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Effects of helium and 40% O2 on graded exercise with self-contained breathing apparatus.

Maximal exercise performance is decreased when breathing from a self-contained breathing apparatus (SCBA), owing to a ventilatory limitation imposed by the increased expiratory resistance. To test the hypothesis that decreasing the density of the breathing gas would improve maximal exercise performance, we studied 15 men during four graded exercise tests with the SCBA. Participants breathed a different gas mixture during each test: normoxia (NOX; 21% O2, 79% N2), hyperoxia (HOX; 40% O2, 60% N2), normoxic helium (HE-OX; 21% O2, 79% He), and hyperoxic helium (HE-HOX; 40% O2, 60% He). Compared to NOX, power output at the ventilatory threshold and at maximal exercise significantly increased with both hyperoxic mixtures. Minute ventilation was increased at peak exercise with both helium mixtures, and maximal aerobic power (VO2max) was significantly increased by 12.9 +/- 5.6%, 10.2 +/- 6.3%, and 21.8 +/- 5.6% with HOX, HE-OX, and HE-HOX, respectively. At peak exercise, the expired breathing resistance imposed by the SCBA was significantly decreased with both helium mixtures, and perceived respiratory distress was lower with HE-HOX. The results show that HE-OX improved maximal exercise performance by minimizing the ventilation limitation. The performance-enhancing effect of HOX may be explained by increased arterial oxygen content. Moreover, HE-HOX appeared to combine the effects of helium and hyperoxia on VO2max.

Adult↗

Influence of anthropometric characteristics on changes in maximal exercise ventilation and breathing pattern during growth in boys.

The aim of this study was to investigate the effect of growth on ventilation and breathing pattern during maximal exercise oxygen consumption (VO2max) and their relationships with anthropometric characteristics. Seventy six untrained schoolboys, aged 10.5-15.5 years, participated in this study. Anthropometric measurements made included body mass, height, armspan, lean body mass, and body surface area. During an incremental exercise test, maximal ventilation (VEmax), tidal volume (VTmax), breathing frequency (fmax), inspiratory and expiratory times (tImax and tEmax), total duration of respiratory cycle (tTOTmax), mean inspiratory flow (VT/tImax), and inspiration fraction (tI/tTOTmax) were measured at VO2max. A power function was calculated between anthropometric characteristics and ventilatory variables to determine the allometric constants. The results showed firstly, that VEmax, VTmax, tImax, tEmax, tTOTmax, and VT/tImax increased with age and anthropometric characteristics (P less than 0.001), fmax decreased (P less than 0.001), and tI/tTOTmax remained constant during growth; secondly that lean body mass explained the greatest percentage of variance of VEmax (62.1%), VTmax (76.8%), and VT/tImax (70.6%), while anthropometric characteristics explained a slight percentage of variance of fmax and timing; and thirdly that VEmax, VTmax, and VT/tImax normalized by lean body mass did not change significantly with age. We concluded that at VO2max there were marked changes in ventilation and breathing pattern with growth. The changes in VEmax, VTmax, and VT/tImax were strongly related to the changes in lean body mass.

Adolescent↗

Changes in maximal exercise ventilation and breathing pattern in boys during growth: a mixed cross-sectional longitudinal study.

The aim of this mixed cross-sectional longitudinal study covering a total age range of 11-17 years, i.e. the entire pubertal growth period, was (1) to specify the changes in maximal breathing pattern during incremental exercise; (2) to determine what parts of the changes are due to anthropometric characteristics, physical fitness and inspiratory or expiratory muscle strength; and (3) to determine if the role of these variables is identical before, during and after pubertal growth spurt. This study was conducted in 44 untrained schoolboys separated into three groups, with an initial age of 11.2 +/- 0.2 years for group A, 12.9 +/- 0.25 years for group B, and 14.9 +/- 0.26 years for group C. These children were subsequently followed for 3 years, during the same time period each year. The maximal inspiratory and expiratory pressures (PI max and PE max) were used as an index of the respiratory muscle strength. During an incremental exercise test, maximal ventilation (VE max), tidal volume (VT max), breathing frequency (fmax), inspiratory and expiratory times (tI max and tE max) and mean inspiratory flow (VT/tI max) were measured at maximal oxygen uptake (VO2max). Our study showed that there was a marked increase with age in VE max, VT max, and VT/tI max, and no significant changes in fmax, tI max and tE max. PI max and PE max showed a general trend towards an increase between 11 and 17 years. The study of the linear correlations between maximal breathing pattern and the anthropometric characteristics, physical fitness and inspiratory or expiratory muscle strength showed that, in the three groups of children, (1) lean body mass was the major determinant of VE max, VT max and VT/tI max and the relationships were significantly different before, during and after the pubertal growth spurt; (2) physical fitness was the main determinant of tI max, tE max and fmax before and after the pubertal growth spurt; and (3) maximal respiratory strength did not play a significant role. In conclusion, this mixed cross-sectional longitudinal study showed, at maximal exercise, a significant increase in VE max during growth due only to a significant increase in VT max and VT/tI max, and that the relationships of anthropometric characteristics and physical fitness with maximal breathing pattern change during growth.

