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Role of the creatine/phosphocreatine system in the regulation of mitochondrial respiration.

The mechanism of metabolic regulation of mitochondrial respiration in cardiac muscle cells was studied experimentally in the permeabilized heart fibres of mice and by computer modelling in silico. The experiments showed that the rate of mitochondrial respiration could be controlled by local production of ADP by mitochondrial creatine kinase in the intermembrane space of mitochondria. The spatially inhomogenous reaction-diffusion model of compartmentalized energy transfer was used to analyse which metabolite level in cytoplasm may be important for regulation of respiration. At low and moderate workloads, up to VO2 equal to 70 micromol min-1 g-1 dry weight, the only factor to which respiration responded was inorganic phosphate. At the values of VO2 higher than 70 micromol min-1 g-1 dry weight, the respiration rate responded mostly to changes in creatine, phosphocreatine and then time-averaged (over the contractile cycle) ADP concentrations in the cytoplasm. These results are taken to show that under conditions of moderate workloads, creatine kinase activity at given physiological creatine and phosphocreatine concentrations (apparent maximal activity achievable under these conditions) is in excess to oxidative phosphorylation rate, which is controlled by Pi concentration changes starting from very low values of the latter. At higher workloads mi-CK should be upregulated by increasing creatine and decreasing phosphocreatine concentrations, and only at very high workloads the ADP diffusion flux should be increased to upregulate oxidative phosphorylation. Thus, on the basis of the study in silico of compartmentalized energy transfer by phophocreatine/creatine system, the authors conclude that there exist multiple parallel regulatory factors controlling the rate of oxygen consumption in dependence of the workload. If creatine kinase is inhibited (and there is no myokinase activity), respiration requires high diffusive flux of ADP back into mitochondria, which is the sole regulator of respiration. This needs, however, increased ADP concentrations in the cytoplasm, which in turn result in inhibition of contraction.

Animals↗

In vivo quantitative near-infrared spectroscopy in skeletal muscle during incremental isometric handgrip exercise.

The aim of this study was to investigate the performance of in vivo quantitative near-infrared spectroscopy (NIRS) in skeletal muscle at various workloads. NIRS was used for the quantitative measurement of O2 consumption (mVO2) in the human flexor digitorum superficialis muscle at rest and during rhythmic isometric handgrip exercise in a broad range of work intensities (10-90% MVC=maximum voluntary contraction force). Six subjects were tested on three separate days. No significant differences were found in mVO2 measured over different days with the exception of the highest workload. The within-subject variability for each workload measured over the three measurements days ranged from 15.7 to 25.6% and did not increase at the high workloads. The mVO2 was 0.14 +/- 0.01 mlO2 min-1 100 g-1 at rest and increased roughly 19 times to 2.68 +/- 0.58 mlO2 min-1 100 g-1 at 72% MVC. These results show that local muscle oxygen consumption at rest as well as during exercise at a broad range of work intensities can be measured reliably by NIRS, applied to a uniform selected subject population. This is of great importance as direct local measurement of mVO2 during exercise is not possible with the conventional techniques. The method is robust enough to measure over separate days and at various workloads and can therefore contribute to a better understanding of human physiology in both the normal and pathological state of the muscle.

Adult↗

A worksheet summary system for clinical laboratory management.

This article describes a simple method for summarizing total activity from the worksheets used at each workstation in a clinical laboratory. Monthly reports display day-to-day trends in total workload, as well as changes in the ratio between charged and total tests. Cumulative summaries of the monthly reports display month-to-month trends of total workload, as well as the ratio between charged and total tests. These reports also provide: (1) a simple method to calculate "lost revenue" (difference between total "chargeable" work and credited revenue); (2) more rapid and more uniform calculation of CAP workload units. In the author's laboratory, time required to maintain this data base and calculate CAP workload units has been less than the time previously required for calculation of CAP workload units alone.

Cost-Benefit Analysis↗

The lack of systematic month-to-month variation over one-year periods in ambulatory surgery caseload -application to anesthesia staffing.

