scholarly journals Metabolic Response to Submaximal and Maximal Exercise in People with Severe Obesity, Prediabetes, and Diabetes

Obesity Facts ◽  
2021 ◽  
pp. 1-10
Author(s):  
Francesca Battista ◽  
Anna Belligoli ◽  
Daniel Neunhaeuserer ◽  
Andrea Gasperetti ◽  
Silvia Bettini ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Maximal Exercise ◽  
Metabolic Response ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise Test ◽  
Peak Exercise ◽  
Cross Sectional ◽  
Cardiopulmonary Exercise ◽  
Significant Difference ◽  
Metabolic Inflexibility

<b><i>Introduction:</i></b> Metabolic adaptations to maximal physical exercise in people with obesity (PwO) are scarcely described. This cross-sectional study evaluates the metabolic response to exercise via the respiratory exchange ratio (RER) in PwO and different degrees of glycemic control. <b><i>Methods:</i></b> Eighty-five PwO (body mass index 46.0 [39.0–54.0] kg/m<sup>2</sup>), that is, 32 normoglycemic (Ob-N), 25 prediabetic (Ob-preDM), and 28 diabetic (Ob-T2DM) subjects and 18 healthy subjects performed an incremental, maximal cardiopulmonary exercise test. The RER was measured at rest (RERrest) and at peak exercise (RERpeak). <b><i>Results:</i></b> RERpeak was significantly higher in healthy subjects than that in PwO. Among those, RERpeak was significantly higher in Ob-N than that in Ob-preDM and Ob-T2DM (1.20 [1.15–1.27] vs. 1.18 [1.10–1.22] <i>p</i> = 0.04 and vs. 1.14 [1.10–1.18] <i>p</i> &#x3c; 0.001, respectively). Accordingly, ΔRER (RERpeak-RERrest) was lower in Ob-preDM and Ob-T2DM than that in Ob-N (0.32 [0.26–0.39] <i>p</i> = 0.04 and 0.29 [0.24–0.36] <i>p</i> &#x3c; 0.001 vs. 0.38 [0.32–0.43], respectively), while no significant difference was found in ΔRER between Ob-preDM and Ob-T2DM and not even between Ob-N and healthy subjects. Moreover, ΔRER in PwO correlated with glucose area under curve (<i>p</i> = 0.002). <b><i>Conclusions:</i></b> PwO demonstrate restricted metabolic response during maximal exercise. Particularly, those with prediabetes already show metabolic inflexibility during exercise, similarly to those with type 2 diabetes. These findings also suggest a potential role of cardiopulmonary exercise testing in detecting early metabolic alterations in PwO.

scholarly journals Investigation of dyspnea using cardiopulmonary exercise test among patients resorting to the respiratory tests

2018 ◽  
Vol 28 (3) ◽  
Author(s):  
Seyedeh Zahra Fotook Kiaee ◽  
Besharat Rahimi
Keyword(s):  
Cardiovascular Diseases ◽  
Exercise Test ◽  
Cross Sectional Study ◽  
Cardiopulmonary Exercise Test ◽  
Pulmonary Diseases ◽  
P Value ◽  
Exertional Dyspnea ◽  
Cross Sectional ◽  
Cardiopulmonary Exercise ◽  
Significant Difference

Exertional dyspnea is a common complaint among patients which may be the final result of many diseases. Few researches have been conducted concerning the role of cardiopulmonary exercise test (CPET) in assessing unexplained dyspnea. Therefore, the aim of this study was a research on unexplained dyspnea using CPET among patients resorting to respiratory test unit of hospitals. This is a cross-sectional study that performed on 100 patients. With the direct supervision of experts, CPET was conducted using ergaspirometery device. The exercise data was interpreted by a pulmonologist and the results were classified into pulmonary diseases, cardiovascular diseases, obesity, deconditioning, and undetermined groups. 100 patients including 57 men and 43 women with an average age of 42 years and an average BMI of 28 and smoking frequency of 12% took part in this research. The following frequencies were reported for each complication: 24% for pulmonary diseases, 23% for cardiovascular diseases, 23% for deconditioning group, 15% for obesity, and 16% for the undetermined group. No significant difference was observed between these five groups in terms of gender distribution and smoking cigarette (P-value>0.05). In the age group older than 42 years, more patients were diagnosed with cardiac diseases and obesity. CPET may be really useful in determining the cause of unexplained dyspnea among most patients. Furthermore, the CPET can determine the presence or absence of disease, and if present, the nature of the limitation.

scholarly journals Exercise Limitation in Children and Adolescents With Severe Refractory Asthma: A Lack of Asthma Control?