Adolescent↗

Chest physiotherapy: a review.

Postural drainage enhances mucociliary clearance and produces larger sputum volumes than an equivalent control period in disease characterised by excessive tracheobronchial secretions. Postural drainage, percussion and vibration will improve pulmonary function only in patients with large sputum volumes. There is no evidence that sputum yield is increased by the addition of percussion and vibration. From radioaerosol studies effective cough is limited to central airways. Breathing exercises may be of some immediate value in asthma but are without long term advantages and probably do not alter the ventilation of the underlying lung. IPPB probably does not improve delivery of bronchodilators and is of no benefit (and possible harmful) in the long term treatment of chronic bronchitis. Infective exacerbations of chronic bronchitis not characterised by copious volumes of sputum, uncomplicated pneumonia and routine post-operative states are not indications for chest physiotherapy. The value of regular physiotherapy on ventilation, gas exchange, work of breathing and incidence of infective exacerbations is uncertain but exercise training and rehabilitation of chronic obstructive airways disease improves exercise tolerance and mobility.

Breathing Exercises↗

Normal values and ranges for ventilation and breathing pattern at maximal exercise.

Assessment of the breathing pattern at maximal exercise in patients is limited because the range of ventilatory responses (minute ventilation; tidal volume; respiratory rate) at maximal exercise in normal humans is unknown. We studied 231 normal subjects (120 women; 111 men) equally distributed according to age from 20 to 80 years. Each subject performed a progressive incremental cycle ergometer exercise test to their symptom-limited maximum. Mean ventilation at the end of exercise (Vemax) was significantly higher in men (mean +/- SD, 97 +/- 25 L/min) than in women (69 +/- 22 L/min) (p less than 0.001). Minute ventilation at the end of exercise as a fraction of predicted maximal voluntary ventilation (Vemax/MVV) for all subjects was 0.61 +/- 0.14 (range, 0.28 to 1.02). There was no difference in Vemax/MVV between men (0.62 +/- 0.14) and women (0.59 +/- 0.14). Tidal volume at the end of exercise (Vtmax) was higher in men (2.70 +/- 0.48 L) than in women (1.92 +/- 0.41 L) (p less than 0.001). Any differences in Vtmax between men and women disappeared when Vtmax was corrected for baseline FVC. Respiratory rate at the end of exercise (RRmax) was 36.1 +/- 9.2 breaths per minute for all subjects. There was no difference in RRmax between men and women. The Vemax correlated best with carbon dioxide output at the end of exercise (r = 0.91; p less than 0.001) and with maximal oxygen uptake (r = 0.90; p less than 0.001) for all subjects. This study of a large group of subjects has demonstrated the wide range of possible breathing patterns which are adopted during exercise and has provided a wide range of "normal" responses which must be taken into consideration when maximal ventilatory data from exercise tests are analyzed.

Adult↗

Important role of carotid afferents in control of breathing.

The purpose of the present study was to determine the effect on breathing in the awake state of carotid body denervation (CBD) over 1-2 wk after denervation. Studies were completed on adult goats repeatedly before and 1) for 15 days after bilateral CBD (n = 8), 2) for 7 days after unilateral CBD (n = 5), and 3) for 15 days after sham CBD (n = 3). Absence of ventilatory stimulation when NaCN was injected directly into a common carotid artery confirmed CBD. There was a significant (P < 0.01) hypoventilation during the breathing of room air after unilateral and bilateral CBD. The maximum PaCO2 increase (8 Torr for unilateral and 11 Torr for bilateral) occurred approximately 4 days after CBD. This maximum was transient because by 7 (unilateral) to 15 (bilateral) days after CBD, PaCO2 was only 3-4 Torr above control. CO2 sensitivity was attenuated from control by 60% on day 4 after bilateral CBD and by 35% on day 4 after unilateral CBD. This attenuation was transient, because CO2 sensitivity returned to control temporally similar to the return of PaCO2 during the breathing of room air. During mild and moderate treadmill exercise 1-8 days after bilateral CBD, PaCO2 was unchanged from its elevated level at rest, but, 10-15 days after CBD, PaCO2 decreased slightly from rest during exercise. These data indicate that 1) carotid afferents are an important determinant of rest and exercise breathing and ventilatory CO2 sensitivity, and 2) apparent plasticity within the ventilatory control system eventually provides compensation for chronic loss of these afferents.

