Ronan P. Donnelly, Anita E. Smyth, Charles Mullan, Marshall S. Riley, D. Paul Nicholls
Introduction
Pulmonary complications in systemic sclerosis (SSc) significantly increase morbidity and mortality. Our aim was to determine the factors limiting exercise capacity in SSc patients with and without interstitial lung disease (ILD), and to identify and quantify abnormalities during exercise that might assist in clinical assessment of this complication.
Methods
Fifteen patients with SSc and ILD (SSc-ILD) were compared with 10 patients with SSc without ILD and 9 age- and sex-matched normal volunteers. Subjects performed symptom-limited incremental treadmill exercise with online measurement of respiratory gas exchange, arterial blood gas sampling and measurement of neurohormones in venous blood.
Results
Patients with SSc-ILD had lower exercise capacity than SSc patients without ILD or normal subjects (peak oxygen consumption (PV̇O2) (17.1 [4.2] vs. 22.0 [4.7] and 23.0 [5.4] ml kg−1 min−1, respectively, mean [SD], p < 0.01 ANOVA), but PV̇O2 did not correlate with static pulmonary function measurements. Ventilatory equivalent for CO2 (V̇E/V̇CO2; nadir) was higher in SSc-ILD patients than the other two groups (36.6 [8.0] vs. 29.9 [4.4] and 30.0 [2.5], p < 0.005) as were peak exercise dead-space tidal volume ratio (0.44 [0.06] vs. 0.26 [0.09] and 0.26 [0.05], p < 0.001) and peak exercise alveolar–arterial difference (28.9 [16.9] vs. 18.8 [14.0] and 11.5 [6.9] mmHg, p < 0.05). Atrial natriuretic peptide was elevated in both SSc patient groups.
Conclusions
SSc-ILD results in lower exercise capacity than SSc without ILD, and abnormalities of gas exchange are seen. The possible use of cardiopulmonary exercise testing to identify disease and quantify impairment in SSc-ILD merits further study.
系统性硬化症(SSc)的肺部并发症显著增加发病率和死亡率。我们的目的是确定伴有或不伴有间质性肺疾病(ILD)的SSc患者运动能力的限制因素，并确定和量化运动过程中的异常，这些异常可能有助于临床评估这一并发症。方法将15例SSc合并ILD患者(SSc-ILD)与10例SSc无ILD患者和9例年龄、性别匹配的正常人进行比较。受试者进行症状限制的渐进式跑步机运动，同时在线测量呼吸气体交换、动脉血气采样和静脉血中神经激素的测量。结果SSc-ILD患者的运动能力低于无ILD的SSc患者或正常受试者(峰值耗氧量(PV (O2))(分别为17.1[4.2]对22.0[4.7]和23.0 [5.4]ml kg - 1 min - 1，平均[SD]， p < 0.01方差分析)，但PV (O2)与静态肺功能测量无相关性。通风CO2当量(V * E/V * CO2;SSc-ILD患者的nadir)高于其他两组(36.6[8.0]比29.9[4.4]和30.0 [2.5]，p < 0.005)，运动峰值死空潮气量比(0.44[0.06]比0.26[0.09]和0.26 [0.05]，p < 0.001)和运动峰值肺泡动脉差(28.9[16.9]比18.8[14.0]和11.5 [6.9]mmHg, p < 0.05)。两组患者心房利钠肽均升高。结论SSc-ILD患者的运动能力低于无ILD的SSc，且气体交换异常。心肺运动试验在SSc-ILD中识别疾病和量化损害的可能性值得进一步研究。
{"title":"Responses to exercise in systemic sclerosis-associated interstitial lung disease","authors":"Ronan P. Donnelly, Anita E. Smyth, Charles Mullan, Marshall S. Riley, D. Paul Nicholls","doi":"10.1111/cpf.12813","DOIUrl":"10.1111/cpf.12813","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pulmonary complications in systemic sclerosis (SSc) significantly increase morbidity and mortality. Our aim was to determine the factors limiting exercise capacity in SSc patients with and without interstitial lung disease (ILD), and to identify and quantify abnormalities during exercise that might assist in clinical assessment of this complication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifteen patients with SSc and ILD (SSc-ILD) were compared with 10 patients with SSc without ILD and 9 age- and sex-matched normal volunteers. Subjects performed symptom-limited