Fletcher HV; Pan Cho PS; Lee Loong S; Estrada-Petrocelli L; Patel AS; Birring SS; Lee KK;

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine [J Clin Sleep Med] 2020 Jul 14. Date of Electronic Publication: 2020 Jul 14.

Study Objectives: Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of CPAP on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following continuous positive airway pressure (CPAP) treatment in OSA patients.
Methods: We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (V̇O₂peak) or maximum rate of oxygen uptake (V̇O₂max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of V̇O₂ peak, V̇O₂ max and AT pre versus post CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis.
Results: The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, six studies were included in the final meta-analysis for V̇O₂ peak, two studies for V̇O₂ max, and five studies for AT. The meta-analysis showed a mean net difference in V̇O₂ peak between pre and post CPAP of 2.69 mL·kg ^-1 ·min ^-1 , p=0.02, favoring the treatment with CPAP. There was no difference in V̇O₂ max or AT with CPAP treatment (mean net difference 0.66 mL·kg ^-1 ·min ^-1 (0.78) and -144.98 mL·min ^-1 (p=0.20) respectively).
Conclusions: There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that V̇O₂ peak increases following CPAP treatment in patients with OSA, but we did not observe any change in V̇O₂ max or AT, Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the V̇O₂ adaptations with CPAP therapy.

Huang SC; Hsu CC; Fu TC; Chen CP; Liao MF; Hsu YH; Wang JS;

Medicine [Medicine (Baltimore)] 2020 Jul 10; Vol. 99 (28), pp. e21058.Publication Type:

A method to perform exercise testing for patients with hemiplegia is unavailable though over half of them have cardio-pulmonary disorders. We aimed to assess the reliability and validity of using a stepper in cardiopulmonary exercise testing (CPET) in this population. 14 stroke patients with hemiplegia who failed to ride the stationary bike were included. Exclusion criteria included manual muscle strength ≦1 in the lower extremity, and conventional contraindications of CPET. They underwent CPET twice by using a stepper to evaluate test-retest reliability and validity. Additionally, 10 healthy participants underwent CPET twice on the cycle ergometer and stepper respectively.In the test-retest, the ratio of two-time difference to mean was 5.0, 3, 11.3 and 12.0% on average for peak oxygen consumption, peak heart rate (HR), anaerobic threshold and minute ventilation – carbonic dioxide production slope respectively. Cronbach’s alpha coefficient of peak oxygen consumption and anaerobic threshold were 0.992 and 0.919. In the stepper exercise testing of the hemiplegic participants, the ratio of peak HR to age-predicted maximal HR was 75% on average. Peak respiratory exchange ratio (mean ± standard deviation = 1.17 ± 0.08) was not different from that of healthy controls (1.21 ± 0.09). Notably, VO2 trajectory in relation to work rate is nonlinear and different in the rest-retest.This is the first research to study CPET variables in detail using stepper in patients with hemiplegia. CPET variables associated with peak are valid and reliable; nonetheless, those with sub-maximum are not. The study provides a method to do exercise testing for the patients with hemiplegia and its notice in application.

Vishram-Nielsen JKK; Deis T; Rossing K; Wolsk E; Alba AC; Gustafsson F;

Scandinavian cardiovascular journal : SCJ [Scand Cardiovasc J] 2020 Jul 15, pp. 1-8. Date of Electronic Publication: 2020 Jul 15.

