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European Respiratory Review : An... Jun 2023Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations.... (Review)
Review
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Lung; Exercise Therapy; Exercise; Exercise Tolerance
PubMed: 37286219
DOI: 10.1183/16000617.0222-2022 -
Sports Medicine (Auckland, N.Z.) May 2014Dietary nitrate is growing in popularity as a sports nutrition supplement. This article reviews the evidence base for the potential of inorganic nitrate to enhance... (Review)
Review
Dietary nitrate is growing in popularity as a sports nutrition supplement. This article reviews the evidence base for the potential of inorganic nitrate to enhance sports and exercise performance. Inorganic nitrate is present in numerous foodstuffs and is abundant in green leafy vegetables and beetroot. Following ingestion, nitrate is converted in the body to nitrite and stored and circulated in the blood. In conditions of low oxygen availability, nitrite can be converted into nitric oxide, which is known to play a number of important roles in vascular and metabolic control. Dietary nitrate supplementation increases plasma nitrite concentration and reduces resting blood pressure. Intriguingly, nitrate supplementation also reduces the oxygen cost of submaximal exercise and can, in some circumstances, enhance exercise tolerance and performance. The mechanisms that may be responsible for these effects are reviewed and practical guidelines for safe and efficacious dietary nitrate supplementation are provided.
Topics: Athletic Performance; Dietary Supplements; Energy Metabolism; Exercise; Exercise Tolerance; Humans; Muscle, Skeletal; Nitrates; Oxygen Consumption; Sports Nutritional Physiological Phenomena
PubMed: 24791915
DOI: 10.1007/s40279-014-0149-y -
JACC. Heart Failure Aug 2016Exercise intolerance, indicated by dyspnea and fatigue during exertion, is a cardinal manifestation of heart failure (HF). Cardiopulmonary exercise testing (CPET)... (Review)
Review
Exercise intolerance, indicated by dyspnea and fatigue during exertion, is a cardinal manifestation of heart failure (HF). Cardiopulmonary exercise testing (CPET) precisely defines maximum exercise capacity through measurement of peak oxygen uptake (VO2). Peak VO2 values have a critical role in informing patient selection for advanced HF interventions such as heart transplantation and ventricular assist devices. Oxygen uptake and ventilatory patterns obtained during the submaximal portion of CPET are also valuable to recognize because of their ease of ascertainment during low-level exercise, relevance to ability to perform activities of daily living, independence from volitional effort, and strong relationship to prognosis in HF. The ability of peak VO2 and other CPET variables to be measured reproducibly and to accurately reflect HF severity is increasingly recognized and endorsed by scientific statements. Integration of CPET with invasive hemodynamic monitoring and cardiac imaging during exercise provides comprehensive characterization of multisystem reserve capacity that can inform prognosis and the need for cardiac interventions. Here, we review both practical aspects of conducting CPETs in patients with HF for clinical and research purposes as well as interpretation of gas exchange patterns across the spectrum of preclinical HF to advanced HF.
Topics: Dyspnea; Exercise Test; Exercise Tolerance; Heart Failure; Hemodynamics; Humans; Oxygen Consumption
PubMed: 27289406
DOI: 10.1016/j.jchf.2016.03.022 -
Chest Jun 2022A cardiopulmonary exercise test (CPET) is ideally suited to quantify exercise tolerance and evaluate the pathophysiological mechanism(s) of dyspnea and exercise... (Review)
Review
A cardiopulmonary exercise test (CPET) is ideally suited to quantify exercise tolerance and evaluate the pathophysiological mechanism(s) of dyspnea and exercise limitation in people with chronic respiratory disease. Although there are several statements on CPET and many outstanding resources detailing the cardiorespiratory and perceptual responses to exercise, limited information is available to support the health care provider in conducting a practical CPET evaluation. This article provides the health care provider with practical and timely information on how to use CPET data to understand dyspnea and exercise intolerance in people with chronic respiratory diseases. Information on CPET protocol, as well as how to evaluate maximal patient effort, peak rate of oxygen consumption, ventilatory demand, pulmonary gas exchange, ventilatory reserve, operating lung volumes, and exertional dyspnea, is presented. Two case examples are also described to highlight how these parameters are evaluated to provide a clinical interpretation of CPET data.