2021 ◽  
Vol 11 ◽  
Author(s):  
Rita C. Faleiro ◽  
Eliane V. Mancuzo ◽  
Fernanda C. Lanza ◽  
Mônica V. N. P. Queiroz ◽  
Luciano F. L. de Oliveira ◽  
...  
Keyword(s):  
Asthma Control ◽  
Cardiopulmonary Exercise Testing ◽  
Forced Expiratory Volume ◽  
Peak Exercise ◽  
Cross Sectional ◽  
Exercise Limitation ◽  
Significant Difference ◽  
Exercise Induced ◽  
Physical Deconditioning ◽  
Refractory Asthma

BackgroundPatients with severe refractory asthma (SRA), even when using high doses of multiple controller medications in a regular and appropriate way, can have persistent complaints of exercise limitation.MethodsThis was a cross-sectional study involving patients with SRA (treated with ≥ 800 μg of budesonide or equivalent, with ≥ 80% adherence, appropriate inhaler technique, and comorbidities treated), who presented no signs of a lack of asthma control other than exercise limitation. We also evaluated healthy controls, matched to the patients for sex, age, and body mass index. All participants underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer, maximum exertion being defined as ≥ 85% of the predicted heart rate, with a respiratory exchange ratio ≥ 1.0 for children and ≥ 1.1 for adolescents. Physical deconditioning was defined as oxygen uptake (VO2) &lt; 80% of predicted at peak exercise, without cardiac impairment or ventilatory limitation. Exercise-induced bronchoconstriction (EIB) was defined as a forced expiratory volume in one second ≥ 10% lower than the baseline value at 5, 10, 20, and 30 minutes after CPET.ResultsWe evaluated 20 patients with SRA and 19 controls. In the sample as a whole, the mean age was 12.9 ± 0.4 years. The CPET was considered maximal in all participants. In terms of the peak VO2 (VO2peak), there was no significant difference between the patients and controls, (P = 0.10). Among the patients, we observed isolated EIB in 30%, isolated physical deconditioning in 25%, physical deconditioning accompanied by EIB in 25%, and exercise-induced symptoms not supported by the CPET data in 15%.Conclusion and Clinical RelevancePhysical deconditioning, alone or accompanied by EIB, was the determining factor in reducing exercise tolerance in patients with SRA and was not therefore found to be associated with a lack of asthma control.

scholarly journals Validity of Maximal Exercise Testing in People With Multiple Sclerosis and Low to Moderate Levels of Disability

2014 ◽  
Vol 94 (8) ◽  
pp. 1168-1175 ◽  
Author(s):  
Martin Heine ◽  
Erwin L.J. Hoogervorst ◽  
Hub G.A. Hacking ◽  
Olaf Verschuren ◽  
Gert Kwakkel
Keyword(s):  
Heart Rate ◽  
Exercise Testing ◽  
Maximal Exercise ◽  
Cardiopulmonary Exercise Testing ◽  
Maximal Heart Rate ◽  
Expanded Disability Status Scale ◽  
Cross Sectional ◽  
Cardiopulmonary Exercise ◽  
Disability Status ◽  
Scale Scores

