Exercise Training Decreases Ventilatory Requirements and Exercise-Induced Hyperinflation at Submaximal Intensities in Patients With COPD

Pórszász, János; Emtner, Margareta; Goto, Shinichi; Somfay, Attila; Whipp, Brian J.; Casaburi, Richard

doi:10.1378/chest.128.4.2025

Cited by 217 publications

(167 citation statements)

References 25 publications

Supporting

Mentioning

136

Contrasting

Unclassified

Order By: Relevance

“…Dynamic training reduces dynamic hyperinflation and improves submaximal exercise tolerance in connection with a reduction in breath rate (33). Lactic acid threshold (LAT) and ventilation response improve (13,33). These results underline the favourable effect of training on the quality of life of patients in a severe stage as well (13,33).…”

Section: High Intensity Endurance Training and Dynamic Hyperinflationmentioning

confidence: 81%

“…High intensity endurance training at a certain level of exercise (isotime) reduces dynamic hyperinflation (33). Dynamic training reduces dynamic hyperinflation and improves submaximal exercise tolerance in connection with a reduction in breath rate (33).…”

Section: High Intensity Endurance Training and Dynamic Hyperinflationmentioning

confidence: 99%

Section: High Intensity Endurance Training and Dynamic Hyperinflationmentioning

confidence: 99%

See 2 more Smart Citations

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Varga¹

2015

Acta Physiologica Hungarica

View full text Add to dashboard Cite

Expiratory flow limitation can develop in parallel with the progression of COPD, and as a consequence, dynamic hyperinflation and lung mechanical abnormalities can develop. Dynamic hyperinflation can cause increased breathlessness and reduction in exercise tolerance. Achievement of critical inspiratory reserve volume is one of the main factors in exercise intolerance. Obesity has specific lung mechanical effects. There is also a difference concerning gender and dyspnoea. Increased nerve activity is characteristic in hyperinflation. Bronchodilator therapy, lung volume reduction surgery, endurance training at submaximal intensity, and heliox or oxygen breathing can decrease the degree of dynamic hyperinflation.Keywords: COPD, dyspnoea, expiratory flow limitation, dynamic hyperinflation, lung mechanics, exercise toleranceOne of the main symptoms in chronic obstructive pulmonary disease (COPD) is dyspnoea, and initially it is manifested during exercise and later at rest with the progression of the disease. Dyspnoea leads to exercise intolerance in parallel with physical inactivity, and as a consequence, disability may develop (28). The main causes of exercise intolerance may be lung mechanical abnormalities and patient's deconditioning (28). Dyspnoea is characterised by an increase in the following factors: respiratory work/ effort ratio, breathing load, end-expiratory lung volume (EELV) related dynamic hyperinflation, intrinsic positive end-expiratory pressure (PEEP) related elastic effort, and neurological sensation (Fig. 1) (28). Dyspnoea manifestation is often associated with dynamic hyperinflation (DH) in patients with COPD from moderate to severe obstruction (26,28,29,35,42). The discrepancy between respiratory centre induced respiratory muscle work and muscle load, and capacity related lung volume changes lead to neuromechanical dissociation (Fig. 2). The consequence of this process is the development of dynamic hyperinflation as a cause of chronic and exertional dyspnoea (28).

show abstract

Section: High Intensity Endurance Training and Dynamic Hyperinflationmentioning

confidence: 81%

Section: High Intensity Endurance Training and Dynamic Hyperinflationmentioning

confidence: 99%

See 1 more Smart Citation

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Varga¹

2015

Acta Physiologica Hungarica

View full text Add to dashboard Cite

show abstract

“…75-80% peak work-rate) have been used to demonstrate the positive effects of interventions such as bronchodilator therapy [252,253,262]; oxygen [263] and heliox [254] administration during exercise; bronchoscopic lung volume reduction [264]; and rehabilitation [265,266]. By using this approach, it is possible to demonstrate a significant improvement in endurance time, mostly due to a reduction in lung dynamic hyperinflation and dyspnoea at isotime (table 3).…”

Section: Symptom-limited Incremental Testmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

Eur Respir J

562

390

View full text Add to dashboard Cite

Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

show abstract

“…In the latter study, there was evidence of an interaction between reduced gas density breathing and relative hyperoxia, although this was seen only in patients with more severe airflow obstruction. Studies of improving physical exercise performance with pulmonary rehabilitation also show a reduction in DH relative to prerehabilitation data, although this too is likely to reflect a lower metabolic carbon dioxide production post-exercise for the same external work [50].…”

Section: Exertion and Breathlessnessmentioning

confidence: 95%

Exercise and dyspnoea in COPD

Calverley¹

2006

Eur Respir Rev

View full text Add to dashboard Cite

Dyspnoea provoked either by exercise or during a disease exacerbation is one of the most feared symptoms of the chronic obstructive pulmonary disease (COPD) patient. It contributes to impaired quality of life and patients who are more limited by exertional dyspnoea are more likely to die. The physiological mechanisms responsible for these two outcomes vary in different settings, but in both situations, changes in the resting lung volume and increased activation of the respiratory muscles relative to their maximum capacity is the final common pathway.Although increased metabolic carbon dioxide production from weak or poorly conditioned muscles is an important cofactor, most patients limited by exertional dyspnoea exhibit dynamic hyperinflation that parallels their symptom intensity. This results from the longer respiratory time constant of the lungs in COPD and coexisting expiratory flow limitation during tidal breathing. The response of the chest wall muscles to this change in lung volume is variable: most patients with more severe COPD allow chest wall volume to increase, while others try to defend chest wall volume. The latter is not a good breathing strategy as the patient's exercise capacity is very limited.Treatment with bronchodilators reduces operating lung volumes and delays the time until tidal volume is mechanically limited by the inspiratory reserve volume. Breathing oxygen and heliox gas mixtures further increases exercise endurance and slows the rate at which end-expiratory lung volume increases.During exacerbations there is a consistent increase in end-expiratory lung volume and this parallels the reduction in forced vital capacity. This suggests that gas trapping due to airway closure is the main mechanism involved here, although changes in lung volume still track the symptomatic improvement in dyspnoea reported by patients both as the episode resolves and after nebulised bronchodilator treatment.

show abstract

Exercise Training Decreases Ventilatory Requirements and Exercise-Induced Hyperinflation at Submaximal Intensities in Patients With COPD

Cited by 217 publications

References 25 publications

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Mechanisms to dyspnoea and dynamic hyperinflation related exercise intolerance in COPD

Recommendations on the use of exercise testing in clinical practice

Exercise and dyspnoea in COPD

Contact Info

Product

Resources

About