Comparable Ventilatory Inefficiency at Maximal and Submaximal Performance in COPD vs. CHF subjects: An Innovative Approach. / Ineficiência Ventilatória Comparável no Desempenho Máximo e Submáximo em Indivíduos com DPOC e ICC: Uma Abordagem Inovadora.

BACKGROUND: Currently, excess ventilation has been grounded under the relationship between minute-ventilation/carbon dioxide output ( V ˙ E - V ˙ CO 2 ). Alternatively, a new approach for ventilatory efficiency ( η E V ˙ ) has been published. OBJECTIVE: Our main hypothesis is that comparatively low levels of η E V ˙ between chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are attainable for a similar level of maximum and submaximal aerobic performance, conversely to long-established methods ( V ˙ E - V ˙ CO 2 slope and intercept). METHODS: Both groups performed lung function tests, echocardiography, and cardiopulmonary exercise testing. The significance level adopted in the statistical analysis was 5%. Thus, nineteen COPD and nineteen CHF-eligible subjects completed the study. With the aim of contrasting full values of V ˙ E - V ˙ CO 2 and η V ˙ E for the exercise period (100%), correlations were made with smaller fractions, such as 90% and 75% of the maximum values. RESULTS: The two groups attained matched characteristics for age (62±6 vs. 59±9 yrs, p>.05), sex (10/9 vs. 14/5, p>0.05), BMI (26±4 vs. 27±3 Kg m2, p>0.05), and peak V ˙ O 2 (72±19 vs. 74±20 %pred, p>0.05), respectively. The V ˙ E - V ˙ CO 2 slope and intercept were significantly different for COPD and CHF (27.2±1.4 vs. 33.1±5.7 and 5.3±1.9 vs. 1.7±3.6, p<0.05 for both), but η V ˙ E average values were similar between-groups (10.2±3.4 vs. 10.9±2.3%, p=0.462). The correlations between 100% of the exercise period with 90% and 75% of it were stronger for η V ˙ E (r>0.850 for both). CONCLUSION: The η V ˙ E is a valuable method for comparison between cardiopulmonary diseases, with so far distinct physiopathological mechanisms, including ventilatory constraints in COPD.

FUNDAMENTO: Atualmente, o excesso de ventilação tem sido fundamentado na relação entre ventilação-minuto/produção de dióxido de carbono ( V ˙ E − V ˙ CO 2 ). Alternativamente, uma nova abordagem para eficiência ventilatória ( η E V ˙ ) tem sido publicada. OBJETIVO: Nossa hipótese principal é que níveis comparativamente baixos de η E V ˙ entre insuficiência cardíaca crônica (ICC) e doença pulmonar obstrutiva crônica (DPOC) são atingíveis para um nível semelhante de desempenho aeróbico máximo e submáximo, inversamente aos métodos estabelecidos há muito tempo (inclinação V ˙ E − V ˙ CO 2 e intercepto). MÉTODOS: Ambos os grupos realizaram testes de função pulmonar, ecocardiografia e teste de exercício cardiopulmonar. O nível de significância adotada na análise estatística foi 5%. Assim, dezenove indivíduos elegíveis para DPOC e dezenove indivíduos elegíveis para ICC completaram o estudo. Com o objetivo de contrastar valores completos de V ˙ E − V ˙ CO 2 e η E V ˙ para o período de exercício (100%), correlações foram feitas com frações menores, como 90% e 75% dos valores máximos. RESULTADOS: Os dois grupos tiveram características correspondentes para a idade (62±6 vs 59±9 anos, p>.05), sexo (10/9 vs 14/5, p>0,05), IMC (26±4 vs 27±3 Kg m2, p>0,05), e pico V ˙ O 2 (72±19 vs 74±20 % pred, p>0,05), respectivamente. A inclinação V ˙ E − V ˙ CO 2 e intercepto foram significativamente diferentes para DPOC e ICC (207,2±1,4 vs 33,1±5,7 e 5,3±1,9 vs 1,7±3,6, p<0,05 para ambas), mas os valores médios da η E V ˙ foram semelhantes entre os grupos (10,2±3,4 vs 10,9±2,3%, p=0,462). As correlações entre 100% do período do exercício com 90% e 75% dele foram mais fortes para η E V ˙ (r>0,850 para ambos). CONCLUSÃO: A η E V ˙ é um método valioso para comparação entre doenças cardiopulmonares, com mecanismos fisiopatológicos até agora distintos, incluindo restrições ventilatórias na DPOC.

Effectiveness of short sprint interval training in women with major depressive disorder: a proof-of-concept study.

