Effects of respiratory muscle unloading on leg muscle oxygenation and blood volume during high-intensity exercise in chronic heart failure

Borghi‐Silva, Audrey; Carrascosa, Cláudia Regina; Oliveira, Cristino Carneiro; Barroco, Adriano; Berton, Danilo Cortozi; Vilaça, Debora; Lira-Filho, Edgar; Ribeiro, Dirceu; Nery, Luíz Eduardo; Neder, J. Alberto

doi:10.1152/ajpheart.91520.2007

Cited by 87 publications

(93 citation statements)

References 60 publications

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“…In fact, the reduction of inspiratory muscle work through noninvasive ventilation in the proportional assisted ventilation may improve physical performance in patients with HF. Recently, it has been shown that such intervention improves the oxygenation of the peripheral muscle microcirculation, which may be compatible with the improvement of local blood flow 65 . These findings have been currently confirmed by Olson et al 66 , whom found that the reduction in inspiratory muscle work increased the leg blood flow and the cardiac output only in patients with HF, remaining unchanged in healthy controls subjects.…”

Section: Resistive Inspirationmentioning

confidence: 83%

The contribution of inspiratory muscles function to exercise limitation in heart failure: pathophysiological mechanisms

Ribeiro¹,

Chiappa²,

Callegaro³

2012

Rev. bras. fisioter.

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Section: Resistive Inspirationmentioning

confidence: 83%

The contribution of inspiratory muscles function to exercise limitation in heart failure: pathophysiological mechanisms

Ribeiro¹,

Chiappa²,

Callegaro³

2012

Rev. bras. fisioter.

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“…[11][12][13] Furthermore, Borghi-Silva, et al 14) demonstrated that CO measurement by this type of impedance method was sensitive at detecting small changes in CO with acceptable accuracy in patients with CHF. The present study was performed to clarify the pattern of SV during exercise in CHF patients with exercise intolerance compared to that in controls.…”

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confidence: 98%

Cardiac Output Response to Exercise in Chronic Cardiac Failure Patients

et al. 2012

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SummaryThe purpose of this study was to investigate the precise pattern of stroke volume (SV) response during exercise in patients with chronic heart failure (CHF) compared with age-matched controls. Fourteen patients with CHF and 7 controls performed symptom-limited bicycle exercise testing with respiratory gas exchange measurement. Patients were classified into group A (n = 7) with peak V ・ O 2 ≥18.0 mL/kg/minute and group B (n = 7) with peak V ・ O 2 < 18.0 mL/kg/ minute. SV and cardiac output (CO) were continuously measured during exercise using a novel thoracic impedance method (Physioflow). CO and SV were lower in the group B patients than those in controls at peak exercise [CO: 11.3 ± 1.0 (SE) versus 15.6 ± 0.9 L/minute, P < 0.05, SV: 89 ± 6 versus 110 ± 6 mL, P < 0.05]. SV reached its peak levels during submaximal exercise and remained close to the peak value until peak exercise in 6 of 7 group B patients (86%). On the other hand, it progressively increased until peak exercise in 6 of 7 controls (86%) and 5 of 7 group A patients (71%). In all subjects, CO at peak exercise was more closely correlated with SV at peak exercise (r = 0.86, P < 0.001) than with peak heart rate (r = 0.69, P < 0.001). CHF patients with impaired exercise capacity had attenuated increment of CO during exercise, and SV reached its peak levels during submaximal exercise. (Int Heart J 2012; 53: 293-298) Key words: Stroke volume, Exercise capacity, Left ventricular function, Cardiopulmonary exercise testing, Impedance method P atients with chronic heart failure (CHF) show exercise intolerance, and their peak oxygen uptake (peak V ・ O 2 ) is reduced compared to healthy individuals of the same age.1,2) Because oxygen uptake (V ・ O 2 ) is the product of cardiac output (CO) and the arterio-venous oxygen content difference [C(a-v)O 2 ], a decrease in peak V ・ O 2 may be due to a decrease in either CO and/or C(a-v)O 2 at peak exercise. The CO response of patients with CHF during exercise is attenuated compared to that in normals. [3][4][5] Thus, in patients with CHF, the heart can not generate a CO that is sufficient to meet the metabolic demands of the tissues during exercise. Since CO is the multiplication of stroke volume (SV) and heart rate (HR), a decrease in CO may be due to either that in SV and/or HR at peak exercise. However, because patients with CHF often have chronotropic incompetence, the mechanism of the decrease in CO at peak exercise has not been fully studied.Because V ・ O 2 is the product of CO and C(a-v)O 2 , and because C(a-v)O 2 primarily reflects the capacity of O 2 uptake in the working muscles, the CO during exercise is a better indicator of cardiac function than peak V ・ O 2 . It has been also shown that the CO during exercise is a prognostic indicator in patients with CHF.6,7) Sullivan, et al 5) demonstrated that SV and CO both during submaximal and maximal exercise are low in patients with CHF. Magnusson, et al 8) also reported that the CO increase during submaximal exercise was attenuated in patients with CHF...

