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The pattern and timing of breathing during incremental exercise: a normative study.

Clinical evaluation of the pattern and timing of breathing during submaximal exercise can be valuable for the identification of the mechanical ventilatory consequences of different disease processes and for assessing the efficacy of certain interventions. Sedentary individuals (60 male/60 female, aged 20-80 yrs) were randomly selected from >8,000 subjects and submitted to ramp incremental cycle ergometry. Tidal volume (VT)/resting inspiratory capacity, respiratory frequency, total respiratory time (Ttot), inspiratory time (TI), expiratory time (TE), duty cycle (TI/Ttot) and mean inspiratory flow (VT/TI) were analysed at selected submaximal ventilatory intensities. Senescence and female sex were associated with a more tachypnoeic breathing pattern during isoventilation. The decline in Ttot was proportional to the TI and TE reductions, i.e. TI/Ttot was remarkably constant across age strata, independent of sex. The pattern, but not timing, of breathing was also influenced by weight and height; a set of demographically and anthropometrically based prediction equations are therefore presented. These data provide a frame of reference for assessing the normality of some clinically useful indices of the pattern and timing of breathing during incremental cycle ergometry in sedentary males and females aged 20-80 yrs.

Adult↗

Effect of GR32191, a potent thromboxane receptor antagonist, on exercise induced bronchoconstriction in asthma.

Previous work suggests a role for mast cell derived mediators in exercise induced asthma. The contribution of newly generated contractile prostaglandins to exercise induced asthma was assessed by using a potent and orally active thromboxane (TP1) receptor antagonist, GR32191. The effect of 120 mg GR32191 on exercise induced asthma was observed in 12 asthmatic subjects. For the exercise challenge the subjects performed six minutes of treadmill exercise, breathing dry air at a work load that had previously been shown to induce a fall in FEV1 of 25% or more from the pre-exercise baseline. No effect of GR32191 on pre-exercise baseline airway calibre was evident. There was no significant difference in the mean maximum percentage fall in FEV1 from baseline after exercise between drug and placebo (placebo 30.2%, GR32191 day 31.6%). It is concluded that the thromboxane antagonist GR32191 has no effect on exercise induced asthma. This suggests that prostaglandins, including PGD2, that act via the thromboxane receptor do not have an important role in exercise induced asthma.

Adult↗

The response of the nasal airway to exercise.

Exercise causes a fall in nasal resistance that may be due to sympathetic vasoconstriction in the nasal mucosa. Other factors potentially involved in the exercise effect on nasal resistance are: increased alae nasi muscle activity, passive redistribution of blood to exercising muscle and away from the nasal mucosa, increased nasal air flow, and hyperventilation. In order to determine the importance of these factors, 6 healthy adults had nasal pressure/flow data collected at rest and after bicycle exercise at 100 to 160 W. Erect exercise with nose breathing, erect exercise with mouth breathing, voluntary isocapnic hyperventilation at the minute volumes achieved during exercise, and supine exercise were performed. The alae nasi muscles were voluntarily activated during pressure/flow measurements. The pressure/flow data were displayed on a logarithmic plot; parallel rightward shifts of this plot indicate falls in nasal resistance mediated by enlargement of the air passage. The position of the plot was defined by the flow rate at which the slope of the logarithmic plot steepens abruptly (Vtr). Erect exercise with nose breathing caused a fall in nasal resistance in all 6 subjects (mean change in Vtr, +14.4 L/min). Exercise mouth breathing and supine exercise caused similar falls in nasal resistance in all subjects (mean change of Vtr, +14.1 and +14.2 L/min, respectively). Voluntary isocapnic hyperventilation had no effect on nasal pressure/flow properties in any subject (mean change in Vtr, -1.3 L/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

A linear scale for measuring vagal tone in man.

1. Different levels of parasympathetic control of the heart were measured using ratios of the longest to the shortest intervals between R-waves in the ECGs (R-R) recorded during a deep breathing exercise in the supine position (respiratory sinus arrhythmia). The mean of absolute differences in consecutive R-R intervals was also measured in the supine position during quiet breathing (beat-to-beat variation), in six healthy volunteers, after cumulative doses of atropine (0.1-2.0 mg 70 kg-1, i.v.). 2. Full atropinization was observed at 2.0 mg 70 kg-1 where the respiratory sinus arrhythmia decreased by 97%, and the beat-to-beat variation dropped by 94%. There was no further drop in both indices at doses above 2.0 mg 70 kg-1. The different levels of parasympathetic control of the heart were directly proportional to the equivalent levels of respiratory sinus arrhythmia or beat-to-beat variation. 3. A universal linear vagal scale was calculated for use with these non-invasive indices to assess the levels of parasympathetic control of the heart. Zero in this scale would represent no activities in the cardiac vagus nerve. 4. It was concluded that vagal tone could be selectively measured in an intact person using these simplified and fast algorithms for quantifying respiratory sinus arrhythmia or beat-to-beat variation. A linear scale for measuring the vagal tone was possible. This linear scale was called the linear vagal scale (LVS).