Background: High-intensity intermittent training has emerged as an option for treating major depressive disorder (MDD). However, short sprint training (sSIT), an efficient HIIT modality, has not been tested yet for this purpose. The sSIT has been proven to induce the same metabolic adaptations, with the advantage of promoting lower muscle fatigue than other HIIT protocols. Methods: Seventeen adult women diagnosed with moderate/severe MDD were randomly allocated into a sSIT group (n=9) or a control condition (n=8). The sSIT group completed, over two weeks, six 6-10-min sessions which consisted of 3-12 "all out" sprints of 5 s interspersed with low-intensity recovery of 30-45 s. The week before and after the intervention, both groups were evaluated with the Hamilton Depression Rating Scale of 21-itens (HAM-D21), and for physical fitness and incidental physical activity. Results: The sSIT group exhibited significant improvements for HAM-D21 scores (24.6±8.2 vs. 16.8±10.1), maximum aerobic power (140±15 vs. 155±15 W), countermovement jump (13.0±3.4 vs. 14.9±3.1 cm), % of body fatness (32.4±4.4 vs. 29.3±3.8%), and 4-days number of steps (13,626±11,309 vs. 16,643±15,371) after the training period when compared to the control group. Conclusion: Less than 1 hour of a sSIT protocol over two weeks have demonstrated to reduce depressive symptoms, while improving aerobic fitness and body composition, and increasing incidental physical activity in a sample of women diagnosed with MDD.

A Rapid Review of Randomized Trials Assessing the Effects of High-Intensity Interval Training on Depressive Symptoms in People with Mental Illness.

OBJECTIVE: to systematically search for randomized controlled trials comparing the effects of high-intensity interval training (HIIT) protocols vs. control without exercise or other exercise protocols, in patients with mental disorders experiencing depressive symptoms, and to provide some guidance based on the current HIIT literature to improve further interventions. METHODS: we searched for relevant studies, published by 18 August 2022 on PubMed, Embase, PsycINFO and SPORTDiscus databases, that used a HIIT protocol, involving adults (≥18 years) with a diagnosis of a mental disorder, participating in a HIIT or a control condition, and assessed for depressive symptoms. RESULTS: Four studies accounting for 108 participants (n HIIT = 55; n comparison groups = 53) met the inclusion criteria. Three out of the four studies included found significant improvements of depressive symptoms after 12 days to 8 weeks of intervention. However, there were no differences to other forms of low-to-moderate continuous exercise in 2/3 studies. CONCLUSIONS: The limited evidence suggests the effectiveness of HIIT interventions for improving depressive symptoms in people with mental illness. However, HIIT was not superior to other exercise treatments, although a trend for its superiority may be recognized. A number of methodological issues should be considered in further interventions to better characterize and identify the most efficient HIIT modalities for the treatment of depressive symptoms in these patients.

Pulmonary Arterial Pressure Changes Under Dobutamine Stress Echocardiography in Non-Anemic Iron Deficient COPD Subjects.

Purpose: Non-anemic iron deficiency (NAID) is common in COPD, and could induce functional/structural changes in the pulmonary vascular bed. Thus, we aimed to study, during resting and ambient oxygen conditions, the systolic pulmonary arterial pressure (sPAP) changes during dobutamine stress echocardiography (DSE) for NAID+ compared to NAID- subjects with COPD. Patients and Methods: We analyzed 24 patients with COPD and evaluated their clinical parameters, including lung function and serum iron profile, followed by the changes in the sPAP under DSE. Results: Ten subjects with NAID+ were compared with fourteen NAID- subjects for sPAP measurement. At baseline, only left atrial volume was significantly different between groups (30±4 vs 23±5 mL*m2), respectively (p-value=0.002). For the right side, tricuspid annular plane systolic excursion (TAPSE) was similar between-groups (22±2 vs 20±4, p-value >0.05), at baseline. The sPAP (mmHg) changes were also not significantly different between groups (pre 32±14 vs peak 48±14 for NAID+ and pre 29±7 vs peak 43±10 for NAID-, Group p-value=0.400, Time p-value <0.0001, and Interaction p-value=0.606). Conclusion: COPD subjects with NAID do not show increased sPAP responses during DSE, compared with iron-replete subjects.

Moderate-intensity exercise with blood flow restriction on cardiopulmonary kinetics and efficiency during a subsequent high-intensity exercise in young women: A cross-sectional study.