Anesthesia groups forecast future workload so that staffing and future hiring can be adjusted. Statistical methods have been developed to estimate the number of anesthesia providers needed to minimize labor costs during regularly scheduled hours, second-shifts, and weekends. These methods are simple, in that they assume that, on this medium-range (11-mo) basis, workload varies irregularly around a mean workload. To test whether this assumption is likely to hold for many anesthesia groups nationwide, raw data from the 1994 to 1996 National Survey of Ambulatory Surgery were reanalyzed. To assure that month-to-month systematic variation in workload (e.g., seasonal variation) could be detected if it were present, the average number of myringotomy tubes inserted each day in ambulatory surgery centers of the United States was also examined. The average number of ambulatory surgery cases performed with an anesthesia provider each day in the United States per 10,000 population was found to have not varied systematically month to month on a medium-range (11-mo) basis. In contrast, the average number of tubes inserted each day varied systematically among months for all 26 of the overlapping 11-mo periods in the 36 mo of the survey. These findings suggest that the relatively simple statistical methods that are available to estimate future anesthesia workload will work for many anesthesia groups.

Ambulatory Surgical Procedures↗

Maximal lactate steady state during the second decade of age.

Maximal lactate steady state (MLSS) presumably corresponds to the highest constant workload that can be performed by oxidative metabolism. The anaerobic and, to a minor extent, the oxidative metabolism have been reported to be affected by age. The second decade of life is the key period in the change in energy metabolism between children and adults. The aim of this study was to evaluate the effects of age on MLSS in 34 male subjects (age: 15.4 +/- 2.8 yr, range: 11-20 yr; height: 171.8 +/- 14.9 cm, range: 134-191 cm; body mass: 59.6 +/- 15.5 kg, range: 27-90 kg) performing an incremental load test to determine maximal workload and several constant load tests for MLSS measurement on a cycle ergometer. MLSS (4.2 +/- 0.7 mmol.l-1, range: 2.8 to 5.5 mmol.l-1) and MLSS intensity related to maximal workload (66.5 +/- 7.7%, range: 50-84%) were independent of age. MLSS heart rate (180.1 +/- 10.1 min-1, range: 156-208 min-1) decreased (P < 0.01) with increasing age, whereas absolute (157.2 +/- 54.8 W, range: 65-240 W) and relative MLSS workload (2.6 +/- 0.5 W.kg-1, range: 1.5 to 4.1 W.kg-1) and absolute (236.9 +/- 79.0 W, range: 100-350 W) and relative maximal workload (3.9 +/- 0.6 W.kg-1, range: 2.7 to 5.5 W.kg-1) increased (P < 0.001) with age. The age independence of MLSS supports the theory that neuromuscular factors may contribute to the frequently observed changes in response to given exercise with physical maturity more than changes in oxidative metabolism and/or glycolysis.

Adolescent↗

Maximal strength and power, endurance performance, and serum hormones in middle-aged and elderly men.

PURPOSE: To examine maximal strength, power and muscle cross-sectional area, maximal and submaximal cycling endurance characteristics, and serum hormone concentrations of testosterone (T), free testosterone (FT), and cortisol (C) in middle-aged and elderly men. METHODS: Maximal knee extension force (isometric; MIF(KE)), power-load curves during concentric actions with loads ranging from 15% to 70% of 1 RM half-squat (1RM(HS)), muscle cross-sectional area of quadriceps femoris (CSA(QF)), workload, heart rate and lactate accumulation during incremental cycling, and serum hormone concentrations were measured in 26 middle-aged (M42 yr) and 21 elderly men (M65 yr). RESULTS: The 1RM(HS) (14%), MIF(KE) (24%) and CSA(QF) (13%) were lower in M65 than in M42 (P < 0.05-0.01). Power during submaximal actions was lower (P < 0.05-0.001) in M65 than in M42, but the differences disappeared when expressed relative to CSA(QF). Serum FT was in M42 higher (P < 0.05) than in M65. Maximal workload, maximal heart rate and peak blood lactate during cycling in M65 were 31%, 11%, and 20% lower than in M42 (P < 0.01). During submaximal cycling blood lactate rose more rapidly with increasing workload in M65 than in M42 (P < 0.05-0.01), but the differences disappeared when expressed relative to CSA(QF). Significant correlations existed between individual values of serum FT:C ratio, C and T, and those of muscle strength and maximal workload. CONCLUSION: Declines in maximal strength, muscle mass, and endurance performance seem to take place with increasing age, although muscle power and demand for aerobic energy per unit of muscle tissue during submaximal loads remain similar. The balance between anabolic and catabolic hormones in aging people over the years may be associated with age-related decreased strength and declines in maximal cycling workload.

