Effects of Endurance Training on Skeletal Muscle Bioenergetics in Chronic Obstructive Pulmonary Disease

Size: px
Start display at page:

Download "Effects of Endurance Training on Skeletal Muscle Bioenergetics in Chronic Obstructive Pulmonary Disease"

Transcription

1 Effects of Endurance Training on Skeletal Muscle Bioenergetics in Chronic Obstructive Pulmonary Disease ERNEST SALA, JOSEP ROCA, RAMÓN M. MARRADES, JULI ALONSO, JOSÉ M. GONZALEZ de SUSO, ANGEL MORENO, JOAN ALBERT BARBERÀ, JOSEP NADAL, LLUIS de JOVER, ROBERT RODRIGUEZ-ROISIN, and PETER D. WAGNER Servie de Pneumologia i Al lèrgia Respiratòria, Departament de Medicina, IDIBAPS (Institut d Investigacions Biomèdiques Pi i Sunyer), Hospital Clínic, Unitat de Medicina Preventiva i Salut Pública, Facultat de Medicina, Universitat de Barcelona, Centre Diagnòstic Pedralbes, Barcelona; Centre d Alt Rendiment, Sant Cugat del Vallès, Spain; and Department of Medicine, Section of Physiology, University of California San Diego, La Jolla, California Physiologic adaptations after an 8-wk endurance training program were examined in 13 patients with chronic obstructive pulmonary disease (COPD) (age, 64 4 [SD] yr; FEV 1, 43 9% pred; Pa O2, 72 8 mm Hg; and Pa CO2, 36 2 mm Hg) and in eight healthy sedentary control subjects (61 4 yr).. Both pre- and post-training studies included: (1) whole-body oxygen consumption ( VO 2 ) and one-leg. O 2 uptake ( VO 2leg ) during exercise; and (2) intracellular ph (phi) and inorganic phosphate to phosphocreatine ratio ([Pi]/[PCr]) during exercise; and half-time of [PCr] recovery. After training, the two. groups increased peak VO 2 (p 0.05 each) and showed a similar fall in submaximal femoral venous. lactate levels (p 0.05 each). However, control subjects increased peak VE (p 0.01) and raised peak O 2 delivery (p 0.05), not shown in patients with COPD. Both groups increased post-training O 2 extraction ratio (p 0.05). The most consistent finding, however, was in patients with COPD, who had a substantial improvement in cellular bioenergetics: (1) half-time of [PCr] recovery fell from 50 8 to 34 7 s (p 0.02); and (2) at a given submaximal work rate, [Pi]/[PCr] ratio decreased and phi increased (p 0.05 each). We conclude that beneficial effects of training in patients with COPD essentially occurred at muscle level during submaximal exercise. Sala E, Roca J, Marrades RM, Alonso J, Gonzalez de Suso JM, Moreno A, Barberà JA, Nadal J, de Jover L, Rodriguez-Roisin R, Wagner PD. Effects of endurance training on skeletal muscle bioenergetics in chronic obstructive pulmonary disease. AM J RESPIR CRIT CARE MED 1999;159: (Received in original form April 28, 1998 and in revised form November 16, 1998) Supported by grants FIS and from the Fondo de Investigaciones Sanitarias; ALFA ETIR 2.42 (8) from the European Union (DG XII); Comissionat per a Universitats i Recerca de la Generalitat de Catalunya (1997 SGR- 0086); and HL from the National Heart, Lung, and Blood Institute. Ernest Sala, M.D., was a Research Fellow supported by the Hospital Clínic (1997). Correspondence and requests for reprints should be addressed to Josep Roca, M.D., Servei de Pneumologia, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain. roca@medicina.ub.es Am J Respir Crit Care Med Vol 159. pp , 1999 Internet address: Respiratory rehabilitation, including lower limb exercise training, is recommended as part of the management for patients with chronic obstructive pulmonary disease (COPD), because it has been consistently shown that this relieves dyspnea and improves health-related quality of life (HRQL) (1). It is of note, however, that the physiologic mechanisms underlying the beneficial consequences of training are poorly understood (1 5). In 1991, Casaburi and colleagues (6) demonstrated that a relatively high-intensity training program was required to improve exercise endurance in patients with moderate COPD. More recently, Maltais and coworkers (7, 8) reported that patients with COPD concurrently showed early rise of blood lactate levels during exercise, together with low concentration of skeletal muscle oxidative enzymes, as compared with normal subjects. The two findings were at least partially corrected after a controlled endurance training program (8). These two groups of investigators (6, 8) hypothesized that reduction of blood lactate levels after training decreased ventilatory requirements during exercise, which in turn would relieve dyspnea and improve exercise tolerance. More recently, Casaburi and colleagues (9) reported that rigorous physical training in patients with severe COPD, in whom blood lactate levels did not increase during exercise, yielded a more efficient breathing pattern and reduced minute ventilation at a given submaximal work rate, hence improving exercise tolerance. An alternative hypothesis is that improvement of HRQL after endurance training is directly and mainly related to enhancement of skeletal muscle bioenergetics during submaximal exercise, rather than to changes in ventilation ( V E). This notion may help to resolve the apparent discrepancies between the consistently beneficial effects of physical training on HRQL (1 4) and the variability among studies regarding the impact of rehabilitation on peak O 2 uptake ( V O 2 peak) (1). The present study examined the relationships among oxygen consumption ( V O 2 ), muscle O 2 transport, and cellular bioenergetics after an 8-wk endurance training program in 13 patients

2 Sala, Roca, Marrades, et al.: Adaptive Responses to Physical Rehabilitation in COPD 1727 with COPD and in eight healthy sedentary subjects used as control subjects. METHODS Study Group Thirteen clinically stable male, steroid-free patients with COPD (mean age, 64 4 [mean SD] yr; height, cm; and weight, 73 8 kg) without recent history (6 mo) of an acute episode of exacerbation, and eight healthy sedentary men (age, 61 4 yr; height, cm; and weight, 73 7 kg) were enrolled in the study. The patients with COPD were selected a priori because of their moderateto-severe ventilatory impairment, but preserved single-breath carbon monoxide transfer capacity (DL CO ). All of them showed only moderate hypoxemia at rest without exercise-induced oxyhemoglobin desaturation. Age, anthropometric variables, lung function measurements, therapy, and smoking habits of the two groups are listed for each individual in Tables 1 and 2. The control group of sedentary subjects was carefully selected on the basis of no previous history of regular or even occasional physical exercise above that required for average daily activities. In each subject, the same measurements described below were carried out before and after the training period. All were informed of any risks and discomfort associated with the experiment, and written informed consent was obtained in accordance with the Committee on Investigations Involving Human Subjects at the Hospital Clínic, Universitat de Barcelona, which approved the study. 31 P-Magnetic Resonance Spectroscopy In eight of the 13 patients with COPD and in all eight healthy sedentary subjects, 31 P-magnetic resonance spectroscopy ( 31 P-MRS) measurements in the quadriceps of the left thigh were carried out less than 1 wk before the study with catheters as described below. Exercise tests during MRS measurements were performed using an ergometer made of nonmagnetic materials conceived to fit into a standard whole-body magnet. The system allowed flexion and extension of both legs by alternatively pressing two foot pedals connected to a hydraulic-controlled resistance system while the subject lay supine on the ergometer table (10). A piezoelectric force transducer (9251A model; Kistler Instruments AG, Winterthur, Switzerland) placed inside one of the pedals was used to provide an on-line measure of both strength and rate of pedaling during the exercise test. Each subject began with an incremental protocol that consisted of a maximum of five periods of 2-min of exercise each, pedaling at 60 rpm. The two first periods were set at 3 W kg 1 muscle mass, with subsequent increases at 7, 9, and 11 W kg 1 muscle mass. After a full 1-h recovery at rest, the subject performed a constant work rate exercise for 2 min. This second protocol was designed to allow evaluation of [PCr] recovery from data collected for 8 min after exercise. The constant work rate used in each subject was chosen to produce a rise in [Pi]/[PCr] ratio of approximately while keeping phi higher than 6.90 units, as measured in the first spectrum of the recovery period. The purpose was to prevent a deleterious effect of low intracellular ph on the rate of oxidative phosphorylation (11 13). 31 P-MRS measurement details. Studies were carried out using a 1.5-T Signa System (Signa Advantage; General Electric Medical Systems, Milwaukee, WI) operating at a frequency of MHz and MHz for the hydrogen-1 and the phosphorus-31 nucleus, respectively, connected to a SPARCStation 20 Workstation (Sun Microsystems, Mountain View, CA). Subjects were placed in the magnet in a supine position, head first, and the elliptical distributed capacitance surface coil (14.5 cm 6.5 cm), pretuned at the phosphorous resonant frequency, was positioned and fixed over the vastus medialis muscle of the left leg. Then the position of the surface coil was checked with spin-echo TABLE 1 INDIVIDUAL ANTHROPOMETRIC DATA, HEMOGLOBIN CONCENTRATION, MEDICATION INTAKE, AND TOBACCO CONSUMPTION Age (yr) Weight (kg) Height (cm) BMI (kg m 2 ) Tobacco (pack-years) Medication (puffs per day) [Hb] (g dl 1 ) Patients with COPD (SB) 12 IB 4 S 4 B (SB) 4 S SB 4 S 4 B (SB) 2 IB (SB) 16 IB 2 S 4 B (SB) (SB) 12 IB 6 S 6 B (SB) (IB) (B) SB 6 IB (SB) 4 S 4 IB 4 B 13.7 Mean SD Healthy Sedentary Subjects Mean SD Definition of abbreviations: B budesonide, 200 g/puff; BMI body mass index; COPD chronic obstructive pulmonary disease; Hb hemoglobin concentration; IB ipratropium bromide, 18 g/puff; ( ) bronchodilators used only occasionally are indicated within parentheses; S salmeterol, 25 g/puff; SB salbutamol, 100 g/puff. Only two of eight control subjects were smokers. Results expressed as individual data and mean standard deviation (SD).

