Systemic oxygen extraction during incremental exercise in patients with severe chronic obstructive pulmonary disease

Oelberg, David A.; Medoff, Benjamin D.; Markowitz, Deborah H.; Pappagianopoulos, Paul P.; Ginns, Leo C.; Systrom, David M.

doi:10.1007/s004210050408

Cited by 17 publications

(9 citation statements)

References 44 publications

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“…Similarities in cardiovascular responses to exercise in COPD and mitral stenosis were reported by Venami et al [40]who found similar decreases in right ventricular ejection fraction. At the anaerobic threshold, Nery et al [47]reported that oxygen uptake in mitral stenosis was decreased, as it is in COPD [30, 48, 49]. These findings are consistent with a low anaerobic threshold in both CHF and COPD due to right ventricular dysfunction, leading to relative ischemia of exercising muscles.…”

Section: Cardiovascular Factors Limiting Exercise In Copdsupporting

confidence: 77%

“…For an anaerobic threshold which occurs at a V̇ O2 of 1,500 ml O 2 /min, the oxygen cost of breathing would be about 150 ml O 2 /min. Contrast this situation with a patient with COPD having a V̇ O2 max of only 1,000 ml/min with an anaerobic threshold at 30% V̇ O2 max [49]or only 300 ml/min just slightly above the total body O 2 requirements at rest. Such a patient would have very little opportunity to exercise aerobically.…”

Section: The Competition Between Ventilatory and Skeletal Musclesmentioning

confidence: 97%

“…Leg blood flow significantly decreased only at maximal exercise, and the lactate production which occurred earlier was attributed to peripheral muscle dysfunction [48]. Oelberg et al [46, 49]found that mixed venous oxygen content was actually increased during exercise in COPD, suggesting that the early lactate production could be related to a diminished capacity of exercising muscles in COPD to extract oxygen. Considering the abnormalities found in skeletal muscle [16]showing reduced oxidative capacity, these findings are not surprising.…”

Section: Cardiovascular Factors Limiting Exercise In Copdmentioning

confidence: 99%

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How and Why Exercise Is Impaired in COPD

Aliverti

Macklem²

2001

Respiration

100

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Published data indicate that exercise in COPD is more often limited by leg effort than breathlessness. This casts some doubt on the classical belief that inability to ventilate limits exercise performance. In fact, symptoms limiting exercise appear to be essentially the same in COPD and in health or congestive heart failure, where exercise is limited by inadequate energy supply to locomotor muscles. In COPD, impaired O₂ delivery to locomotor muscles is suggested by: (1) the O₂ cost (v̇_O2) of breathing may be ∼50% of whole body v̇_O2; (2) decreasing the work of breathing improves performance and v̇_O2 of locomotor muscles, and (3) locomotor muscle v̇_O2 is greater when it is the only muscle exercising than during whole body exercise. Excessive expiratory pressures when expiratory flow is limited may lead to decreased venous return and contribute importantly to exercise limitation.

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Section: Cardiovascular Factors Limiting Exercise In Copdsupporting

confidence: 77%

Section: The Competition Between Ventilatory and Skeletal Musclesmentioning

confidence: 97%

Section: Cardiovascular Factors Limiting Exercise In Copdmentioning

confidence: 99%

See 1 more Smart Citation

How and Why Exercise Is Impaired in COPD

Aliverti

Macklem²

2001

Respiration

100

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“…The results of blood gas analysis and oximetry both at rest and on exercise, plus BMI measures confirmed this. The potential contributions of drug therapy and cigarette smoking to skeletal muscle dysfunction have been mentioned recently by OELBERG et al [19]. These factors would not explain the current results.…”

Section: Discussionmentioning

confidence: 54%

Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training

Clark¹,

Cochrane²,

Mackay³

et al. 2000

Eur Respir J

183

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This study poses two questions: 1) is there an abnormality in isokinetic skeletal muscle strength and endurance in mild chronic obstructive pulmonary disease (COPD)? and 2) what is the effect of a randomized, controlled, 12 week hospital outpatient weight training programme in terms of skeletal muscle function and exercise tolerance?Upper and lower limb isokinetic maximum and sustained muscle function were compared in 43 COPD patients (age 4911 yrs), mean forced expiratory volume in one second (FEV1) 7723% pred and 52 healthy, sedentary subjects (age 51 (10) yrs), mean FEV1 10916% pred. The 43 COPD patients were randomly allocated into training (n=26) and control (n=17) groups. Isokinetic and isotonic muscle function, whole body endurance, maximal exercise capacity and lung function were measured.The COPD patients had reduced isokinetic muscle function (with the exception of sustained upper limb strength) as compared with healthy sedentary subjects. Muscle function improved after weight training in the COPD patients. Whole body endurance during treadmill walking also improved with no change in maximal oxygen consumption.A deficit in skeletal muscle function can be identified in patients with mild chronic obstructive pulmonary disease which cannot be explained by factors such as hypoxaemia and malnutrition. Intervention with weight training is effective in countering this deficit which the authors conclude is probably due to muscle deconditioning. Eur Respir J 2000; 15: 92±97.

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“…In a previous study, maximal oxygen consumption in stroke patients during incremental exercise was lower than that in healthy subjects [7]. A decrease in respiratory function causes a rapid increase in the blood lactate concentration even at a low work rate; i.e., a decrease in LT [25].…”

Section: Discussionmentioning

confidence: 78%

Changes in the Lactate Threshold During Treadmill Exercise After Microsphere-Induced Infarction in Rats

Takahashi¹,

Himi²,

Kuniyasu³

et al. 2012

Journal of Stroke and Cerebrovascular Diseases

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Objectives The aim of this study was to clarify changes in the lactate threshold (LT) in the acute period after cerebral infarction.Methods Cerebral infarction was induced by the injection of microspheres (MS) into the right internal carotid artery. To estimate the degree of neurological deficit caused by surgery, the behaviors of all rats were evaluated in terms of typical symptoms of stroke in rats. A rotarod test was used to evaluate equilibrium function. Rats were forced to perform stepwise treadmill exercises and serial changes in the blood lactate concentration were measured for determination of the LT. ResultsThe average treadmill speed at the LT and rotarod performance in MS rats was significantly lower than those in sham-operated rats on the 2 nd days after surgery.However, while neurological deficits disappeared on the 7 th days after surgery in MS rats, the LT and rotarod performance were significantly lower than those in shamoperated rats. ConclusionThese results suggest that the decrease in the LT in the acute period following cerebral infarction may be induced by impairment of the equilibrium function.Other possibilities are also discussed.

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Systemic oxygen extraction during incremental exercise in patients with severe chronic obstructive pulmonary disease

Cited by 17 publications

References 44 publications

How and Why Exercise Is Impaired in COPD

How and Why Exercise Is Impaired in COPD

Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training

Changes in the Lactate Threshold During Treadmill Exercise After Microsphere-Induced Infarction in Rats

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