incremental treadmill exercise with online measurement of respiratory gas exchange, arterial blood gas sampling and measurement of neurohormones in venous blood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with SSc-ILD had lower exercise capacity than SSc patients without ILD or normal subjects (peak oxygen consumption (PV̇O<sub>2</sub>) (17.1 [4.2] vs. 22.0 [4.7] and 23.0 [5.4] ml kg<sup>−1</sup> min<sup>−1</sup>, respectively, mean [SD], <i>p</i> < 0.01 ANOVA), but PV̇O<sub>2</sub> did not correlate with static pulmonary function measurements. Ventilatory equivalent for CO<sub>2</sub> (V̇E/V̇CO<sub>2</sub>; nadir) was higher in SSc-ILD patients than the other two groups (36.6 [8.0] vs. 29.9 [4.4] and 30.0 [2.5], <i>p</i> < 0.005) as were peak exercise dead-space tidal volume ratio (0.44 [0.06] vs. 0.26 [0.09] and 0.26 [0.05], <i>p</i> < 0.001) and peak exercise alveolar–arterial difference (28.9 [16.9] vs. 18.8 [14.0] and 11.5 [6.9] mmHg, <i>p</i> < 0.05). Atrial natriuretic peptide was elevated in both SSc patient groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SSc-ILD results in lower exercise capacity than SSc without ILD, and abnormalities of gas exchange are seen. The possible use of cardiopulmonary exercise testing to identify disease and quantify impairment in SSc-ILD merits further study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"43 4","pages":"253-262"},"PeriodicalIF":1.8,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9573936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert W. Spitz, Scott J. Dankel, Matthew B. Jessee, Vickie Wong, Zachary W. Bell, Takashi Abe, Jeremy P. Loenneke
The purpose of this study was to determine if muscle growth mediates increases in a strength task which was not directly trained. One hundred fifty-one participants were randomized into control, one-repetition maximum training (1RM-TRAIN), or traditional training (TRAD-TRAIN). Training groups performed isotonic elbow flexion 3x/week for 6 weeks. Anterior muscle thickness at 50%, 60% and 70% upper arm length, and maximal isokinetic torque at 60°/sec were assessed pre- and post-training. Change-score mediation models (adjusted for sex, pre-muscle thickness, and pre-strength) were constructed for each muscle thickness site. The effects of each training group were evaluated relative to the control. Data is presented as coefficient (95% CI). There were no significant relative direct effects on nonspecific strength for either training group outside of the 60% model (1.7 [0.13, 3.27] Nm). The relative effect of 1RM-TRAIN on muscle thickness was greater in 60% (0.09 [0.01, 0.17] cm) and 70% (0.09 [0.00, 0.17] cm) models; while TRAD-TRAIN was greater in all three: (50% = 0.24 [0.15, 0.32]; 60% = 0.24 [0.16, 0.33]; 70% = 0.22 [0.14, 0.31] cm). The effect of muscle thickness on nonspecific strength was only significant for the 60% (−3.06 [−5.7, −0.35] Nm) model. The relative indirect effect on nonspecific strength was not significant for the 1RM-TRAIN or TRAD-TRAIN. Similar to previous findings on specific strength, we did not find evidence for a mediating effect of muscle growth on training induced increases in nonspecific strength. The importance of muscle growth for changes in nonspecifically trained strength may need to be reconsidered.
