Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives:...Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives: In this retrospective pilot study, we evaluated patients with hematologic and solid malignancies by CPET to determine the primary source of their dyspnea. Methods: Subjects were exercised on a cycle ergometer with increasing workloads. Minute ventilation, heart rate, breathing reserve, oxygen uptake (V’O<sub>2</sub>), O<sub>2</sub>-pulse, ventilatory equivalents for carbon dioxide and oxygen (V’<sub>E</sub>/V’CO<sub>2</sub> and V’<sub>E</sub>/V’O<sub>2</sub>, respectively) were measured at baseline and peak exercise. The slope and intercept for V’<sub>E</sub>/V’CO<sub>2</sub> was computed for all subjects. Peak V’O<sub>2</sub> 4% predicted indicated a circulatory or ventilatory limitation. Results: Complete clinical and physiological data were available for 36 patients (M/F 20/16);32 (89%) exhibited ventilatory or circulatory limitation as shown by a reduced peak V’O<sub>2</sub> and 10 subjects with normal physiologic data. The largest cohort comprised the pulmonary vascular group (n = 18) whose mean ± SD peak V’O<sub>2</sub> was 61% ± 17% predicted. There were close associations between V’O<sub>2</sub> and spirometric values. Peak V’<sub>E</sub>/V’O<sub>2</sub> and V’<sub>E</sub>/V’CO<sub>2</sub> were highest in the circulatory and ventilatory cohorts, consistent with increase in dead space breathing. The intercept of the V’<sub>E</sub>-V’CO<sub>2</sub> relationship was lowest in patients with cardiovascular impairment. Conclusion: Dyspneic patients with malignancies exhibit dead space breathing, many exhibiting a circulatory source for exercise limitation with a prominent pulmonary vascular component. Potential factors include effects of chemo- and radiation therapy on cardiac function and pulmonary vascular endothelium.展开更多
One of the most important prognostic factors in heart failure patients is physical capacity. Patients with very poor physical performance and otherwise eligible, may be listed as candidates for heart transplantation(H...One of the most important prognostic factors in heart failure patients is physical capacity. Patients with very poor physical performance and otherwise eligible, may be listed as candidates for heart transplantation(HTx). After such surgery, life-long immunosuppression therapy is needed to prevent rejection of the new heart. The dark side of immunosuppression is the increased risk of infections, kidney failure, cancer and advanced atherosclerosis(cardiac allograft vasculopathy), with the two latter conditions as the main causes of later mortality. In a worldwide perspective, 50% of the HTx patients survive past 10 years. Poor aerobic capacity prior to graft deterioration is not only limited to the failing heart, but also caused by peripheral factors, such as limited function in the skeletal muscles and in the blood vessels walls. Exercise rehabilitation after HTx is of major importance in order to improve physical capacity and prognosis. Effects of high-intensity interval training(HIT) in HTx recipients is a growing field of research attracting worldwide focus and interest. Accumulating evidence has shown that HIT is safe and efficient in maintenance HTx recipients; with superior effects on physical capacity compared to conventional moderate exercise. This article generates further evidence to the field by summarizing results from a decade of research performed at our center supported by a broad, but not strict formal, literature review. In short, this article demonstrates a strong association between physical capacity measured after HTx and long-term survival. It describes the possible "HITeffect" with increased levels of inflammatory mediators of angiogenesis. It also describes long-term effects of HIT; showing a positive effect in development of anxiety symptoms despite that the improved physical capacity was not sustained, due to downregulation ofexercise and intensity. Finally, our results are linked to the ongoing HITTS study, which investigates safety and efficiency of HIT in de novo HTx recipients. Together with previous results, this study may have the potential to change existing guidelines and contribute to a better prognosis for the HTx population as a whole.展开更多