3 1728 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL T1-weighted images (10). Phosphorous-31 spectra were obtained using 180 pulses as measured at the center of the coil. A total of 1,024 data points were accumulated for the measurements at rest, 12 scans for each work rate of the incremental exercise, and blocks of eight scans were continuously recorded during the 8-min recovery period form the constant work rate exercise. Free induction decays were analyzed in the time domain with the magnetic resonance user interface software (14). All resonances were fitted to single lorentzian functions with the nonlinear least-squares variable projection method (15, 16) and the estimated amplitudes of the time domain signals, which correspond to the area under each resonance in the frequency domain, and their chemical shifts were directly used for calculations. The individual half-time of phosphocreatine ([PCr]) recovery was calculated by fitting the time domain amplitudes to a monoexponential function (Figure P; Biosoft, Cambridge, UK). The intracellular ph (phi) was calculated using the formula: phi log [(d 3.27)/(5.69 d)], where di is the chemical shift distance in ppm between the Pi and the PCr resonances (17). Whole-body and One-leg O 2 Uptake Measurements Subject preparation, safety precautions, and technical aspects of the central measurements (arterial and femoral venous blood gases and femoral venous blood flow) have been described in detail elsewhere (18 21). Briefly, one catheter was placed in the radial artery of the nondominant arm to measure PO 2, PCO 2, ph, Sa O2, lactate, and hemoglobin in arterial blood. In the femoral vein of the left leg, a 7-F catheter was advanced 7 cm into the vessel with the tip oriented distally and a 2.5-F thermistor was advanced 5 cm proximally into the same vessel. Each subject performed an incremental cycle exercise test (10-watt [W] increments every 2 min in patients with COPD and 20-W increments every 2 min in healthy sedentary control subjects, without an initial period cycling at zero watts) breathing room air (FI O2 0.21) until exhaustion. The exercise protocol was done using an electromagnetically-braked cyclo ergometer (CardiO 2 cycle; Medical Graphics Corporation, St. Paul, MN) with a mechanical assist to overcome the internal frictional resistances. On-line calculations of whole-body V O 2, CO 2 output ( V CO 2 ), minute ventilation ( V E), respiratory exchange ratio (RER), heart rate (HR), and respiratory rate (RR) were averaged sequentially over 15-s intervals and displayed on a screen monitor to observe the progress of the tests. In each subject, simultaneous arterial and femoral venous blood samples were collected at rest and during the second minute of each incremental work rate. Femoral venous blood flow measurements were made by short-term steady-state thermodilution using iced saline (18, 19) immediately after femoral venous blood sampling. In each instance, the following measurements were made: (1) PO 2, PCO 2, ph (IL model 1302, ph/blood gas analyzer and tonometer model 237; Instrumentation Laboratories, Milan, Italy), oxyhemoglobin saturation, hemoglobin concentration (Hb) (IL 482 co-oximeter), and whole-blood lactate concentrations (YSI 23L blood lactate analyzer; Yellow Springs Instruments, Yellow Springs, OH) from simultaneous arterial and femoral venous blood samples; and (2) femoral venous blood flow ( Q. leg) and arterial pressure. As indicated above, V E, fraction of expired oxygen (FE O2 ), fraction of expired carbon dioxide (FE CO2 ), and HR were continuously monitored. Technical aspects of these measurements have been previously provided in detail (18 21). In the pre-training studies of five of the 13 patients with COPD, femoral venous flow was measured only at approximately 30, 60, 80, and 100% of peak work rate (as assessed in a preliminary incremental exercise protocol done in all subjects before inclusion in the study). Measurements of leg blood flow at each work rate were done in all the remaining pre- and post-training studies of the two groups of subjects (patients with COPD and control subjects). In the present study, blood O 2 content was calculated as follows: [(1.39 Hb measured oxyhemoglobin saturation) (0.003 PO 2 )]. TABLE 2 PULMONARY FUNCTION AND PEAK EXERCISE DATA FEV 1 (% pred) (L) FEV 1 /FVC (%) TLC (% pred) RV/TLC (%) DL CO SB (% pred) Pa O2 (mm Hg) W peak (W) V O 2 peak (L min 1 ) Patients with COPD Mean SD Healthy Sedentary Subjects Mean SD Definition of abbreviations: COPD chronic obstructive pulmonary disease; DL CO single-breath diffusing capacity for carbon monoxide expressed as percent predicted; RV/TLC residual volume to TLC ratio expressed as actual percentage; TLC total lung capacity, expressed as percent predicted; V O 2 peak whole-body O 2 uptake at peak exercise, in L min 1 ; W peak work rate, in watts. Results expressed as individual data and mean standard deviation (SD).

4 Sala, Roca, Marrades, et al.: Adaptive Responses to Physical Rehabilitation in COPD 1729 This was done for arterial (Ca O2 ) as well as venous (Cfv O ) blood. The 2 O 2 delivery to the exercising leg ( Q. O 2leg ) was calculated as the product of arterial O 2 content and leg blood flow [ Q. O 2leg Ca O2 Q. leg]. Leg O 2 uptake ( V O 2leg ) was obtained as the product of Q. leg and the arterial femoral venous difference of O 2 content [ V O 2leg Q. leg (Ca O2 Cfv )]. Leg O O 2 2 extraction ratio (O 2 ER) was calculated as the ratio of the arterial to femoral venous O 2 content difference and the arterial O 2 content [O 2 ER 100 (Ca O2 Cfv )/Ca O 2 O 2 ]. In each subject, measured O 2 saturation and the corresponding PO 2 from all samples were used to estimate the oxygen half-saturation pressure (P 50 ) of hemoglobin. Training Program The two groups of subjects (patients with COPD and control subjects) exercised on a cycle ergometer (Monark model 810; Monark, Sweden) 5 d per week for 8 wk. The training sessions were directly supervised by one of the members of the team (J.N.). The compliance of the subjects was excellent, with no withdrawals during the training period. During the cycling sessions, HR was continuously monitored (Sport- Tester PE 3000 System; Polar Electro, Kemple, Finland). The training sessions, approximately 60-min duration, consisted of (1) 5 min of cycling at the low work rate, 40% of the peak work rate (40% W peak ) Figure 1. One-leg O 2 uptake ( V O 2leg ) and whole-body O 2 uptake ( V O 2 ) plotted against work rate. Healthy subjects are indicated by triangles (pre-training study, open symbols, and post-training study, filled symbols). Patients with COPD are indicated by squares (pre-training study, open symbols, and post-training study, filled symbols). Results are expressed as mean ( SEM) data obtained at rest (zero watts) and at approximately 30%, 60%, 80%, and 100% peak work rate. Training effects on exercise response in the control subjects were those expected from the literature (26 29). Peak whole-body V O 2 and peak work rate significantly increased after training in the two groups of subjects. Post-training peak V O 2leg significantly increased in healthy sedentary subjects, but not in patients with COPD. In the patients, at given submaximal work rate, both pre- and post-training V O 2leg (and also whole-body V O 2 ) were significantly higher than in the control subjects (see text for further explanations). achieved in the previous control; (2) 20 min cycling at the high work rate, 70 90% W peak ; (3) 5 min cycling at 40% W peak ; (4) 20 min cycling at 70 90% W peak ; and (5) 5 min at 40% W peak. The rate of pedaling during the sessions was kept at 60 rpm. The progress of work rate during the training period was decided on an individual basis to maximize the training effect. During the first 3 wk of the program, cycling at the high work rate was set at least 70% W peak. Thereafter, it was increased at least by 5% every week up to a maximum of 90% of the actual W peak during the last 2 wk of the training program. Data Analysis Results are expressed as mean SD. Comparisons of pre- and posttraining incremental exercise within each group (13 patients versus eight control subjects) were done, unless otherwise stated, using Student s paired t test to examine the slopes (and intercepts) derived from individual least-squares regression lines of each variable versus work rate and V O 2 (both whole-body V O 2 and V O 2leg ). Comparisons of peak exercise values between pre- and post-training were analyzed similarly. The effects of training on femoral venous lactate concentrations ([La]fv) compared post-training to pre-training values by regression analysis. Comparisons of pre-training data between patients with COPD and control subjects were done using Student s unpaired t test to examine the slopes (and intercepts) derived from individual results. Comparison of the profiles of the O 2 extraction ratio (O 2 ER) response to exercise was carried out using a repeated measurements analysis of variance (MANOVA). Since we found that the O 2 ER profile was substantially different between groups (p 0.03), the analysis of the O 2 ER response during exercise was done for each group separately. Statistical significance was set up at p value equal or lower than RESULTS Lung Function and Exercise Tolerance before Training The characteristics of the patients with COPD and the healthy sedentary control subjects are depicted in Tables 1 and 2. The 13 patients with COPD presented moderate to severe airflow obstruction (FEV 1, L, 43 9% predicted) (22 24), slight single-breath DL CO impairment (79 17% predicted) (25), and only moderate hypoxemia at rest (72 8 mm Hg). Arterial PO 2 did not show significant changes from rest to peak exercise ( versus mm Hg, patients with COPD and control subjects, respectively). While arterial PCO 2 did not change (from to mm Hg) during exercise in control subjects, Pa CO2 significantly increased at peak exercise in patients with COPD (from to mm Hg) (p ). Arterial O 2 content (Ca O2 ) was similar in the two groups both at rest ( versus ml O ml 1 blood, patients with COPD and control subjects, respectively) and at peak exercise ( versus ml O ml 1 blood). As expected, the patients with COPD showed exercise intolerance as assessed by both lower peak work rate (85 26 versus W) (p 0.005) and peak whole-body O 2 uptake ( versus L min 1 ) (p 0.008) than control subjects. Peak O 2 uptake expressed as percent of predicted values was 69 16% and 85 16% (p 0.04), respectively. The patients with COPD in the present study showed, at a given submaximal work rate (40 W), significantly higher whole-body V O 2 (p 0.009) and V O 2leg (p 0.02) than the healthy sedentary control subjects with similar slopes of O 2 uptake versus work rate relationships in the two groups for both whole-body O 2 uptake (12 3 versus 12 1 ml min 1 W 1, respectively), as shown in Figure 1. The ventilatory and heart rate responses to exercise in patients with COPD were similar to those reported in the literature (30). Peak ventilation was lower in patients with COPD than in control subjects ( versus L min 1,

