Effect of exercise training on ventilatory efficiency in patients with heart disease: a review

Abstract

The analysis of ventilatory efficiency in cardiopulmonary exercise testing has proven useful for assessing the presence and severity of cardiorespiratory diseases. During exercise, efficient pulmonary gas exchange is characterized by uniform matching of lung ventilation with perfusion. By contrast, mismatching is marked by inefficient pulmonary gas exchange, requiring increased ventilation for a given CO2 production. The etiology of increased and inefficient ventilatory response to exercise in heart disease is multifactorial, involving both peripheral and central mechanisms. Exercise training has been recommended as non-pharmacological treatment for patients with different chronic cardiopulmonary diseases. In this respect, previous studies have reported improvements in ventilatory efficiency after aerobic exercise training in patients with heart disease. Against this background, the primary objective of the present review was to discuss the pathophysiological mechanisms involved in abnormal ventilatory response to exercise, with an emphasis on both patients with heart failure syndrome and coronary artery disease. Secondly, special focus was dedicated to the role of aerobic exercise training in improving indices of ventilatory efficiency among these patients, as well as to the underlying mechanisms involved.

Effect of exercise training on cardiac mitochondrial respiration, biogenesis, dynamics, and mitophagy in ischemic heart disease

“…This is evidenced by different studies that explored on how ET can reconstruct the cardiac mitochondria that has been dysregulated by different heart ailments such as IHD and HF (22,76). Moreover, different studies also showed how ET improves cardiorespiratory endurance and different cardiovascular risk factors, which in turn helps improve the QoL of IHD patients (77,78).…”

The effect of the protective face mask on cardiorespiratory response during aerobic exercise

“…Physical exercise poses the greatest physiological challenge to the ventilatory, cardiovascular, and skeletal muscle system called the “oxygen transport system”. Specifically, aerobic capacity depends on adequate oxygen transport by the cardiorespiratory system from environmental air to the working skeletal muscles and the efficiency in terms of oxygen utilization by the mitochondria 10,11 . In this scenario, cardiorespiratory control is one of the major challenges regarding the integrated multi‐system coordination to physical effort 24,25 …”

“…Briefly, three physical factors determine the ventilatory control: (1) metabolic CO 2 production, (2) mean PaCO 2 set point, and (3) VD/VT ratio. Moreover, ventilatory response during exercise may be explained by the following equation: 10,37 in which: 863 is the constant correcting for the different standard conditions used to report ventilatory and gas exchange volumes, i.e., body temperature pressure and saturation (BTPS) and standard temperature and pressure dry (STPD), respectively; VCO 2 , pulmonary CO 2 output; PaCO 2 , arterial PaCO 2 ; and VD/VT, physiological dead space to tidal volume.…”

“…In this respect, cardiovascular and respiratory systems provide the capacity to sustain physical tasks over extended periods. More specifically, the cardiorespiratory adjustment during aerobic exercise in terms of increased cardiac output and ventilatory response is needed to maintain the oxygen supply to the locomotor muscles 10 . Within this scenario, both convective O 2 transport (product of arterial O 2 content × blood flow) to the working locomotor muscles and O 2 diffusive transport from muscle capillaries to mitochondria are of paramount importance to endurance performance 10,11 …”

“…It has been demonstrated that wearing a PFM during aerobic exercise increases breathing resistance, decreases arterial oxygen saturation, and could lead to respiratory discomfort 5,10,12–14 . Additionally, the use of the PFM also causes an increase in both air temperature and humidity inside the face mask, which affects the subjective perception of breathing difficulty 7,15 .…”