Adult↗

Control of ventilation in running birds: effects of hypoxia, hyperoxia, and CO2.

Minute volume (V), tidal volume (VT), respiratory frequency (f), venous lactate, and clavicular air sac gas composition were measured in domestic fowl at rest and during exercise, breathing hypoxic, hyperoxic, or hypercapnic gas. Hyperoxia produced no significant change in ventilation, CO2 inhalation produced increases in V and VT, but the changes in f appeared to be related to the stage of exercise at which CO2 was administered. The sensitivity of the hypercapnic response was similar in resting and exercising birds. Compared with the effects of CO2, hypoxia elicited only a weak ventilatory response in rest and exercise conditions despite severe tissue anaerobiosis.

Animals↗

Nostril dilatation increases capacity to sustain moderate exercise under nasal breathing condition.

BACKGROUND: Effect of nasal breathing without and with nostril dilatation on sustainability of moderate exercise (75% VO2max) and selected respiratory variables were examined. METHODS EXPERIMENTAL DESIGN: Nine healthy male subjects completed three randomly assigned exhaustive treadmill runnings under three breathing conditions: (i) oronasal breathing (CON), (ii) nasal breathing with external nasal dilator strip (NBENDS), and (iii) nasal breathing with fake nasal strip (NBFNS). RESULTS: Pre-exercise peak nasal inspiratory flow was increased with NBENDS but not with NBFNS. Pre-exercise nasal 12-sec maximum voluntary ventilation with NBENDS was greater than that with NBFNS while both were less than oronasal value. Exercise time to exhaustion in NBFNS trial, which was 23.6+/-6.7% less than the CON value, increased 31.9+/-12.3% under NBENDS condition. During exercise at exhaustion, although the difference in ventilation among all trials was not significant, lower breathing frequency in NBFNS and NBENDS exercises and higher end-tidal CO2 tension in NBFNS trial were found in comparison to CON values. Ratings of perceived magnitude of breathing effort (RPMBE) and exertion (RPE) at exhaustion were similar among all trials. However, RPMBE at exhaustion during NBFNS exercise was higher than that at the iso-time point during CON and NBENDS exercises. Similar result in RPE was found between NBFNS and CON exercises. After exercise, maximum inspiratory and expiratory pressures reduced. The reduction of each variable was similar among the three trials. CONCLUSIONS: Nasal breathing reduces the sustainability of moderate exercise measured under oronasal breathing condition. Nostril dilatation increases the capacity to sustain moderate exercise under nasal breathing condition.

Adult↗

Lung function and exercise capacity in thalassaemia major.

Lung function abnormalities in thalassaemia major are various and complex; however, patients still die from cardiac lesions. This study aimed to investigate pulmonary and cardiac involvement at an early stage in thalassaemic patients and study their respective implications at rest and during exercise. Ten patients (five adults and five children) with thalassaemia major were investigated by echocardiography, lung function and exercise testing a few days after transfusion. All have had regular transfusions and chelation with deferoxamine and none had chronic pulmonary disease symptoms. Minor lung function abnormalities were found: two patients had moderate obstructive syndrome and two had a decreased carbon monoxide transfer factor. Hypoxaemia was never found at rest and no desaturation was observed at the end of exercise. Echocardiographic abnormalities were also moderate. Peak oxygen consumption (V'O2) was decreased in three adults and was lower in adults than children (means 27.7+/-4.6 and 41.1+/-4.8 mL.kg(-1).min(-2) respectively). The V'O2/cardiac frequency slope was lower in adults than children (0.25+/-0.06 versus 0.42+/-0.10 mL.kg(-1).min(-2)), whereas end-exercise breathing reserve was >40% maximal voluntary ventilation for all patients. In conclusion, none of the patients had ventilatory limitations but older patients had cardiac limitations assessed by the relationship between oxygen consumption and cardiac frequency. Exercise testing may detect cardiac impairment in thalassaemia major earlier than investigations at rest.

Adolescent↗

[Management of unilateral vocal cord paralysis].

The phoniatric analysis evaluates the importance of the vocal disorder and the appearance of the larynx what permets to find five clinical cases. For each one, there is a precise treatment: no treatment, rehabilitation with precises exercises in each case, collagen injection, early or secondary to rehabilitation. The rehabilitation will be intensive and done as soon as possible. It is based on a well known body proprioception. Intrinsic laryngeal muscles work, breathing exercises, exercises aimed at restoring the laryngeal sphincter will precede the pure vocal work. Author's experience shows that the results are good if rehabilitation is well indicated from the beginning and the patient with good motivations.

