Pattern of breathing during progressive exercise in chronic heart failure.

This descriptive study analyzed serial, individual changes in the exercise pattern of breathing (POB) of patients with stable chronic heart failure (CHF). Twenty-two CHF patients underwent maximal, symptom-limited cardiopulmonary exercise test on a treadmill. Minute ventilation (VE), tidal volume (VT), breathing frequency (f), the ventilatory equivalent for carbon dioxide (VE/VCO2) and estimated dead-space to tidal volume ratio (VD/VT) were continuously recorded. The VE/VCO2 slope was calculated in every subject as the slope of the regression line relating VE to VCO2 during exercising testing. Pattern of breathing was investigated by constructing the individual VT-f relationship for each patient separately. In 16 (73%) patients (group 1), the VT-f plot was initially linear, but subsequently exhibited an inflection point at which VT stopped increasing with further increases in f. In six (27%) patients (group 2) no inflection point was evident on the VT-f relation; in four of these patients the VT-f relation remained linear but shifted to the right throughout testing, and two patients decreased VT before peak exercise achieving high breathing frequencies. Comparing group 1 to group 2 patients, they had higher VEmax (68+/-23 vs. 44+/-10 l/min, P=0.02) and VO2max (17+/-5 vs. 12+/-3 ml/min/kg, P=0.01). In contrast, the two groups did not differ in terms of age, weight, height, diagnosis, ejection fraction or VE/VCO2 slope. In conclusion, patients with CHF adopt variable breathing patterns during exercise; specific patterns are associated with greater impairment in functional capacity.

Contribution of lung function to exercise capacity in patients with chronic heart failure.

BACKGROUND: The importance of exercise capacity as an indicator of prognosis in patients with heart disease is well recognized. However, factors contributing to exercise limitation in such patients have not been fully characterized and in particular, the role of lung function in determining exercise capacity has not been extensively investigated. OBJECTIVE: To examine the extent to which pulmonary function and respiratory muscle strength indices predict exercise performance in patients with moderate to severe heart failure. METHODS: Fifty stable heart failure patients underwent a maximal symptom-limited cardiopulmonary exercise test on a treadmill to determine maximum oxygen consumption (VO2max), pulmonary function tests and maximum inspiratory (PImax) and expiratory (PEmax) pressure measurement. RESULTS: In univariate analysis, VO2max correlated with forced vital capacity (r = 0.35, p = 0.01), forced expiratory volume in 1 s (r = 0.45, p = 0.001), FEV1/FVC ratio (r = 0.37, p = 0.009), maximal midexpiratory flow rate (FEF25-75, r = 0. 47, p < 0.001), and PImax (r = 0.46, p = 0.001), but not with total lung capacity, diffusion capacity or PEmax. In stepwise linear regression analysis, FEF25-75 and PImax were shown to be independently related to VO2max, with a combined r and r2 value of 0. 56 and 0.32, respectively. CONCLUSIONS: Lung function indices overall accounted for only approximately 30% of the variance in maximum exercise capacity observed in heart failure patients. The mechanism(s) by which these variables could set exercise limitation in heart failure awaits further investigation.

Effects of severity of long-standing congestive heart failure on pulmonary function.

To investigate the effects of severity of long-standing congestive heart failure (CHF) on pulmonary function, we studied 53 (47 men) consecutive patients, all heart transplant candidates. Their mean (+/- SD) age and ejection fraction were 47 +/- 12 years and 23 +/- 7%, respectively. All patients underwent spirometry, lung volume, diffusion capacity (DLCO), maximum inspiratory (PImax) and expiratory pressure (PEmax) measurement. Maximum cardiopulmonary exercise test on a treadmill was also performed to determine maximum oxygen consumption (VO2max). On the basis of VO2max, the patients were then divided into those with a VO2max > 14 ml min-1 kg-1 (group 1, n = 30) and those with a VO2max < or = 14 ml min-1 kg-1 (group 2, n = 23). In comparison with group 1, group 2 patients had lower FEV1/FVC (70 +/- 8% vs 75 +/- 7%, P = 0.008), lower FEF25-75 (46 +/- 21 vs 70 +/- 26%pred, P < 0.001), lower TLC (76 +/- 15 vs 85 +/- 13%pred, P = 0.02) and lower PImax (68 +/- 20 vs 87 +/- 22 cmH2O, P = 0.003), but comparable DLCO (84 +/- 15 vs 88 +/- 20%pred, P = N.S.), and PEmax (99 +/- 25 vs 96 +/- 22 cmH2O, P = N.S.). In conclusion, our data suggest that respiratory abnormalities, such as restrictive defects, airway obstruction, and inspiratory muscle weakness, are more pronounced in patients with severe CHF than in those with mild-to-moderate disease. Further studies are required to investigate the extent to which these abnormalities contribute to dyspnoea during daily activities in patients with heart failure.

Influence of carbohydrate supplementation early in exercise on endurance running capacity.

