We tested whether the increased cycling endurance observed after respiratory muscle training (RMT) in healthy sedentary humans was associated with a training-induced increase in cardiac stroke volume (SV) during exercise, similar to the known effect of endurance training. Thirteen subjects underwent RMT by normocapnic hyperpnea, nine underwent aerobic endurance training (cycling and/or running) and fifteen served as non-training controls. Training comprised 40 sessions performed within 15 weeks, where each session lasted 30 min. RMT increased cycling endurance at 70% maximal aerobic power (Wmax) by 24% [mean (SD) 35.6 (11.9) min vs 44.2 (17.6) min, P < 0.05], but SV at 60% Wmax was unchanged [94 (21) ml vs 93 (20) ml]. Aerobic endurance training increased both SV [89 (24) ml vs 104 (32) ml, P < 0.01] and cycling endurance [37.4 (12.8) min vs 52.6 (16.9) min, P < 0.01]. In the control group, no changes were observed in any of these variables. It is concluded that the increased cycling endurance that is observed after RMT is not due to cardiovascular adaptations, and that the results provide evidence for the role of the respiratory system as an exercise-limiting factor.

Isolated respiratory muscle endurance training (RMT) can prolong constant-intensity cycling performance. We tested whether RMT affects O2 supply during exercise, i.e. whether the partial pressure of oxygen in arterial blood (Pa,O2) and/or its oxygen saturation (SaO2) are higher during exercise after RMT than before. A group of 28 sedentary subjects were randomly assigned to either an RMT (n = 13) or a control group (n = 15). The RMT consisted of 40x30 min sessions of normocapnic hyperpnoea. The control group did not perform any training. Breathing and cycling endurance time as well as PaO2 and SaO2 during cycling at a constant intensity of 70% maximum power output were measured before and after the RMT or the control period. Mean breathing endurance increased significantly after RMT compared to control [RMT 5.2 (SD 2.9) vs 38.1 (SD 6.8) min, control 6.5 (SD 5.7) vs 6.4 (SD 7.6) min; P < 0.01], as did mean cycling endurance [RMT 35.6 (SD 11.9) vs 44.0 (SD 17.2) min, control 32.8 (SD 11.6) vs 31.4 (SD 14.4) min; P<0.05]. The RMT did not affect PaO2 which ranged from 11.6 to 12.3 kPa (87-92 mmHg), and SaO2 which ranged from 96% to 98% throughout all tests. In conclusion, RMT substantially increased breathing and cycling endurance in sedentary subjects. These changes, however, cannot be attributed to increased O2 supply, as neither PaO2 nor SaO2 were increased during exercise after RMT.

BackgroundPaediatric end-of-life care is challenging and requires a high level of professional expertise. It is important that healthcare teams have a thorough understanding of paediatric subspecialties and related knowledge of disease-specific aspects of paediatric end-of-life care. The aim of this study was to comprehensively describe, explore and compare current practices in paediatric end-of-life care in four distinct diagnostic groups across healthcare settings including all relevant levels of healthcare providers in Switzerland.MethodsIn this nationwide retrospective chart review study, data from paediatric patients who died in the years 2011 or 2012 due to a cardiac, neurological or oncological condition, or during the neonatal period were collected in 13 hospitals, two long-term institutions and 10 community-based healthcare service providers throughout Switzerland.ResultsNinety-three (62%) of the 149 reviewed patients died in intensive care units, 78 (84%) of them following withdrawal of life-sustaining treatment. Reliance on invasive medical interventions was prevalent, and the use of medication was high, with a median count of 12 different drugs during the last week of life. Patients experienced an average number of 6.42 symptoms. The prevalence of various types of symptoms differed significantly among the four diagnostic groups. Overall, our study patients stayed in the hospital for a median of six days during their last four weeks of life. Seventy-two patients (48%) stayed at home for at least one day and only half of those received community-based healthcare.ConclusionsThe study provides a wide-ranging overview of current end-of-life care practices in a real-life setting of different healthcare providers. The inclusion of patients with all major diagnoses leading to disease- and prematurity-related childhood deaths, as well as comparisons across the diagnostic groups, provides additional insight and understanding for healthcare professionals. The provision of specialised palliative and end-of-life care services in Switzerland, including the capacity of community healthcare services, need to be expanded to meet the specific needs of seriously ill children and their families.

We hypothesised that L: -carnitine could accelerate recovery from exhaustive exercise since increased blood L: -carnitine concentrations elicit a vasodilation in isolated animal vessels as well as in patients with peripheral vascular or coronary artery disease during exercise. Twelve subjects received either 2 g L: -carnitine or a placebo in a study which was double-blind and crossover in design. Two hours after administration, the subjects performed a constant-load exercise test (CET(1)) cycling at their individual anaerobic threshold to exhaustion. Three hours later this test was repeated (CET(2)). After 4-14 days, each subject performed the same cycling tests after having taken the other substance. Exercise times of the 12 subjects were identical with L: -carnitine (CET(1): 21.3+/-5.7 min; CET(2): 21.4+/-5.3 min) and placebo (CET(1): 21.9+/-6.2 min; CET(2): 20.4+/-4.8 min). Also, heart rate, oxygen consumption, respiratory exchange ratio, and blood lactate concentration were identical. In conclusion, 2 g of L-carnitine taken 2 h before a first of two constant-load exercise tests had no influence on the second tests performed 3 h after the first test compared with placebo.