Humans↗

The beneficial effect of nasal breathing on exercise-induced bronchoconstriction.

In the first step of a study of the relation of nasal and oral breathing during moderate treadmill exercise to the onset of bronchoconstriction in young patients with perennial bronchial asthma, it was observed that most subjects spontaneously breathed with their mouths open when instructed to breathe "naturally." Subsequently, when they were required to breathe only through the nose during the exercise, an almost complete inhibition of the postexercise bronchoconstrictive airway response was demonstrated. When instructed to breathe only through the mouth during exercise, an increased bronchoconstrictive airway response occurred, as measured by spirometry, flow-volume relationships, and body plethysmography. These findings suggest that the nasopharynx and the oropharynx play important roles in the phenomenon of exercise-induced bronchoconstriction.

Adolescent↗

Rehabilitation of the geriatric orthopaedic patient.

Older patients who are referred for rehabilitation after undergoing orthopaedic procedures have numerous age-related conditions that may interfere with physical performance and safety. The general rehabilitation goals are to return each patient to the premorbid functional level of mobility and self-care, teach the exercises that are to be performed after hospital discharge, reduce the risk of falls, and ensure that the patient is discharged to a safe environment. Before elective surgery, the elderly orthopaedic patient should be instructed to perform breathing exercises to prevent pulmonary complications and active lower limb exercises to maintain good circulation and joint mobility, and be instructed in functional activities for mobilization in and out of bed. Postoperatively, the interdisciplinary rehabilitation team must facilitate early resumption of active exercises and self-care tasks and discourage prolonged bed rest and dependency on nursing staff and family members. Physical and occupational therapy should be provided to restore mobility and self-care functions. If discharge to home is planned, the home environment should be assessed and modifications recommended to reduce the risk of falls and ensure independent functioning to the extent possible. When the rehabilitation goals have been obtained, the patient should be discharged from the hospital, but additional therapy may be required, either at home or at an outpatient facility.

Accidental Falls↗

Metabolic effects of exposure to hypoxia plus cold at rest and during exercise in humans.

To determine effects on metabolic responses, subjects were exposed to four environmental conditions for 90 min at rest followed by 30 min of exercise: breathing room air with an ambient temperature of 25 degrees C (NN); breathing room air with an ambient temperature of 8 degrees C (NC); hypoxia (induced by breathing 12% O2 in N2) with a neutral temperature (HN); and hypoxia in the cold (HC). Hypoxia increased heart rate (HR), systolic blood pressure (SBP), pulmonary ventilation (VE), respiratory exchange ratio (R), blood lactate, and perceived exertion during exercise while depressing rectal temperature (Tre) and O2 uptake (VO2). Cold exposure elevated SBP, diastolic blood pressure (DBP), VE, VO2, blood glucose, and blood glycerol but decreased HR, Tre, and R. Shivering and DBP were higher and Tre was lower in HC compared with NC. HR, SBP, VE, R, and lactate tended to be higher in HC compared with NC, whereas VO2 and blood glycerol tended to be depressed. These results suggest that cold exposure during hypoxia results in an increased reliance on shivering for thermogenesis at rest whereas, during exercise, heat loss is accelerated.

Adult↗

[Maternity education in primary care. Efficacy, utility and satisfaction of pregnant women].

OBJECTIVE: To evaluate the Maternity Education (ME) programme: improvement of previous knowledge, changes in hygiene and dietary habits, attitudes to giving birth, satisfaction with the development of the sessions and perceived use. DESIGN: Pre-test/post-test. SETTING: Urban Health Centre. PARTICIPANTS: 222 pregnant women who attended ME. 211 answered the first questionnaire, 145 also the second, and 113 all three. MEASUREMENTS AND MAIN RESULTS: Self-administered questionnaires on social and demographic profile, hygiene and diet habits and knowledge of pregnancy, birth and caring for the new-born. Satisfaction and perceived use survey. Mean overall knowledge went up by 4.97 points (CI 95%: 4.5-5.44). Age (p < 0.0001), greater educational level (p < 0.001) and not being primiparas (p < 0.001) were linked to better initial knowledge. 46.7% of smokers stopped smoking between the start of pregnancy and the start of ME. By the end 23.6% of the women smoked, with an average of 4.53 cigarettes per day. Consumption of milk products per day went up from 2.78 to 3.07 (p = 0.002). Those taking physical exercise went up from 22.4% to 57.6% (p = 0.0001). 99.5% considered the sessions very pleasant; 89%, easily understandable; and 100% took part freely in the discussions. 86.7% had little or no fear of giving birth. 92.8% found the breathing exercises useful; and 69.8% the relaxation exercises. 98.2% thought that all pregnant women should experience ME. CONCLUSIONS: Group ME is effective for improving knowledge and health habits. Pregnant women thought it useful for confronting the birth and were very satisfied with the methods used.

