Acute respiratory muscle unloading by normoxic helium–O2 breathing reduces the O2 cost of cycling and perceived exertion in obese adolescents

Salvadego, Desy; Sartório, Alessandro; Agosti, Fiorenza; Tringali, Gabriella; Patrizi, Alessandra; Mauro, A. Lo; Aliverti, Andréa; Grassi, Bruno

doi:10.1007/s00421-014-2993-8

Cited by 19 publications

(33 citation statements)

References 40 publications

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“…However, it has become clear that the ΔVO 2 /ΔWR can be influenced by cardiac output and muscle blood flow and perfusion (41), and not solely by the oxygen required to rephosphorylate ADP. In the case of the high-BMI group in our study, if the work of breathing increased nonlinearly as ergometer work increased (again, as hinted in the Salvadego study [35]), then the lower ΔVO 2 /ΔWR in the high-BMI individuals could indicate impaired oxygen delivery since the actual work performed would be greater than the ΔWR gauged solely from the cycle ergometer.…”

Section: Discussionsupporting

confidence: 57%

“…For example, the work of breathing may substantially increase nonlinearly (even as WR increases linearly) because respiratory rate and tidal volumes increase as exercise progresses and the work of breathing in the obese individual is substantially greater because of chest wall mass and the resistive effects on the diaphragm of increased visceral abdominal fat. The study of Salvadego et al (35) supports the notion that work of breathing is inordinately high and increases nonlinearly in obese subjects. We did not observe substantial abnormalities in the ΔVE/ΔVCO 2 , suggesting that despite an increase in work of breathing, abnormalities in dead space or respiratory control that do influence the ΔVE/ΔVCO 2 in lung diseases such as cystic fibrosis (29), respiratory physiology remained largely intact in the high-BMI group.…”

Section: Discussionmentioning

confidence: 75%

“…Shim and coworkers (37), in obese children with asthma, and Marinov and coworkers (28), in otherwise healthy obese children, for example, noted greater sense of breathlessness at high WRs than in normal-BMI children. Salvadego et al (35), in a recent elegant study, showed that by reducing the work of breathing using heliox, obese adolescents improved their rate of perceived exertion during high-intensity exercise.…”

Section: Discussionmentioning

confidence: 99%

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Cardiopulmonary Exercise Testing in Children and Adolescents with High Body Mass Index

Leu

Taylor-Lucas

et al. 2016

Pediatric Exercise Science

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Consensus has yet to be achieved on whether obesity is inexorably tied to poor fitness. We tested the hypothesis that appropriate reference of cardiopulmonary exercise testing (CPET) variables to lean body mass (LBM) would eliminate differences in fitness between high-BMI (≥ 95th percentile, n = 72, 50% female) and normal-BMI (< 85th percentile, n = 142, 49% female), otherwise-healthy children and adolescents typically seen when referencing body weight. We measured body composition with dual x-ray absorptiometry (DXA) and CPET variables from cycle ergometry using both peak values and submaximal exercise slopes (peak VO2, ΔVO2/ΔHR, ΔWR/ΔHR, ΔVO2/ΔWR, and ΔVE/ΔVCO2). In contrast to our hypothesis, referencing to LBM tended to lessen, but did not eliminate, the differences (peak VO2 [p < .004] and ΔVO2/ΔHR [p < .02]) in males and females; ΔWR/ΔHR differed between the two groups in females (p = .041) but not males (p = .1). The mean percent predicted values for all CPET variables were below 100% in the high-BMI group. The pattern of CPET abnormalities suggested a pervasive impairment of O2 delivery in the high-BMI group (ΔVO2/ΔWR was in fact highest in normal-BMI males). Tailoring lifestyle interventions to the specific fitness capabilities of each child (personalized exercise medicine) may be one of the ways to stem what has been an intractable epidemic.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Cardiopulmonary Exercise Testing in Children and Adolescents with High Body Mass Index

Leu

Taylor-Lucas

et al. 2016

Pediatric Exercise Science

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“…However, additional studies of obese adolescents are needed to determine the effects of 3 weeks of energy-restricted diet plus aerobic training alone in comparison with the results obtained in the present study. In a previous study (Salvadego et al 2015) carried out in a similar population, it was observed that acute respiratory muscle unloading by normoxic helium-O 2 breathing determined a reduced oxygen cost of cycling and lower dyspnea and limb discomfort during moderate-to-heavy-intensity exercise at a constant work rate. These findings suggest that in the obese population, interventions specifically aimed at reducing the mechanical load and (or) increasing respiratory muscle endurance and strength could be recommended to improve exercise tolerance.…”

Section: Mbwrp Effectmentioning

confidence: 91%

Effects of a multidisciplinary body weight reduction program on static and dynamic thoraco-abdominal volumes in obese adolescents

LoMauro

Cesareo

Agosti

et al. 2016

Appl. Physiol. Nutr. Metab.