{"title":"Does muscle growth mediate changes in a nonspecific strength task?","authors":"Robert W. Spitz, Scott J. Dankel, Matthew B. Jessee, Vickie Wong, Zachary W. Bell, Takashi Abe, Jeremy P. Loenneke","doi":"10.1111/cpf.12810","DOIUrl":"10.1111/cpf.12810","url":null,"abstract":"<p>The purpose of this study was to determine if muscle growth mediates increases in a strength task which was not directly trained. One hundred fifty-one participants were randomized into control, one-repetition maximum training (1RM-TRAIN), or traditional training (TRAD-TRAIN). Training groups performed isotonic elbow flexion 3x/week for 6 weeks. Anterior muscle thickness at 50%, 60% and 70% upper arm length, and maximal isokinetic torque at 60°/sec were assessed pre- and post-training. Change-score mediation models (adjusted for sex, pre-muscle thickness, and pre-strength) were constructed for each muscle thickness site. The effects of each training group were evaluated relative to the control. Data is presented as coefficient (95% CI). There were no significant relative direct effects on nonspecific strength for either training group outside of the 60% model (1.7 [0.13, 3.27] Nm). The relative effect of 1RM-TRAIN on muscle thickness was greater in 60% (0.09 [0.01, 0.17] cm) and 70% (0.09 [0.00, 0.17] cm) models; while TRAD-TRAIN was greater in all three: (50% = 0.24 [0.15, 0.32]; 60% = 0.24 [0.16, 0.33]; 70% = 0.22 [0.14, 0.31] cm). The effect of muscle thickness on nonspecific strength was only significant for the 60% (−3.06 [−5.7, −0.35] Nm) model. The relative indirect effect on nonspecific strength was not significant for the 1RM-TRAIN or TRAD-TRAIN. Similar to previous findings on specific strength, we did not find evidence for a mediating effect of muscle growth on training induced increases in nonspecific strength. The importance of muscle growth for changes in nonspecifically trained strength may need to be reconsidered.</p>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"43 4","pages":"223-231"},"PeriodicalIF":1.8,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma Nyman, Christer Grönlund, Davide Vanoli, Per Liv, Margareta Norberg, Anna Bengtsson, Patrik Wennberg, Per Wester, Ulf Näslund, for the VIPVIZA trial group
Objectives
Reduced progression of atherosclerosis can decrease the risk of cardiovascular disease (CVD). This study aimed at evaluating the effect of a pictorial intervention showing atherosclerotic severity on the progression of carotid atherosclerosis.
Methods
A prospective randomised open-label blinded end-point trial with participants aged 40–60 years enroled from a routine CVD prevention programme. The intervention group (n: 1575) and their treating physicians received an image based presentation of subclinical atherosclerotic severity measured by carotid ultrasound. The control group (n: 1579) did not receive any information about ultrasound results. Carotid ultrasound at baseline and at 3-year follow-up contained plaque detection and measurements of carotid intima media thickness (cIMT). The left, right and bilateral-mean-cIMT, plaque prevalence and total plaque area (TPA) at 3-year follow-up were compared between groups. Significance level was set to p = 0.01 to adjust for multiple comparisons.
Results
The intervention group revealed reduced cIMT progression in the left-mean-cIMT of −0.011 mm (p = 0.001) compared with the control group. The intervention effect on cIMT progression was most prominent in individuals with increased cIMT and plaque prevalence at baseline (−0.021 mm, p = 0.005). There were no differences in progression between groups for the right-and bilateral-mean-cIMT (−0.005 mm, p = 0.223 and −0.005 mm, p = 0.036, respectively), nor any differences between groups for plaque prevalence or TPA (odds ratio 0.88, p = 0.09 and 0.89, p = 0.21, respectively).
Conclusion
Pictorial presentation of subclinical atherosclerotic severity sent to both the individual and their treating physician resulted in significantly reduced left cIMT progression. Pictorial presentation has the potential to increase adherence in CVD prevention.