Afferent Pathways↗

Hatha yoga: improved vital capacity of college students.

CONTEXT: The vital capacity of the lungs is a critical component of good health. Vital capacity is an important concern for those with asthma, heart conditions, and lung ailments; those who smoke; and those who have no known lung problems. OBJECTIVE: To determine the effects of yoga postures and breathing exercises on vital capacity. DESIGN: Using the Spiropet spirometer, researchers measured vital capacity. Vital capacity determinants were taken near the beginning and end of two 17-week semesters. No control group was used. SETTING: Midwestern university yoga classes taken for college credit. PARTICIPANTS: A total of 287 college students, 89 men and 198 women. INTERVENTION: Subjects were taught yoga poses, breathing techniques, and relaxation in two 50-minute class meetings for 15 weeks. MAIN OUTCOME MEASURES: Vital capacity over time for smokers, asthmatics, and those with no known lung disease. RESULTS: The study showed a statistically significant (P < .001) improvement in vital capacity across all categories over time. CONCLUSIONS: It is not known whether these findings were the result of yoga poses, breathing techniques, relaxation, or other aspects of exercise in the subjects' life. The subjects' adherence to attending class was 99.96%. The large number of 287 subjects is considered to be a valid number for a study of this type. These findings are consistent with other research studies reporting the positive effect of yoga on the vital capacity of the lungs.

Adolescent↗

Reduced exercise capacity in untreated adults with primary growth hormone resistance (Laron syndrome).

OBJECTIVE: Primary IGF-I deficiency (Laron syndrome, LS) may decrease exercise capacity as a result of a lack of an IGF-I effect on heart, peripheral muscle or lung structure and/or function. METHODS: Eight patients (six females) who had never received treatment with IGF-I, with mean age of 36 +/- 10 (SD) years (range 21-48), weight 47 +/- 9 kg (31-61), height 126 +/- 12 cm (112-140) and body mass index of 29 +/- 4 kg/m2 (24-34), and 12 age-matched controls, underwent lung function tests and incremental cycling to the limit of tolerance (CPX, MedGraphics). Predicted values for the patients were derived from adult equations based on height. RESULTS: In LS patients, lung function was near normal; vital capacity was 84 +/- 11% of expected (66-103). Peak exercise O2-uptake and the anaerobic threshold were reduced, 57 +/- 20% of predicted and 33 +/- 9% of predicted peak (P = 0.005 vs. controls), despite normal mean exercise breathing reserve. All parameters were normal in the controls. CONCLUSION: Exercise capacity in untreated adults with LS is significantly reduced. The limitation for most patients was not ventilatory but resulted either from low cardiac output and/or from dysfunction of the peripheral muscles. However, the relative contribution of each of these elements and/or the role of poor fitness needs further study.

Adult↗

Work of breathing is increased during exercise with the self-contained breathing apparatus regulator.

The self-contained breathing apparatus (SCBA) increases the expiratory pressure required to maintain high rates of ventilation, suggesting that the expiratory work of breathing (WOB) is increased; however, this has never been reported. The objective of this study, therefore, was to determine if the WOB is increased with the SCBA regulator (BA condition) compared with a low-resistance breathing valve (RV condition) during exercise. Twelve healthy male subjects underwent two randomized exercise trials, consisting of cycling at 150, 180, 210, and 240 W. Inspired and expired tidal volumes were measured using a body plethysmograph, whereas esophageal pressures were measured with an esophageal balloon. Modified Campbell diagrams were created to calculate the resistive and elastic components of WOB during inspiration and expiration. There were no differences in WOB between BA and RV conditions at 150 W. End-inspiratory and -expiratory lung volumes were elevated (p < 0.05) in the BA condition at higher ventilation rates, which increased inspiratory elastic work and decreased expiratory elastic work at 180 and 210 W (p < 0.05). At 240 W (VE=112 +/- 17 L.min-1 in the BA condition), active expiratory resistive work increased by 59% +/- 51%, inspiratory elastic work increased by 26% +/- 24%, and total WOB increased by 13% +/- 12% in the BA condition (p < 0.05). The SCBA regulator causes an increase in the active expiratory resistive work to maintain high ventilatory rates and an increase inspiratory elastic work through an elevation in lung volumes.