5 1730 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL respectively) (p 0.001), but peak respiratory rate was similar ( versus min 1 ). At a given submaximal work rate (40 W), V E was higher in patients with COPD than in control subjects ( versus L min 1 ) (p 0.02). The response of VT to exercise was also different between groups; while in the control group mean VT rose progressively throughout exercise, the patients with COPD showed a well-defined plateau in VT above approximately 60 W. Mean peak heart rates were not different between groups ( versus min 1, patients with COPD and control subjects, respectively), but HR at a given submaximal work rate (40 W) was significantly higher in patients with COPD than in control subjects ( versus min 1 ) (p 0.05). The RER at peak exercise was also significantly lower in patients with COPD than in control subjects ( versus ) (p 0.002). Training Response Muscle O 2 transport and O 2 uptake. Peak V O 2leg (Figure 1, upper panel) significantly increased after training in the control group (by L min 1 ) (p 0.002). The difference in peak V O 2leg of the patients with COPD ( L min 1 ) was not significant (p 0.2). In contrast, peak whole-body V O 2 (Figure 1, bottom panel) rose in both groups (by and by L min 1, patients with COPD and control subjects) (p 0.05 and p 0.005, respectively). Likewise, peak work rate significantly increased with training in both groups (by W and by W, patients with COPD and control subjects, respectively) (p 0.01 each). RER at peak exercise did not change after training in patients with COPD (from to ), but it increased in the control group (from to ) (p 0.04). As depicted in Figure 1, the slope of post-training V O 2 (both whole-body V O 2 and V O 2leg ) versus work rate was not different between patients with COPD and control subjects, and in the two groups it essentially overlaid the pre-training data. For both subject groups, the plots of both post-training oneleg blood flow ( Q leg ) and post-training one-leg O 2 delivery ( QO 2leg ) versus work rate (or O 2 uptake) essentially overlaid the pre-training data, as shown for QO 2leg in Figure 2 (upper panel). The normal subjects showed a significant increase in these two variables at peak exercise: peak Q leg increased by L min 1 (p 0.03) and peak QO 2leg rose by L min 1 (p 0.05). However, no changes were observed in the patients with COPD after training (Table 3). Both leg blood flow and leg O 2 delivery at a given submaximal work rate were not significantly different between patients with COPD and control subjects in either of the studies (pre- and post-training). The arterial minus femoral venous blood O 2 content gradient at peak exercise did not show significant changes with training in patients with COPD (from to ml O ml 1 blood) nor in the control group (from to ml O ml 1 blood). Peak oxygen extraction ratio (O 2 ER, %) increased in both the patients with COPD (from to %) (p 0.02) and the control group (from to %) (p 0.05), but did not differ between groups. O 2 ER during submaximal exercise was significantly higher in patients with COPD than in control subjects (p 0.03) both in the pre- and post-training (Figure 2, bottom). Figure 3 (upper panel) shows that while the normal subjects moderately decreased V E at a given submaximal work rate (40 W) from to L min 1 (p 0.02) and substantially increased peak V E from to L min 1 (p 0.004), no significant effects of training on submaximal V E nor in peak V E were observed in patients with COPD (Table 3). It is of note, however, that submaximal V E after training showed a trend to fall, by 1.9 L min 1 (p 0.07, one tail). Control subjects significantly increased posttraining peak HR (from to cycles min 1 ) (p 0.03), a change not seen in patients with COPD ( compared with cycles min 1 ). The COPD group did, however, show a significant reduction of HR at a given submaximal work rate (40 W), by min 1 (p 0.01). Despite the substantial differences in FEV 1 between patients with COPD and control subjects, physical training decreased femoral venous lactate concentrations ([La]fv) at any work rate in a similar magnitude in the two groups, as indicated in Figure 3 (lower panel) (p 0.05, each). After training, however, while differences in base excess between patients with COPD and control subjects disappeared, [La]fv levels were still higher in patients with COPD than in control subjects (at 40 W, versus mm L 1, respectively) (p ). Skeletal muscle bioenergetics. Pre-training half-time of [PCr] recovery was significantly longer in the patients with COPD (50 8 s) than in control subjects (35 7 s) (p 0.02). Figure 2. One-leg oxygen transport variables (top panel, O 2 delivery, and bottom panel, O 2 extraction ratio) plotted against work rate. Healthy subjects are indicated by triangles (pre-training study, open symbols, and post-training study, filled symbols). Patients with COPD are indicated by squares (pre-training study, open symbols, and post-training study, filled symbols). Results are expressed as mean ( SEM) data obtained at rest (zero watts) and at approximately 30%, 60%, 80%, and 100% peak work rate. In healthy sedentary subjects, one-leg O 2 delivery at peak exercise was significantly higher than pre-training data, but not in patients with COPD. The two groups of subjects showed a significant rise in peak O 2 extraction ratio after training. O 2 extraction ratio showed higher values at moderate submaximal exercise in patients with COPD than in control subjects, both in the pre- and post-training studies (see text for further explanations).

6 Sala, Roca, Marrades, et al.: Adaptive Responses to Physical Rehabilitation in COPD 1731 TABLE 3 TRAINING RESPONSE IN HEALTHY SUBJECTS AND PATIENTS WITH COPD Training Response (mean post- minus pre-training difference) Healthy Subjects Patients with COPD Difference % p Value Difference % p Value WR peak, W Whole-body V O 2 peak, L min V E peak, L min V E submax, L min HR peak, beats min HR submax, beats min Q leg peak, L min Q O 2 peak, L min Peak (a-fv) O 2 diff, mlo ml O 2 ER peak, % [La]fv peak, mm L [La]fv submax, mm L [Pi]/[PCr] peak [Pi]/[PCr] submax phi peak phi submax T 1/2 of [PCr] recovery, s Definition of abbreviations: COPD chronic obstructive pulmonary disease; HR heart rate; [La]fv femoral venous lactate concentration; [PCr] phosphocreatine concentration; Peak (a-fv) O 2 diff difference between arterial and femoral venous blood oxygen content; phi intracellular ph; [Pi] inorganic phosphorus concentration; Q leg leg blood flow; Q O 2leg leg oxygen delivery; T 1/2 of [PCr] recovery half-time of phosphocreatine concentration recovery. Training response expressed as absolute post- minus pre-training differences and as percentage of change after training; p value is Student s paired t test between pre- and post-training absolute values. Results at submaximal work rate were calculated at 40 W for the following variables measured during cycling exercise: V E, HR, Q leg, Q O 2leg, and [La]fv. Results for [Pi]/[PCr] and phi correspond to pooled data obtained during the incremental protocol done within the magnet. After training, half-time of [PCr] recovery substantially fell to normal levels in patients with COPD (34 7 s) (p 0.02), but this variable did not show significant changes in the healthy sedentary subjects (29 8 s). The analysis of changes in halftime recovery was done in only six control subjects, since two of them (subjects no. 1 and 2) had to be excluded because phi fell below 6.9 either in the pre- or post-training study. Endurance training improved the skeletal muscle bioenergetic status to normal levels in patients with COPD during incremental exercise (Figure 4), as shown by the lesser increase in the [Pi] to [PCr] ratio and the lesser reduction in phi at a given submaximal exercise. For example, at 27 W the [Pi]/[PCr] ratio fell from 2.8 to 1.3 (p 0.05) and the phi increased from 6.83 to 6.98 (p 0.04). In contrast, the normal sedentary subjects did not show significant changes in the [Pi]/[PCr] ratio nor in phi at this level of exercise. It is of note, however, that the control group showed a trend toward improvement of the bioenergetic status after training at the last step of the exercise protocol (Figure 4). DISCUSSION Nature of the Training Response The present study shows that patients with COPD and healthy sedentary control subjects presented clear physiologic training effects both at peak work rate and during submaximal exercise. After training, peak whole-body V O 2 and peak work rate significantly increased in the COPD group (by 10% and 15%, respectively) (p 0.01 each) and in the control group (by 13% and 20%) (p 0.05 and p 0.01). Likewise, post-training [La]fv during submaximal exercise (at 40 W) fell by 32% (p 0.03) in the patients with COPD and by 26% (p 0.05) in the healthy sedentary control group. The two groups, however, showed quite different physiologic adaptations to endurance training (Table 3). Whereas the healthy subjects markedly increased the central factors governing convective O 2 transport at peak exercise: (1) femoral venous blood flow and heart rate; (2) ventilation; and (3) O 2 delivery, no changes in any of these variables at peak exercise were observed in the patients with COPD (Figures 2 and 3, upper panels). In fact, similarities of pre- and post-training ventilatory responses to exercise (as well as the observed plateau in tidal volume above 60% peak work rate) in the patients with COPD support the notion that ventilatory capacity was one of the factors (albeit not the only one) limiting peak exercise in these patients. The lack of a significant reduction of post-training V E during submaximal exercise (by 1.9 L min 1 ) should be attributed to a type II error. It is of note that post-training heart rate during submaximal exercise (at 40 W) fell by 8% (p 0.01) in the COPD group. The most consistent effects of the training program in patients with COPD were: (1) a significant increase in peak O 2 extraction ratio (also seen in the control group); (2) reduced half-time of [PCr] recovery; and (3) improved cellular bioenergetics during submaximal exercise ([Pi]/[PCr] ratio and phi) (Figure 4). Overall, the post-training findings in patients with COPD indicate that the physiologic changes provoked by endurance training essentially took place at the level of the skeletal muscle during submaximal exercise. The increase in peak whole-body V O 2 after training in the patients can be interpreted as the end-result of the skeletal muscle changes alluded to above. The O 2 extraction ratio ( V O 2 / Q O 2 ), at any given work rate, can be analyzed as the ratio of peripheral to central components of O 2 transport (18, 31). While the denominator ( QO 2 ) includes only central components of O 2 transport (leg blood flow and arterial O 2 concentration), the numerator ( V O 2 ) can be expressed as a reflection of peripheral O 2 transfer. According to the laws of diffusion, V O 2 is the product of muscle capillary O 2 conductance and the PO 2 difference between muscle capillaries and mitochondria. In the present study, since peak QO 2 did not change (patients with COPD) or even increased

7 1732 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL (healthy sedentary control subjects) (Figure 2, bottom panel), the rise in peak %O 2 ER after training should be interpreted as an improvement of the muscle O 2 transfer. There are three potential mechanisms to explain such an increase in peak %O 2 ER with training: (1) higher capillary-to-muscle fiber ratio due to training-induced angiogenesis, which would effectively enlarge the area for O 2 transfer in the muscle microcirculation; (2) improved mitochondrial oxidative capacity, which might potentially increase the O 2 transfer gradient between capillary and mitochondria; and (3) the combined effects of these two phenomena. Unfortunately, the analysis of structural changes provoked by training was beyond the scope of the present study. In the patients with COPD, however, since the half-time of [PCr] recovery fell to normal levels after training, it can be hypothesized that physical training significantly improved mitochondrial oxidative capacity, as suggested by previous studies (8). The half-time of [PCr] recovery is an overall marker of the dynamics of muscle bioenergetics. It is well accepted, however, that when this variable is measured after a low-intensity constant work rate exercise preventing a marked fall in phi would otherwise negatively interfere oxidative phosphorylation, the half-time of [PCr] recovery reflects skeletal muscle mitochondrial oxidative capacity (11 13, 32). A fundamental outcome of the post-training study in patients with COPD is the improvement of cellular bioenergetics ([Pi]/[PCr] ratio and phi) during submaximal exercise up to normal levels, despite the lack of improvement in convective O 2 transport ( QO 2 ) (Figure 2, upper panel). The results of the present study suggest that physical deconditioning plays a key role in the impairment of skeletal muscle bioenergetics in patients with COPD. The prominence of the training effects on cellular bioenergetics in the COPD group may not be representative of the average training response usually seen in the clinical setting. Both the intensity of the controlled training program and the inclusion criteria of the patients can be important factors in explaining our results. It is well accepted that healthy sedentary subjects show clear training effects on both cellular metabolism and muscle O 2 transport (33). The lack of improvement in the cellular Figure 3. Minute ventilation (upper panel) and lactate levels in femoral venous blood ([La]fv) (bottom panel) plotted against work rate. Healthy subjects are indicated by triangles (pre-training study, open symbols, and post-training study, filled symbols). Patients with COPD are indicated by squares (pre-training study, open symbols, and post-training study, filled symbols). Results are expressed as mean ( SEM) data obtained at rest (zero watts), and at approximately 30%, 60%, 80%, and 100% peak work rate. Ventilation at peak exercise increased after training in healthy sedentary subjects, but not in patients with COPD. The control subjects, but not the patients with COPD, also reduced post-training ventilation at a given submaximal exercise. The two groups, however, showed a similar fall in post-training (La)fv at a given submaximal exercise (see text for further explanations). Figure 4. Inorganic phosphate ([Pi]) to phosphocreatine [PCr] ratio and intracellular ph (phi) plotted against work rate. Healthy subjects are indicated by triangles (pre-training study, open symbols, and post-training study, filled symbols). Patients with COPD are indicated by squares (pre-training study, open symbols, and post-training study, filled symbols). The results, expressed as mean ( SEM), were obtained during the incremental protocol carried out within the magnet. Data at zero watts are measurements done at rest. The three subsequent points in each line correspond to submaximal work rates achieved by all the subjects. The last measurement corresponds to peak exercise in the patients with COPD but not in the control group. In patients with COPD post-training [Pi]/[PCr] ratio and phi markedly improved up to normal levels. Healthy sedentary subjects were explored only at very low work rates relative to their peak exercise (see text for further explanation).