目的减少动脉粥样硬化的进展可以降低心血管疾病(CVD)的风险。本研究旨在评估图像干预显示动脉粥样硬化严重程度对颈动脉粥样硬化进展的影响。方法前瞻性随机开放标签盲法终点试验，参与者年龄40-60岁，来自常规心血管疾病预防计划。干预组(n: 1575)及其治疗医生接受了基于图像的颈动脉超声测量的亚临床动脉粥样硬化严重程度。对照组(n: 1579)没有收到任何关于超声结果的信息。基线和3年随访时的颈动脉超声包括斑块检测和颈动脉内膜中膜厚度(cIMT)的测量。比较两组3年随访时左、右、双侧平均cimt、斑块患病率和总斑块面积(TPA)。显著性水平设为p = 0.01以调整多重比较。结果干预组与对照组相比，左平均cIMT进展减少- 0.011 mm (p = 0.001)。干预对cIMT进展的影响在基线时cIMT和斑块患病率增加的个体中最为突出(- 0.021 mm, p = 0.005)。右侧和双侧平均cimt组间无进展差异(分别为- 0.005 mm, p = 0.223和- 0.005 mm, p = 0.036)，斑块患病率和TPA组间无差异(比值比分别为0.88,p = 0.09和0.89,p = 0.21)。结论:将亚临床动脉粥样硬化严重程度的图像呈现给患者及其治疗医生，可显著降低左cIMT的进展。图片展示有可能增加心血管疾病预防的依从性。
{"title":"Reduced progression of carotid intima media thickness by personalised pictorial presentation of subclinical atherosclerosis in VIPVIZA—A randomised controlled trial","authors":"Emma Nyman, Christer Grönlund, Davide Vanoli, Per Liv, Margareta Norberg, Anna Bengtsson, Patrik Wennberg, Per Wester, Ulf Näslund, for the VIPVIZA trial group","doi":"10.1111/cpf.12811","DOIUrl":"10.1111/cpf.12811","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Reduced progression of atherosclerosis can decrease the risk of cardiovascular disease (CVD). This study aimed at evaluating the effect of a pictorial intervention showing atherosclerotic severity on the progression of carotid atherosclerosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective randomised open-label blinded end-point trial with participants aged 40–60 years enroled from a routine CVD prevention programme. The intervention group (<i>n</i>: 1575) and their treating physicians received an image based presentation of subclinical atherosclerotic severity measured by carotid ultrasound. The control group (<i>n</i>: 1579) did not receive any information about ultrasound results. Carotid ultrasound at baseline and at 3-year follow-up contained plaque detection and measurements of carotid intima media thickness (cIMT). The left, right and bilateral-mean-cIMT, plaque prevalence and total plaque area (TPA) at 3-year follow-up were compared between groups. Significance level was set to <i>p</i> = 0.01 to adjust for multiple comparisons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The intervention group revealed reduced cIMT progression in the left-mean-cIMT of −0.011 mm (<i>p</i> = 0.001) compared with the control group. The intervention effect on cIMT progression was most prominent in individuals with increased cIMT and plaque prevalence at baseline (−0.021 mm, <i>p</i> = 0.005). There were no differences in progression between groups for the right-and bilateral-mean-cIMT (−0.005 mm, <i>p</i> = 0.223 and −0.005 mm, <i>p</i> = 0.036, respectively), nor any differences between groups for plaque prevalence or TPA (odds ratio 0.88, <i>p</i> = 0.09 and 0.89, <i>p</i> = 0.21, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pictorial presentation of subclinical atherosclerotic severity sent to both the individual and their treating physician resulted in significantly reduced left cIMT progression. Pictorial presentation has the potential to increase adherence in CVD prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"43 4","pages":"232-241"},"PeriodicalIF":1.8,"publicationDate":"2023-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12811","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9942186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carotid stiffening is found to be present in patients with type 2 diabetes mellitus (T2DM) together with endothelial dysfunction and it remains unclear about the role of carotid elasticity in the development of diabetic vascular damage. The aim of the study was to investigate changes and significance of carotid artery elasticity in diabetic patients with or without microvascular complications using velocity vector imaging (VVI) analysis.