AIM To study exercise capacity and determinants of early peak oxygen consumption(VO_(2peak)) in a cohort of de novo heart transplant(HTx) recipients. METHODS To determine possible central(chronotropic responses, cardi...AIM To study exercise capacity and determinants of early peak oxygen consumption(VO_(2peak)) in a cohort of de novo heart transplant(HTx) recipients. METHODS To determine possible central(chronotropic responses, cardiopulmonary and hemodynamic function) and peripheral factors(muscular exercise capacity and body composition) predictive of VO_(2peak), a number of different measurements and tests were performed, as follows: Cardiopulmonary exercise testing(CPET) was performed mean 11 wk after surgery in 81 HTx recipients > 18 years and was measured with breath by breath gas exchange on a treadmill or bicycle ergometer. Metabolic/respiratory measures include VO_(2peak) and VE/VCO2 slope. Additional measures included muscle strength testing, bioelectrical impedance analysis, echocardiography, blood sampling and health-related quality of life. Based on the VO_(2peak)(mL/kg per minute) median value, the study population was divided into two groups defined as a low-capacity group and a high-capacity group. Potential predictors were analyzed using multiple regression analysis with VO_(2peak)(L/min) as the dependent variable.RESULTS The mean ± standard deviation(SD) age of the total study population was 49 ± 13 years, and 73% were men. This de novo HTx cohort demonstrated a median VO_(2peak) level of 19.4 mL/kg per min at 11 ± 1.8 wk postHTx. As compared with the high-capacity group, the low-capacity group exercised for a shorter time, had lower maximal ventilation, O_2 pulse, peak heart rate and heart rate reserve, while the VE/VCO_2 slope was higher. The low-capacity group had less muscle strength and muscular exercise capacity in comparison with the highcapacity group. In order of importance, O_2 pulse, heart rate reserve, muscular exercise capacity, body mass index, gender and age accounted for 84% of the variance in VO_(2peak)(L/min). There were no minor or major serious adverse events during the CPET. CONCLUSION Although there is great individual variance among de novo HTx recipients, early VO_(2peak) measures appear to be influenced by both central and peripheral factors.展开更多
Aging induces decrease of locomotor capacity and its decrease is associated with an increased risk of falls. Several lines of evidence indicate that both change in muscle power and aerobic fitness are causative. Mobil...Aging induces decrease of locomotor capacity and its decrease is associated with an increased risk of falls. Several lines of evidence indicate that both change in muscle power and aerobic fitness are causative. Mobility tests are usually based on a maximal exercise stress test;however, this test is often difficult and sometimes frightening to older persons. Therefore, the objective of this study was to examine age and gender differences in 3-min walk distance test (3WDT), and time of chair-rising test (CRT) of functional mobility. 153 men and 159 women aged from 20 to 78 years were recruited as subjects of the present study. The body composition measured the height, body mass (BM), body mass index (BMI), lean tissue mass (LTM), and waist circumference (WC). The Functional mobility tests measured the peak oxygen uptake (VO2peak), 3WDT, leg extension strength (LES), and times of CRT. Both in men and women, height and BMI, WC decreased and increased, respectively, with age. Height, BM, LTM, WC in men are higher than in women. We found no correlation between ages and 3WDT in women and a significant, negative correlation in men. All parameters of fitness performance were negatively correlated with age. Both in men and women, all parameters of fitness performance were positively correlated with sex. Both in men and women, VO2peak, 3WDT, and LES decreased with age. All parameters of fitness performance in men are higher than in women. Both in men and women were observed for the correlation between 3WDT and VO2peak, LES and CRT respectively. Although as the correlation coefficient between 3WTD and VO2peak, LES and CRT were low (r = 0.28 - 0.38), an error may occur, this study shows that 3WDT and CRT test can be a feasible method of providing the information for muscle power and aerobic fitness, possibly avoiding the need for a maximal stress test.展开更多
Objective This study evaluated the effect of maximal oxygen pulse(O_(2)P_(max))on patients with chronic obstructive pulmonary disease(COPD)and confirmed the predictive effect on acute exacerbations of COPD(AECOPD).Met...Objective This study evaluated the effect of maximal oxygen pulse(O_(2)P_(max))on patients with chronic obstructive pulmonary disease(COPD)and confirmed the predictive effect on acute exacerbations of COPD(AECOPD).Methods This retrospective study included 91 participants who underwent cardiopulmonary exercise testing(CPET),lung function testing,a dyspnea scale assessment,and a 3-year follow-up.The participants were divided into two groups according to the O_(2)P_(max)value.Exercise capacity,ventilatory conditions,gas exchange efficiency,and dyspnea symptoms were compared,and the correlations between O_(2)P_(max)and these indices were evaluated.The ability of O_(2)P_(max)to predict AECOPD was examined.Results Exercise