Topics: Dyspnea; Exercise Test; Exercise Tolerance; Humans; Oxygen Consumption; Respiratory Function Tests
PubMed: 35065052
DOI: 10.1016/j.chest.2022.01.021 -
Journal of Cardiac Failure Jan 2022Heart failure (HF) fundamentally reflects an inability of the heart to provide adequate blood flow to the body without incurring the cost of increased cardiac filling... (Review)
Review
Heart failure (HF) fundamentally reflects an inability of the heart to provide adequate blood flow to the body without incurring the cost of increased cardiac filling pressures. This failure occurs first during the stressed state, but progresses until hemodynamic derangements become apparent at rest. As such, the measurement and interpretation of both resting and stressed hemodynamics serve an integral role in the practice of the HF clinician. In this review, we discuss conceptual and technical best practices in the performance and interpretation of both resting and invasive exercise hemodynamic catheterization, relate important pathophysiologic concepts to clinical care, and discuss updated, evidence-based applications of hemodynamics as they pertain to the full spectrum of HF conditions.
Topics: Cardiac Catheterization; Exercise Test; Exercise Tolerance; Heart Failure; Hemodynamics; Humans; Stroke Volume
PubMed: 34389460
DOI: 10.1016/j.cardfail.2021.07.012 -
Respiratory Research Jan 2022Unexplained exertional dyspnoea or fatigue can arise from a number of underlying disorders and shows only a weak correlation with resting functional or imaging tests.... (Review)
Review
Unexplained exertional dyspnoea or fatigue can arise from a number of underlying disorders and shows only a weak correlation with resting functional or imaging tests. Noninvasive cardiopulmonary exercise testing (CPET) offers a unique, but still under-utilised and unrecognised, opportunity to study cardiopulmonary and metabolic changes simultaneously. CPET can distinguish between a normal and an abnormal exercise response and usually identifies which of multiple pathophysiological conditions alone or in combination is the leading cause of exercise intolerance. Therefore, it improves diagnostic accuracy and patient health care by directing more targeted diagnostics and facilitating treatment decisions. Consequently, CPET should be one of the early tests used to assess exercise intolerance. However, this test requires specific knowledge and there is still a major information gap for those physicians primarily interested in learning how to systematically analyse and interpret CPET findings. This article describes the underlying principles of exercise physiology and provides a practical guide to performing CPET and interpreting the results in adults.
Topics: Adult; Dyspnea; Exercise Tolerance; Humans; Practice Guidelines as Topic; Respiratory Function Tests
PubMed: 35022059
DOI: 10.1186/s12931-021-01895-6 -
International Journal of Environmental... May 2022Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous disease, with pulmonary and extrapulmonary manifestations, which leads to the need to... (Review)
Review
Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease (COPD) as Part of a Respiratory Rehabilitation Program Implementation of Mechanical Devices: A Systematic Review.
Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous disease, with pulmonary and extrapulmonary manifestations, which leads to the need to personalize the assessment and treatment of these patients. The latest updates of national and international guidelines for the management of COPD reveal the importance of respiratory rehabilitation (RR) and its role in improving symptoms, quality of life, and psychosocial sphere of patients. Within RR, the inspiratory muscle training (IMT) has received special interest, showing benefits in maximum inspiratory pressure, perception of well-being, and health status in patients with chronic heart disease, respiratory diseases, and dyspnea during exercise. The aim of this review is to assess the efficacy of IMT in COPD patients through the use of inspiratory muscle training devices, compared with respiratory rehabilitation programs without inspiratory muscle training. In the last years, many mechanical devices focused on inspiratory muscle training have been developed, some of them, such as the AirOFit PRO™, PowerBreath, or FeelBreathe, have shown clear benefits. The active search for candidate patients to undergo the RR program with inspiratory muscle training using this type of device in COPD patients represents an advance in the treatment of this disease, with direct benefits on the quality of life of the patients. In this article, we review the available evidence on IMT in these patients and describe the different devices used for it.