Background Cardiopulmonary exercise testing can be considered the gold standard for assessing cardiorespiratory fitness. Little is known about the criteria for maximal exercise testing in people with multiple sclerosis (MS) and how these criteria behave across different levels of neurological disability. Objective The study objectives were to determine the criteria for maximal exercise testing across various levels of disability and to assess concomitant subgroup differences in measures related to the participant, disease, and function. Design This was a cross-sectional study. Methods Cardiopulmonary exercise testing was conducted with a sample of 56 participants with MS. Analysis of variance was used to assess the criteria in participants with MS and low, mild, and moderate levels of disability. Results Mean peak oxygen consumption (V̇o2peak) was 21.4 (SD=7.1) mL·kg−1·min−1. An oxygen consumption (V̇o2) plateau was seen in 37.5% of participants. A respiratory exchange ratio of 1.10 or greater was achieved by 69.6% of the participants, a maximal heart rate within 90% of their age-predicted maximal heart rate was achieved by 48.2% of the participants, and 23.2% of the participants perceived their exertion to be 18 or greater on the Borg Scale of Perceived Exertion (scores of 6–20). The values for achieved heart rate and incidence of a V̇o2 plateau were significantly lower in participants with moderate levels of disability than in those with mild levels of disability. Limitations The primary limitations of this study were its cross-sectional nature and relatively small sample of participants with moderate levels of disability. Conclusion The findings suggest that the outcome of cardiopulmonary exercise testing in people with MS and low to mild levels of disability (Expanded Disability Status Scale scores of ≤4.0) is a valid measure of cardiorespiratory fitness, whereas the outcome in people with moderate levels of disability (Expanded Disability Status Scale scores of &gt;4.0) is most likely symptom limited.

Feasibility and safety of cardiopulmonary exercise testing in children with pulmonary hypertension

2015 ◽  
Vol 26 (6) ◽  
pp. 1144-1150 ◽  
Author(s):  
Mohammad R. Abumehdi ◽  
Andrew J. Wardle ◽  
Rewa Nazzal ◽  
Athanasios Charalampopoulos ◽  
Ingram Schulze-Neick ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Cardiopulmonary Exercise Test ◽  
World Health ◽  
Peak Exercise ◽  
Exercise Tests ◽  
Cardiopulmonary Exercise ◽  
Patient Reported

AbstractBackgroundCardiopulmonary exercise testing helps prognosticate and guide treatment in adults with pulmonary hypertension. Concerns regarding its feasibility and safety limit its use in children with pulmonary hypertension. We aimed to assess the feasibility and safety of cardiopulmonary exercise testing in a large paediatric pulmonary hypertension cohort.MethodsWe reviewed all consecutive cardiopulmonary exercise tests performed between March, 2004 and November, 2013. The exclusion criteria were as follows: height <120 cm, World Health Organization class IV, history of exercise-induced syncope, or significant ischaemia/arrhythmias. Significant events recorded were as follows: patient-reported symptoms, arrhythmias, electrocardiogram abnormalities, and abnormal responses of arterial O2 saturation.ResultsA total of 98 children underwent 167 cardiopulmonary exercise tests. The median age was 14 years (inter-quartile range 10–15 years). Peak oxygen uptake was 20.4±7.3 ml/kg/minute, corresponding to 51.8±18.3% of the predicted value. Peak respiratory quotient was 1.08±0.16. All the tests except two were maximal, being terminated prematurely for clinical reasons. Baseline Oxygen saturation was 93.3±8.8% and was 81.2±19.5% at peak exercise. A drop in arterial O2 saturation >20% was observed in 23.5% of the patients. Moreover, five patients (3.0%) experienced dizziness, one requiring termination of cardiopulmonary exercise testing; five children (3.0%) experienced chest pain, with early cardiopulmonary exercise test termination in one patient. No significant arrhythmias or electrocardiogram changes were observed.ConclusionExercise testing in non-severely symptomatic children with pulmonary hypertension is safe and practical, and can be performed in a large number of children with pulmonary hypertension in a controlled environment with an experienced team. Side-effects were not serious and were resolved promptly with test termination.

