The effect of D-cycloserine on brain processing of breathlessness over pulmonary rehabilitation - an experimental medicine study

Sl, Finnegan; Harrison, Olivia K.; Booth, Sara; Dennis, Andrea; Ezra, Martyn; Cj, Harmer; Herigstad, Mari; Guillaume, Bryan; Te, Nichols; Rahman, Najib M.; Reinecke, Andrea; Renaud, Olivier; Kts., Pattinson

doi:10.1101/2021.06.24.21259306

Cited by 1 publication

(1 citation statement)

References 81 publications

(72 reference statements)

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“…Compelling evidence highlights how PLOS ONE pulmonary rehabilitation, the current most effective treatment for chronic breathlessness in COPD, has little effect on lung function but significantly improves feelings of breathlessness via changes in brain processes [9]. While a number of brain-targeted therapeutic approaches, including pharmacological [34,35], direct brain stimulation [36] and cognitive [37] have been explored with varying degrees of success, VR offers another approach in which sensory input may be realigned with expectation in an example of "fool the brain, treat the lungs" [10]. The high entertainment value of immersive VR, good immersion as demonstrated by scores on the presence questionnaire, and increasing affordability also has clear potential within a framework of pulmonary rehabilitation to promote exercise engagement and expose patients to "real-life" environments in which to overcome fearful breathlessness safely.…”

Section: Future Directionsmentioning

confidence: 99%

Breathlessness in a virtual world: An experimental paradigm testing how discrepancy between VR visual gradients and pedal resistance during stationary cycling affects breathlessness perception

et al. 2023

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Introduction The sensation of breathlessness is often attributed to perturbations in cardio-pulmonary physiology, leading to changes in afferent signals. New evidence suggests that these signals are interpreted in the light of prior "expectations". A misalignment between afferent signals and expectations may underly unexplained breathlessness. Using a novel immersive virtual reality (VR) exercise paradigm, we investigated whether manipulating an individual’s expectation of effort (determined by a virtual hill gradient) may alter their perception of breathlessness, independent from actual effort (the physical effort of cycling). Methods Nineteen healthy volunteers completed a single experimental session where they exercised on a cycle ergometer while wearing a VR headset. We created an immersive virtual cycle ride where participants climbed up 100 m hills with virtual gradients of 4%, 6%, 8%, 10% and 12%. Each virtual hill gradient was completed twice: once with a 4% cycling ergometer resistance and once with a 6% resistance, allowing us to dissociate expected effort (virtual hill gradient) from actual effort (power). At the end of each hill, participants reported their perceived breathlessness. Linear mixed effects models were used to examine the independent contribution of actual effort and expected effort to ratings of breathlessness (0–10 scale). Results Expectation of effort (effect estimate ± std. error, 0.63 ± 0.11, P < 0.001) and actual effort (0.81 ± 0.21, P < 0.001) independently explained subjective ratings of breathlessness, with comparable contributions of 19% and 18%, respectively. Additionally, we found that effort expectation accounted for 6% of participants’ power and was a significant, independent predictor (0.09 ± 0.03; P = 0.001). Conclusions An individuals’ expectation of effort is equally important for forming perceptions of breathlessness as the actual effort required to cycle. A new VR paradigm enables this to be experimentally studied and could be used to re-align breathlessness and enhance training programmes.

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