Changes in pulmonary function after long-duration adventure racing in adolescent athletes

The present study investigated the acute effects of a mixed-modality, long-duration adventure race on pulmonary function in adolescent athletes. Twenty male adolescents aged 14 to 17 years volunteered to participate in a wilderness adventure race of 68.5-km. Expiratory function was evaluated before, immediately after, and 24 h after race completion. Measurements included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF). Maximal inspiratory and expiratory mouth static pressures (MIP and MEP, respectively) were also measured using a portable hand-held mouth pressure meter across the same time points. The mean completion time of the race was 05:38 ± 00:20 hours. A significant post-race decrease in FVC was observed immediately after the race (-5.2%, p = 0.01). However, no significant changes were observed for FEV1, PEF and the FEV1/FVC and FEV1/PEF ratios. In addition, estimates of respiratory muscle strength (MIP and MEP) were unaffected by the race. The long-duration adventure race induced no marked reduction in expiratory pulmonary function and this response was associated with no apparent respiratory muscle fatigue. Therefore, the pulmonary system of trained adolescent athletes was sufficiently robust to sustain the mixed-modality, long-duration adventure race of ∽5-6 h.

Impact of wearing a surgical and cloth mask during cycle exercise

We sought to determine the impact of wearing cloth or surgical masks on the cardiopulmonary responses to moderate-intensity exercise. Twelve subjects (n=5 females) completed three, 8-min cycling trials while breathing through a: non-rebreathing valve (laboratory control), cloth, or surgical mask. Heart rate (HR), oxyhemoglobin saturation (SpO2), breathing frequency (Fb), mouth pressure, partial pressure of end-tidal carbon dioxide (PetCO2) and oxygen (PetO2), dyspnea, were measured throughout exercise. A subset of n=6 subjects completed an additional exercise bout without a mask (ecological control). There were no differences in Fb, HR or SpO2 across conditions (all p>0.05). Compared to the laboratory control (0.9±0.7cmH2O[mean±SD]), mouth pressure swings were greater with the surgical mask (4.7±0.9; p<0.0001), but similar with the cloth mask (3.6±4.8cmH2O; p=0.66). Wearing a cloth mask decreased PetO2 (-3.5±3.7mmHg) and increased PetCO2 (+2.0±1.3mmHg) relative to the ecological control (both p<0.05). There were no differences in end-tidal gases between mask conditions and laboratory control (both p>0.05). Dyspnea was similar between the control conditions and the surgical mask (p>0.05) but was greater with the cloth mask compared to laboratory (+0.9±1.2) and ecological (+1.5±1.3) control conditions (both p<0.05). Wearing a mask during short-term moderate-intensity exercise may increase dyspnea but has minimal impact on the cardiopulmonary response. Novelty bullets: • Wearing surgical or cloth masks during exercise has no impact on breathing frequency, tidal volume, oxygenation, heart rate • However, there are some changes in inspired and expired gas fractions that are physiologically irrelevant. • In young healthy individuals, wearing surgical or cloth masks during submaximal exercise has few physiological consequences.

Measuring the mechanical input impedance of the respiratory system with breath-driven flow oscillations

The technique of oscillometry for measuring the mechanical input impedance of the respiratory system is gaining traction as a clinical diagnostic tool, but the portability of existing commercially available devices is limited by the size and weight of oscillator motors and power supplies. We show that impedance can be measured by oscillations in mouth pressure and flow generated by mucus-clearing devices that are powered by the subject’s own respiratory flow. This principle might thus be employed in lightweight ambulatory oscillometry devices.