Methods
Fifty participants were enrolled and divided into health Control group, the uncomplicated DM (uDM) group and the complicated DM (cDM) group. All of them underwent carotid ultrasound examinations. VVI was used to evaluate the common carotid artery (CCA) elasticity and intima-media thickness (IMT) was also measured. Flow-mediated dilation (FMD) was performed to detect the vascular endothelial function. Then differences and correlations of variables between three groups were compared and analyzed.
Results
CCA elasticity measured by VVI decreased significantly between three groups (p < 0.05), while FMD decreased significantly only in cDM group (p < 0.01) and only IMT in cDM group was significantly thicker than that of Control group (p < 0.05). Representative VVI variables were independently, negatively related to the known duration and microalbuminuria (p < 0.05). All VVI variables were significantly correlated with FMD (0.5 ≤ |r | <0.8, p < 0.001), and just a small part of VVI variables were significantly correlated with IMT (0.3 ≤ |r | <0.5, p < 0.05).
Conclusion
Compared with FMD, CCA elasticity measured by VVI showed more obvious changes in diabetic patients with different levels of vascular damage and may be considered as an alternative indicator in evaluating arterial status of T2DM.
{"title":"A preliminary study of changes in carotid artery elasticity in type 2 diabetes mellitus","authors":"Chun-xiang Jin, Jing Tian, Hui-hui Yang, Yu He","doi":"10.1111/cpf.12808","DOIUrl":"10.1111/cpf.12808","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Carotid stiffening is found to be present in patients with type 2 diabetes mellitus (T2DM) together with endothelial dysfunction and it remains unclear about the role of carotid elasticity in the development of diabetic vascular damage. The aim of the study was to investigate changes and significance of carotid artery elasticity in <i>diabetic patients with or without microvascular complications</i> using velocity vector imaging (VVI) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty participants were enrolled and divided into health Control group, the uncomplicated DM (uDM) group and the complicated DM (cDM) group. All of them underwent carotid ultrasound examinations. VVI was used to evaluate the common carotid artery (CCA) elasticity and intima-media thickness (IMT) was also measured. Flow-mediated dilation (FMD) was performed to detect the vascular endothelial function. Then differences and correlations of variables between three groups were compared and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CCA elasticity measured by VVI decreased significantly between three groups (<i>p</i> < 0.05), while FMD decreased significantly only in cDM group (<i>p</i> < 0.01) and only IMT in cDM group was significantly thicker than that of Control group (<i>p</i> < 0.05). Representative VVI variables were independently, negatively related to the known duration and microalbuminuria (<i>p</i> < 0.05). All VVI variables were significantly correlated with FMD (0.5 ≤ |<i>r</i> | <0.8, <i>p</i> < 0.001), and just a small part of VVI variables were significantly correlated with IMT (0.3 ≤ |<i>r</i> | <0.5, <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared with FMD, CCA elasticity measured by VVI showed more <i>obvious</i> changes in diabetic patients <i>with different levels of vascular damage</i> and may be considered as <i>an alternative</i> indicator in evaluating arterial status of T2DM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"43 3","pages":"181-191"},"PeriodicalIF":1.8,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9245376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mathieu Marillier, Anne-Catherine Bernard, Samuel Verges, Onofre Moran-Mendoza, J. Alberto Neder
Background
Hypoxaemia and cardiocirculatory abnormalities may impair muscle oxygen (O2) delivery relative to O2 requirements thereby increasing the rate of O2 extraction during incremental exercise in fibrotic interstitial lung disease (f-ILD). Using changes in deoxyhaemoglobin concentration ([HHb]) by near-infrared spectroscopy (NIRS) as a proxy of O2 extraction, we investigated whether a simplified (double-linear) approach, previously tested in heart failure, would provide useful estimates of muscle deoxygenation in f-ILD.