capacity,ventilatory conditions,and gas exchange efficiency were lower,and dyspnea symptom scores were higher in the impaired O_(2)P_(max)group(P<0.05).O_(2)P_(max)was positively correlated with forced vital capacity(FVC)%,forced expiratory volume in 1 sec(FEV_(1))%,FEV_(1)/FVC%,anaerobic threshold(AT),work rate(WR)%,aximal oxygen uptake(VO_(2))%,VO_(2)/kg_(max),VO_(2)/kg_(max)%,WR_(AT),WR_(max),VO_(2AT),VO_(2max),and V,and was negatively correlated with EqCO_(2AT),and EqCO_(2max)(P<0.05).Most importantly,O_(2)P_(max)could be used to predict AECOPD,and the best cut-off value was 89.5%(area under the curve,0.739;95%CI,0.609–0.869).Conclusion O_(2)P_(max)reflected exercise capacity,ventilation capacity,gas exchange capacity,and dyspnea symptoms in patients with COPD and may be an independent predictor of AECOPD.展开更多
文摘Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives: In this retrospective pilot study, we evaluated patients with hematologic and solid malignancies by CPET to determine the primary source of their dyspnea. Methods: Subjects were exercised on a cycle ergometer with increasing workloads. Minute ventilation, heart rate, breathing reserve, oxygen uptake (V’O<sub>2</sub>), O<sub>2</sub>-pulse, ventilatory equivalents for carbon dioxide and oxygen (V’<sub>E</sub>/V’CO<sub>2</sub> and V’<sub>E</sub>/V’O<sub>2</sub>, respectively) were measured at baseline and peak exercise. The slope and intercept for V’<sub>E</sub>/V’CO<sub>2</sub> was computed for all subjects. Peak V’O<sub>2</sub> 4% predicted indicated a circulatory or ventilatory limitation. Results: Complete clinical and physiological data were available for 36 patients (M/F 20/16);32 (89%) exhibited ventilatory or circulatory limitation as shown by a reduced peak V’O<sub>2</sub> and 10 subjects with normal physiologic data. The largest cohort comprised the pulmonary vascular group (n = 18) whose mean ± SD peak V’O<sub>2</sub> was 61% ± 17% predicted. There were close associations between V’O<sub>2</sub> and spirometric values. Peak V’<sub>E</sub>/V’O<sub>2</sub> and V’<sub>E</sub>/V’CO<sub>2</sub> were highest in the circulatory and ventilatory cohorts, consistent with increase in dead space breathing. The intercept of the V’<sub>E</sub>-V’CO<sub>2</sub> relationship was lowest in patients with cardiovascular impairment. Conclusion: Dyspneic patients with malignancies exhibit dead space breathing, many exhibiting a circulatory source for exercise limitation with a prominent pulmonary vascular component. Potential factors include effects of chemo- and radiation therapy on cardiac function and pulmonary vascular endothelium.
文摘One of the most important prognostic factors in heart failure patients is physical capacity. Patients with very poor physical performance and otherwise eligible, may be listed as candidates for heart transplantation(HTx). After such surgery, life-long immunosuppression therapy is needed to prevent rejection of the new heart. The dark side of immunosuppression is the increased risk of infections, kidney failure, cancer and advanced atherosclerosis(cardiac allograft vasculopathy), with the two latter conditions as the main causes of later mortality. In a worldwide perspective, 50% of the HTx patients survive past 10 years. Poor aerobic capacity prior to graft deterioration is not only limited to the failing heart, but also caused by peripheral factors, such as limited function in the skeletal muscles and in the blood vessels walls. Exercise rehabilitation after HTx is of major importance in order to improve physical capacity and prognosis. Effects of high-intensity interval training(HIT) in HTx recipients is a growing field of research attracting worldwide focus and interest. Accumulating evidence has shown that HIT is safe and efficient in maintenance HTx recipients; with superior effects on physical capacity compared to conventional moderate exercise. This article generates further evidence to the field by summarizing results from a decade of research performed at our center supported by a broad, but not strict formal, literature review. In short, this article demonstrates a strong association between physical capacity measured after HTx and long-term survival. It describes the possible "HITeffect" with increased levels of inflammatory mediators of angiogenesis. It also describes long-term effects of HIT; showing a positive effect in development of anxiety symptoms despite that the improved physical capacity was not sustained, due to downregulation ofexercise and intensity. Finally, our results are linked to the ongoing HITTS study, which investigates safety and efficiency of HIT in de novo HTx recipients. Together with previous results, this study may have the potential to change existing guidelines and contribute to a better prognosis for the HTx population as a whole.