Cardiopulmonary Exercise Testing in Combined Pulmonary Fibrosis and Emphysema

Respiration ◽  
2021 ◽  
pp. 369-377
Author(s):  
Michael Westhoff ◽  
Patric Litterst ◽  
Ralf Ewert
Keyword(s):  
Body Weight ◽  
Pulmonary Fibrosis ◽  
Sensitivity And Specificity ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Arterial Oxygen ◽  
Peak Exercise ◽  
Cutoff Value ◽  
Cardiopulmonary Exercise ◽  
Peak Vo2

Background: Combined pulmonary fibrosis and emphysema (CPFE) is a distinct entity among fibrosing lung diseases with a high risk for lung cancer and pulmonary hypertension (PH). Notably, concomitant PH was identified as a negative prognostic indicator that could help with early diagnosis to provide important information regarding prognosis. Objectives: The current study aimed to determine whether cardiopulmonary exercise testing (CPET) can be helpful in differentiating patients having CPFE with and without PH. Methods: Patients diagnosed with CPFE in 2 German cities (Hemer and Greifswald) over a period of 10 years were included herein. CPET parameters, such as peak oxygen uptake (peak VO2), functional dead space ventilation (VDf/VT), alveolar-arterial oxygen difference (AaDO2), arterial-end-tidal CO2 difference [P(a-ET)CO2] at peak exercise, and the minute ventilation-carbon dioxide production relationship (VE/VCO2 slope), were compared between patients with and without PH. Results: A total of 41 patients with CPET (22 with PH, 19 without PH) were analyzed. Right heart catheterization was performed in 15 of 41 patients without clinically relevant complications. Significant differences in peak VO2 (861 ± 190 vs. 1,397 ± 439 mL), VO2/kg body weight/min (10.8 ± 2.6 vs. 17.4 ± 5.2 mL), peak AaDO2 (72.3 ± 7.3 vs. 46.3 ± 14.2 mm Hg), VE/VCO2 slope (70.1 ± 31.5 vs. 39.6 ± 9.6), and peak P(a-ET)tCO2 (13.9 ± 3.5 vs. 8.1 ± 3.6 mm Hg) were observed between patients with and without PH (p < 0.001). Patients with PH had significantly higher VDf/VT at rest, VT1, and at peak exercise (65.6 ± 16.8% vs. 47.2 ± 11.6%; p < 0.001) than those without PH. A cutoff value of 44 for VE/VCO2 slope had a sensitivity and specificity of 94.7 and 72.7%, while a cutoff value of 11 mm Hg for P(a-ET)CO2 in combination with peak AaDO2 >60 mm Hg had a specificity and sensitivity of 95.5 and 84.2%, respectively. Combining peak AaDO2 >60 mm Hg with peak VO2/body weight/min <16.5 mL/kg/min provided a sensitivity and specificity of 100 and 95.5%, respectively. Conclusion: This study provided initial data on CPET among patients having CPFE with and without PH. CPET can help noninvasively detect PH and identify patients at risk. AaDO2 at peak exercise, VE/VCO2 slope, peak P(a-ET)CO2, and peak VO2 were parameters that had high sensitivity and, when combined, high specificity.

scholarly journals Skeletal muscle is associated with exercise tolerance evaluated by cardiopulmonary exercise testing in Japanese patients with chronic obstructive pulmonary disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hiroki Tashiro ◽  
Koichiro Takahashi ◽  
Masahide Tanaka ◽  
Hironori Sadamatsu ◽  
Yuki Kurihara ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Skeletal Muscle ◽  
Exercise Tolerance ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Exercise ◽  
Chronic Obstructive ◽  
Clinical Parameters ◽  
Obstructive Pulmonary Disease ◽  
Cardiopulmonary Exercise ◽  
Copd Assessment Test