Objective: To examine clinical characteristics and outcomes in women and men referred for advanced heart failure (HF) therapies such as left ventricular assist device (LVAD) or heart transplantation (HTx).
Design: A retrospective study of 429 (23% women) consecutive adult HF patients not on inotropic or mechanical circulatory support with left ventricular ejection fraction ≤45% referred for assessment of advanced HF therapies at a single tertiary institution between 2002 and 2016. Clinical characteristics and outcomes were compared in women and men, and all patients underwent right heart catheterization (RHC).
Results: At evaluation, women were younger than men (48 ± 13 vs. 51 ± 12 years, p  = .02), and less likely to have ischemic cardiomyopathy. There were no significant differences in NYHA class, contemporary HF therapy use, or physical examination findings, except for lower jugular vein distension and body surface area in women. On RHC, women had lower cardiac filling pressures, but similar pulmonary vascular resistance and cardiac index. Peak oxygen uptake from cardiopulmonary exercise testing was similar in both sexes. At total follow-up time, there were 164 deaths (21% vs. 44%, p  < .0001), 46 LVADs (3% vs. 13%, p  = .005), 110 HTxs (32% vs. 25%, p  = .15), and 82 HTxs without requiring LVAD (29% vs. 16%, p  = .03) in women and men. The time from RHC to HTx (±LVAD) was significantly shorter in women compared to men. Female sex was significantly associated with higher survival independent of time-trend, age, and comorbidities.
Conclusion: At evaluation, hemodynamics were less deranged in women. A higher proportion of women received HTx, their waitlist time was shorter, and survival greater.

van Campen CLM; Rowe PC; Visser FC;

Healthcare (Basel, Switzerland) [Healthcare (Basel)] 2020 Jun 30; Vol. 8 (3). Date of Electronic Publication: 2020 Jun 30.

Introduction: Effort intolerance along with a prolonged recovery from exercise and post-exertional exacerbation of symptoms are characteristic features of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The gold standard to measure the degree of physical activity intolerance is cardiopulmonary exercise testing (CPET). Multiple studies have shown that peak oxygen consumption is reduced in the majority of ME/CFS patients, and that a 2-day CPET protocol further discriminates between ME/CFS patients and sedentary controls. Limited information is present on ME/CFS patients with a severe form of the disease. Therefore, the aim of this study was to compare the effects of a 2-day CPET protocol in female ME/CFS patients with a severe grade of the disease to mildly and moderately affected ME/CFS patients.
Methods and Results: We studied 82 female patients who had undergone a 2-day CPET protocol. Measures of oxygen consumption (VO ₂ ), heart rate (HR) and workload both at peak exercise and at the ventilatory threshold (VT) were collected. ME/CFS disease severity was graded according to the International Consensus Criteria. Thirty-one patients were clinically graded as having mild disease, 31 with moderate and 20 with severe disease. Baseline characteristics did not differ between the 3 groups. Within each severity group, all analyzed CPET parameters (peak VO ₂ , VO ₂ at VT, peak workload and the workload at VT) decreased significantly from day-1 to day-2 ( p -Value between 0.003 and <0.0001). The magnitude of the change in CPET parameters from day-1 to day-2 was similar between mild, moderate, and severe groups, except for the difference in peak workload between mild and severe patients ( p = 0.019). The peak workload decreases from day-1 to day-2 was largest in the severe ME/CFS group (-19 (11) %).
Conclusion: This relatively large 2-day CPET protocol study confirms previous findings of the reduction of various exercise variables in ME/CFS patients on day-2 testing. This is the first study to demonstrate that disease severity negatively influences exercise capacity in female ME/CFS patients. Finally, this study shows that the deterioration in peak workload from day-1 to day-2 is largest in the severe ME/CFS patient group.

Sheill G; Reynolds S; O’Neill L; Mockler D; Reynolds JV; Hussey J; Guinan E;

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2020 Jul 06. Date of Electronic Publication: 2020 Jul 06.

Background: Cardiopulmonary exercise testing (CPX) can objectively measure fitness and oxygen uptake at anaerobic threshold. The relationship between fitness and postoperative outcomes after upper gastro-intestinal surgery is unclear. The aim of the present review is to assess the prognostic ability of CPX in predicting postoperative outcome associated with oesophagogastric surgery.
Methods: Relevant studies were identified through a systematic search of EMBASE, Medline, CINAHL, Cochrane Library, and Web of Science to July 2019. The eligibility criteria for studies included prognostic studies of upper gastro-intestinal surgery among adult populations using a preoperative CPX and measurement of postoperative outcome (mortality or morbidity or length of stay). Risk of bias was assessed using the QUIPS Quality in Prognostic Studies validated tool.
Results: Thirteen papers with a total of 1735 participants were included in data extraction. A total of 7 studies examined the association between CPX variables and postoperative mortality. Patients undergoing gastro-intestinal surgery with lower anaerobic threshold values were found to have an increased risk of postoperative mortality. Similarly, a lower rate of oxygen consumption was found to be associated with higher mortality. There was conflicting evidence regarding the association between CPX variables and postoperative morbidity. The evidence did not demonstrate any association between preoperative CPX variables and hospital length of stay.
Conclusion: Studies report an association between CPX variables and postoperative mortality; however, there is conflicting evidence regarding the association between CPX variables and postoperative morbidity.