Methods
A total of 25 patients (23 men, 72 ± 8 years; 20 with idiopathic pulmonary fibrosis, lung diffusing capacity for carbon monoxide = 44 ± 11% predicted) and 12 age- and sex-matched healthy controls performed incremental cycling to symptom limitation. Changes in vastus lateralis [HHb] assessed by NIRS were analysed in relation to work rate (WR) and O2 uptake throughout the exercise.
Results
Patients showed lower exercise capacity than controls (e.g., peak WR = 67 ± 18% vs. 105 ± 20% predicted, respectively; p < 0.001). The [HHb] response profile was typically S-shaped, presenting three distinct phases. Exacerbated muscle deoxygenation in patients versus controls was evidenced by: (i) a steeper mid-exercise [HHb]-WR slope (0.30 ± 0.22 vs. 0.11 ± 0.08 μmol/W; p = 0.008) (Phase 2), and (ii) a larger late-exercise increase in [HHb] (p = 0.002) (Phase 3). Steeper [HHb]-WR slope was associated with lower peak WR (r = –0.70) and greater leg discomfort (r = 0.77; p < 0.001) in f-ILD.
Conclusion
This practical approach to interpreting [HHb] during incremental exercise might prove useful to determine the severity of muscle deoxygenation and the potential effects of interventions thereof in hypoxemic patients with f-ILD.
{"title":"Quantifying leg muscle deoxygenation during incremental cycling in hypoxemic patients with fibrotic interstitial lung disease","authors":"Mathieu Marillier, Anne-Catherine Bernard, Samuel Verges, Onofre Moran-Mendoza, J. Alberto Neder","doi":"10.1111/cpf.12809","DOIUrl":"10.1111/cpf.12809","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypoxaemia and cardiocirculatory abnormalities may impair muscle oxygen (O<sub>2</sub>) delivery relative to O<sub>2</sub> requirements thereby increasing the rate of O<sub>2</sub> extraction during incremental exercise in fibrotic interstitial lung disease (<i>f</i>-ILD). Using changes in deoxyhaemoglobin concentration ([HHb]) by near-infrared spectroscopy (NIRS) as a proxy of O<sub>2</sub> extraction, we investigated whether a simplified (double-linear) approach, previously tested in heart failure, would provide useful estimates of muscle deoxygenation in <i>f</i>-ILD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 25 patients (23 men, 72 ± 8 years; 20 with idiopathic pulmonary fibrosis, lung diffusing capacity for carbon monoxide = 44 ± 11% predicted) and 12 age- and sex-matched healthy controls performed incremental cycling to symptom limitation. Changes in vastus lateralis [HHb] assessed by NIRS were analysed in relation to work rate (WR) and O<sub>2</sub> uptake throughout the exercise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients showed lower exercise capacity than controls (e.g., peak WR = 67 ± 18% vs. 105 ± 20% predicted, respectively; <i>p</i> < 0.001). The [HHb] response profile was typically S-shaped, presenting three distinct phases. Exacerbated muscle deoxygenation in patients versus controls was evidenced by: (i) a steeper mid-exercise [HHb]-WR slope (0.30 ± 0.22 vs. 0.11 ± 0.08 μmol/W; <i>p</i> = 0.008) (Phase 2), and (ii) a larger late-exercise increase in [HHb] (<i>p</i> = 0.002) (Phase 3). Steeper [HHb]-WR slope was associated with lower peak WR (<i>r</i> = –0.70) and greater leg discomfort (<i>r</i> = 0.77; <i>p</i> < 0.001) in <i>f</i>-ILD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This practical approach to interpreting [HHb] during incremental exercise might prove useful to determine the severity of muscle deoxygenation and the potential effects of interventions thereof in hypoxemic patients with <i>f</i>-ILD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"43 3","pages":"192-200"},"PeriodicalIF":1.8,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9260413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adrian W. Midgley, Andrew R. Levy, Felipe A. Cunha, Angela Key, Joanne M. Patterson, Simon N. Rogers
Purpose
Assess safety and feasibility of the cardiopulmonary exercise test (CPET) for evaluating head and neck cancer (HaNC) survivors. Also compare their cardiorespiratory fitness to age and sex-matched norms and establish current physical activity levels.