AbstractDecreasing exercise tolerance is one of the key features related to a poor prognosis in patients with chronic obstructive pulmonary disease (COPD). Cardiopulmonary exercise testing (CPET) is useful for evaluating exercise tolerance. The present study was performed to clarify the correlation between exercise tolerance and clinical parameters, focusing especially on the cross-sectional area (CSA) of skeletal muscle. The present study investigated 69 patients with COPD who underwent CPET. The correlations between oxygen uptake ($${{\dot{\text{V}} \text{O}}}_{2}$$ V ˙ O 2 ) at peak exercise and clinical parameters of COPD, including skeletal muscle area measured using single-section axial computed tomography (CT), were evaluated. The COPD assessment test score (ρ = − 0.35, p = 0.02) was weakly correlated with $${{\dot{\text{V}} \text{O}}}_{2}$$ V ˙ O 2 at peak exercise. In addition, forced expiratory volume in one second (FEV1) (ρ = 0.39, p = 0.0009), FEV1/forced vital capacity (ρ = 0.33, p = 0.006), and the CSA of the pectoralis muscles (PMs) (ρ = 0.36, p = 0.007) and erector spinae muscles (ECMs) (ρ = 0.39, p = 0.003) were correlated with $${{\dot{\text{V}} \text{O}}}_{2}$$ V ˙ O 2 at peak exercise. Multivariate analysis adjusted by age and FEV1 indicated that PMCSA was weakly correlated after adjustment (β value [95% confidence interval] 0.175 [0.03–0.319], p = 0.02). In addition, ECMCSA tended to be correlated, but not significantly after adjustment (0.192 [− 0.001–0.385] p = 0.052). The COPD assessment test, FEV1, FEV1/FVC, PMCSA, and ECMCSA were significantly correlated with $${{\dot{\text{V}} \text{O}}}_{2}$$ V ˙ O 2 at peak exercise.

Abstract 13745: Severity of Functional Mitral Regurgitation During Maximal Exercise Testing in Heart Failure: Additional Value of Combining Echocardiography with Cardiopulmonary Exercise Testing

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Greta Generati ◽  
Francesco Bandera ◽  
Marta Pellegrino ◽  
Valentina Labate ◽  
Eleonora Alfonzetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Functional Mitral Regurgitation ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Hemodynamic ◽  
Increased Risk

Background: In heart failure (HF) patients the severity of mitral regurgitation (MR) at rest has a well established prognostic value and its increase during exercise further adds to an increased risk. Our goal was to define the relationship between the degree of exercise MR severity with cardiopulmonary and echocardiographic related phenotypes in a cohort of HF patients. Methods: 71 HF reduced ejection fraction patients (mean age 67±11; male 72%; ischemic etiology 61%; NYHA class I, II, III and IV 13%, 36%, 39% and 12%, mean ejection fraction 33±9%) underwent cardiopulmonary exercise test (CPET) on tiltable cycle-ergometer combined with echocardiography at rest and during exercise. The population was divided into two groups according to the degree of functional peak MR: no to mild/moderate MR (no MR, MR1+ and MR2+) vs moderate/severe MR (MR3+ and MR4+). Results: A good correlation (ρ coefficient= 0.49) was found between the degree of dynamic MR and PASP at peak exercise. Despite similar echocardiographic profile at rest patients with significant peak MR (MR≥3+) had worse exercise performance (lower peak VO2, O2 pulse and workload) and impaired ventilatory efficiency (higher VE/VCO2 slope). Conclusions: In HF patients the severity of exercise-induced MR is associated with the most unfavorable performance and pulmonary hemodynamic response. A combined approach with CPET and echocardiographic assessment can help to early unmask and target functional MR and its related unfavorable phenotypes.

scholarly journals Cardiopulmonary exercise testing as a predictor of complications in oesophagogastric cancer surgery

2013 ◽  
Vol 95 (2) ◽  
pp. 125-130 ◽  
Author(s):  
LH Moyes ◽  
CJ McCaffer ◽  
RC Carter ◽  
GM Fullarton ◽  
CK Mackay ◽  
...  
Keyword(s):  
High Risk ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Major Surgery ◽  
Peak Exercise ◽  
Icu Admission ◽  
Cardiopulmonary Exercise ◽  
High Dependency ◽  
Cardiopulmonary Complications ◽  
Oesophagogastric Cancer