8 Sala, Roca, Marrades, et al.: Adaptive Responses to Physical Rehabilitation in COPD 1733 bioenergetic status ([Pi]/[PCr] ratio and phi) during submaximal incremental exercise in our control group can be largely attributed to the design of the 31 P-MRS study. The use of an identical incremental protocol for the two groups of subjects had some advantages, but only allowed exploration of very low work rates relative to the expected peak exercise for the control group. Post-training improvement of cellular bioenergetics in the healthy sedentary subjects likely would have been shown by exploring further steps in the incremental protocol within the magnet. This was not, however, a central aim of the present study. Moreover, the absence of a significant fall in half-time of [PCr] recovery after training (from 35 to 28 s) in normal subjects can be most likely attributed to a type II error since only six subjects could be included in the final analysis. O 2 Uptake at Early Submaximal Exercise It is well accepted that patients with COPD show relationships between O 2 uptake and work rate within the normal range such that O 2 uptake for a given submaximal work rate in these patients is similar to that seen in healthy sedentary subjects (30). It is of note, however, that in the present study the patients with COPD showed, at a given submaximal work rate, significantly higher whole-body V O 2 (p 0.009) and V O 2leg (p 0.02) than the healthy sedentary control subjects (Figure 1) with no differences in the slopes of O 2 uptake (whole body and leg) versus work rate between groups. We can reasonably assume the reliability of our results because whole-body V O 2 and V O 2leg are independent measurements, and similar differences between the two groups were obtained in the pre- and post-training studies. Since the problem appears in the transitional zone from rest to slight exercise without measurements obtained during unloaded (zero watts) cycling, it is difficult to provide a clean explanation for such a difference in O 2 uptake at early submaximal exercise. The design of the incremental exercise protocol without the recommended 3-min unloaded exercise (34, 35) could be considered a weakness of the study, but to our understanding it does not constrain the interpretation of the beneficial effects of physical training in patients with COPD, which, in fact, is the main outcome of the present investigation. In summary, the present study suggests that the sedentary lifestyle of these patients with COPD due to psychological and/or physiologic factors provokes functional changes in the skeletal muscle that can be partly or completely reversed by physical rehabilitation, as shown by the improvement of cellular bioenergetics in skeletal muscles to normal levels. The results of the investigation stress the importance of physical deconditioning in the skeletal muscle dysfunction observed in patients with COPD. It can be hypothesized that such an enhancement of the cellular bioenergetic status after physical rehabilitation may contribute to the underlying physiologic basis of the improved HRQL observed in most of the studies (1). Physiologic adaptations to physical training essentially take place at muscle level, and they do not necessarily have an appreciable impact on the ventilatory response to incremental exercise. Our results support the notion that improvement of the bioenergetic status of the skeletal muscle during submaximal exercise should constitute one of the crucial components of the expected goals of physical training. The findings of the present study may be of help in better identifying outcome variables for physical rehabilitation programs. Acknowledgment : The authors are grateful to Felip Burgos, Jaume Cardús, and all the technical staff of the Lung Function Laboratory for their skillful support during the study; to Vicky Cabestany, Lola Núñez, and Conxi Gistau for their outstanding support in the training program; to Narcis Gusí for his advice in conducting the training program; and to Mirjam Hillenius for typing the manuscript. References 1. Lacasse, Y., E. Wong, G. H. Guyatt, D. King, D. J. Cook, and R. S. Goldstein Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet 348: Celli, B Is pulmonary rehabilitation an effective treatment for chronic obstructive pulmonary disease? Yes. Am. J. Respir. Crit. Care Med. 155: Albert, R Is pulmonary rehabilitation an effective treatment for chronic obstructive pulmonary disease? No. Am. J. Respir. Crit. Care Med. 155: Celli, B. R Pulmonary rehabilitation in patients with COPD. Am. J. Respir. Crit. Care Med. 152: Wijkstra, P., T. Van Der Mark, J. Kraan, R. Van Altena, G. Köeter, and D. Postma Long-term effects of home rehabilitation on physical performance in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 153: Casaburi, R., A. Patessio, F. Ioli, S. Zanaboni, C. F. Donner, and K. Wasserman Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am. Rev. Respir. Dis. 143: Maltais, F., A. A. Simard, C. Simard, J. Jobin, P. Desgagnes, and P. Leblanc Oxidative capacity of the skeletal muscle and lactic acid kinetics during exercise in normal subjects and in patients with COPD. Am. J. Respir. Crit. Care Med. 153: Maltais, F., P. Leblanc, C. Simard, J. Jobin, C. Bérubé, J. Bruneau, L. Carrier, and R. Belleau Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 154: Casaburi, R., J. Porszasz, M. R. Burns, R. S. Y. Chang, and C. B. Cooper Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 155: Gonzalez de Suso, J. M., G. Bernús, A. Alonso, A. Alay, A. Capdevila, J. Gili, J. A. Prat, and C. Arús Development and characterization of an ergometer to study the bioenergetics of the human quadriceps muscle by 31 P-NMR spectroscopy inside a standard NMR scanner. Magn. Reson. Med. 29: Kemp, G. J., C. H. Thompson, D. J. Taylor, L. J. Hands, B. Rajagopalan, and G. K. Radda Quantitative analysis of defects of mitochondrial oxidation during recovery from exercise. Biochem. Soc. Trans. 21:176S. 12. Thompson, C. H., G. J. Kemp, A. L. Sanderson, and G. K. Radda Skeletal muscle mitochondrial function studied by kinetic analysis of postexercise phosphocreatine resynthesis. J. Appl. Physiol. 78: Thompson, C. H., R. J. O. Davies, D. Kemp, D. J. Taylor, G. K. Radda, and B. Rajagopalan Skeletal muscle metabolism during exercise and recovery in patients with respiratory failure. Thorax 48: Van den Boogaart, A The Use of Signal Processing Algorithms to Obtain Biochemically Relevant Parameters from Magnetic Resonance Data Sets (doctoral thesis). University of London, London. 15. Golub, G. H., and V. Pereyra The differentiation of pseudoinverses and nonlinear least squares problems whose variables separate. SIAM J. Number Anal. 10: Van der Veen, J. W. C., R. de Beer, R. Luyten, and D. van Ormondt Accurate quantification of in vivo 31 P-NMR signals using the variable projection method and prior knowledge. Magn. Reson. Med. 6: Taylor, D. J., P. J. Bore, P. Stylen, D. G. Gadian, and G. K. Radda Bioenergetics of intact human muscle: a 31 P-nuclear magnetic resonance study. Mol. Biol. Med. 1: Roca, J., A. G. Agustí, A. Alonso, J. A. Barberà, R. Rodriguez-Roisin, and P. D. Wagner Effects of training on muscle O 2 transport at VO 2 max. J. Appl. Physiol. 73: Agustí, A. G., J. Roca, J. A. Barberà, J. Casademont, R. Rodriguez-Roisin, and P. D. Wagner Effect of sampling site on femoral venous blood gas values. J. Appl. Physiol. 77: Marrades, R. M., J. Roca, J. M. Campistol, O. Diaz, J. A. Barberà, J. V. Torregrosa, J. R. Masclans, A. Cobos, R. Rodriguez-Roisin, and P. D. Wagner Effects of erythropoietin on muscle O 2 transport during exercise in patients with chronic renal failure. J. Clin. Invest. 97: Marrades, R. M., J. Alonso, J. Roca, J. M. González de Suso, J. M. Campistol, J. A. Barberà, O. Diaz, J. V. Torregrosa, J. R. Masclans, R.