The aim of this study is to examine the effect of carbohydrate (CHO) ingestion during the first hour of treadmill running on endurance capacity. Eleven male subjects ran at 70% VO2max to exhaustion on three occasions one week apart. On two occasions two CHO-electrolyte solutions (a 5.5% (E) and a 6.9% (L) were ingested for the first hour of exercise; water was ingested until exhaustion. On the third occasion water (W) was ingested throughout the run. The order testing was randomly assigned. Exhaustion times for the W, E, and L trials were 109.6 +/- 9.6 min, 124.5 +/- 8.4 min, and 121.4 +/- 9.4 min, respectively. There was no difference between the two CHO trials, but time to exhaustion was longer only for the E trial (P < 0.05), compared with the W trial. Nevertheless the average performance times for the combined results of the two CHO trials were longer than the water trial. Carbohydrate ingestion resulted in higher blood glucose concentration (P < 0.01) at 20 min in the E trail only and lower (P < 0.05) serum growth hormone and plasma FFA and glycerol concentrations at 60 min but not at exhaustion in both E and L trials compared with the W trial. Blood lactate, plasma ammonia, electrolytes, catecholamines, and serum insulin and cortisol concentrations were not different in the three trials. In conclusion, CHO ingestion during the first hour of exercise improves endurance capacity go a greater extent compared with water alone.

Carbohydrate ingestion and single muscle fiber glycogen metabolism during prolonged running in men.

The aim of this study was to examine the effect of carbohydrate (CHO) ingestion on glycogen degradation in type I and type II muscle fibers during prolonged running by using a quantitative biochemical method. To this end, eight male subjects ran at 70% maximal oxygen uptake to exhaustion on a motorized treadmill on two occasions, 1 wk apart. On each occasion, the subjects ingested 8 ml/kg body wt of either placebo (Pl) or a 5.5% CHO-electrolyte solution (CHO-E) immediately before the start of the run and 2 ml/kg body wt every 20 min thereafter. Needle biopsy samples were obtained from the vastus lateralis muscle before and after each trial and also at the time coinciding with Pl exhaustion in the CHO-E trial. Running time to exhaustion was longer (P < 0.01) in the CHO-E trial compared with the Pl trial (132.4 +/- 12.3 and 104.3 +/- 8.6 min, respectively). A 25% reduction in glycogen utilization in type I fibers only was observed in the CHO-E trial compared with the Pl trial (215.2 +/- 27.5 vs. 285.4 +/- 30.1 mmol/kg dry wt; P < 0.01). Furthermore, in the CHO-E trial, in contrast to the Pl trial, both muscle ATP and phosphocreatine concentrations were well maintained throughout exercise. Therefore, because in both the Pl and CHO-E trials the type I fibers were glycogen depleted at the point of exhaustion (31.6 +/- 10.3 and 28.1 +/- 7.1 mmol/kg dry wt, respectively), it is proposed that CHO ingestion improved endurance capacity by contributing to oxidative ATP production specifically in type I fibers and by doing so delayed the development of glycogen depletion in this fiber type.

Carbohydrate ingestion and glycogen utilization in different muscle fibre types in man.

1. The effect of carbohydrate (CHO) ingestion on muscle glycogen utilization during exercise was examined on seven male subjects completing two 60 min treadmill runs at 70% maximum oxygen uptake (VO2,max), 1 week apart. On each occasion the subjects consumed either water or a 5.5% CHO-electrolyte solution immediately before and during exercise. Muscle samples were obtained from the vastus lateralis by needle biopsy before and immediately after exercise. Venous blood samples were also collected from an ante-cubital vein at rest and at 10, 20, 40 and 60 min into the run. 2. Higher blood glucose concentrations (P < 0.01) were observed throughout the run during the CHO trial compared with the water trial. Serum insulin concentration was only higher after 20 min of exercise (P < 0.01). 3. A 28% reduction in mixed glycogen utilization was observed as a result of CHO ingestion when compared with water ingestion (108.7 +/- 16.3 vs. 150.9 +/- 19.9 mmol (kg dry matter)-1, respectively; P < 0.01). 4. The ingestion of the CHO solution resulted in sparing of glycogen in type I (slow twitch) fibres only (38 +/- 7% degradation of glycogen as opposed to 66 +/- 3% during the water trial; P = 0.01).

Influence of carbohydrate-electrolyte drinks on marathon running performance.

The aim of this study was to compare the effects of drinking two carbohydrate (CHO) electrolyte solutions and water on marathon running performance. Seven endurance-trained runners completed three 42.2-km treadmill time-trials which were randomly assigned and 4 weeks apart. On each occasion the subjects ingested 3 ml.Kg-1 body weight of either water (W), a 6.9% CHO solution (O) or a 5.5% CHO solution (L) immediately prior to the start of the run and 2 ml.kg-1 body weight every 5 km thereafter. The total volume of fluid ingested [mean (SEM)] was 1112 (42), 1116 (44) and 1100 (44) ml, respectively. Running times for W, O and L trials were 193.9 (5.0), 192.4 (3.3) and 190.0 (3.9) min, respectively. Performance time for the L trial was faster (P < 0.05) compared with that of the W trial. Running speed was maintained in the L trial, whereas it decreased after 10 km (P < 0.05) in the W and after 25 km (P < 0.05) in the O trial. Blood glucose and lactate, and hormonal responses to fluid ingestion were similar in all three trials. Higher plasma free fatty acid and glycerol concentrations were observed at the end of the W trial compared with those obtained after the O and L trials, respectively (P < 0.05). Plasma ammonia concentration was higher (P < 0.01) at the end of the L trial compared with the W trial. Plasma creatine kinase concentration was higher (P < 0.05) 24 h after the completion of the L trial than after the W trial.(ABSTRACT TRUNCATED AT 250 WORDS)