Adult↗

Evaluating labour ward services: the art of the possible.

Midwives have contended that midwifery and obstetric workloads could not be measured and that only a 1:1 ratio of mother to midwife should occur, at least in the labour ward environment. This would appear to be true if traditional hospital statistics are used. However, this project set out to measure workload and staffing requirements. Using clinically based process and outcome criteria, dependency classification enabled daily, weekly and monthly workload and patterns of workload to be studied. Contrary to widely held beliefs it was demonstrated that mothers could be classified according to levels of need which form consistent patterns of distribution. A mean average of the total time spent on the labour wards by mothers was calculated for each level of need using 11 months' data. This produced a positive correlation with the dependency classification. Dependency classification and total time spent on the labour wards provides a mechanism for measuring workloads. To enable economic use of resources, a level of dependency for which a 1:1 ratio of staff:mother is considered essential has to be agreed. To assist with this decision two surveys designed to collect information concerning the percentage of the mothers' time spent in contact with the nursing/midwifery staff was conducted. The results were remarkably similar and again demonstrated a positive correlation with dependency classification. It was recognized that midwifery is a chronically understaffed service and that midwives working within the service felt unable to give the care they considered a woman in labour deserves.(ABSTRACT TRUNCATED AT 250 WORDS)

England↗

Effect of tidal volume and respiratory rate on the power of breathing calculation.

BACKGROUND: The power of breathing (PoB) is used to estimate the mechanical workload of the respiratory system. Aim of this study was to investigate the effect of different tidal volume-respiratory rate combinations on the PoB when the elastic load is constant. In order to assure strict control of the experimental conditions, the PoB was calculated on an airway pressure-volume curve in mechanically ventilated patients. METHODS: Ten patients received three different tidal volume-respiratory rate combinations while minute ventilation was constant. Respiratory mechanics, PoB and its elastic and resistive components were calculated. Alternative methods to estimate the elastic workload were assessed: elastic work of breathing per litre per minute, elastic workload index (the square root of elastic work of breathing multiplied by respiratory rate) and elastic double product of the respiratory system (the elastic pressure multiplied by respiratory rate). RESULTS: Despite constant elastance and minute ventilation, the elastic PoB showed an increment greater than 200% from the lower to the greater tidal volume, accounting for approximately 80% of the whole PoB increment. On the contrary, elastic work of breathing per litre per minute, elastic workload index and elastic double product did not change. CONCLUSION: Changes in breathing pattern markedly affect the PoB despite constant mechanical load. Other indexes could assess the elastic workload without tidal volume dependence. Power of breathing use should be avoided to compare different mechanical loads or efficiencies of the respiratory muscles when tidal volume is variable.

Aged↗

Microcomputer servo-controlled bicycle ergometer system for psychophysiological research.

Steady state exercise is widely used for psychophysiological studies in which a constant heart rate at a predetermined level is desired. We have developed a microcomputer servo-controlled bicycle ergometer system that can be used for administering steady state exercise. Fourteen healthy male subjects, with a wide range of fitness levels (measured by VO2max) were exercised to either a fixed workload (130 watts) or a predetermined heart rate level (servo-heart rate) of 122 bpm (i.e., 65% of maximum calculated heart rate for the sample). Servo-heart rate was implemented using a feedback loop that automatically adjusted workload to compensate for immediate variations in heart rate, resulting in a more consistent heart rate. Heart rate varied from the predetermined value by 17 bpm during fixed workload but only 3 bpm during servo-heart rate (p less than .05). Therefore, by using the microcomputer servo-controlled bicycle ergometer, heart rate was maintained at a predetermined level regardless of the subject's fitness level. VO2max and workload during servo-heart rate were significantly correlated (r = .85, p less than .05). Therefore, the workload necessary to maintain heart rate at a constant level may provide an approximate index of aerobic fitness level.

Adult↗

Which patient is most likely to benefit from a rate responsive pacemaker?