9 1734 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL Rodriguez-Roisin, and P. D. Wagner Cellular bioenergetics after erythropoietin therapy in chronic renal failure. J. Clin. Invest. 97: Roca, J., J. Sanchis, A. Agustí-Vidal, E. Cobo, P. Casan, J. Segarra, and R. Rodriguez-Roisin Spirometric reference values for a Mediterranean population. Bull. Eur. Physiopathol. Respir. 22: Roca, J., F. Burgos, J. A. Barberà, J. Sunyer, R. Rodriguez-Roisin, J. Castellsague, J. Sanchis, J. M. Antó, P. Casan, and J. L. Clausen Prediction equations for plethysmographic lung volumes. Respir. Med. 92: Roca, J., F. Burgos, J. Sunyer, M. Saez, S. Chinn, J. M. Antó, R. Rodriguez-Roisin, P. H. Quanjer, D. Nowak, and P. Burney Reference values for forced spirometry. Eur. Respir. J. 11: Roca, J., R. Rodriguez-Roisin, E. Cobo, F. Burgos, J. Perez, and J. L. Clausen Single-breath carbon monoxide diffusing capacity (DCLO) prediction equations for a Mediterranean population. Am. Rev. Respir. Dis. 141: Wenger, H. A., and G. Bell The interactions of intensity, frequency, and duration of exercise training in altering cardio-respiratory fitness. Sports Med. 3: Kilbon, A., L. Hartley, B. Saltin, J. Bjure, and G. Astrand Physical training in sedentary middle-aged and older men. Scand. J. Clin. Lab. Invest. 24: Wilmore, J., J. Royce, R. Girandola, F. Katch, and V. Katch Physiological alternatives resulting from a 10-week jogging program. Med. Sci. Sports 9: Hickson, R., J. Hagberg, A. Ehsani, and J. Holloszy Time course of the adaptive responses of aerobic power and heart rate to training. Med. Sci. Sports Exerc. 13: Gallagher, C. G Exercise limitation and clinical exercise testing in chronic obstructive pulmonary disease. Clin. Chest Med. 15: Wagner, P. D An integrated view of the determinants of maximum oxygen uptake. In N. Gonzalez and M. R. Fedde, editors. Oxygen Transfer from Atmosphere to Tissues. Plenum Press, New York McCully, K., K. Vanderborne, J. D. Posner, and J. S. Leigh Muscle metabolism in track athletes, using 31 P magnetic resonance spectroscopy. Can. J. Physiol. Pharmacol. 70: Astrand, P. O., and K. Rodahl Physical training. In P. O. Astrand and K. Rodahl, editors. Textbook of Work Physiology: Physiological Bases of Exercise, 3rd ed. McGraw-Hill, New York ERS Task Force Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies. Eur. Respir. J. 10: Wasserman, K., J. E. Hansen, D. Y. Sue, B. J. Whipp, and R. Casaburi Protocols for exercise testing. In K. Wasserman, editor. Principles of Exercise Testing and Interpretation, 2nd ed. Lea & Febiger, Malvern, PA

Exercise Stress Testing: Cardiovascular or Respiratory Limitation?

Exercise Stress Testing: Cardiovascular or Respiratory Limitation? Exercise Stress Testing: Cardiovascular or Respiratory Limitation? Marshall B. Dunning III, Ph.D., M.S. Professor of Medicine & Physiology Medical College of Wisconsin What is exercise? Physical activity

More information

Pulmonary Rehabilitation Focusing on Rehabilitative Exercise Prof. Richard Casaburi

Pulmonary Rehabilitation Focusing on Rehabilitative Exercise Prof. Richard Casaburi Pulmonary Rehabilitation 1 Rehabilitation Clinical Trials Center Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance, California, USA Historical perspective on rehabilitative

More information

Interval versus continuous training in patients with severe COPD: a randomized clinical trial

Interval versus continuous training in patients with severe COPD: a randomized clinical trial Eur Respir J 1999; 14: 258±263 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 0903-1936 Interval versus continuous training in patients with severe

More information

COMPARISON OF EFFECTS OF STRENGTH AND ENDURANCE TRAINING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

COMPARISON OF EFFECTS OF STRENGTH AND ENDURANCE TRAINING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE E1 Online Supplement for: COMPARISON OF EFFECTS OF STRENGTH AND ENDURANCE TRAINING IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE METHODS Subjects The study population consisted of patients with

More information

Impairment of exercise tolerance in COPD patients. Encouraged 6-min Walking Test Indicates Maximum Sustainable Exercise in COPD Patients*

Impairment of exercise tolerance in COPD patients. Encouraged 6-min Walking Test Indicates Maximum Sustainable Exercise in COPD Patients* Encouraged 6-min Walking Test Indicates Maximum Sustainable Exercise in COPD Patients* Alejandro Casas, MD; Jordi Vilaro, PT; Roberto Rabinovich, MD; Anamaria Mayer, PT; Joan Albert Barberà, MD; Robert

More information

FOLLOW-UP MEDICAL CARE OF SERVICE MEMBERS AND VETERANS CARDIOPULMONARY EXERCISE TESTING

FOLLOW-UP MEDICAL CARE OF SERVICE MEMBERS AND VETERANS CARDIOPULMONARY EXERCISE TESTING Cardiopulmonary Exercise Testing Chapter 13 FOLLOW-UP MEDICAL CARE OF SERVICE MEMBERS AND VETERANS CARDIOPULMONARY EXERCISE TESTING WILLIAM ESCHENBACHER, MD* INTRODUCTION AEROBIC METABOLISM ANAEROBIC METABOLISM

More information

Respiratory Pathophysiology Cases Linda Costanzo Ph.D.

Respiratory Pathophysiology Cases Linda Costanzo Ph.D. Respiratory Pathophysiology Cases Linda Costanzo Ph.D. I. Case of Pulmonary Fibrosis Susan was diagnosed 3 years ago with diffuse interstitial pulmonary fibrosis. She tries to continue normal activities,

More information

Exercise Rehabilitation and Chronic Obstructive Pulmonary Disease Stage

Exercise Rehabilitation and Chronic Obstructive Pulmonary Disease Stage Exercise Rehabilitation and Chronic Obstructive Pulmonary Disease Stage MICHAEL J. BERRY, W. JACK REJESKI, NORMAN E. ADAIR, and DANIEL ZACCARO Department of Health and Exercise Science, Department of Public

More information

Evidence for early Pulmonary Rehabilitation following hospitalisation for exacerbation of COPD

Evidence for early Pulmonary Rehabilitation following hospitalisation for exacerbation of COPD Centre for Inflammation Research Evidence for early Pulmonary Rehabilitation following hospitalisation for exacerbation of COPD Pulmonary Rehabilitation Clinicians Day Roberto A. Rabinovich ELEGI/Colt

More information

Ventilation-Perfusion Mismatch in Patients with Pleural Effusion Effects of Thoracentesis

Ventilation-Perfusion Mismatch in Patients with Pleural Effusion Effects of Thoracentesis Ventilation-Perfusion Mismatch in Patients with Pleural Effusion Effects of Thoracentesis ALVAR G. N. AGUSTÍ, JAUME CARDÚS, JOSEP ROCA, JOSEP M. GRAU, ANTONI XAUBET, and ROBERT RODRIGUEZ-ROISIN Serveis

More information

Key words: exercise therapy; exercise tolerance; lung diseases; obstructive; oxygen consumption; walking

Key words: exercise therapy; exercise tolerance; lung diseases; obstructive; oxygen consumption; walking Exercise Outcomes After Pulmonary Rehabilitation Depend on the Initial Mechanism of Exercise Limitation Among Non-Oxygen-Dependent COPD Patients* John F. Plankeel, MD; Barbara McMullen, RRT; and Neil R.

More information

Fitting a Single-Phase Model to the Post-Exercise Changes in Heart Rate and Oxygen Uptake

Fitting a Single-Phase Model to the Post-Exercise Changes in Heart Rate and Oxygen Uptake Fitting a Single-Phase Model to the Post-Exercise Changes in Heart Rate and Oxygen Uptake R. STUPNICKI, T. GABRYŚ, U. SZMATLAN-GABRYŚ, P. TOMASZEWSKI University of Physical Education, Warsaw, Poland Summary

More information

Exercise Respiratory system Ventilation rate matches work rate Not a limiting factor Elite athletes

Exercise Respiratory system Ventilation rate matches work rate Not a limiting factor Elite athletes Respiratory Exercise Response Chapter 11 Exercise Respiratory system Ventilation rate matches work rate Not a limiting factor Elite athletes Submaximal (

More information

"Acute cardiovascular responses to different types of exercise and in different populations"

Acute cardiovascular responses to different types of exercise and in different populations "Acute cardiovascular responses to different types of exercise and in different populations" Dott. Anna Baraldo Phd Course In Science of Physical Exercise and Human Movement - 24 Department of Neurological

More information

UNIVERSITY OF BOLTON SCHOOL OF SPORT AND BIOMEDICAL SCIENCES SPORT PATHWAYS WITH FOUNDATION YEAR SEMESTER TWO EXAMINATIONS 2015/2016

UNIVERSITY OF BOLTON SCHOOL OF SPORT AND BIOMEDICAL SCIENCES SPORT PATHWAYS WITH FOUNDATION YEAR SEMESTER TWO EXAMINATIONS 2015/2016 LH8 UNIVERSITY OF BOLTON SCHOOL OF SPORT AND BIOMEDICAL SCIENCES SPORT PATHWAYS WITH FOUNDATION YEAR SEMESTER TWO EXAMINATIONS 2015/2016 INTRODUCTION TO HUMAN PHYSIOLOGY MODULE NO: SRB3008 Date: Monday

More information

Content Display. - Introduction to Unit 4. Unit 4 - Cardiorespiratory Response to Exercise : Lesson 1. KINE xxxx Exercise Physiology

Content Display. - Introduction to Unit 4. Unit 4 - Cardiorespiratory Response to Exercise : Lesson 1. KINE xxxx Exercise Physiology Content Display Unit 4 - Cardiorespiratory Response to Exercise : Lesson KINE xxxx Exercise Physiology 5 Unit 4 - Cardiorespiratory Response to Exercise Lesson U4LP - Introduction to Unit 4 The specific

More information

Pulmonary rehabilitation in severe COPD.

Pulmonary rehabilitation in severe COPD. Pulmonary rehabilitation in severe COPD daniel.langer@faber.kuleuven.be Content Rehabilitation (how) does it work? How to train the ventilatory limited patient? Chronic Obstructive Pulmonary Disease NHLBI/WHO

More information

DIFFERENCE IN MAXIMAL OXYGEN UPTAKE (VO 2 max) DETERMINED BY INCREMENTAL AND RAMP TESTS

DIFFERENCE IN MAXIMAL OXYGEN UPTAKE (VO 2 max) DETERMINED BY INCREMENTAL AND RAMP TESTS STUDIES IN PHYSICAL CULTURE AND TOURISM Vol. 17, No. 2, 2010 MIŁOSZ CZUBA, ADAM ZAJĄC, JAROSŁAW CHOLEWA, STANISŁAW POPRZĘCKI, ROBERT ROCZNIOK The Jerzy Kukuczka Academy of Physical Education in Katowice,

More information

Unchanged Muscle Deoxygenation Heterogeneity During Bicycle Exercise After 6 Weeks of Endurance Training

Unchanged Muscle Deoxygenation Heterogeneity During Bicycle Exercise After 6 Weeks of Endurance Training Unchanged Muscle Deoxygenation Heterogeneity During Bicycle Exercise After 6 Weeks of Endurance Training Ryotaro Kime, Masatsugu Niwayama, Masako Fujioka, Kiyoshi Shiroishi, Takuya Osawa, Kousuke Shimomura,

More information

Effect of Pulmonary Rehabilitation on Quadriceps Fatiguability during Exercise

Effect of Pulmonary Rehabilitation on Quadriceps Fatiguability during Exercise Effect of Pulmonary Rehabilitation on Quadriceps Fatiguability during Exercise M. JEFFERY MADOR, THOMAS J. KUFEL, LILIBETH A. PINEDA, ANN STEINWALD, AJAY AGGARWAL, AMITA M. UPADHYAY, and MOHAMMED A. KHAN