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Abstract:The objective of this study was to characterize static and dynamic thoraco-abdominal volumes in obese adolescents and to test the effects of a 3-week multidisciplinary body weight reduction program (MBWRP), entailing an energy-restricted diet, psychological and nutritional counseling, aerobic physical activity, and respiratory muscle endurance training (RMET), on these parameters. Total chest wall (V CW ), pulmonary rib cage (V RC,p ), abdominal rib cage (V RC,a ), and abdominal (V AB ) volumes were measured on 11 male adolescents (Tanner stage: 3-5; BMI standard deviation score: >2; age: 15.9 ± 1.3 years; percent body fat: 38.4%) during rest, inspiratory capacity (IC) maneuver, and incremental exercise on a cycle ergometer at baseline and after 3 weeks of MBWRP. At baseline, the progressive increase in tidal volume was achieved by an increase in end-inspiratory V CW (p < 0.05) due to increases in V RC,p and V RC,a with constant V AB . End-expiratory V CW decreased with late increasing V RC,p , dynamically hyperinflating V RC,a (p < 0.05), and progressively decreasing V AB (p < 0.05). After MBWRP, weight loss was concentrated in the abdomen and total IC decreased. During exercise, abdominal rib cage hyperinflation was delayed and associated with 15% increased performance and reduced dyspnea at high workloads (p < 0.05) without ventilatory and metabolic changes. We conclude that otherwise healthy obese adolescents adopt a thoracoabdominal operational pattern characterized by abdominal rib cage hyperinflation as a form of lung recruitment during incremental cycle exercise. Additionally, a short period of MBWRP including RMET is associated with improved exercise performance, lung and chest wall volume recruitment, unloading of respiratory muscles, and reduced dyspnea.Key words: obesity, pediatrics, exercise, pulmonary physiology, exercise physiology, kinesiology.Résumé : Cette étude a pour objectif de déterminer les volumes thoraco-abdominaux statiques et dynamiques chez des adolescents obèses et d'évaluer sur ces variables les effets de 3 semaines d'un programme multidisciplinaire de perte de poids (MBWRP) comprenant un régime restrictif, du counseling psychologique et nutritionnel, de l'activité physique aérobie et un entraînement en endurance des muscles respiratoires (RMET). On mesure les volumes de la cage thoracique totale (V CW ), du compartiment pulmonaire (V RC,p ), du compartiment abdominal (V RC,a ) et de l'abdomen (V AB ) de 11 adolescents mâles (stade de Tanner : 3-5, IMC > 2 écarts-types, âge 15,9 ± 1,3 ans, pourcentage de gras corporel : 38,4 %) au repos, la capacité inspiratoire (IC), une manoeuvre de capacité inspiratoire (IC) et un test d'effort progressif sur cycloergomètre au début et après 3 semaines de MBWRP. Au début, le volume courant s'accroit progressivement par l'augmentation de V CW à la fin de l'inspiration (p < 0,05) due à l'agrandissement des deux compartiments de la cage thoracique, V AB demeurant constant. V CW à la fin de l'expiration diminue en présence d'une augmentation...

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“…Additionally, obesity increases the work of breathing from both obstructive and restrictive alterations leading to increases in O 2 cost of exercise and reduced exercise tolerance (96;97). Conceivably, the combination of asthma and obesity would lead to further impairments in exercise tolerance, lung function, and increased work of breathing, particularly at high-intensity exercise.…”

Section: The Development Of the Obese Asthmatic Child–possible Mechanmentioning

confidence: 99%

Obesity, Asthma, and Exercise in Child and Adolescent Health

Manoukian

Radom‐Aizik

et al. 2016

Pediatric Exercise Science

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Obesity increases the risk of asthma throughout life but the underlying mechanisms linking these all too common threats to child health are poorly understood. Acute bouts of exercise, aerobic fitness, and levels of physical activity clearly play a role in the pathogenesis and/or management of both childhood obesity and asthma. Moreover, both obesity and physical inactivity are associated with asthma symptomatology and response to therapy (a particularly challenging feature of obesity-related asthma). In this article, we review current understandings of the link between physical activity, aerobic fitness and the asthma-obesity link in children and adolescents (e.g., the impact of chronic low-grade inflammation, lung mechanics, and direct effects of metabolic health on the lung). Gaps in our knowledge regarding the physiological mechanisms linking asthma, obesity and exercise are often compounded by imprecise estimations of adiposity and challenges of assessing aerobic fitness in children. Addressing these gaps could lead to practical interventions and clinical approaches that could mitigate the profound health care crisis of the increasing comorbidity of asthma, physical inactivity, and obesity in children.

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Acute respiratory muscle unloading by normoxic helium–O2 breathing reduces the O2 cost of cycling and perceived exertion in obese adolescents

Cited by 19 publications

References 40 publications

Cardiopulmonary Exercise Testing in Children and Adolescents with High Body Mass Index

Cardiopulmonary Exercise Testing in Children and Adolescents with High Body Mass Index

Effects of a multidisciplinary body weight reduction program on static and dynamic thoraco-abdominal volumes in obese adolescents

Obesity, Asthma, and Exercise in Child and Adolescent Health

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