In order to provide information about indications for rate responsive pacing, we examined the exercise capacity of a typical collective of pacemaker patients. One hundred seven patients participated in the study, 50/107 (46.8%) suffered from sick sinus syndrome, 37/107 (34.6%) showed complete AV block, 12/107 (11.2%) had bradyarrhythmia and 8/107 (7.4%) had other diseases. All patients underwent treadmill exercise with increasing workloads up to the individual's maximum workload. We monitored heart rate, respiratory rate, workload, the subjective perception of stress according to the Borg scale, and the reason for the termination of exercise. Calculation of oxygen uptake was done according to an equation given by Givoni. During the tests, all implanted pacemakers have been programmed to VVI 70 mode. We found that all pacemaker patients showed a reduction of their exercise capacity compared to the age-related normal values. Particularly in patients with AV block or bradyarrhythmia, the maximum achievable workload often did not even reach levels of everyday activities such as going upstairs; patients with sick sinus syndrome showed slightly better exercise capability, probably due to the higher increase of average heart rate. Despite objective differences of maximum workload, all patients had the same subjective perception at the end of the tests; the course of respiratory rate indicated that all persons finished the tests in the range of individual maximum exercise capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Bradycardia↗

The A-R interval as exercise indicator: a new option for rate adaptation in single and dual chamber pacing.

We investigated the possibility to use the interval from an atrial stimulus to the ventricular R wave (A-R interval) as an indicator of physical stress, in 16 patients with pacemakers implanted for severe atrial bradycardia but with intact AV conduction. The A-R interval was studied during incremental atrial pacing at rest and during exercise with a constant workload. In addition, the atrial pacing rate was kept constant just above spontaneous sinus rate and the dynamics of the A-R interval were studied during exercise with a low constant workload and during a maximal exercise test with increasing workload. Incremental atrial pacing prolonged the A-R interval and this response was blunted during exercise (P less than 0.003). Atrial pacing at a constant rate and during a constant workload resulted in an almost direct shortening of the A-R interval. When the workload was increased but the atrial rate kept constant, a pronounced shortening of the A-R interval was noted (P less than 0.0001). It is concluded that changes of the A-R interval during different kinds of exercise were prompt and predictable in patients with sinus node dysfunction but intact AV conduction. In these patients the shortening of the A-R interval during exercise may be a suitable indicator for rate adaptive atrial pacing.

Adult↗

Increased temperature, not cardiac load, activates heat shock transcription factor 1 and heat shock protein 72 expression in the heart.

The expression of myocardial heat shock protein 72 (HSP72) postexercise is initiated by the activation of heat shock transcription factor 1 (HSF1). However, it remains unknown which physiological stimuli govern myocardial HSF1 activation during exercise. These experiments tested the hypothesis that thermal stress and mechanical load, concomitant with simulated exercise, provide independent stimuli for HSF1 activation and ensuing cardiac HSP72 gene expression. To elucidate the independent roles of increased temperature and cardiac workload in the exercise-mediated upregulation of left-ventricular HSP72, hearts from adult male Sprague-Dawley rats were randomly assigned to one of five simulated exercise conditions. Upon reaching a surgical plane of anesthesia, each experimental heart was isolated and perfused using an in vitro working heart model, while independently varying temperatures (i.e., 37 degrees C vs. 40 degrees C) and cardiac workloads (i.e., low preload and afterload vs. high preload and afterload) to mimic exercise responses. Results indicate that hyperthermia, independent of cardiac workload, promoted an increase in nuclear translocation and phosphorylation of HSF1 compared with normothermic left ventricles. Similarly, hyperthermia, independent of workload, resulted in significant increases in cardiac levels of HSP72 mRNA. Collectively, these data suggest that HSF1 activation and HSP72 gene transcriptional competence during simulated exercise are linked to elevated heart temperature and are not a direct function of increased cardiac workload.

Animals↗

Training-induced alterations of carbohydrate metabolism in women: women respond differently from men.

