Assessing respiratory mechanics and muscle function is critical for both clinical practice and research purposes. Several methodological developments over the past two decades have enhanced our understanding of respiratory muscle function and responses to interventions across the spectrum of health and disease. They are especially useful in diagnosing, phenotyping and assessing treatment efficacy in patients with respiratory symptoms and neuromuscular diseases. Considerable research has been undertaken over the past 17 years, since the publication of the previous American Thoracic Society (ATS)/European Respiratory Society (ERS) statement on respiratory muscle testing in 2002. Key advances have been made in the field of mechanics of breathing, respiratory muscle neurophysiology (electromyography, electroencephalography and transcranial magnetic stimulation) and on respiratory muscle imaging (ultrasound, optoelectronic plethysmography and structured light plethysmography). Accordingly, this ERS task force reviewed the field of respiratory muscle testing in health and disease, with particular reference to data obtained since the previous ATS/ERS statement. It summarises the most recent scientific and methodological developments regarding respiratory mechanics and respiratory muscle assessment by addressing the validity, precision, reproducibility, prognostic value and responsiveness to interventions of various methods. A particular emphasis is placed on assessment during exercise, which is a useful condition to stress the respiratory system.

To determine the effect of mild-to-moderate airflow limitation on exercise tolerance and end-expiratory lung volume (EELV), we studied 9 control subjects with normal pulmonary function [forced expired volume in 1 s (FEV1) 105% pred; % of forced vital capacity expired in 1 s (FEV1/FVC%) 81] and 12 patients with mild-to-moderate airflow limitation (FEV1 72% pred; FEV1/FVC % 58) during progressive cycle ergometry. Maximal exercise capacity was reduced in patients [69% of pred maximal O2 uptake (VO2max)] compared with controls (104% pred VO2max, P less than 0.01); however, maximal expired minute ventilation-to-maximum voluntary ventilation ratio and maximal heart rate were not significantly different between controls and patients. Overall, there was a close relationship between VO2max and FEV1 (r2 = 0.62). Resting EELV was similar between controls and patients [53% of total lung capacity (TLC)], but at maximal exercise the controls decreased EELV to 45% of TLC (P less than 0.01), whereas the patients increased EELV to 58% of TLC (P less than 0.05). Overall, EELV was significantly correlated to both VO2max (r = -0.71, P less than 0.001) and FEV1 (r = -0.68, P less than 0.001). This relationship suggests a ventilatory influence on exercise capacity; however, the increased EELV and associated pleural pressures could influence cardiovascular function during exercise. We suggest that the increase in EELV should be considered a response reflective of the effect of airflow limitation on the ventilatory response to exercise.

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OBJECTIVE:To investigate the effect of mild-to-moderate obesity on respiratory mechanics at rest and during exercise in obese men. We hypothesized that the simple mass loading of obesity would alter both end-expiratory lung volume (EELV) and respiratory pressures (gastric, P ga and transpulmonary, P TP ) in resting body positions and during graded cycle ergometry to exhaustion. SUBJECTS: A total of 10 obese (3875% body fat; mean7s.d.) and nine lean (1874%) men were studied. METHODS: Body composition (by body circumferences and hydrostatic weighing) and pulmonary function were measured at rest. Breathing mechanics were measured at rest in the upright-seated position, supine, and during cycling exercise. Data were analyzed by independent t-test. RESULTS: EELV was significantly lower in the obese men in the supine (3074 vs 3776% total lung capacity (TLC)) and seated (3976 vs 4775%TLC) positions and at ventilatory threshold (3575 vs 4577%TLC) (Po0.01). In contrast, at peak exercise, EELV was not different between groups. Respiratory pressures (P ga and P TP ) were elevated (Po0.05) during one or more phases of the breathing cycle at rest and during exercise in obese men.CONCLUSION: These data demonstrate that mild-to-moderate obesity in young men results in reduced lung volumes and alterations in respiratory mechanics when supine, seated at rest, and during exercise. During moderate exercise, obesity does not appear to limit changes in EELV; however, the regulation of EELV during heavy exercise appears to be affected.