Adult↗

Effect of respiratory muscle fatigue on breathing pattern during incremental exercise.

We examined the breathing pattern during incremental exercise before and after induction of inspiratory muscle fatigue. Our aim was to determine whether induction of fatigue alters the ventilatory response to exercise and in particular whether such changes are most apparent at high levels of exercise when minute ventilation and thus inspiratory load are greatest. A group of 10 healthy subjects was studied on a cycle ergometer. Fatigue was achieved by having the subject breathe against an inspiratory threshold load that required the subject to generate 80% of the predetermined maximal mouth pressure to initiate airflow. Breathing pattern, oxygen consumption (VO2), mouth occlusion pressure (P0.1), and a visual analog scale (VAS) for respiratory effort were obtained for 3 min at rest and at 25, 50, 75, and 100% of the subject's maximal work load (Wmax) as determined by preliminary testing. Exercise was performed on two separate occasions, once immediately after induction of fatigue and the other as a control. Induction of fatigue had no effect on resting breathing and only minimal effects at the lower work loads (25 and 50% Wmax). At the higher work loads (75 and 100% Wmax) induction of fatigue significantly altered the pattern of breathing during exercise. At 75% of Wmax the respiratory frequency (f) increased from 22.5 +/- 4.4 (SD) during control to 27.0 +/- 6.7 breaths/min (p less than 0.02) following induction of fatigue; tidal volume was not significantly altered, 2.15 +/- 0.65 versus 2.24 +/- 0.74 L during control. The increase in f was due to reductions in both inspiratory and expiratory time because fractional inspiratory time remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Biological quality control for exercise testing.

BACKGROUND: A study was undertaken to evaluate the use of a biological quality control programme for a computer controlled, breath-by-breath exercise test system over a 2.5 year period. METHODS: One healthy volunteer performed a regular progressive treadmill test with breath-by-breath measurements of oxygen uptake (VO(2)), carbon dioxide output (VCO(2)), ventilation (VE), and the ECG heart rate (HR). Following a familiarisation period, five consecutive tests were performed and the measurements at peak exercise were averaged to give baseline values. All tests were compared with these values. RESULTS: A total of 35 tests were recorded. The within subject standard deviation for measurements at peak exercise were 52 ml/min for VO(2), 74 ml/min for VCO(2), 3.1 l/min for VE, and 3 beats/min for HR. The mean (SE) percentage variation in measurements at peak exercise compared with the baseline values was +0.37 (0.30)% for VO(2), -0.10 (0.39)% for VCO(2), -0.88 (0.52)% for VE, and +1.2 (0.26)% for HR. The variability present in measurements made during high and moderate intensity exercise (73% VO(2)peak) was not significantly different (p>0.05). During the study period the quality control detected a fault on the oxygen analyser which was not apparent from the automatic calibration. CONCLUSIONS: Regular quality control using a healthy volunteer allows all components of the breath-by-breath system to be checked simultaneously and in a manner which is consistent with its clinical use. This practice can highlight faults not detected by automatic calibration.

Calibration↗

Exercise hypercapnia in advanced chronic obstructive pulmonary disease: the role of lung hyperinflation.

In severe chronic obstructive pulmonary disease (COPD), carbon dioxide retention during exercise is highly variable and is poorly predicted by resting pulmonary function and arterial blood gases or by tests of ventilatory control. We reasoned that in patients with compromised gas exchange capabilities, exercise hypercapnia could be explained, in part, by the restrictive consequences of dynamic lung hyperinflation. We studied 20 stable patients with COPD (FEV(1) = 34 +/- 3 percent predicted; mean +/- SEM) with varying gas exchange abnormalities (Pa(O(2)) range, 35 to 84 mm Hg; Pa(CO(2)) range, 31 to 64 mm Hg). During symptom-limited maximum cycle exercise breathing room air, Pa(CO(2)) increased 7 +/- 1 mm Hg (p < 0.05) from rest to peak exercise (range, -6 to 25 mm Hg). We measured the change in Pa(CO(2)) after hyperoxic breathing at rest as an indirect test of ventilation-perfusion abnormalities. The change in Pa(CO(2)) from rest to peak exercise correlated best with the acute change in Pa(CO(2)) during hyperoxia at rest (r(2) = 0.62, p < 0.0005) and with resting arterial oxygen saturation (r(2) = 0.30, p = 0.011). During exercise, the strongest correlates of serial changes in Pa(CO(2)) from rest included concurrent changes in end-expiratory lung volume expressed as a percentage of total lung capacity (partial correlation coefficient [r] = 0.562, p < 0.0005) and oxygen saturation (partial r = 0.816, p < 0.0005). In severe COPD, the propensity to develop carbon dioxide retention during exercise reflects marked ventilatory constraints as a result of lung hyperinflation as well as reduced gas exchange capabilities.