Noninvasive Assessment of Neuromechanical Coupling and Mechanical Efficiency of Parasternal Intercostal Muscle during Inspiratory Threshold Loading

This study aims to investigate noninvasive indices of neuromechanical coupling (NMC) and mechanical efficiency (MEff) of parasternal intercostal muscles. Gold standard assessment of diaphragm NMC requires using invasive techniques, limiting the utility of this procedure. Noninvasive NMC indices of parasternal intercostal muscles can be calculated using surface mechanomyography (sMMGpara) and electromyography (sEMGpara). However, the use of sMMGpara as an inspiratory muscle mechanical output measure, and the relationships between sMMGpara, sEMGpara, and simultaneous invasive and noninvasive pressure measurements have not previously been evaluated. sEMGpara, sMMGpara, and both invasive and noninvasive measurements of pressures were recorded in twelve healthy subjects during an inspiratory loading protocol. The ratios of sMMGpara to sEMGpara, which provided muscle-specific noninvasive NMC indices of parasternal intercostal muscles, showed nonsignificant changes with increasing load, since the relationships between sMMGpara and sEMGpara were linear (R2 = 0.85 (0.75–0.9)). The ratios of mouth pressure (Pmo) to sEMGpara and sMMGpara were also proposed as noninvasive indices of parasternal intercostal muscle NMC and MEff, respectively. These indices, similar to the analogous indices calculated using invasive transdiaphragmatic and esophageal pressures, showed nonsignificant changes during threshold loading, since the relationships between Pmo and both sEMGpara (R2 = 0.84 (0.77–0.93)) and sMMGpara (R2 = 0.89 (0.85–0.91)) were linear. The proposed noninvasive NMC and MEff indices of parasternal intercostal muscles may be of potential clinical value, particularly for the regular assessment of patients with disordered respiratory mechanics using noninvasive wearable and wireless devices.

Effect of Moderate- or High-Intensity Inspiratory Muscle Strength Training on Maximal Inspiratory Mouth Pressure and Swimming Performance in Highly Trained Competitive Swimmers

Purpose: Inspiratory muscle strength training (IMST) can improve exercise performance. Increased maximal inspiratory mouth pressure (MIP) could be beneficial for swimmers to enhance their performance. This study aimed to clarify the effect of high-intensity IMST for 6 weeks on MIP and swimming performance in highly trained competitive swimmers. Methods: Thirty male highly trained competitive swimmers were assigned to high-intensity IMST (HI; n = 10), moderate-intensity IMST (MOD; n = 10), and control (n = 10) groups. The 6-week IMST intervention comprised twice daily sessions for 6 d/wk at inspiratory pressure threshold loads equivalent to 75% MIP (HI) and 50% MIP (MOD). Before and after the intervention, MIP and swimming performance were assessed. Swimming performance was evaluated in free and controlled frequency breathing 100-m freestyle swimming time trials in a 25-m pool. For controlled frequency breathing, participants took 1 breath every 6 strokes. Results: The MIP values after 2 and 6 weeks of IMST in the HI and MOD groups were significantly higher than those before IMST (P = .0001). The magnitudes of the MIP increases after 6 weeks of IMST did not differ between the HI (13.4% [8.7%]) and MOD (13.1% [10.1%]) groups (P = .44). The 100-m freestyle swimming times under the controlled frequency condition were significantly shorter after IMST than those before IMST in both the HI (P = .046) and MOD (P = .042) groups. Conclusions: Inspiratory pressure threshold load equivalent to 50% MIP could be sufficient to improve MIP and swimming performance under the controlled frequency breathing condition in highly trained competitive swimmers.

The cardiovascular consequences of fatiguing expiratory muscle work in otherwise resting healthy humans