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“…The Pilates method involves essentially isometric and respiratory exercises, which may contribute to improved ventilatory efficiency and reduced energy requirements for movement. These effects are mediated by the attenuation of the inspiratory muscle metaboreflex, with consequent improvement of blood flow to the exercising muscle [24]. The response of heart rate and blood pressure during Pilates and conventional training were not studied.…”

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confidence: 99%

Pilates in Heart Failure Patients: A Randomized Controlled Pilot Trial

Guimarães

Carvalho

Bocchi

et al. 2011

Cardiovascular Therapeutics

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Background: Conventional cardiac rehabilitation program consist of 15 min of warmup, 30 min of aerobic exercise and followed by 15 min calisthenics exercise. The Pilates method has been increasingly applied for its therapeutic benefits, however little scientific evidence supports or rebukes its use as a treatment in patients with heart failure (HF). Purpose: Investigate the effects of Pilates on exercise capacity variables in HF. Methods: Sixteen pts with HF, left ventricular ejection fraction 27 ± 14%, NYHA class I-II were randomly assigned to conventional cardiac rehabilitation program (n = 8) or mat Pilates training (n = 8) for 16 weeks of 30 min of aerobic exercise followed by 20 min of the specific program. Results: At 16 weeks, pts in the mat Pilates group and conventional group showed significantly increase on exercise time 11.9 ± 2.5 to 17.8 ± 4 and 11.7 ± 3.9 to 14.2 ± 4 min, respectively. However, only the Pilates group increased significantly the ventilation (from 56 ± 20 to 69 ± 17 L/min, P = 0.02), peak VO 2 (from 20.9 ± 6 to 24.8 ± 6 mL/kg/min, P = 0.01), and O 2 pulse (from 11.9 ± 2 to 13.8 ± 3 mL/bpm, P = 0.003). The Pilates group showed significantly increase in peak VO 2 when compared with conventional group (24.8 ± 6 vs. 18.3 ± 4, P = 0.02). Conclusions: The result suggests that the Pilates method may be a beneficial adjunctive treatment that enhances functional capacity in patients with HF who are already receiving standard medical therapy. BackgroundHeart failure (HF) is considered to be the last stage of heart diseases and a worldwide cause of mortality and morbidity [1,2]. It is characterized by a persistent overactivity of the neurohormonal system [3], endothelial dysfunction [4], exercise intolerance [5,6], high mortality [7], and a poor quality of life [8].Exercise training has been recommended as an important tool in HF treatment. It improves exercise capacity [9], quality of life [10], besides reducing endothelial dysfunction [11], catecholamine levels [12], and morbity [13].Pilates is a particular exercise approach that was founded on the teachings of Joseph Pilates (1880Pilates ( -1967 and was initially practiced almost exclusively by athletes and dancers. Pilates has become a fast-growing, popular trend in rehabilitation and fitness programs in recent years. The goal of Pilates training is improvement of general body flexibility and health, emphasizing core (truncal) strength, posture, and coordination of breathing with movement. Anecdotal evidence suggests that as the Pilates method increases core strength, the natural flexibility of the spine and limbs returns [14,15,16].Despite this promising method, there is little scientific research on the effectiveness of Pilates. The purpose of this study was to investigate the effects of Pilates on exercise capacity variables in HF patients. Methods Study PopulationA total of 26 outpatients with HF were recruited from a tertiary cardiology hospital with the following criteria: clinical and optimized farmacological treatment (for at least 3...

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Effects of respiratory muscle unloading on leg muscle oxygenation and blood volume during high-intensity exercise in chronic heart failure

Cited by 87 publications

References 60 publications

The contribution of inspiratory muscles function to exercise limitation in heart failure: pathophysiological mechanisms

The contribution of inspiratory muscles function to exercise limitation in heart failure: pathophysiological mechanisms

Cardiac Output Response to Exercise in Chronic Cardiac Failure Patients

Pilates in Heart Failure Patients: A Randomized Controlled Pilot Trial

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