Methods
Fifty HaNC survivors [29 male; mean (SD) age, 62 (8) years], who had completed treatment up to 1 year previously, were recruited. Participants performed a CPET on a cycle ergometer to symptom-limited tolerance. Participants completed a questionnaire to report contributory factors they perceived as influencing test termination. Physical activity levels were determined using a self-reported physical activity questionnaire.
Results
Three participants did not complete the CPET because (1) poor fitting mouthpiece and naso-oral mask due to facial disfiguration from surgery; (2) knee pain elicited by cycling; and (3) early CPET termination due to electrocardiogram artefacts. Participants reached a mean peak oxygen uptake that was 34% lower than predicted and the mean (SD) CPET duration of 7:52 (2:29) min:s was significantly lower than the target test duration of 10 min (p < 0.001). Leg muscle aches and/or breathing discomfort were major contributory factors influencing test termination for 78% of participants, compared to 13% for dry mouth/throat and/or drainage in the mouth/throat. No major adverse events occurred. Participants were categorised as 26% active, 8% moderately active, and 66% insufficiently active.
Conclusion
These preliminary data suggest the CPET appears safe and feasible for most HaNC survivors when strict exclusion criteria are applied; however, low levels of cardiorespiratory fitness should be considered when calculating an appropriate ramp rate.
{"title":"Safety and feasibility of cardiopulmonary exercise testing in head and neck cancer survivors","authors":"Adrian W. Midgley, Andrew R. Levy, Felipe A. Cunha, Angela Key, Joanne M. Patterson, Simon N. Rogers","doi":"10.1111/cpf.12807","DOIUrl":"10.1111/cpf.12807","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Assess safety and feasibility of the cardiopulmonary exercise test (CPET) for evaluating head and neck cancer (HaNC) survivors. Also compare their cardiorespiratory fitness to age and sex-matched norms and establish current physical activity levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty HaNC survivors [29 male; mean (<i>SD</i>) age, 62 (8) years], who had completed treatment up to 1 year previously, were recruited. Participants performed a CPET on a cycle ergometer to symptom-limited tolerance. Participants completed a questionnaire to report contributory factors they perceived as influencing test termination. Physical activity levels were determined using a self-reported physical activity questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three participants did not complete the CPET because (1) poor fitting mouthpiece and naso-oral mask due to facial disfiguration from surgery; (2) knee pain elicited by cycling; and (3) early CPET termination due to electrocardiogram artefacts. Participants reached a mean peak oxygen uptake that was 34% lower than predicted and the mean (<i>SD</i>) CPET duration of 7:52 (2:29) min:s was significantly lower than the target test duration of 10 min (<i>p</i> < 0.001). Leg muscle aches and/or breathing discomfort were major contributory factors influencing test termination for 78% of participants, compared to 13% for dry mouth/throat and/or drainage in the mouth/throat. No major adverse events occurred. Participants were categorised as 26% active, 8% moderately active, and 66% insufficiently active.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These preliminary data suggest the CPET appears safe and feasible for most HaNC survivors when strict exclusion criteria are applied; however, low levels of cardiorespiratory fitness should be considered when calculating an appropriate ramp rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"43 3","pages":"170-180"},"PeriodicalIF":1.8,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9613791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter Gottfridsson, Lucy Law, Roman A'roch, Tomi Myrberg, Magnus Hultin, Per Lindqvist, Michael Haney
Background
Cardiac mechanics are influenced by loading conditions as well as sympathetic tone. Left atrial (LA) contractile function assessed by two-dimensional (2D) strain has been described in the setting of controlled preload alterations; however, studies show conflicting findings about change or direction of change. We hypothesized that the controlled preload reduction and the sympathetic nervous system activation that occurs during a standardized Valsalva manoeuvre would bring about a change in LA contraction strain.