Topics: Breathing Exercises; Exercise Tolerance; Humans; Pulmonary Disease, Chronic Obstructive; Quality of Life; Respiratory Muscles
PubMed: 35564959
DOI: 10.3390/ijerph19095564 -
European Journal of Physical and... Feb 2015Although pursed-lip breathing (PLB) has been advocated to reduce respiratory rate and improve oxygen saturation in patients with chronic obstructive pulmonary disease... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Although pursed-lip breathing (PLB) has been advocated to reduce respiratory rate and improve oxygen saturation in patients with chronic obstructive pulmonary disease (COPD) at rest, the evidence of its effects on dynamic hyperinflation (DH) and exercise tolerance is scarce.
AIM
To evaluate the effect of PLB on exercise tolerance, breathing pattern, dynamic hyperinflation and arterial oxygenation in COPD patients during high-intensity exercise.
DESIGN
Randomized crossover study.
SETTING
Laboratory of Respiration Physiology, Federal University of Rio de Janeiro.
POPULATION
Forty stable COPD patients aged 40-75 years and with FEV1<60%.
METHODS
In a randomized order, all patients performed PLB and control breathing (CB) during constant work-rate exercise in an electrically-braked cycloergometer. Dynamic hyperinflation, oxygen saturation and breathing pattern were recorded at rest, in isotime and in peak exercise.
RESULTS
The nine patients who increased their endurance time by more than 25% during PLB (6.42 ± 2.36 vs. 10.51 ± 3.83 min; P < 0.05) were considered as the Improver sub-group. Compared to the Non-improver subgroup, these patients presented a lower expiratory peak flow - EPF (40.2 ± 8.6 vs. 53.3 ± 17.8 % predicted, P<0.05). The ROC Curve analysis of the EPF as a percentage of the predicted values (%pred) was performed to identify cut-off values that had greater sensitivity and specificity in differentiating between IMPROVER and NON-IMPROVER. We observed 61% sensitivity and 89% specificity with a 47.7% pred EPF. At isotime, PLB yielded higher inspiratory capacity (IC) and oxygen saturation (1.19 ± 0.33 to 1.35 ± 0.39 L; P < 0.05 and 93.1 ± 4.6 to 94.0 ± 4.1%; P<0.05), and lower respiratory rate than CB only in Improver. Non-improver patients showed thoracoabdominal asynchrony during PLB in isotime. At peak exercise, PLB improved the arterial oxygenation in Improver, but there were no changes in the breathing pattern in the analyzed subgroups.
CONCLUSION
In COPD patients with low PEF, pursed-lip breathing reduces dynamic hyperinflation and improves exercise tolerance, breathing pattern and arterial oxygenation at submaximal intensity exercise.
CLINICAL REHABILITATION IMPACT
This study points to a possible application of PLB in a selected group of COPD patients aiming at improving the exercise tolerance. PEF measurements can help to indicate PLB for COPD patients.
Topics: Adult; Aged; Cross-Over Studies; Exercise Test; Exercise Tolerance; Female; Humans; Male; Middle Aged; Plethysmography; Pulmonary Disease, Chronic Obstructive; Respiration; Spirometry
PubMed: 24691248
DOI: No ID Found -
Physiotherapy Research International :... Jan 2023Dyspnea, fatigue, and reduced exercise tolerance are common in post-COVID-19 patients. In these patients, rehabilitation can improve functional capacity, reduce...
Effects of continuous aerobic training associated with resistance training on maximal and submaximal exercise tolerance, fatigue, and quality of life of patients post-COVID-19.