Heiden GI; Sobral JB; Gonçalves Freitas CS; Pereira de Albuquerque AL;Salge JM; Kairalla RA; César Dos Santos Fernandes CJ; Ribeiro Carvalho CR; Souza R; Baldi BG;

Chest [Chest] 2020 Jun 29. Date of Electronic Publication: 2020 Jun 29.

Background: Pulmonary Langerhans cell histiocytosis (PLCH) determines reduced exercise capacity. The speculated mechanisms of exercise impairment in PLCH are ventilatory and cardiocirculatory limitations, including pulmonary hypertension (PH).
Research Question: What are the mechanisms of exercise limitation, the exercise capacity and the prevalence of dynamic hyperinflation (DH) and PH in PLCH?
Study Design and Methods: In a cross-sectional study, PLCH patients underwent an incremental treadmill cardiopulmonary exercise test with an evaluation of DH, pulmonary function tests, and transthoracic echocardiography. Those patients with lung diffusing capacity for carbon monoxide (DLCO) less than 40% predicted and/or transthoracic echocardiogram with tricuspid regurgitation velocity (TRV) greater than 2.5 m/s and/or with indirect PH signs underwent right heart catheterization.
Results: Thirty-five patients were included (68% women, 47 ± 11 years old). Ventilatory and cardiocirculatory limitations, impairment suggestive of PH, and impaired gas exchange occurred in 88%, 67%, 29%, and 88% of patients, respectively. The limitation was multifactorial in 71%, exercise capacity was reduced in 71%, and DH occurred in 68% of patients. Forced expiratory volume in the first second (FEV ₁ ) and DLCO were 64 ± 22% predicted and 56 ± 21% predicted, respectively. Reduction in DLCO, an obstructive pattern, and air trapping occurred in 80%, 77%, and 37% of patients, respectively. FEV ₁ and DLCO were good predictors of exercise capacity. The prevalence of PH was 41%, predominantly with pre-capillary pattern, and mean pulmonary artery pressure correlated best with FEV ₁ and TRV.
Interpretation: PH is frequent and exercise impairment is common and multifactorial in PLCH. The most prevalent mechanisms include ventilatory, cardiocirculatory, and suggestive of PH limitations.

Aly S; Lizano Santamaria RW; Devlin PJ; Jegatheeswaran A; Russell J;Seed M; McCrindle BW;

The Canadian journal of cardiology [Can J Cardiol] 2020 Jun 29. Date of Electronic Publication: 2020 Jun 29.

Background: Up to 25% of children with congenital heart disease are obese, which may have negative physiologic consequences for patients with repaired tetralogy of Fallot (rTOF).
Methods: Patients with rTOF who underwent cardiac magnetic resonance (CMR) and cardiopulmonary exercise testing from 2007-2018 were reviewed. Complex rTOF patients were excluded. Obese patients (body mass index [BMI]≥95th%ile) were compared to normal-weight patients (BMI<85 ^th %ile). CMR data was indexed to actual body surface area (aBSA), height, and BSA assuming ideal body weight (iBSA).
Results: We compared 32 obese patients matched to 64 normal-weight patients. Obese versus normal-weight patients had significantly lower right (RV) and left ventricular (LV) (EF)ejection fractions (EF) [RVEF 45%(42-48) vs 52%(47-55), p<0.0001; and LVEF 52%(47-56) vs 56% (54-60), p<0.0001, respectively]. There were no statistically significant differences regarding aBSA-indexed volumes of the RV or LV at either end-diastole (EDV) or end-systole. However, when indexed to either height or iBSA, obese patients had significantly greater RVEDV and LVEDV, greater LV mass, and higher RV and LV stroke volumes. Obese patients had lower peak oxygen consumption and oxygen consumption at anaerobic threshold. These results did not change after adjusting for degree of pulmonary regurgitation.
Conclusions: Obesity is associated with increased biventricular size, decreased biventricular EF and impaired exercise performance after rTOF. These data suggest a potential role for cardiac rehabilitation for weight management and to optimize fitness.