We examined the hypothesis that glucose flux was directly related to relative exercise intensity both before and after a 12-wk cycle ergometer training program [5 days/wk, 1-h duration, 75% peak O2 consumption (VO2 peak)] in healthy female subjects (n = 17; age 23.8 +/- 2.0 yr). Two pretraining trials (45 and 65% of VO2 peak) and two posttraining trials [same absolute workload (65% of old VO2 peak) and same relative workload (65% of new VO2 peak)] were performed on nine subjects by using a primed-continuous infusion of [1-13C]- and [6,6-2H]glucose. Eight additional subjects were studied by using [6, 6-2H]glucose. Subjects were studied postabsorption for 90 min of rest and 1 h of cycling exercise. After training, subjects increased VO2 peak by 25.2 +/- 2.4%. Pretraining, the intensity effect on glucose kinetics was evident between 45 and 65% of VO2 peak with rates of appearance (Ra: 4.52 +/- 0.25 vs. 5.53 +/- 0.33 mg . kg-1 . min-1), disappearance (Rd: 4.46 +/- 0.25 vs. 5.54 +/- 0.33 mg . kg-1 . min-1), and oxidation (Rox: 2.45 +/- 0.16 vs. 4.35 +/- 0.26 mg . kg-1 . min-1) of glucose being significantly greater (P </= 0.05) in the 65% than in the 45% trial. Training reduced Ra (4.7 +/- 0.30 mg . kg-1 . min-1), Rd (4.69 +/- 0.20 mg . kg-1 . min-1), and Rox (3.54 +/- 0.50 mg . kg-1 . min-1) at the same absolute workload (P </= 0. 05). When subjects were tested at the same relative workload, Ra, Rd, and Rox were not significantly different after training. However, at both workloads after training, there was a significant decrease in total carbohydrate oxidation as determined by the respiratory exchange ratio. These results show the following in young women: 1) glucose use is directly related to exercise intensity; 2) training decreases glucose flux for a given power output; 3) when expressed as relative exercise intensity, training does not affect the magnitude of blood glucose flux during exercise; but 4) training does reduce total carbohydrate oxidation.

Adolescent↗

Bicarbonate infusion and pH clamp moderately reduce hyperventilation during ramp exercise in humans.

To test the hypothesis that the decrease in plasma pH contributes to the hyperventilation observed in humans in response to exercise at high workloads, five healthy male subjects performed a ramp exercise [maximal workload: 352 W (SD 35)] in a control situation and when arterialized plasma pH was maintained at the resting level (pH clamp) by intravenous infusion of sodium bicarbonate [129 mmol (SD 23), beginning at 59% maximal workload (SD 5)]. Bicarbonate infusion did not modify O(2) consumption (Vo(2)) but significantly (P < 0.05) increased arterial Pco(2), plasma bicarbonate concentration, and respiratory exchange ratio (P < 0.05). At the three highest workloads, pulmonary ventilation (Ve) and Ve/Vo(2) were approximately 5-10% lower (P < 0.05) when bicarbonate was infused than in the control situation, and hyperventilation was reduced by 15-30%. These data suggest that the decrease in plasma pH is one of the factors that contribute to the hyperventilation observed at high workloads.

Acid-Base Equilibrium↗

A combined neurophysiological and behavioural study into the stimulating effects of fexofenadine on performance.

Antihistamines are known for their sedative effects. However, some studies suggested mild stimulant effects in the case of fexofenadine. The goals of this study are to examine whether fexofenadine possesses stimulating properties and to determine whether such stimulating effects are related to workload. Sixteen healthy volunteers received a single dose of 180 and 360 mg fexofenadine and placebo on separate test days. Drug effects were assessed using a divided attention task (DAT), continuous performance task (CPT) and motor choice reaction time test (MCRT). Sensitivity of the tasks was increased by manipulating the workload during task performance. Event Related brain Potentials (ERPs) were measured in the DAT and CPT to study the underlying neurophysiological processes. An interaction effect of Treatment and Workload was found on tracking performance in the DAT and on movement time in the MCRT. Performance on the DAT was less affected by increments in workload after fexofenadine as compared to placebo. P1 and P3 latency were affected by Treatment x Workload and Treatment respectively and indicated faster attentional and information processing latencies following fexofenadine treatment. Treatment did not influence performance in the CPT task or in the ERPs measured during this task. The MCRT demonstrated faster movement times following fexofenadine treatment. These results suggest that although the neurophysiological data indicate central nervous system (CNS) activation after fexofenadine treatment, the magnitude of the centrally activating effects is too small to produce relevant performance improvement at the behavioural level.

Adult↗

Maximal work capacity in relation to nutritional status in children with cystic fibrosis.