In 11 healthy adults (25 ± 4 years; 2 females), we investigated the effect of expiratory resisted loaded breathing [65% maximal expiratory mouth pressure (MEP), 15 breaths·min−1, duty cycle 0.5; ERLPm] on mean arterial pressure (MAP), leg vascular resistance (LVR), and leg blood flow (Q̇L). On a separate day, a subset of 5 males performed ERL targeting 65% of maximal expiratory gastric pressure (ERLPga). ERL-induced expiratory muscle fatigue was confirmed by a 17 ± 5% reduction in MEP (P < 0.05) and a 16 ± 12% reduction in the gastric twitch pressure response to magnetic nerve stimulation (P = 0.09) from before to after ERLPm and ERLPga, respectively. From rest to task failure in ERLPm and ERLPga, MAP increased (ERLPm = 31 ± 10 mmHg, ERLPga = 18 ± 9 mmHg, both P < 0.05), but group mean LVR and Q̇L were unchanged (ERLPm: LVR = 0.78 ± 0.21 vs. 0.97 ± 0.36 mmHg·ml−1·min−1, Q̇L = 133 ± 34 vs. 152 ± 74 ml·min−1; ERLPga: LVR = 0.70 ± 0.21 vs. 0.84 ± 0.33 mmHg·ml−1·min−1, Q̇L = 160 ± 48 vs. 179 ± 110 ml·min−1) (all P ≥ 0.05). Interestingly, Q̇L during ERLPga oscillated within each breath, increasing (~66%) and decreasing (~50%) relative to resting values during resisted expirations and un-resisted inspirations, respectively. In conclusion, fatiguing expiratory muscle work did not affect group mean LVR or Q̇L in otherwise resting humans. We speculate that any sympathetically-mediated peripheral vasoconstriction was counteracted by transient mechanical effects of high intra-abdominal pressures during ERL.

Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study

ObjectivesTo examine whether audio-voice guidance application improves adherence to resuscitation sequence and recommended time frames during neonatal resuscitation.MethodsA prospective, randomized, pilot study examining the use of an audio-voice application for guiding resuscitation on newborn mannequins, based on the Neonatal Resuscitation Program (NRP) algorithm. Two different scenarios, with and without voice guidance, were presented to 20 medical personnel (2 midwives, 8 nurses, and 10 physicians) in random order, and their performance videotaped.ResultsAudio-voice guided resuscitation compared with non-guided resuscitation, resulted in significantly better compliance with NRP order sequence (p<0.01), correct use of oxygen supplementation (p<0.01) and performance of MR SOPA (Mask, reposition, suction, open mouth, pressure, airway) (p<0.01), and shortened the time to “positive pressure ventilation” (p<0.01).ConclusionsIn this pilot study, audio-voice guidance application for newborn resuscitation simulation on mannequins, based on the NRP algorithm, improved adherence and performance of NRP guidelines.

An alternative way to measure total lung capacity: a pilot study

Total lung capacity is usually measured by a body plethysmograph or helium dilution methods. In this study an alternative approach to obtain total lung capacity of spontaneous breathing subjects is introduced. The device utilises an optoelectronic plethysmograph and a small tube, which measures mouth pressure and allows total lung capacity to be obtained, which differs less than 0.4 L from the total lung capacity of the body plethysmograph. The method shows potential to be a less burdensome method to estimate total lung capacity determination than the body plethysmograph.

Effect of inspiratory resistive training on diaphragm shear modulus and accessory inspiratory muscle activation

This study aimed to elucidate changes in diaphragm and accessory inspiratory muscle (sternocleidomastoid (SCM) muscle and intercostal muscle (IC)) function after a 6-week training program. Nineteen male elite collegiate swimmers were assigned to either a control group (n = 9) or training group (n = 10). The subjects in the training group performed 30 maximum inspirations at a load resistance of 50% of maximum inspiratory mouth pressure (PImax) using an inspiratory muscle training device. These were conducted twice per day and 6 days per week. At baseline and after 6 weeks, PImax, shear modulus of the diaphragm, and electromyograms (EMG) of the SCM and IC during a maximal inspiratory maneuver were evaluated. Relative change in PImax was greater in the training group than in controls. The shear modulus during a PImax maneuver had increased significantly in both groups after 6 weeks. EMG amplitudes of the SCM increased in the training group after 6 weeks, but not in the control group. EMG amplitudes of the IC did not change after 6 weeks in either group. These results suggest that 6-week inspiratory resistive training significantly improves the activation of the SCM, which could be one of the major mechanisms behind increases in inspiratory muscle strength after resistive training. Novelty Six-week inspiratory resistive training increased diaphragm stiffness during maximal inspiration maneuver. Six-week inspiratory resistive training increased electromyogram amplitudes of the sternocleidomastoid during maximal inspiration maneuver.