Ercin DOZ; Alkan H; Findikoglu G; Dursunoglu N; Evyapan F; Ardic F

Journal of cardiopulmonary rehabilitation and prevention [J Cardiopulm Rehabil Prev] 2020 Jul; Vol. 40 (4), pp. 268-275.

Purpose: The aim of this study was to compare the efficacy of the supervised pulmonary rehabilitation programs consisting of either an interval or continuous aerobic exercise program, with a home-based exercise program in patients with chronic obstructive pulmonary disease (COPD) who were overweight or obese.
Methods: In this randomized controlled study, 72 overweight and obese patients diagnosed as having COPD were randomly assigned to 3 groups. Group 1 received an interval-type (IT) aerobic exercise program, group 2 received a continuous-type (CT) aerobic exercise program (both groups performed home exercises as well) and group 3 was only given a home-based exercise (HE) program. For the evaluation of patients, anthropometric measures, cardiopulmonary exercise testing (CPX), 6-min walk test (6MWT), modified-Borg dyspnea and leg fatigue scores, St George’s Respiratory Questionnaire, and Hospital Anxiety and Depression Scale were used.
Results: Both IT and CT groups showed significant improvement on CPX parameters, 6MWT distances, mental health, and health-related quality of life (HRQoL) compared with the HE group in overweight and obese patients with COPD (P < .001). Moreover, the IT group demonstrated a significant decrease in the modified-Borg dyspnea and leg fatigue during the CPX compared with both CT and HE groups (P < .001). Furthermore, the Borg dyspnea and leg fatigue during training were lower in the IT group than in the CT group (P < .05).
Conclusions: An interval or continuous aerobic exercise program added onto a home-based exercise program improved exercise capacity and HRQoL, and reduced anxiety and depression levels in overweight and obese patients with COPD.

Faghy MA; Sylvester KP; Cooper BG; Hull JH;

British journal of anaesthesia [Br J Anaesth] 2020 Jun 11. Date of Electronic Publication: 2020 Jun 11.

No abstract available

Ferrer-Sargues FJ; Peiró-Molina E; Salvador-Coloma P; Carrasco Moreno JI; Cano-Sánchez A; Vázquez-Arce MI; Insa Albert B; Sepulveda Sanchis P; Cebrià I Iranzo MÀ;

nternational journal of environmental research and public health [Int J Environ Res Public Health] 2020 Jun 17; Vol. 17 (12). Date of Electronic Publication: 2020 Jun 17.

Critical surgical and medical advances have shifted the focus of congenital heart disease (CHD) patients from survival to achievement of a greater health-related quality of life (HRQoL). HRQoL is influenced, amongst other factors, by aerobic capacity and respiratory muscle strength, both of which are reduced in CHD patients. This study evaluates the influence of a cardiopulmonary rehabilitation program (CPRP) on respiratory muscle strength and functional capacity.
Fifteen CHD patients, ages 12 to 16, with reduced aerobic capacity in cardiopulmonary exercise testing (CPET) were enrolled in a CPRP involving strength and aerobic training for three months. Measurements for comparison were obtained at the start, end, and six months after the CPRP. A significant improvement of inspiratory muscle strength was evidenced (maximum inspiratory pressure 21 cm H ₂ O, 23%, p < 0.01). The six-minute walking test showed a statistically and clinically significant rise in walked distance (48 m, p < 0.01) and a reduction in muscle fatigue (1.7 out of 10 points, p = 0.017).
These results suggest CPRP could potentially improve respiratory muscle function and functional capacity, with lasting results, in children with congenital heart disease, but additional clinical trials must be conducted to confirm this finding.