Exercise Capacity and Ventilatory, Circulatory, and Symptom Limitation in Patients with Chronic Airflow Limitation

Killian, Kieran J.; Leblanc, Pierre; Martín, David H.; Summers, Edith; Jones, Norman L.; Campbell, Edward J.

doi:10.1164/ajrccm/146.4.935

Cited by 463 publications

(265 citation statements)

References 2 publications

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“…In addition, a heightened perception of leg effort may be a limiting factor in a substantial number of patients, particularly during cycle-ergometer exercise [63,77]. Importantly, the development of dynamic hyperinflation has been recognised as an important limiting factor responsible for the development of intolerable dyspnoea during exercise ( fig.…”

Section: Chronic Obstructive Pulmonary Diseasementioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Section: Chronic Obstructive Pulmonary Diseasementioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

View full text Add to dashboard Cite

show abstract

“…The symptoms that people report as limiting their exercise capacity are also variable. In a large unselected population of patients undergoing cardiorespiratory exercise testing, a majority of patients said that they stopped exercising during cycle exercise because of leg fatigue or a combination of leg fatigue and dyspnoea [15]. It was proposed that factors that determine peripheral skeletal muscle performance, such as oxygen delivery during exercise and the presence of peripheral muscle weakness [16], were at least as important as variables related to lung mechanics in determining exercise performance in COPD.…”

Section: Physiological Factors Limiting Exercise Capacity In Copdmentioning

confidence: 99%

Exercise and dyspnoea in COPD

Calverley¹

2006

European Respiratory Review

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Dyspnoea provoked either by exercise or during a disease exacerbation is one of the most feared symptoms of the chronic obstructive pulmonary disease (COPD) patient. It contributes to impaired quality of life and patients who are more limited by exertional dyspnoea are more likely to die. The physiological mechanisms responsible for these two outcomes vary in different settings, but in both situations, changes in the resting lung volume and increased activation of the respiratory muscles relative to their maximum capacity is the final common pathway.Although increased metabolic carbon dioxide production from weak or poorly conditioned muscles is an important cofactor, most patients limited by exertional dyspnoea exhibit dynamic hyperinflation that parallels their symptom intensity. This results from the longer respiratory time constant of the lungs in COPD and coexisting expiratory flow limitation during tidal breathing. The response of the chest wall muscles to this change in lung volume is variable: most patients with more severe COPD allow chest wall volume to increase, while others try to defend chest wall volume. The latter is not a good breathing strategy as the patient's exercise capacity is very limited.Treatment with bronchodilators reduces operating lung volumes and delays the time until tidal volume is mechanically limited by the inspiratory reserve volume. Breathing oxygen and heliox gas mixtures further increases exercise endurance and slows the rate at which end-expiratory lung volume increases.During exacerbations there is a consistent increase in end-expiratory lung volume and this parallels the reduction in forced vital capacity. This suggests that gas trapping due to airway closure is the main mechanism involved here, although changes in lung volume still track the symptomatic improvement in dyspnoea reported by patients both as the episode resolves and after nebulised bronchodilator treatment.

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“…No test performed under resting condition is able to predict the cardiac and respiratory functions, and symptoms linked to physical activity, especially dyspnea, are weakly correlated with cardio-pulmonary function evaluations when performed at rest. Physical exercise, involving different organs and systems such as heart, lungs and muscles, allows a more complete evaluation of the functional reserve [15][16][17]. Individual exercise capacity can be assessed only by means of a standardized reproducible physical effort.…”

Section: Introductionmentioning

confidence: 99%

Critical review of the equations predicting 6-minute walking distance in obese subjects

Donini

Poggiogalle

Mosca

et al. 2016

Monaldi Arch Chest Dis

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The correlation between the 6-minute walking distance and obesity has been only partially explored. Results obtained from the existing predictive equations are influenced by a variety of factors (health status, severity of obesity, reduced muscle strength and mobility, decreased aerobic capacity, presence of comorbidities).The aim of our study was to verify, compare and discuss the 6MWD predictive capacity of the equations currently available in the literature in a sample of obese subjects.Despite similar study design, the considered articles varied with regard to the number of individuals included and to age range. None of the equations available in the literature was able to accurately predict the six-minute walked distance performed by the obese subjects involved in our study. The six-minute walked distance performed by obese subjects seems to be influenced by other factors than the variables included in the equations from the literature, suggesting that they may not thoroughly capture the complexity of disability in obese people. Future research should be designed in order to validate population-specific equations, by including variables related to clinical, functional, and psychological areas, which are usually impaired in obese individuals.

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Exercise Capacity and Ventilatory, Circulatory, and Symptom Limitation in Patients with Chronic Airflow Limitation

Cited by 463 publications

References 2 publications

Recommendations on the use of exercise testing in clinical practice

Recommendations on the use of exercise testing in clinical practice

Exercise and dyspnoea in COPD

Critical review of the equations predicting 6-minute walking distance in obese subjects

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