Methods
Healthy young adults of both sexes were recruited. Transthoracic echocardiographic ultrasound images were collected before and during a Valsalva manoeuvre. Standard imaging windows for LA strain assessment were used and the images were copied and stored for later offline analysis. These were assessed for adequate atrial wall visualization in 2D strain assessment. Paired comparisons were carried out using Student's T test.
Result
Thirty-eight participants were included and there were 22 complete studies with paired pre- and during Valsalva manoeuvre. LA contraction strain at baseline was 10.5 ± 2.8% (standard deviation) and during the Valsalva manoeuvre 10.6 ± 4.6%, p = 0.86.
Conclusion
The Valsalva manoeuvre, a combination of preload reduction and sympathetic nervous system activation, seems not to be associated with a change in LA contraction strain in healthy young individuals. LA contraction strain should be interpreted in the context of both atrial loading conditions and prevailing autonomic nervous system activity.
{"title":"Left atrial contraction strain during a Valsalva manoeuvre: A study in healthy humans","authors":"Peter Gottfridsson, Lucy Law, Roman A'roch, Tomi Myrberg, Magnus Hultin, Per Lindqvist, Michael Haney","doi":"10.1111/cpf.12806","DOIUrl":"10.1111/cpf.12806","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac mechanics are influenced by loading conditions as well as sympathetic tone. Left atrial (LA) contractile function assessed by two-dimensional (2D) strain has been described in the setting of controlled preload alterations; however, studies show conflicting findings about change or direction of change. We hypothesized that the controlled preload reduction and the sympathetic nervous system activation that occurs during a standardized Valsalva manoeuvre would bring about a change in LA contraction strain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Healthy young adults of both sexes were recruited. Transthoracic echocardiographic ultrasound images were collected before and during a Valsalva manoeuvre. Standard imaging windows for LA strain assessment were used and the images were copied and stored for later offline analysis. These were assessed for adequate atrial wall visualization in 2D strain assessment. Paired comparisons were carried out using Student's <i>T</i> test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Thirty-eight participants were included and there were 22 complete studies with paired pre- and during Valsalva manoeuvre. LA contraction strain at baseline was 10.5 ± 2.8% (standard deviation) and during the Valsalva manoeuvre 10.6 ± 4.6%, <i>p</i> = 0.86.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Valsalva manoeuvre, a combination of preload reduction and sympathetic nervous system activation, seems not to be associated with a change in LA contraction strain in healthy young individuals. LA contraction strain should be interpreted in the context of both atrial loading conditions and prevailing autonomic nervous system activity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10504,"journal":{"name":"Clinical Physiology and Functional Imaging","volume":"43 3","pages":"165-169"},"PeriodicalIF":1.8,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cpf.12806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9613794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura Pavlin, Florian Fernandez, Rauhiti Lowgreen, Isabelle Ohresser, Jean-Paul Cristol, Cécile Turc-Baron, Henri Bernardi, Robin Candau
Purpose
This study aimed to evaluate feasibility and early effects of moderate intensity bed-cycling eccentric training on healthy individuals, and establish whether this training modality could be implemented into bedridden patients' routine care.
Methods
Longitudinal study with prepost exercise intervention measurements. The development of a bed-adapted eccentric ergometer allowed to conduct five training sessions during 3 weeks at increasing intensity on 11 healthy individuals. Force-speed relationship, maximal voluntary knee extension force and neural activation of subjects were evaluated before and after the programme.
Results
Five training sessions were sufficient to decrease the rate of perceived exertion whereas eccentric power output increased (+40%). After training, maximal voluntary isometric contraction force measured during knee extension had significantly improved in all subjects, with a mean increase of 17%. Maximal cycling power was also significantly higher (+7%) after the training programme.
Conclusion
Taken together, these results show that moderate load eccentric bed cycling (i) was feasible and efficient, (ii) did not generate excessive individual perception of effort during exercise nor develop major muscular or joint pain after training and (iii) allowed early force and power gains in healthy subjects.
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