More information

Gender Differences in Aerobic and Anaerobic Exercise. Samaria K. Cooper. Ball State University

Gender Differences in Aerobic and Anaerobic Exercise. Samaria K. Cooper. Ball State University Gender Differences in Aerobic and Anaerobic Exercise Samaria K. Cooper Ball State University School of Physical Education, Sport, and Exercise Science Advanced Physiology 493s1 Dr. Anthony D. Mahon 6 December

More information

Clinical exercise testing

Clinical exercise testing Basic principles of clinical exercise testing Clinical exercise testing This article is adapted from the on Basic principles of clinical exercise testing organised in Rome, March 2 4, 2006. Original slides,

More information

Blood Lactate Changes during Isocapnic Buffering in Sprinters and Long Distance Runners

Blood Lactate Changes during Isocapnic Buffering in Sprinters and Long Distance Runners Journal of PHYSIOLOGICAL ANTHROPOLOGY and Applied Human Science Original Blood Lactate Changes during Isocapnic Buffering in Sprinters and Long Distance Runners Kohji Hirakoba 1) and Takahiro Yunoki 2)

More information

todays practice of cardiopulmonary medicine

todays practice of cardiopulmonary medicine todays practice of cardiopulmonary medicine Concepts and Applications of Cardiopulmonary Exercise Testing* Karl T. Weber, M.D.; Joseph S. Janicki, Ph.D.; Patricia A. McElroy, M.D.; and Hanumanth K. Reddy,

More information

Pathophysiology Department

Pathophysiology Department UNIVERSITY OF MEDICINE - PLOVDIV Pathophysiology Department 15A Vasil Aprilov Blvd. Tel. +359 32 602311 Algorithm for interpretation of submaximal exercise tests in children S. Kostianev 1, B. Marinov

More information

Increased difference between slow and forced vital capacity is associated with reduced exercise tolerance in COPD patients

Increased difference between slow and forced vital capacity is associated with reduced exercise tolerance in COPD patients Yuan et al. BMC Pulmonary Medicine 2014, 14:16 RESEARCH ARTICLE Open Access Increased difference between slow and forced vital capacity is associated with reduced exercise tolerance in COPD patients Wei

More information

RELATIVE EXERCISE INTENSITY, HEART RATE, OXYGEN CONSUMPTION, AND CALORIC EXPENDITURE WHEN EXERCISING ON VARIOUS NON-IMPACT CARDIO TRAINERS

RELATIVE EXERCISE INTENSITY, HEART RATE, OXYGEN CONSUMPTION, AND CALORIC EXPENDITURE WHEN EXERCISING ON VARIOUS NON-IMPACT CARDIO TRAINERS RELATIVE EXERCISE INTENSITY, HEART RATE, OXYGEN CONSUMPTION, AND CALORIC EXPENDITURE WHEN EXERCISING ON VARIOUS NON-IMPACT CARDIO TRAINERS Kirsten Hendrickson, B.S. John P. Porcari, Ph.D. Carl Foster,

More information

Title : Adaptation to exercise

Title : Adaptation to exercise Title : Adaptation to exercise Teacher: Magdalena Gibas MD PhD Coll. Anatomicum, 6 Święcicki Street, Dept. of Physiology I. Exercise physiology 1. The acute and chronic responses to exercise depend upon

More information

E xercise limitation is a major symptom of patients with

E xercise limitation is a major symptom of patients with 853 ORIGINAL ARTICLE Proportional assist ventilation as an aid to exercise training in severe chronic obstructive pulmonary disease P Hawkins, L C Johnson, D Nikoletou, C-H Hamnegård, R Sherwood, M I Polkey,

More information

Effects of Erythropoietin on Muscle O 2 Transport during Exercise in Patients with Chronic Renal Failure

Effects of Erythropoietin on Muscle O 2 Transport during Exercise in Patients with Chronic Renal Failure Effects of Erythropoietin on Muscle O 2 Transport during Exercise in Patients with Chronic Renal Failure Ramon M. Marrades,* Josep Roca,* Josep M. Campistol,* Orlando Diaz,* Joan A. Barberà,* Josep V.

More information

Chapter 21 Training for Anaerobic and Aerobic Power

Chapter 21 Training for Anaerobic and Aerobic Power Section 06: Exercise Training to Improve Performance Chapter 21 Training for Anaerobic and Aerobic Power Chapter 22 Muscular Strength: Training Muscles to Become Stronger Chapter 23 Special Aids to Exercise

More information

Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees

Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees Journal of Rehabilitation Research and Development Vol. 38 No. 1, January/February 2001 Pages 7 11 Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees T. Chin,

More information

Effects of two types of training on pulmonary and cardiac responses to moderate exercise in patients with COPD

Effects of two types of training on pulmonary and cardiac responses to moderate exercise in patients with COPD Eur Respir J 2; 15: 126±132 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 2 European Respiratory Journal ISSN 93-1936 Effects of two types of training on pulmonary and cardiac responses

More information

MAXIMAL AEROBIC POWER (VO 2max /VO 2peak ) Application to Training and Performance

MAXIMAL AEROBIC POWER (VO 2max /VO 2peak ) Application to Training and Performance MAXIMAL AEROBIC POWER (VO 2max /VO 2peak ) Application to Training and Performance Presented by Coaching and Sports Science Division of the United States Olympic Committee Revised July 2004 MAXIMAL AEROBIC

More information

reported a considerably greater rate of blood lactate

reported a considerably greater rate of blood lactate 4 Brit J. Sports Med. - Vol. 17 No. 1, March 1983, pp. 4-45 s ~~~~~EFFECT BLOOD OFLACTATE PHYSICALDISAPPEARANCE CONDITIONING ON g AFTER SUPRAMAXIMAL EXERCISE Blanche W. EVANS, EdD and K. J. CURETON, PhD

More information

Pulmonary Rehabilitation in Chronic Lung Disease; Components and Organization. Prof. Dr. Müzeyyen Erk Cerrahpaşa Medical Faculty Chest Disease Dept.

Pulmonary Rehabilitation in Chronic Lung Disease; Components and Organization. Prof. Dr. Müzeyyen Erk Cerrahpaşa Medical Faculty Chest Disease Dept. Pulmonary Rehabilitation in Chronic Lung Disease; Components and Organization Prof. Dr. Müzeyyen Erk Cerrahpaşa Medical Faculty Chest Disease Dept. Plan Chronic Respiratory Disease Definition Factors Contributing

More information

CHAPTER THREE JOURNAL MANUSCRIPT

CHAPTER THREE JOURNAL MANUSCRIPT CHAPTER THREE JOURNAL MANUSCRIPT 13 PHYSIOLOGICAL AND METABOLIC RESPONSES TO CONSTANT-LOAD EXERCISE ON AN INCLINED STEPPER AND TREADMILL by Brian W. Rieger Dr. Shala Davis, Chairman Department of Human

More information

C hronic obstructive pulmonary disease (COPD) is an

C hronic obstructive pulmonary disease (COPD) is an 932 CHRONIC OBSTRUCTIVE PULMONARY DISEASE Adenine nucleotide loss in the skeletal muscles during exercise in chronic obstructive pulmonary disease M C Steiner, R Evans, S J Deacon, S J Singh, P Patel,

More information

THE EFFECT OF MODE AND INTENSITY ON VO 2 KINETICS IN THE SEVERE INTENSITY DOMAIN. Rhonda S. Updyke, B.S. Thesis Prepared for the Degree of

THE EFFECT OF MODE AND INTENSITY ON VO 2 KINETICS IN THE SEVERE INTENSITY DOMAIN. Rhonda S. Updyke, B.S. Thesis Prepared for the Degree of 0 1 2 THE EFFECT OF MODE AND INTENSITY ON VO 2 KINETICS IN THE SEVERE INTENSITY DOMAIN Rhonda S. Updyke, B.S. Thesis Prepared for the Degree of MASTER OF SCIENCE UNIVERSITY OF NORTH TEXAS May 2000 APPROVED:

More information

AEROBIC METABOLISM DURING EXERCISE SYNOPSIS

AEROBIC METABOLISM DURING EXERCISE SYNOPSIS SYNOPSIS This chapter begins with a description of the measurement of aerobic metabolism by direct calorimetry and spirometry and proceeds with a discussion of oxygen drift as it occurs in submaximal exercise

More information

Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies

Clinical exercise testing with reference to lung diseases: indications, standardization and interpretation strategies Eur Respir J 1997; 10: 2662 2689 DOI: 10.1183/09031936.97.10112662 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 0903-1936 ERS TASK FORCE Clinical

More information

Title. Author(s)YANO, T.; OGATA, H.; MATSUURA, R.; ARIMITSU, T.; YUN. CitationPhysiological Research, 56: Issue Date Doc URL.

Title. Author(s)YANO, T.; OGATA, H.; MATSUURA, R.; ARIMITSU, T.; YUN. CitationPhysiological Research, 56: Issue Date Doc URL. Title Comparison of Oxygen Uptake at the Onset of Decremen Author(s)YANO, T; OGATA, H; MATSUURA, R; ARIMITSU, T; YUN CitationPhysiological Research, 56: 169-174 Issue Date 27 Doc URL http://hdlhandlenet/2115/51987

More information

Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease 136 PHYSIOLOGY CASES AND PROBLEMS Case 24 Chronic Obstructive Pulmonary Disease Bernice Betweiler is a 73-year-old retired seamstress who has never been married. She worked in the alterations department

More information

Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease

Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease Eur Respir J 2002; 20: 564 569 DOI: 10.1183/09031936.02.02092001 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2002 European Respiratory Journal ISSN 0903-1936 Physiological responses to

More information

Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure. chronic obstructive pulmonary disease

Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure. chronic obstructive pulmonary disease Eur Respir J, 199, 9, 124 124 DOI: 1.1183/93193.9.9124 Printed in UK - all rights reserved Copyright ERS Journals Ltd 199 European Respiratory Journal ISSN 93-193 Noninvasive ventilatory support does not

More information

Josh Stanton and Michael Epton Respiratory Physiology Laboratory, Canterbury Respiratory Research Group Christchurch Hospital

Josh Stanton and Michael Epton Respiratory Physiology Laboratory, Canterbury Respiratory Research Group Christchurch Hospital Josh Stanton and Michael Epton Respiratory Physiology Laboratory, Canterbury Respiratory Research Group Christchurch Hospital Setting Scene Advancements in neonatal care over past 30 years has resulted

More information

Adenine Nucleotide Loss in the Skeletal Muscles During Exercise in. Chronic Obstructive Pulmonary Disease

Adenine Nucleotide Loss in the Skeletal Muscles During Exercise in. Chronic Obstructive Pulmonary Disease Thorax Online First, published on July 29, 2005 as 10.1136/thx.2004.038802 Adenine Nucleotide Loss in the Skeletal Muscles During Exercise in Chronic Obstructive Pulmonary Disease Michael C. Steiner *,

More information

Keywords: Non-invasive mechanical ventilation, Respiratory Failure, Respiratory muscles, Hypercapnia, Breathing pattern.