基金Supported by the Norwegian Health Association,No.12906Scandiatransplantthe South-Eastern Norway Regional Authority,No.2013111
文摘AIM To study exercise capacity and determinants of early peak oxygen consumption(VO_(2peak)) in a cohort of de novo heart transplant(HTx) recipients. METHODS To determine possible central(chronotropic responses, cardiopulmonary and hemodynamic function) and peripheral factors(muscular exercise capacity and body composition) predictive of VO_(2peak), a number of different measurements and tests were performed, as follows: Cardiopulmonary exercise testing(CPET) was performed mean 11 wk after surgery in 81 HTx recipients > 18 years and was measured with breath by breath gas exchange on a treadmill or bicycle ergometer. Metabolic/respiratory measures include VO_(2peak) and VE/VCO2 slope. Additional measures included muscle strength testing, bioelectrical impedance analysis, echocardiography, blood sampling and health-related quality of life. Based on the VO_(2peak)(mL/kg per minute) median value, the study population was divided into two groups defined as a low-capacity group and a high-capacity group. Potential predictors were analyzed using multiple regression analysis with VO_(2peak)(L/min) as the dependent variable.RESULTS The mean ± standard deviation(SD) age of the total study population was 49 ± 13 years, and 73% were men. This de novo HTx cohort demonstrated a median VO_(2peak) level of 19.4 mL/kg per min at 11 ± 1.8 wk postHTx. As compared with the high-capacity group, the low-capacity group exercised for a shorter time, had lower maximal ventilation, O_2 pulse, peak heart rate and heart rate reserve, while the VE/VCO_2 slope was higher. The low-capacity group had less muscle strength and muscular exercise capacity in comparison with the highcapacity group. In order of importance, O_2 pulse, heart rate reserve, muscular exercise capacity, body mass index, gender and age accounted for 84% of the variance in VO_(2peak)(L/min). There were no minor or major serious adverse events during the CPET. CONCLUSION Although there is great individual variance among de novo HTx recipients, early VO_(2peak) measures appear to be influenced by both central and peripheral factors.
文摘Aging induces decrease of locomotor capacity and its decrease is associated with an increased risk of falls. Several lines of evidence indicate that both change in muscle power and aerobic fitness are causative. Mobility tests are usually based on a maximal exercise stress test;however, this test is often difficult and sometimes frightening to older persons. Therefore, the objective of this study was to examine age and gender differences in 3-min walk distance test (3WDT), and time of chair-rising test (CRT) of functional mobility. 153 men and 159 women aged from 20 to 78 years were recruited as subjects of the present study. The body composition measured the height, body mass (BM), body mass index (BMI), lean tissue mass (LTM), and waist circumference (WC). The Functional mobility tests measured the peak oxygen uptake (VO2peak), 3WDT, leg extension strength (LES), and times of CRT. Both in men and women, height and BMI, WC decreased and increased, respectively, with age. Height, BM, LTM, WC in men are higher than in women. We found no correlation between ages and 3WDT in women and a significant, negative correlation in men. All parameters of fitness performance were negatively correlated with age. Both in men and women, all parameters of fitness performance were positively correlated with sex. Both in men and women, VO2peak, 3WDT, and LES decreased with age. All parameters of fitness performance in men are higher than in women. Both in men and women were observed for the correlation between 3WDT and VO2peak, LES and CRT respectively. Although as the correlation coefficient between 3WTD and VO2peak, LES and CRT were low (r = 0.28 - 0.38), an error may occur, this study shows that 3WDT and CRT test can be a feasible method of providing the information for muscle power and aerobic fitness, possibly avoiding the need for a maximal stress test.
基金supported by the National Natural Science Foundation of China[No.82000043]Key Clinical Specialty Construction Program of Beijing(2020-2022)Beijing Hospitals Authority Youth Program[No.QML20180107]。
文摘Objective This study evaluated the effect of maximal oxygen pulse(O_(2)P_(max))on patients with chronic obstructive pulmonary disease(COPD)and confirmed the predictive effect on acute exacerbations of COPD(AECOPD).Methods This retrospective study included 91 participants who underwent cardiopulmonary exercise testing(CPET),lung function testing,a dyspnea scale assessment,and a 3-year follow-up.The participants were divided into two groups according to the O_(2)P_(max)value.Exercise capacity,ventilatory conditions,gas exchange efficiency,and dyspnea symptoms were compared,and the correlations between O_(2)P_(max)and these indices were evaluated.The ability of O_(2)P_(max)to predict AECOPD was examined.Results Exercise capacity,ventilatory conditions,and gas exchange efficiency were lower,and dyspnea symptom scores were higher in the impaired O_(2)P_(max)group(P<0.05).O_(2)P_(max)was positively correlated with forced vital capacity(FVC)%,forced expiratory volume in 1 sec(FEV_(1))%,FEV_(1)/FVC%,anaerobic threshold(AT),work rate(WR)%,aximal oxygen uptake(VO_(2))%,VO_(2)/kg_(max),VO_(2)/kg_(max)%,WR_(AT),WR_(max),VO_(2AT),VO_(2max),and V,and was negatively correlated with EqCO_(2AT),and EqCO_(2max)(P<0.05).Most importantly,O_(2)P_(max)could be used to predict AECOPD,and the best cut-off value was 89.5%(area under the curve,0.739;95%CI,0.609–0.869).Conclusion O_(2)P_(max)reflected exercise capacity,ventilation capacity,gas exchange capacity,and dyspnea symptoms in patients with COPD and may be an independent predictor of AECOPD.
