Online ahead of print.

BACKGROUND: Hemodynamic parameters at rest are known to correlate poorly with peak oxygen uptake (VO2) in heart failure. However, we hypothesized that hemodynamic parameters at rest could predict exercise capacity in patients with left ventricular assist device (LVAD), because LVAD pump rotational speed does not respond during exercise. Therefore, we investigated the relationships between hemodynamic parameters at rest (measured with right heart catheterization) and exercise capacity (measured with cardiopulmonary exercise testing) in patients with implantable LVAD.
METHODS: We performed a retrospective medical record review of patients who received implantable LVAD at our institution from November 2013 to December 2017.
RESULTS: A total of 20 patients were enrolled in this study (15 males; mean age, 45.8 years; median duration of LVAD support, 356 days). The mean peak VO2 and cardiac index (CI) were 13.5 mL/kg/min and 2.6 L/min/m2, respectively. CI and hemoglobin level were significantly associated with peak VO2 (CI: r = 0.632, p = 0.003; hemoglobin: r = 0.520, p = 0.019). In addition, pulmonary capillary wedge pressure, right atrial pressure, and right ventricular stroke work index were also significantly associated with peak VO2. In multiple linear regression analysis, CI and hemoglobin level remained independent predictors of peak VO2 (CI: β = 0.559, p = 0.006; hemoglobin: β = 0.414, p = 0.049).
CONCLUSIONS: CI at rest and hemoglobin level are associated with poor exercise capacity in patients with LVAD.

Mikami Y; Kouda K; Kawasaki S; Kawai M; Kitahata Y; Miyazawa M; Hirono S; Unno M; Tajima F;Yamaue H;

The Tohoku journal of experimental medicine [Tohoku J Exp Med] 2020; Vol. 251 (4), pp. 279-285.

Low preoperative physical function in cancer patients is associated with postoperative complications; however, there have been no reports on the benefits of in-hospital preoperative rehabilitation on preoperative physical function in patients with pancreatic cancer. Therefore, the aim of this study was to quantitatively determine the effects of preoperative in-hospital rehabilitation provided under the supervision of a physiotherapist, on preoperative physical function in patients with pancreatic cancer.
The study subjects were 26 patients (15 males, 11 females; age 71.2 ± 8.5 years, range: 51-87 years), including four patients with preoperative chemotherapy, scheduled for surgery for pancreatic cancer. Muscle strengthening exercises and aerobic exercises were conducted 11.9 ± 5.1 days prior to surgery. Cardiopulmonary exercise testing, 6-minute walk distance, and the Functional Independence Measure score were measured before and after the rehabilitation program. We also investigated the relation between the rehabilitation program and incidence of postoperative complications.
All 26 study patients completed the preoperative rehabilitation program and no adverse events were noted. Peak oxygen uptake during cardiopulmonary exercise testing and 6-minute walk distance increased significantly after the rehabilitation program. The Functional Independence Measure score remained constant throughout the intervention. No wound infection, delirium, deep vein thrombosis, or respiratory complications were encountered postoperatively. In-hospital preoperative rehabilitation under the supervision of a physiotherapist significantly improved physical function and maintained physical activity in patients with pancreatic cancer.
Such improvements may contribute toward preventing serious postoperative complications, resulting in better outcomes.

Tran D; Munoz P; Lau EMT; Alison JA; Brown M; Zheng Y; Corkery P; Wong K;Lindstrom S; Celermajer DS; Davis GM;Cordina R;

Heart, lung & circulation [Heart Lung Circ] 2020 Jul 07. Date of Electronic Publication: 2020 Jul 07.

Background: Exercise intolerance is present even in the early stages of pulmonary arterial hypertension (PAH) and is associated with poorer prognosis. Respiratory muscle dysfunction is common and may contribute to exercise limitation. We sought to investigate the effects of inspiratory muscle training (IMT) to improve exercise capacity in PAH.
Methods: Adults with PAH were prospectively recruited and randomly assigned to either IMT or a control group. At baseline and after 8 weeks, assessment of respiratory muscle function, pulmonary function, neurohormonal activation, 6-minute walk distance and cardiopulmonary exercise testing variables were conducted. Inspiratory muscle strength was assessed by maximal static inspiratory pressure (PImax). The IMT group performed two cycles of 30 breaths at 30-40% of their PImax 5 days a week for 8 weeks.
Results: Twelve (12) PAH patients (60±14 years, 10 females) were recruited and randomised (six in the IMT group and six in the control group). After 8 weeks, the IMT group improved PImax by 31 cmH ₂ O compared with 10 cmH ₂ O in controls, p=0.02. Following IMT, 6-minute walk distance improved by 24.5 m in the IMT group and declined by 12 m in the controls (mean difference 36.5 m, 95% CI 3.5-69.5, p=0.03). There was no difference in peak oxygen uptake between-groups (mean difference 0.4 mL/kg/min, 95% CI -2.6 to 3.4, p=0.77). There was no difference in the mean change between-groups in neurohormonal activation or pulmonary function.
Conclusion: In this pilot randomised controlled study, IMT improved PImax and 6-minute walk distance in PAH patients.