Carbon Dioxide↗

Effect of exercise induced hypoxaemia on myocardial repolarisation in severe chronic obstructive pulmonary disease.

BACKGROUND: Exercise training is being promoted increasingly for patients with chronic obstructive pulmonary disease (COPD). Many of these patients experience exercise related arterial desaturation but the clinical importance of these hypoxaemic episodes is not known. QTc dispersion is a marker of myocardial repolarisation abnormalities and there has been much interest in its role as a non-invasive predictor of cardiac arrhythmias and sudden death. However, little is known about the dynamic effects that exercise and hypoxaemia have on QTc dispersion in patients with COPD. METHODS: 20 patients with severe COPD (FEV1 < 40% predicted) undertook two 15 minute treadmill tests at a speed calculated to produce a constant workload of 50% maximum oxygen consumption (VO2max) during which they were blindly given either air or 35% oxygen in random order. Physiological measurements taken throughout exercise included 12 lead electrocardiograms from which QTc dispersion values were calculated according to standard criteria. Nine of the patients who desaturated with exercise were studied further. A similar degree of hypoxaemia was induced at rest by giving them a titrated mixture of air and oxygen and the changes in QTc dispersion were recorded. RESULTS: 11 of the 20 patients developed significant hypoxaemia (desaturation by > or = 5% to < 90%) with exercise breathing air. There were no significant changes in QTc dispersion with either exercise or hypoxaemia. There were no significant changes in QTc dispersion when comparing those who did and did not desaturate, and those with and without a high baseline QTc dispersion values (60 ms). Induced hypoxaemia without exercise also failed to worsen QTc dispersion. CONCLUSIONS: No evidence was found to suggest that exercise, even when associated with hypoxaemia, causes myocardial repolarisation abnormalities in patients with COPD.

Aged↗

Metabolic and ventilatory responses to submaximal and maximal exercise using different breathing assemblies.

This study compared ventilatory and metabolic responses during exercise using three breathing assemblies: mouthpiece/noseclip (BV); mouth/face mask (MM); and facemask (FM). Ten male runners completed three maximal treadmill tests with breathing assembly randomly assigned. Metabolic and ventilatory data were recorded every 15s, and heart rate (HR) and rating of perceived exertion (RPE) each min. No significant differences were found for treadmill run time, HRmax, respiratory exchange ratio (RER), and RPE, indicating similar efforts on all trials. No significant differences were found at maximal exercise for VO2 minute ventilation (VE), tidal volume (VT), and breathing frequency (f). At ventilatory threshold (TVENT), VO2, VE, and f were not significantly different. However, peak flow (PF) was significantly higher for BV than FM, and VT was significantly higher for BV than MM and FM. Results indicate alterations in ventilatory mechanics occur at TVENT, but type of breathing assembly does not significantly affect maximal values.

Adult↗

Changes in breath 13CO2/12CO2 during exercise of different intensities.