Family Practice↗

Improved breathing capacity during exercise in severe obstructive airway disease.

In severe COPD, ventilation at peak exercise may exceed the resting maximal voluntary ventilation (MVV). We investigated the mechanisms by which the breathing capacity can improve during exercise in COPD. A total of 13 patients with an FEV1 of 32+/-12% (SD) predicted, performed an incremental maximal exercise test and FVC and MVV maneuvers at rest and during constant work rate exercise. Maximal exercise ventilation was 3+/-2 L/min higher than resting MVV. Breathing capacity improved during exercise; resting MVV was 30+/-3 (SE) L/min, while it reached 38+/-3 L/min during exercise (P < 0.002). FEV1 improved from 0.86+/-0.1 L at rest to 1.01+/-0.1 L during exercise (P < 0.004), which is consistent with exercise-induced bronchodilatation. It is concluded that in severe COPD, breathing capacity improves during exercise. Assuming that the change in FEV1 reflects improved airway function, these data suggest that exercise-induced bronchodilatation contributed to that improvement.

Adult↗

Breathing pattern during exercise in myopathic subjects.

Previous studies have described a neurogenic-induced ventilatory tachypneic response during exercise. The present paper compares the breathing pattern of control and myopathic human subjects submitted to exercise. Peripheral neurogenic stimuli (PNS) at the same level of oxygen consumption should be enhanced in myopathic subjects as a consequence of muscular mass loss. Myopathic individuals showed hyperventilation (increased VeO2 and VeCO2) which was mostly due to higher respiratory frequency. The shorter respiratory cycle was due chiefly to Te reduction, since the Ti/TTOT ratio was greater in the myopathic individuals for a VO2 of 1 L. These results are in agreement with previous studies in anesthetized dogs and in unanesthetized humans in which a tachypneic mechanism associated to the relative work load was observed. These results also suggest that PNS may have a facilitatory effect upon the inspiratory off switch mechanism.

Adolescent↗

[Psychoautonomic and neurovascular disorders in patients with autonomic vascular dystonia and the hyperventilation syndrome and methods for their correction].

35 patients with vegetocirculatory dystonia and hyperventilation syndrome, but without the signs of organic lesion of nervous system were treated. The complex treatment included the breathing exercises with feedback mechanisms, the correction of psychovegetative and neurovascular disturbances, the massage of neck region and a head, psychotherapy, angioprotective, vegeto- and psychotropic drug therapy. The disappearance of acute vascular attacks and paroxysms of migrainous headache, the normalization of all breathing parameters and the improvement of vegetative status were observed in all patients.

Adolescent↗

Effect of vagotomy on the breathing pattern and exercise ability in emphysematous patients.

1. The potential value of right vagotomy for the relief of breathlessness has been explored in five patients with emphysema. Two patients had symptomatic improvement, two had minor symptomatic improvement, and one was unchanged. 2. Exercise ventilation was not noticeably depressed by unilateral right vagotomy in the two patients investigated fully, but the pattern of breathing was altered. After vagotomy, breathing was deeper, and the rise in the frequency of breathing with exercise was depressed. 3. After right vagotomy the response to rebreathing carbon dioxide also consisted of slower deeper breaths. 4. Right vagotomy sometimes appears to remove an influence preventing slow deep breathing and exacerbating dyspnoea. 5. Results of bilateral pulmonary denervation, attempted in one patient, were complicated by the need for left thoracotomy, which removed any possible beneficial effects.

Aged↗

Effectiveness of complementary and self-help treatments for depression.

OBJECTIVES: To review the evidence for the effectiveness of complementary and self-help treatments for depression. DATA SOURCES: Systematic literature search using PubMed, PsycLit, the Cochrane Library and previous review papers. DATA SYNTHESIS: Thirty-seven treatments were identified and grouped under the categories of medicines, physical treatments, lifestyle, and dietary changes. We give a description of each treatment, the rationale behind the treatment, a review of studies on effectiveness, and the level of evidence for the effectiveness studies. RESULTS: The treatments with the best evidence of effectiveness are St John's wort, exercise, bibliotherapy involving cognitive behaviour therapy and light therapy (for winter depression). There is some limited evidence to support the effectiveness of acupuncture, light therapy (for non-seasonal depression), massage therapy, negative air ionisation (for winter depression), relaxation therapy, S-adenosylmethionine, folate and yoga breathing exercises. CONCLUSION: Although none of the treatments reviewed is as well supported by evidence as standard treatments such as antidepressants and cognitive behaviour therapy, many warrant further research.

Acupuncture Therapy↗