Cardiopulmonary and Muscular Interactions: Potential Implications for Exercise (In)tolerance in Symptomatic Smokers Without Chronic Obstructive Pulmonary Disease

Abstract

Smoking and physical inactivity are important preventable causes of disability and early death worldwide. Reduced exercise tolerance has been described in smokers, even in those who do not fulfill the extant physiological criteria for chronic obstructive pulmonary disease (COPD) and are not particularly sedentary. In this context, it is widely accepted that exercise capacity depends on complex cardio-pulmonary interactions which support oxygen (O 2 ) delivery to muscle mitochondria. Although peripheral muscular factors, O 2 transport disturbances (including the effects of increased carboxyhemoglobin) and autonomic nervous system unbalance have been emphasized, other derangements have been more recently described, including early microscopic emphysema, pulmonary microvascular disease, ventilatory and gas exchange inefficiency, and left ventricular diastolic dysfunction. Using an integrative physiological approach, the present review summarizes the recent advances in knowledge on the effects of smoking on the lung-heart-muscle axis under the stress of exercise. Special attention is given to the mechanisms connecting physiological abnormalities such as early cardio-pulmonary derangements, inadequate oxygen delivery and utilization, and generalized bioenergetic disturbances at the muscular level with the negative sensations (sense of heightened muscle effort and breathlessness) that may decrease the tolerance of smokers to physical exercise. A deeper understanding of the systemic effects of smoking in subjects who did not (yet) show evidences of COPD and ischemic heart disease – two devastating smoking related diseases – might prove instrumental to fight their ever-growing burden.

Effect of Six-Minute Walk Test and Incremental Exercise on Inspiratory Capacity, Ventilatory Constraints, Breathlessness and Exercise Performance in Sedentary Male Smokers without Airway Obstruction

“…Reduced maximal VE in smokers may be related to the chronic effects of smoking on pulmonary function. Our result was following previous studies demonstrating that VE was greater during heavy work [ 42 , 43 ]. Moreover, smokers had a higher VE for a given submaximal exercise intensity compared to non-smokers with a lower VO 2 leading to the elevation in VE/VO 2 .…”

The Chronic Effects of Narghile Use on Males’ Cardiovascular Response During Exercise: A Systematic Review

“…According to Hawari et al (2013) , the acute harmful effects could be related to the reduced capacity for carrying oxygen due to the increase in carbon monoxide levels. The second hypothesis can be extrapolated from the effect of cigarette smoking on exercise capacity ( Muller et al, 2019 ). Muller et al (2019) identified abnormalities in the cardio-circulatory and respiratory chain, supporting oxygen delivery to muscle.…”

“…The second hypothesis can be extrapolated from the effect of cigarette smoking on exercise capacity ( Muller et al, 2019 ). Muller et al (2019) identified abnormalities in the cardio-circulatory and respiratory chain, supporting oxygen delivery to muscle.…”

Effect of Tobacco Smoke Exposure on Functional Capacity, Respiratory Muscle Strength, and Physical Activity Level in Patients with Pulmonary Arterial Hypertension: A Preliminary Study

“…In addition, reduced exercise capacity has shown in smoker older people compared with nonsmoker older people (24). The musclelung-heart axis may cause reduced exercise capacity in smokers (25,26). Physical activity and smoking are inversely related as physical activity and exercise can decrease inflammatory markers associated with decreased cardiovascular fitness (27).…”