The measurement of breath 13CO2/12CO2 is commonly used during exercise to evaluate the oxidation rate of exogenous carbohydrates enriched in 13C. The aim of this study was to investigate whether exercise itself affects the 13C/12C ratio in expired air CO2 in relation to exercise intensity. The relative abundance of 13C and 12C in expired air CO2 was determined by isotoperatio mass spectrometry and expressed as delta 13C (in %o) by using Craig's formula and calibrated standards. Five healthy young men exercised on a treadmill after an overnight fast during > or = 105 min on four occasions and in a randomized order. Work rates were performed at approximately 30, 45, 60, and 75% of their maximal O2 uptake (VO2max). Delta 13C in expired air CO2 and respiratory exchange ratio (RER) were determined every 15 or 30 min during exercise. At 30 and 45% VO2max, a slight and not statistically significant increase in delta 13C was observed at 30 min. In contrast, at 60 75% VO2max, the rise was statistically significant and averaged 0.83 and 0.99%o, respectively. Average delta 13C (between 0 and 105 min) progressively increased with the intensity of exercise. Individual values of delta 13C and RER were positively correlated (r = 0.653, P = 0.002) as were values of delta 13C and endogenous carbohydrates utilized (r = 0.752, P < 0.001). Factitious or "pseudooxidation" of a 13C-enriched exogenous glucose load (indeed noningested) was calculated from the changes in expired air delta 13C. Over the whole period of exercise it was not statistically significant at 30 and 40% VO2max. However, over the first 60 min of exercise, such pseudooxidation of exogenous glucose was significant at 30 and 45% VO2max. In conclusion, by modifying the mix of endogenous substrates oxidized, exercise at 60% VO2max and above significantly increases the 13C/12C ratio in expired air CO2. At these intensities, this could lead to overestimation of the oxidation of 13C-labeled substrates given orally. At lower intensities of exercise, such overestimation is much smaller an affects mainly the values recorded during the initial part of the exercise bout.

Adult↗

Arterial catecholamines in hypoxic exercise in man.

1. We measured the minute ventilation and arterial blood catecholamine concentrations in four normal men standing and at two levels of moderate treadmill exercise breathing 14% oxygen or air. 2. Minute ventilation was significantly higher during hypoxic exercise than during normoxic exercise at an oxygen uptake of 1500 ml/min. 3. Arterial plasma noradrenaline during hypoxic exercise at an oxygen uptake of 1500 ml/min was significantly greater than at rest. 4. Arterial plasma noradrenaline during normoxic exercise at an oxygen uptake of 1500 ml/min was not elevated above the resting concentration. 5. The results are compatible with the suggestion that increased concentrations of arterial plasma noradrenaline contribute to the hypoxic potentiation of the respiratory response to moderate exercise.

Adult↗

Breath isoprene: temporal changes in respiratory output after exposure to ozone.

Isoprene is a major hydrocarbon found in human breath. This study was conducted to evaluate whether respiratory isoprene output could serve as a monitor for ozone exposure. Healthy young adult subjects (n = 10) underwent chamber exposure on separate days to filtered air and to a variable concentration of ozone. Exposures had durations of 130 min that included alternate periods of rest and light treadmill exercise; breath was sampled pre- and postexposure. For six subjects, breath was resampled 19 +/- 1 h postexposure. Breath samples were concentrated cryogenically and analyzed by capillary gas chromatography. Isoprene output immediately postexposure was significantly reduced by ozone or filtered air (17 and 19%, respectively). These results suggest that exercise alone reduces isoprene levels in breath without an additive ozone effect. However, in the six subjects restudied 19 +/- 1 h postexposure to ozone, breath isoprene concentrations were now increased above the preexposure output by 99% (P < 0.01) and exceeded the 51% increase in output of isoprene at this time point after filtered-air exposure (P < 0.01). Therefore, breath isoprene is proposed as a noninvasive marker of a physiological response to oxidant-induced injury to epithelial membranes and fluid linings of the lower respiratory tract by ozone.

Adult↗

Empowering: the experiences of exercise among heart transplantation patients in Taiwan.

AIM: To explore the experiences of exercise among Taiwanese heart transplant patients on the basis of a grounded theory. BACKGROUND: Although studies conducted around the world have proven how important exercise is to heart transplant patients, little information was found about heart transplant patients' exercise experience. In addition, because of different cultural backgrounds, people in Taiwan do not care about 'regular exercise' as much as Americans and Europeans do. Therefore, it is very important to find ways so that they can value 'regular exercise.' METHODS: In-depth interviews were undertaken with a purposive sample of eight heart transplant patients. Data was analysed by repeated verification. RESULTS: Eight valid cases were separately and thoroughly interviewed while they were exercising at a sports medical centre. The results revealed that 'empowering the new heart' is the core reason for their exercise. During the exercise training process, every participant felt that his or her new heart was filled with power or energy. The 'hardness and endurance' in terms of feeling discomfort in the body was identified at the beginning of post-surgical exercise training. Throughout the process of empowerment, patients experienced the following five interactive behaviour categories: 'self-protection', 'sharing', 'being watched and cared for', 'being aware of the benefits', and 'strengthening the new heart'. CONCLUSIONS: Exercise can empower the new heart. After the exercise training, all patients felt that their new hearts were empowered with energy and vigour, and thus were willing to continue exercising. They even expanded their regimen to include folk therapies such as Tai Chi and breathing exercises.

Activities of Daily Living↗