Molgat-Seon Y; Schaeffer MR; Ryerson CJ; Guenette JA;

Frontiers in physiology [Front Physiol] 2020 Jul 10; Vol. 11, pp. 832. Date of Electronic Publication: 2020 Jul 10 (Print Publication: 2020).

Interstitial lung disease (ILD) is a heterogeneous group of conditions characterized by fibrosis and/or inflammation of the lung parenchyma. The pathogenesis of ILD consistently results in exertional dyspnea and exercise intolerance. Cardiopulmonary exercise testing (CPET) provides important information concerning the pathophysiology of ILD that can help inform patient management. Despite the purported benefits of CPET, its clinical utility in ILD is not well defined; however, there is a growing body of evidence that provides insight into the potential value of CPET in ILD. Characteristic responses to CPET in patients with ILD include exercise-induced arterial hypoxemia, an exaggerated ventilatory response, a rapid and shallow breathing pattern, critically low inspiratory reserve volume, and elevated sensations of dyspnea and leg discomfort. CPET is used in ILD to determine cause(s) of symptoms such as exertional dyspnea, evaluate functional capacity, inform exercise prescription, and determine the effects of pharmacological and non-pharmacological interventions on exercise capacity and exertional symptoms. However, preliminary evidence suggests that CPET in ILD may also provide valuable prognostic information and can be used to ascertain the degree of exercise-induced pulmonary hypertension. Despite these recent advances, additional research is required to confirm the utility of CPET in patients with ILD. This brief review outlines the clinical utility of CPET in patients with ILD. Typical patterns of response are described and practical issues concerning CPET interpretation in ILD are addressed. Additionally, important unanswered questions relating to the clinical utility of CPET in the assessment, prognostication, and management of patients with ILD are identified.

Beltrame T; Gois MO; Hoffmann U; Koschate J; Hughson RL; Frade MCM; Linares SN; Torres RDS; Catai AM;

Journal of applied physiology (Bethesda, Md. : 1985) [J Appl Physiol (1985)] 2020 Jul 30. Date of Electronic Publication: 2020 Jul 30.

Efforts to better understand cardiorespiratory health are relevant for the future development of optimized physical activity programs. We aimed to explore the impact of the signal quality on the expected associations between the ability of the aerobic system in supplying energy as fast as possible during moderate exercise transitions with its maximum capacity to supply energy during maximal exertion. It was hypothesized that a slower aerobic system response during moderate exercise transitions is associated with a lower maximal aerobic power; however, this relationship relies on the quality of the oxygen uptake dataset.
Forty-three apparently healthy participants performed a moderate constant work rate (CWR) followed by a pseudorandom binary sequence (PRBS) exercise protocol on a cycle ergometer. Participants also performed a maximum incremental cardiopulmonary exercise testing (CPET). The maximal aerobic power was evaluated by the peak oxygen uptake during the CPET and the aerobic fitness was estimated from different approaches for oxygen uptake dynamics analysis during the CWR and PRBS protocols at different levels of signal-to-noise ratio. The product moment correlation coefficient was used to evaluate the correlation level between variables. Aerobic fitness was correlated with maximum aerobic power, but this correlation increased as a function of the signal-to-noise ratio.
Aerobic fitness is related to maximal aerobic power; however, this association appeared to be highly dependent on the data quality and analysis for aerobic fitness evaluation. Our results show that simpler moderate exercise protocols might be as good as maximal exertion exercise protocols to obtain indexes related to cardiorespiratory health.

Arthur G; Vandenberghe D; Abassi H; Huguet H; Macioce V; Picot MC; Guillaumont S; Matecki S; Amedro P;

Archives of disease in childhood [Arch Dis Child] 2020 Jul 30. Date of Electronic Publication: 2020 Jul 30.

Objectives: Cardiopulmonary exercise test (CPET) provides accurate evaluation of physical capacity and disease severity in children with congenital heart disease (CHD). However, full participation to obtain optimal measure of VO _2max may be difficult. As an alternative, the oxygen uptake efficiency slope (OUES) is a reproducible and reliable parameter measured during CPET, which does not require a maximal exercise to be interpretable. This study aimed to evaluate the OUES of a large cohort of children with CHD, in comparison with healthy controls. We also intended to identify, in this specific population, the clinical and CPET variables associated with the OUES.
Methods: This cross-sectional study was carried out between November 2010 and September 2015 in two tertiary care paediatric and congenital cardiology centres.
Results: 709 children were included (407 CHD and 302 healthy controls). The association of clinical characteristics with weight-normalised OUES (OUES _kg ) was studied using a multivariable analysis. The mean OUES _kg was significantly lower in CHD than in healthy controls (38.6±8.5 and 43.9±8.5; p<0.001, respectively), especially in the most severe CHD. The OUES _kg correlated with VO _2max (r=0.85, p<0.001), with cut-off values for normal exercise capacity of 38.4 in boys and 31.0 in girls. The decrease of OUES _kg was associated with increased age, increased Body Mass Index, number of cardiac catheter or surgical procedures, female gender and decreased forced vital capacity (Z-score).
Conclusion: The OUES is significantly impaired in children with CHD and strongly correlates with VO _2max . The OUES has the same clinical determinants as VO _2max and therefore may be of interest in submaximal exercise.