Keywords: Non-invasive mechanical ventilation, Respiratory Failure, Respiratory muscles, Hypercapnia, Breathing pattern. Monaldi Arch Chest Dis 2004; 61: 2, 81-85 ORIGINAL ARTICLE Inspiratory muscle workload due to dynamic intrinsic PEEP in stable COPD patients: effects of two different settings of non-invasive pressure-support

More information

Peak and submaximal physiologic responses following electrical stimulation leg cycle ergometer training

Peak and submaximal physiologic responses following electrical stimulation leg cycle ergometer training NI%, VZN, Department Veterans Affairs Journal of Rehabilitation Research and Development Vol. 32 No. 4, November 1995 Pages 361 366 Peak and submaximal physiologic responses following electrical stimulation

More information

Dyspnea is a common exercise-induced

Dyspnea is a common exercise-induced MK pg 214 Mædica - a Journal of Clinical Medicine STATE-OF-THE-ART Cardiopulmonary exercise testing in differential diagnosis of dyspnea Nora TOMA, MD; Gabriela BICESCU, MD, PhD; Raluca ENACHE, MD; Ruxandra

More information

The systems physiology of exercise

The systems physiology of exercise The systems physiology of exercise Professor Graham Kemp Department of Musculoskeletal Biology, Institute of Ageing & Chronic Disease Magnetic Resonance & Image Analysis Research Centre University of Liverpool

More information

Effect of exercise mode on oxygen uptake and blood gases in COPD patients

Effect of exercise mode on oxygen uptake and blood gases in COPD patients Respiratory Medicine (2004) 98, 656 660 Effect of exercise mode on oxygen uptake and blood gases in COPD patients C.C. Christensen a,b, *, M.S. Ryg b, A. Edvardsen a,b, O.H. Skjønsberg a a Department of

More information

PULMONARY FUNCTION TESTING. Purposes of Pulmonary Tests. General Categories of Lung Diseases. Types of PF Tests

PULMONARY FUNCTION TESTING. Purposes of Pulmonary Tests. General Categories of Lung Diseases. Types of PF Tests PULMONARY FUNCTION TESTING Wyka Chapter 13 Various AARC Clinical Practice Guidelines Purposes of Pulmonary Tests Is lung disease present? If so, is it reversible? If so, what type of lung disease is present?

More information

Exercise physiology and sports performance

Exercise physiology and sports performance Klinikum rechts der Isar Technische Universität München Exercise physiology and sports performance Axel Preßler Lehrstuhl und Poliklinik für Prävention, Rehabilitation und Sportmedizin Klinikum rechts

More information

The Work Rate Corresponding to Ventilatory Threshold During Steady-State and Ramp Exercise

The Work Rate Corresponding to Ventilatory Threshold During Steady-State and Ramp Exercise International Journal of Sports Physiology and Performance, 2006;1:222-232 2006 Human Kinetics, Inc. The Work Rate Corresponding to Ventilatory Threshold During Steady-State and Ramp Exercise Oliver Faude,

More information

CHAPTER 5: Training methods and aerobic training Practice questions - text book pages 91-92

CHAPTER 5: Training methods and aerobic training Practice questions - text book pages 91-92 QUESTIONS AND ANSWERS CHAPTER 5: Training methods and aerobic training Practice questions - text book pages 91-92 1) Mary is a 20 year old college student What is her theoretical maximum heart rate? a

More information

Acute Changes in Oxyhemoglobin Affinity EFFECTS ON OXYGEN TRANSPORT AND UTILIZATION

Acute Changes in Oxyhemoglobin Affinity EFFECTS ON OXYGEN TRANSPORT AND UTILIZATION Acute Changes in Oxyhemoglobin Affinity EFFECTS ON OXYGEN TRANSPORT AND UTILIZATION Thomas E. Riggs,, A. William Shafer, Clarence A. Guenter J Clin Invest. 1973;52(10):2660-2663. https://doi.org/10.1172/jci107459.

More information

QATs. VCE Physical Education SCHOOL-ASSESSED COURSEWORK UNIT 3 OUTCOME 2. Introduction. Quality Assessment Tasks

QATs. VCE Physical Education SCHOOL-ASSESSED COURSEWORK UNIT 3 OUTCOME 2. Introduction. Quality Assessment Tasks QATs Quality Assessment s Introduction UNIT 3 OUTCOME 2 VCE Physical Education SCHOOL-ASSESSED COURSEWORK Outcome 2 Use data collected in practical activities to analyse how the major body and energy systems

More information

The most common functional impairment in patients. Predictors of Oxygen Desaturation During Submaximal Exercise in 8,000 Patients*

The most common functional impairment in patients. Predictors of Oxygen Desaturation During Submaximal Exercise in 8,000 Patients* Predictors of Oxygen Desaturation During Submaximal Exercise in 8,000 Patients* Khaled O. Hadeli, MD; Erin M. Siegel, MS; Duane L. Sherrill, PhD; Ken C. Beck, PhD; and Paul L. Enright, MD Study objectives:

More information

Upper Body Exercise Capacity in Youth With Spina Bifida

Upper Body Exercise Capacity in Youth With Spina Bifida ADAPTED PHYSICAL ACTIVITY QUARTERLY, 1993.10.22-28 O 1993 Human Kinetics Publishers, Inc. Upper Body Exercise Capacity in Youth With Spina Bifida Kenneth Coutts, Donald McKenzie, Christine Loock, Richard

More information

Oxygen Uptake Kinetics During Exercise

Oxygen Uptake Kinetics During Exercise REVIEW ARTICLE Sports Med 1999 May; 27 (5): 313-327 0112-1642/99/0005-0313/$07.50/0 Adis International Limited. All rights reserved. Oxygen Uptake Kinetics During Exercise Fan Xu and Edward C. Rhodes School

More information

Concord Repatriation General Hospital, 2 The University of Sydney Australia

Concord Repatriation General Hospital, 2 The University of Sydney Australia Leung et al: training in people with COPD Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial

More information

Gas Exchange in the Tissues

Gas Exchange in the Tissues Gas Exchange in the Tissues As the systemic arterial blood enters capillaries throughout the body, it is separated from the interstitial fluid by only the thin capillary wall, which is highly permeable

More information

Energy sources in skeletal muscle

Energy sources in skeletal muscle Energy sources in skeletal muscle Pathway Rate Extent ATP/glucose 1. Direct phosphorylation Extremely fast Very limited - 2. Glycolisis Very fast limited 2-3 3. Oxidative phosphorylation Slow Unlimited

More information

Workshop: Pulmonary rehabilitation and NIV

Workshop: Pulmonary rehabilitation and NIV Workshop: Pulmonary rehabilitation and NIV Jean-Christian Borel INSERM U 1042, HP2 Laboratory, Université Joseph Fourier, Faculté de Médecine, Grenoble, France, AGIRadom, Research and Development department,

More information

Key words: cycle ergometer; 1-min step exercise protocol; ramp exercise protocol

Key words: cycle ergometer; 1-min step exercise protocol; ramp exercise protocol Comparison of the Peak Exercise Response Measured by the Ramp and 1-min Step Cycle Exercise Protocols in Patients With Exertional Dyspnea* Sue M. Revill, PhD; Katy E. Beck, BSc; and Mike D. L. Morgan,

More information

PFT Interpretation and Reference Values

PFT Interpretation and Reference Values PFT Interpretation and Reference Values September 21, 2018 Eric Wong Objectives Understand the components of PFT Interpretation of PFT Clinical Patterns How to choose Reference Values 3 Components Spirometry

More information

Clinical pulmonary physiology. How to report lung function tests

Clinical pulmonary physiology. How to report lung function tests Clinical pulmonary physiology or How to report lung function tests Lung function testing A brief history Why measure? What can you measure? Interpretation/ reporting Examples and case histories Exercise

More information

Key words: interval exercise; obstructive lung disease; pulmonary rehabilitation; skeletal muscle biopsy

Key words: interval exercise; obstructive lung disease; pulmonary rehabilitation; skeletal muscle biopsy Skeletal Muscle Adaptations to Interval Training in Patients With Advanced COPD* Ioannis Vogiatzis, PhD; Gerasimos Terzis, PhD; Serafeim Nanas, MD; Grigoris Stratakos, MD; Davina C. M. Simoes, PhD; Olga

More information

THE VENTILATORY RESPONSE TO HYPOXIA DURING EXERCISE IN CYANOTIC CONGENITAL HEART DISEASE

THE VENTILATORY RESPONSE TO HYPOXIA DURING EXERCISE IN CYANOTIC CONGENITAL HEART DISEASE Clinical Science and Molecular Medicine (1973) 45,99-5. THE VENTILATORY RESPONSE TO HYPOXIA DURING EXERCISE IN CYANOTIC CONGENITAL HEART DISEASE M. R. H. TAYLOR Department of Paediatrics, Institute of

More information

Critical Power Concept: Males vs. Females and the Impact of Muscle Fiber Composition

Critical Power Concept: Males vs. Females and the Impact of Muscle Fiber Composition Original Research Critical Power Concept: Males vs. Females and the Impact of Muscle Fiber Composition MICHAEL A. KANTOR 1,2, JESSICA ALBERS 1, KATELYN WEED 1, and ZACHARY O. ERICKSON *1 1 Taylor Center

More information

Testing Clinical Implications

Testing Clinical Implications Cardiopulmonary Exercise Testing Clinical Implications Dr Sahajal Dhooria Outline Basic concepts Case studies Recent advances in clinical applications of CPET Basic Concepts Exercise Any physical activity

More information

t Departments of Physiology and Anaesthesia, University of Toronto,

t Departments of Physiology and Anaesthesia, University of Toronto, J. Physiol. (1977), 272, pp. 553-561 553 With 3 text-figure Printed in Great Britain THE ENTRAINMENT OF BREATHING FREQUENCY BY EXERCISE RHYTHM BY R. R. BECHBACHE* AND J. DUFFINt * From the Department of

More information

Steven S. Saliterman, MD, FACP

Steven S. Saliterman, MD, FACP Ashley Wagner, Sochi 2014 www.gotceleb.com Steven S. Saliterman, MD, FACP Adjunct Professor Department of Biomedical Engineering, University of Minnesota http://saliterman.umn.edu/ Aerobic (Oxidative Phosphorylation)

More information

Basics of Cardiopulmonary Exercise Test Interpretation. Robert Kempainen, MD Hennepin County Medical Center