ABSTRACT: Blood flow restriction (BFR) training applied prior to a subsequent exercise has been used as a method to induce changes in oxygen uptake pulmonary kinetics (O2P) and exercise performance. However, the effects of a moderate-intensity training associated with BFR on a subsequent high-intensity exercise on O2P and cardiac output (QT) kinetics, exercise tolerance, and efficiency remain unknown.This prospective physiologic study was performed at the Exercise Physiology Lab, University of Brasilia. Ten healthy females (mean ±â€ŠSD values: age = 21.3 ±â€Š2.2 years; height = 1.6 ±â€Š0.07 m, and weight = 55.6 ±â€Š8.8 kg) underwent moderate-intensity training associated with or without BFR for 6 minutes prior to a maximal high-intensity exercise bout. O2P, heart rate, and QT kinetics and gross efficiency were obtained during the high-intensity constant workload exercise test.No differences were observed in O2P, heart rate, and QT kinetics in the subsequent high-intensity exercise following BFR training. However, exercise tolerance and gross efficiency were significantly greater after BFR (220 ±â€Š45 vs 136 ±â€Š30 seconds; P < .05, and 32.8 ±â€Š6.3 vs 27.1 ±â€Š5.4%; P < .05, respectively), which also resulted in lower oxygen cost (1382 ±â€Š227 vs 1695 ±â€Š305 mL min-1).We concluded that moderate-intensity BFR training implemented prior to a high-intensity protocol did not accelerate subsequent O2P and QT kinetics, but it has the potential to improve both exercise tolerance and work efficiency at high workloads.

Ventilatory inefficiency during graded exercise in COPD: A pragmatic approach.

BACKGROUND/OBJECTIVE: The current approach to measuring ventilatory (in)efficiency (V'E -V'CO2 slope, nadir and intercept) presents critical drawbacks in the evaluation of COPD subjects, owing mainly to mechanical ventilatory constraints. Thus, we aimed to compare the current approach with a new method we have developed for ventilatory efficiency calculation. METHODS: The new procedure was based on measuring the amount of CO2 cleared by the lungs (V'CO2 , L/min) plotted against a predefined range of increase in minute ventilation (V'E ) (ten-fold increase based on semilog scale) during incremental exercise to symptom-limited maximum tolerance. This value was compared to a hypothetical predicted maximum CO2 output at the predicted maximal voluntary ventilation, defining ventilatory efficiency (ηV'E , %). The results were used to compare 30 subjects with COPD (II-IV Global Initiative for Chronic Obstructive Lung Disease, GOLD) and 10 non-COPD smokers, to establish the best discriminative physiological variable for disease severity through logistic multinomial regression. RESULTS: The new approach was more sensitive to progressive deterioration of airway obstruction, resulting in worse ηV'E as lung function worsens throughout the GOLD panel (ηV'E (%), p < .001), when compared with V'E -V'CO2 slope (p = .715) or V'E -V'CO2 nadir (p = .070), besides showing the best model based on the logistic regression approach. CONCLUSION: Although requiring more complex calculations compared to the current procedure, the new approach is highly sensitive to true ventilatory/gas-exchange deterioration, even throughout more severe pulmonary lung function in COPD subjects.

Pulmonary diffusing capacity measured by NO/CO transfer in Tunisian boys.

BACKGROUND: The diffusing capacity, which measures gas-exchange, uses reference values based on data from American or European studies. There are currently no reference values of pulmonary diffusing capacity (TL) and its components, such as the conductance of the membrane (Dm) and capillary lung volume (Vc) for healthy North African children. OBJECTIVES: We determined the prediction equations-reference values for TL, Dm, Vc and the alveolar volume (VA) in healthy Tunisian boys. METHODS: Values of Vc, Dm, TL, and VA were measured by the NO/CO transfer method, using a single breath maneuver in 118 Tunisian boys (8-14 years old) at rest. We performed linear regression analysis of the pulmonary parameters and independent variables, such as height, weight, and age. RESULTS: The reference equations for pulmonary diffusing capacity for carbon monoxide (TLCO ) was 0.201 × weight (kg) + 8.979; for TLNO was 0.76 × height (cm)-24.383; for Dm was 0.388 × height (cm)- 12.555 and for VA was 0.34 × height (cm)-3.951. Vc increased significantly with weight (P < .05) but not with age (P > .05). CONCLUSIONS: References norms for TLCO and TL for nitric oxide and its components in young Tunisian boys are similar to data from other countries. The prediction equations we developed can be extended to clinical practice in Tunisia and can be considered for use in neighboring North African countries.

Incorporating Lung Diffusing Capacity for Carbon Monoxide in Clinical Decision Making in Chest Medicine.

Lung diffusing capacity for carbon monoxide (Dlco) remains the only noninvasive pulmonary function test to provide an integrated picture of gas exchange efficiency in human lungs. Due to its critical dependence on the accessible "alveolar" volume (Va), there remains substantial misunderstanding on the interpretation of Dlco and the diffusion coefficient (Dlco/Va ratio, Kco). This article presents the physiologic and methodologic foundations of Dlco measurement. A clinically friendly approach for Dlco interpretation that takes those caveats into consideration is outlined. The clinical scenarios in which Dlco can effectively assist the chest physician are discussed and illustrative clinical cases are presented.

Left ventricular diastolic dysfunction and exertional ventilatory inefficiency in COPD.