To investigate the effects of obesity on the regulation of end-expiratory lung volume (EELV) during exercise we studied nine obese (41 +/- 6% body fat and 35 +/- 7 yr, mean +/- SD) and eight lean (18 +/- 3% body fat and 34 +/- 4 yr) women. We hypothesized that the simple mass loading of obesity would constrain the decrease in EELV in the supine position and during exercise. All subjects underwent respiratory mechanics measurements in the supine and seated positions, and during graded cycle ergometry to exhaustion. Data were analyzed between groups by independent t-test in the supine and seated postures, and during exercise at ventilatory threshold and peak. Total lung capacity (TLC) was reduced in the obese women (P < 0.05). EELV was significantly lower in the obese subjects in the supine (37 +/- 6 vs. 45 +/- 5% TLC) and seated (45 +/- 6 vs. 53 +/- 5% TLC) positions and at ventilatory threshold (41 +/- 4 vs. 49 +/- 5% TLC) (P < 0.01). In conclusion, despite reduced resting lung volumes and alterations in respiratory mechanics during exercise, mild obesity in women does not appear to constrain EELV during cycling nor does it limit exercise capacity. Also, these data suggest that other nonmechanical factors also regulate the level of EELV during exercise.

To investigate the effects of mechanical ventilatory limitation on the ventilatory response to exercise, eight older subjects with normal lung function were studied. Each subject performed graded cycle ergometry to exhaustion once while breathing room air; once while breathing 3% CO2-21% O2-balance N2; and once while breathing HeO2 (79% He and 21% O2). Minute ventilation (VE) and respiratory mechanics were measured continuously during each 1-min increment in work rate (10 or 20 W). Data were analyzed at rest, at ventilatory threshold (VTh), and at maximal exercise. When the subjects were breathing 3% CO2, there was an increase (P < 0.001) in VE at rest and at VTh but not during maximal exercise. When the subjects were breathing HeO2, VE was increased (P < 0.05) only during maximal exercise (24 +/- 11%). The ventilatory response to exercise below VTh was greater only when the subjects were breathing 3% CO2 (P < 0.05). Above VTh, the ventilatory response when the subjects were breathing HeO2 was greater than when breathing 3% CO2 (P < 0.01). Flow limitation, as percent of tidal volume, during maximal exercise was greater (P < 0.01) when the subjects were breathing CO2 (22 +/- 12%) than when breathing room air (12 +/- 9%) or when breathing HeO2 (10 +/- 7%) (n = 7). End-expiratory lung volume during maximal exercise was lower when the subjects were breathing HeO2 than when breathing room air or when breathing CO2 (P < 0.01). These data indicate that older subjects have little reserve for accommodating an increase in ventilatory demand and suggest that mechanical ventilatory constraints influence both the magnitude of VE during maximal exercise and the regulation of VE and respiratory mechanics during heavy-to-maximal exercise.

Dyspnea on exertion is prevalent in otherwise healthy obese women, which seems to be strongly associated with an increased oxygen cost of breathing. Exercise capacity is not reduced in obese women with dyspnea on exertion.

Mechanical ventilatory constraints in aging, lung disease, and obesity; perspectives and brief review. Med. Sci. Sports Exerc., Vol. 31, No. 1 (Suppl.), pp. S12-S22, 1999. One of the most difficult tasks of cardiopulmonary exercise testing is to determine the influence of ventilatory limitations on the ventilatory response to exercise. Currently there is no generally accepted method in which to quantify the magnitude of mechanical ventilatory constraints during exercise. Nor is there agreement on how to quantify maximal ventilatory capacity. To address these issues, this article focuses on the evaluation of mechanical ventilatory constraints during exercise and provides an overview of the mechanical ventilatory constraints that are encountered with aging, lung disease, and obesity.