Basics of Cardiopulmonary Exercise Test Interpretation. Robert Kempainen, MD Hennepin County Medical Center Basics of Cardiopulmonary Exercise Test Interpretation Robert Kempainen, MD Hennepin County Medical Center None Conflicts of Interest Objectives Explain what normally limits exercise Summarize basic protocol

More information

A DIAGNOSTIC STUDY OF DEVELOPMENT OF ENDURANCE IN VOLLEYBALL PLAYERS BY USING TWO DIFFERENT TRAINING METHODS ALONG WITH PRANAYAMA:

A DIAGNOSTIC STUDY OF DEVELOPMENT OF ENDURANCE IN VOLLEYBALL PLAYERS BY USING TWO DIFFERENT TRAINING METHODS ALONG WITH PRANAYAMA: A DIAGNOSTIC STUDY OF DEVELOPMENT OF ENDURANCE IN VOLLEYBALL PLAYERS BY USING TWO DIFFERENT TRAINING METHODS ALONG WITH PRANAYAMA: INTRODUCTION: Training: The word Training has been a part of human language

More information

Decreased Affinity of Blood for Oxygen in Patients with Low-Output Heart Failure

Decreased Affinity of Blood for Oxygen in Patients with Low-Output Heart Failure Decreased Affinity of Blood for Oxygen in Patients with Low-Output Heart Failure By James Metcalfe, M.D., Dharam S. Dhindsa, Ph.D., Miles J. Edwards, M.D., and Athanasios Mourdjinis, M.D. ABSTRACT Oxygen

More information

CARDIO-RESPIRATORY RESPONSE TO EXERCISE IN NORMAL CHILDREN

CARDIO-RESPIRATORY RESPONSE TO EXERCISE IN NORMAL CHILDREN Clinical Science (1971) 40, 419431. CARDIORESPIRATORY RESPONSE TO EXERCISE IN NORMAL CHILDREN S. GODFREY, C. T. M. DAVIES, E. WOZNIAK AND CAROLYN A. BARNES Institute of Diseases of the Chest, London, and

More information

Effect of Training Mode on Post-Exercise Heart Rate Recovery of Trained Cyclists

Effect of Training Mode on Post-Exercise Heart Rate Recovery of Trained Cyclists Digital Commons at Loyola Marymount University and Loyola Law School Undergraduate Library Research Award ULRA Awards Effect of Training Mode on Post-Exercise Heart Rate Recovery of Trained Cyclists Kelia

More information

End-tidal pressure of CO 2 and exercise performance in healthy subjects

End-tidal pressure of CO 2 and exercise performance in healthy subjects DOI 10.1007/s00421-008-0773-z ORIGINAL ARTICLE End-tidal pressure of CO 2 and exercise performance in healthy subjects Maurizio Bussotti Æ Damiano Magrì Æ Emanuele Previtali Æ Stefania Farina Æ Anna Torri

More information

MALLEABILITY OF THE SYSTEM IN OVERCOMING LIMITATIONS: FUNCTIONAL ELEMENTS

MALLEABILITY OF THE SYSTEM IN OVERCOMING LIMITATIONS: FUNCTIONAL ELEMENTS J. exp. Biol. 115,345-354 (1985) 345 Printed in Great Britain The Company of Biologists Limited 1985 MALLEABILITY OF THE SYSTEM IN OVERCOMING LIMITATIONS: FUNCTIONAL ELEMENTS BYB. SALTIN August Krogh Institute,

More information

Effect of different intensities of aerobic training on vital capacity of middle aged obese men

Effect of different intensities of aerobic training on vital capacity of middle aged obese men ISSN: 2347-3215 Volume 2 Number 8 (August-2014) pp. 85-90 www.ijcrar.com Effect of different intensities of aerobic training on vital capacity of middle aged obese men M.Muralikrishna and P.V. Shelvam*

More information

Endurance ability characteristics of professional sportsmen

Endurance ability characteristics of professional sportsmen Proceeding 6th INSHS International Christmas Sport Scientific Conference, 11-14 December 2011. International Network of Sport and Health Science. Szombathely, Hungary Endurance ability characteristics

More information

CHAPTER 2: Energy systems part two

CHAPTER 2: Energy systems part two CHAPTER 2: Energy systems part two Practice questions - text book pages 35-37 1) Which one of the following is defined as the greatest amount of oxygen the body can take in and use during exercise? a V

More information

The Truth About Cardio Programming By Paul Robbins Date Released : 18 Jul 2001

The Truth About Cardio Programming By Paul Robbins Date Released : 18 Jul 2001 Page 1 of 5 close The Truth About Cardio Programming By Paul Robbins Date Released : 18 Jul 2001 There are three main components of an effective weight loss program: Proper diet, effective weight training

More information

CHAPTER 2 FATIGUE AND RECOVERY

CHAPTER 2 FATIGUE AND RECOVERY SECTION A CHAPTER 2 FATIGUE AND RECOVERY 188 CHAPTER 2 FATIGUE AND RECOVERY Fatigue Effects of fatigue on performance Performance can be affected by muscle fatigue, the depletion of energy stores in muscle

More information

Thorax Online First, published on December 8, 2009 as /thx

Thorax Online First, published on December 8, 2009 as /thx Thorax Online First, published on December 8, 2009 as 10.1136/thx.2009.123000 Interval versus continuous training in individuals with COPD - a systematic review Marla K. Beauchamp, 1,2 Thomas E. Dolmage,

More information

University of Groningen. Physical activity and fitness in patients with COPD Altenburg, Wytske Agatha

University of Groningen. Physical activity and fitness in patients with COPD Altenburg, Wytske Agatha University of Groningen Physical activity and fitness in patients with COPD Altenburg, Wytske Agatha DOI: 10.1016/j.rmed.2014.10.020 10.1016/j.rmed.2011.11.008 10.1016/j.rmed.2013.06.002 IMPORTANT NOTE:

More information

OGA, KOICHI NISHIMURA, MITSUHIRO TSUKINO, TAKASHI HAJIRO, AKIHIKO IKEDA,

OGA, KOICHI NISHIMURA, MITSUHIRO TSUKINO, TAKASHI HAJIRO, AKIHIKO IKEDA, The Effects of Oxitropium Bromide on Exercise Performance in Patients with Stable Chronic Obstructive Pulmonary Disease A Comparison of Three Different Exercise Tests TORU OGA, KOICHI NISHIMURA, MITSUHIRO

More information

Cardiopulmonary Exercise Testing Cases

Cardiopulmonary Exercise Testing Cases Canadian Respiratory Conference - 217 Cardiopulmonary Exercise Testing Cases Darcy D Marciniuk, MD FRCPC FCCP Associate Vice-President Research, University of Saskatchewan Professor, Respirology, Critical

More information

Carbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water

Carbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water Module H: Carbon Dioxide Transport Beachey Ch 9 & 10 Egan pp. 244-246, 281-284 Carbon Dioxide Transport At the end of today s session you will be able to : Describe the relationship free hydrogen ions

More information

THIS MATERIAL IS A SUPPLEMENTAL TOOL. IT IS NOT INTENDED TO REPLACE INFORMATION PROVIDED IN YOUR TEXT AND/OR STUDENT HAND-BOOKS

THIS MATERIAL IS A SUPPLEMENTAL TOOL. IT IS NOT INTENDED TO REPLACE INFORMATION PROVIDED IN YOUR TEXT AND/OR STUDENT HAND-BOOKS THIS MATERIAL IS A SUPPLEMENTAL TOOL. IT IS NOT INTENDED TO REPLACE INFORMATION PROVIDED IN YOUR TEXT AND/OR STUDENT HAND-BOOKS. REVIEW CHAPTERS 8, 9, 10, and 12 OF TEXT BOOK Homework Review; Lab 1 Review

More information

E ndurance training has been shown to reduce ventilatory

E ndurance training has been shown to reduce ventilatory 126 CHRONIC OBSTRUCTIVE PULMONARY DISEASE Continuous and intermittent exercise responses in individuals with chronic obstructive pulmonary disease S Sabapathy, R A Kingsley, D A Schneider, L Adams, N R

More information

Evaluation of a method for assessing respiratory mechanics during noninvasive ventilation

Evaluation of a method for assessing respiratory mechanics during noninvasive ventilation Eur Respir J 2; 16: 7±79 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 2 European Respiratory Journal ISSN 93-1936 Evaluation of a method for assessing respiratory mechanics during noninvasive

More information

Aerobic Conditioning in Mild Asthma Decreases the Hyperpnea of Exercise and Improves Exercise and Ventilatory Capacity*

Aerobic Conditioning in Mild Asthma Decreases the Hyperpnea of Exercise and Improves Exercise and Ventilatory Capacity* preliminary report Aerobic Conditioning in Mild Asthma Decreases the Hyperpnea of Exercise and Improves Exercise and Ventilatory Capacity* Teal S. Hallstrand, MD; Peter W. Bates, MD, FCCP; and Robert B.

More information

Paula Radcliffe is an English marathon runner

Paula Radcliffe is an English marathon runner EXCLUSIVE ACE SPONSORED RESEARCH Validity of the Talk Test in Identifying the Respiratory Compensation Threshold By Maria L. Cress, M.S., John P. Porcari, Ph.D., Carl Foster, Ph.D., Pedro Recalde, M.S.,

More information

(Astrand and Saltin 1961, Balke 1963, Cooper 1968,

(Astrand and Saltin 1961, Balke 1963, Cooper 1968, 24 Brit.J.Sports Med.: 1979, 13, 24-28 A STUDY OF MAXIMUM OXYGEN UPTAKE AND HEART RATE DURING WORK AND RECOVERY AS MEASURED ON CYCLE ERGOMETER ON NATIONAL INDIAN SPORTSMEN S. K. VERMA,1 MSc, L. S. SIDHU,2

More information

Strategies of muscle training in very severe COPD patients

Strategies of muscle training in very severe COPD patients Eur Respir J 2011; 38: 971 975 DOI: 10.1183/09031936.00075011 CopyrightßERS 2011 SERIES: NOVELTIES IN PULMONARY REHABILITATION Edited by E. Clini and N. Ambrosino Number 2 in this Series Strategies of

More information

Ventilatory Anaerobic Threshold and Improves

Ventilatory Anaerobic Threshold and Improves 324 Exercise Training in Patients With Chronic Heart Failure Delays Ventilatory Anaerobic Threshold and Improves Submaximal Exercise Performance Martin J. Sullivan, MD, Michael B. Higginbotham, MB, and

More information

Lung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects

Lung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects Lung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects Use of GOLD and ATS Criteria Connie Paladenech, RRT, RCP, FAARC Benefits and Limitations of Pulmonary Function Testing Benefits

More information