BACKGROUND AND PURPOSE
Dyspnea, fatigue, and reduced exercise tolerance are common in post-COVID-19 patients. In these patients, rehabilitation can improve functional capacity, reduce deconditioning after a prolonged stay in the intensive care unit, and facilitate the return to work. Thus, the present study verified the effects of cardiopulmonary rehabilitation consisting of continuous aerobic and resistance training of moderate-intensity on pulmonary function, respiratory muscle strength, maximum and submaximal tolerance to exercise, fatigue, and quality of life in post-COVID-19 patients.
METHODS
Quasi-experimental study with a protocol of 12 sessions of an outpatient intervention. Adults over 18 years of age (N = 26) with a diagnosis of COVID-19 and hospital discharge at least 15 days before the first evaluation were included. Participants performed moderate-intensity continuous aerobic and resistance training twice a week. Maximal and submaximal exercise tolerance, lung function, respiratory muscle strength, fatigue and quality of life were evaluated before and after the intervention protocol.
RESULTS
Cardiopulmonary rehabilitation improved maximal exercise tolerance, with 18.62% increase in peak oxygen consumption (VO2peak) and 29.05% in time to reach VO peak. VE/VCO slope reduced 5.21% after intervention. We also observed increased submaximal exercise tolerance (increase of 70.57 m in the 6-min walk test, p = 0.001), improved quality of life, and reduced perceived fatigue after intervention.
DISCUSSION
Patients recovered from COVID-19 can develop persistent dysfunctions in almost all organ systems and present different signs and symptoms. The complexity and variability of the damage caused by this disease can make it difficult to target rehabilitation programs, making it necessary to establish specific protocols. In this work, cardiopulmonary rehabilitation improved lung function, respiratory muscle strength, maximal and submaximal exercise tolerance, fatigue and quality of life. Continuous aerobic and resistance training of moderate intensity proved to be effective in the recovery of post-COVID-19 patients.
Topics: Adult; Humans; Adolescent; Quality of Life; Exercise Tolerance; Resistance Training; COVID-19; Fatigue
PubMed: 36088642
DOI: 10.1002/pri.1972 -
Brazilian Journal of Medical and... Aug 2002Physical exercise is associated with parasympathetic withdrawal and increased sympathetic activity resulting in heart rate increase. The rate of post-exercise...
Physical exercise is associated with parasympathetic withdrawal and increased sympathetic activity resulting in heart rate increase. The rate of post-exercise cardiodeceleration is used as an index of cardiac vagal reactivation. Analysis of heart rate variability (HRV) and complexity can provide useful information about autonomic control of the cardiovascular system. The aim of the present study was to ascertain the association between heart rate decrease after exercise and HRV parameters. Heart rate was monitored in 17 healthy male subjects (mean age: 20 years) during the pre-exercise phase (25 min supine, 5 min standing), during exercise (8 min of the step test with an ascending frequency corresponding to 70% of individual maximal power output) and during the recovery phase (30 min supine). HRV analysis in the time and frequency domains and evaluation of a newly developed complexity measure - sample entropy - were performed on selected segments of heart rate time series. During recovery, heart rate decreased gradually but did not attain pre-exercise values within 30 min after exercise. On the other hand, HRV gradually increased, but did not regain rest values during the study period. Heart rate complexity was slightly reduced after exercise and attained rest values after 30-min recovery. The rate of cardiodeceleration did not correlate with pre-exercise HRV parameters, but positively correlated with HRV measures and sample entropy obtained from the early phases of recovery. In conclusion, the cardiodeceleration rate is independent of HRV measures during the rest period but it is related to early post-exercise recovery HRV measures, confirming a parasympathetic contribution to this phase.
Topics: Adult; Analysis of Variance; Entropy; Exercise; Exercise Tolerance; Heart Rate; Humans; Male; Parasympathetic Nervous System; Rest
PubMed: 12185393
DOI: 10.1590/s0100-879x2002000800018