In children with cystic fibrosis, objective parameters of exercise tolerance are needed which are easy to measure in nonspecialized centres. We investigated maximal workload (W'max) in children with cystic fibrosis in relation to body weight and fat-free mass, and compared this with results for maximal oxygen consumption (V'O2,max). Fourteen patients with cystic fibrosis performed an incremental maximal exercise test on a bicycle ergometer. W'max, V'O2,max, body weight and fat-free mass were measured. W'max and V'O2,max were significantly correlated (r = 0.91; p < 0.001). Using standard deviation scores in relation to reference values, W'max and V'O2,max per kilogram body weight were significantly higher than uncorrected W'max and V'O2,max (mean difference (95% CI) 0.63 (0.24-1.01) and 0.91 (0.32-1.49) SD units, respectively). There was no such difference after correction for fat-free mass. Standardized V'O2,max was significantly higher than standardized W'max (mean difference (95% CI): 1.59 (1.14-2.04)), also after correction for body weight and fat-free mass. In children with mild-to-moderate cystic fibrosis, maximal workload per kilogram fat-free mass, but not per kilogram body weight, is a useful parameter to correct for diminished nutritional status. In these patients, maximal workload is consistently lower than maximal oxygen consumption. Taking into account this difference, maximal workload and maximal workload per kilogram fat-free mass can be used for follow-up of paediatric patients with cystic fibrosis in nonspecialized settings.

Adolescent↗

Manual wheelchair propulsion: effects of power output on physiology and technique.

Eight wheelchair sportsmen conducted eight wheelchair exercise tests on a treadmill. Two workload strategies were followed: strategy 1--increments in speed at a constant slope and strategy 2--increments in slope at constant velocity. Thus, data on cardio-respiratory and propulsion technique parameters were obtained on two identical series of 16 speed and slope combinations. Between each two identical speed and slope combinations of strategies 1 and 2, a different workload history is apparent. A four-factor analysis of variance with repeated measures on the factors "strategy" (workload history), "speed," and "slope" was applied (P less than 0.05). No "strategy" effect was seen in the cardio-respiratory parameters (gross mechanical efficiency, ventilation, oxygen consumption, and heart rate), work/cycle, and cycle time. Thus, within the experimental set-up, workload history did not affect the parameters studied and 3-min workload periods appeared sufficiently long for experienced wheelchair users to adapt to the requirements of a given speed and slope combination. Significant effects were found on "speed," "slope," and their interaction in all parameters tested. Moreover, a comparison of two equal levels of power output, but different speed and slope, led to a significantly higher efficiency, cycle time, and work per cycle for the "low speed and high slope" combination. Push time and recovery time appeared highly dependent on speed and slope, respectively. The findings indicate that propulsion technique and cardio-respiratory parameters should not merely be studied in relation to power output, but also with respect to its constituents, speed, and slope/resistance.

Adult↗

Comparison of oxygen saturation by pulse oximetry and co-oximetry during exercise testing in patients with COPD.

INTRODUCTION: Measurement of oxygen saturation by pulse oximetry (SpO2) is frequently performed during exercise testing of patients with COPD to monitor for hypoxemia. The purpose of this study was to assess the accuracy and precision of pulse oximetry during exercise. We hypothesized that the SpO2 would more closely reflect oxygen saturation as measured by co-oximetry (SaO2) when it was corrected for carboxyhemoglobin (COHb). We also hypothesized that SpO2 would more closely reflect SaO2 when the pulse rate by oximeter was equivalent to the heart rate by ECG. Finally, we hypothesized that SpO2 would be a better measure of SaO2 at maximal workloads than at rest or submaximal workloads. METHODS: Eight white men with severe COPD (mean +/- SD FEV1, 0.91 +/- 0.37) underwent progressive, symptom-limited exercise testing by cycle ergometry. SaO2 was measured from arterial blood at each workload using a co-oximeter. SpO2 and pulse rate were obtained by a pulse oximeter (Ohmeda 3700). Heart rate was continuously monitored by ECG. RESULTS: Reliable oximetric values as determined by a dicrotic notch in each waveform and adequate signal intensity were obtained in all eight patients. SpO2 was a moderately accurate measure of SaO2 (bias, 1.7%; precision, 2.9). The bias actually increased (4.1%) when SpO2 was corrected for COHb. Accuracy of SpO2 was not improved when pulse rate by oximetry and heart rate by ECG were equivalent, nor was the accuracy improved at maximal workloads relative to submaximal workloads during the exercise test. CONCLUSION: Oxygen saturation as measured by pulse oximetry (SpO2) in patients with COPD undergoing exercise testing is not sufficiently accurate to replace SaO2 as the gold standard for oxygen saturation.

Carboxyhemoglobin↗