Introduction An anaerobic threshold (AT) of <11ml/min/kg can identify patients at high risk of cardiopulmonary complications after major surgery. The aim of this study was to assess the value of cardiopulmonary exercise testing (CPET) in predicting cardiopulmonary complications in high risk patients undergoing oesophagogastric cancer resection. Methods Between March 2008 and October 2010, 108 patients (83 men, 25 women) with a median age of 66 years (range: 38–84 years) underwent CPET before potentially curative resections for oesophagogastric cancers. Measured CPET variables included AT and maximum oxygen uptake at peak exercise (VO2 peak). Outcome measures were length of high dependency unit stay, length of hospital stay, unplanned intensive care unit (ICU) admission, and postoperative morbidity and mortality. Results The mean AT and VO2 peak were 10.8ml/min/kg (standard deviation [SD]: 2.8ml/min/kg, range: 4.6–19.3ml/min/kg) and 15.2ml/min/kg (SD: 5.3ml/min/kg, range: 5.4–33.3ml/min/kg) respectively; 57 patients (55%) had an AT of <11ml/min/ kg and 26 (12%) had an AT of <9ml/min/kg. Postoperative complications occurred in 57 patients (29 cardiopulmonary [28%] and 28 non-cardiopulmonary [27%]). Four patients (4%) died in hospital and 21 (20%) required an unplanned ICU admission. Cardiopulmonary complications occurred in 42% of patients with an AT of <9ml/min/kg compared with 29% of patients with an AT of ≥9ml/min/kg but <11ml/min/kg and 20% of patients with an AT of ≥11ml/min/kg (p=0.04). There was a trend that those with an AT of <11ml/min/kg and a low VO2 peak had a higher rate of unplanned ICU admission. Conclusions This study has shown a correlation between AT and the development of cardiopulmonary complications although the discriminatory ability was low.

scholarly journals Ventilatory compensation during the incremental exercise test is inversely correlated with air trapping in COPD

F1000Research ◽  
2020 ◽  
Vol 8 ◽  
pp. 1661
Author(s):  
Rottem Kuint ◽  
Neville Berkman ◽  
Samir Nusair
Keyword(s):  
Gas Exchange ◽  
Exercise Testing ◽  
Exercise Test ◽  
Cardiopulmonary Exercise Testing ◽  
Incremental Exercise ◽  
Peak Exercise ◽  
Air Trapping ◽  
Incremental Exercise Test ◽  
Cardiopulmonary Exercise ◽  
Copd Patients

Background: Air trapping and gas exchange abnormalities are major causes of exercise limitation in chronic obstructive pulmonary disease (COPD). During incremental cardiopulmonary exercise testing, actual nadir values of ventilatory equivalents for carbon dioxide (V E/VCO 2) and oxygen (V E/VO 2) may be difficult to identify in COPD patients because of limited ventilatory compensation capacity. Therefore, we aimed in this exploratory study to detect a possible correlation between the magnitude of ventilation augmentation, as manifested by increments in ventilatory equivalents from nadir to peak exercise values and air trapping, detected with static testing.    Methods: In this observational study, we studied data obtained previously from 20 COPD patients who, during routine follow-up, underwent a symptom-limited incremental exercise test and in whom a plethysmography was obtained concurrently. Air trapping at rest was assessed by measurement of the residual volume (RV) to total lung capacity (TLC) ratio (RV/TLC). Gas exchange data collected during the symptom-limited incremental cardiopulmonary exercise test allowed determination of the nadir and peak exercise values of V E/VCO 2 and V E/VO 2, thus enabling calculation of the difference between peak exrcise value and nadir values of  V E/VCO 2 and V E/VO 2, designated ΔV E/VCO 2 and ΔV E/VO 2, respectively. Results: We found a statistically significant inverse correlation between both ΔV E/VCO 2 (r = -0. 5058, 95% CI -0.7750 to -0.08149, p = 0.0234) and ΔV E/VO 2 (r = -0.5588, 95% CI -0.8029 to -0.1545, p = 0.0104) and the degree of air trapping (RV/TLC). There was no correlation between ΔV E/VCO 2 and forced expiratory volume in the first second, or body mass index.  Conclusions: The ventilatory equivalents increment to compensate for acidosis during incremental exercise testing was inversely correlated with air trapping (RV/TLC).

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