BACKGROUND: Left ventricular diastolic dysfunction (LVDD) is highly prevalent in COPD and conflicting results have emerged regarding the consequences on exercise capacity in the 6MWT. We sought to examine the ventilatory efficiency and variability metrics as the primary endpoint and aerobic capacity (V'O2) as the secondary endpoint. METHODS: Forty subjects were included and submitted to comprehensive lung function tests, detailed pulsed-Doppler echocardiography, and cardiopulmonary exercise testing. Four subjects were excluded due to concomitant cardiac disease and two owing to COPD exacerbation. RESULTS: Seventeen COPD/LVDD+ and seventeen COPD/LVDD-individuals were closely matched for baseline characteristics. Throughout the exercise, there was no difference between-groups for primary (V'E/V'CO2slope and V'E/V'CO2nadir, p > 0.05 for both) or secondary endpoints (V'O2peak%pred, p > 0.05). Ventilatory variability remained unchanged. However, after very well age- and sex-matched subgroup analysis, five-moderate and three-mild COPD/LVDD + subjects with elevated left ventricular filling pressure (E/e'>13, n = 8), presented a downward-shifted V'E/V'CO2slope (25.7 ±â€¯5.1 vs 33.4 ±â€¯7.1, p = 0.031) and V'E/V'CO2nadir reduction (29.7 ±â€¯3.9 vs 36.3 ±â€¯7.2, p = 0.042) besides significantly better V'O2peak%pred (92.1 ±â€¯21.6% vs 75.8 ±â€¯13.1%, p = 0.045) compared to 8 COPD/LVDD-controls. Ventilatory variability remained once again unchanged. CONCLUSIONS: COPD/LVDD overlap is not associated with worse exercise tolerance and/or wasted ventilation in excess compared to controls, even when suspected for elevated left ventricular filling pressure. Further studies are warranted to study specifically if augmented pulmonary blood transit time can allow better gas-exchange, thus preserving exercise capacity under specific conditions in COPD patients without heart failure.

Neurodegenerative disorders increase decline in respiratory muscle strength in older adults.

INTRODUCTION: Respiratory muscle strength (RMS) is a determinant of vital capacity, and its decline can lead to inadequate ventilation and deficiency in the elimination of secretions from the airways. Studies analyzing RMS in older adults with Parkinson's disease (PD) and Alzheimer's disease (AD) remain scarce, making the analysis of this variable still very uncertain. The aim of this study was to analyze the RMS of older adults diagnosed with PD and AD, in relation to healthy control peers. METHODS: A cross-sectional study was conducted involving 65 older adults comprising 3 groups: PD (n = 20), AD (n = 20), and control (n = 25). The participants underwent anthropometric and cirtometric measurements associated with maximal respiratory pressures. We analyzed data using descriptive (mean and SD) and inferential statistics (1-way analysis of variance, Student t test, and Scheffé post hoc) with a level of significance of 5% (P < .05) and a CI of 95%. RESULTS: Although the anthropometric and cirtometric variables indicated similarity of values between groups (P > .05), the maximal inspiratory and expiratory pressures were considerably lower in the subjects with PD and AD (P < .01). CONCLUSIONS: The control of the anthropometric and cirtometric variables of the subjects indicates that RMS is affected by the aging process, and its decline increases in neurodegenerative conditions. This fact represents a serious risk for the development of atelectasis and other pneumo-functional complications, which must be considered in proposing of future therapies.

Hyperlactemia induction modes affect the lactate minimum power and physiological responses in cycling.

The aim of this study was to verify the influence of hyperlactemia and blood acidosis induction on lactate minimum intensity (LMI). Twenty recreationally trained males who were experienced in cycling (15 cyclists and 5 triathletes) participated in this study. The athletes underwent 3 lactate minimum tests on an electromagnetic cycle ergometer. The hyperlactemia induction methods used were graded exercise test (GXT), Wingate test (WAnT), and 2 consecutive Wingate tests (2 × WAnTs). The LMI at 2 × WAnTs (200.3 ± 25.8 W) was statistically higher than the LMI at GXT (187.3 ± 31.9 W) and WAnT (189.8 ± 26.0 W), with similar findings for blood lactate, oxygen uptake, and pulmonary ventilation at LMI. The venous pH after 2 × WAnTs was lower (7.04 ± 0.24) than in (p ≤ 0.05) the GXT (7.19 ± 0.05) and WAnT (7.19 ± 0.05), whereas the blood lactate response was higher. In addition, similar findings were observed for bicarbonate concentration [HCO3] (2 × WAnTs lower than WAnT; 15.3 ± 2.6 mmol·L and 18.2 ± 2.7 mmol·L1, respectively) (p ≤ 0.05). However, the maximal aerobic power and total time measured during the incremental phase also did not differ. Therefore, we can conclude that the induction mode significantly affects pH, blood lactate, and [HCO3] and consequently they alter the LMI and physiological parameters at LMI.