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Effects of QiGong on brain function.

QiGong is an ancient and widely practiced Chinese meditation exercise. We studied the effects of QiGong on brain function with modern neuromonitoring tools in two subjects. In a male QiGong master (extremely trained practitioner), the technique induced reproducible changes in transcranial Doppler sonography, EEG, stimulus-induced 40 Hz oscillations, and near-infrared spectroscopy findings. Similar effects were seen after the application of multimodal stimuli and when the master concentrated on intense imagined stimuli (e.g. 22.2% increase in mean blood flow velocity (vm) in the posterior cerebral artery, and a simultaneous 23.1% decrease of vm in the middle cerebral artery). Similar effects were seen in the female subject. Neuromonitoring during QiGong appears able to objectify accompanied cerebral modulations surrounding this old Chinese meditation exercise.

Acoustic Stimulation↗

Inspiratory muscle training in chronic airflow limitation: effect on exercise performance.

The effect of inspiratory muscle training (IMT) on exercise capacity in patients with chronic airflow limitation (CAL) has been debated. The present study was planned to further investigate the effects of IMT on exercise performance. Twenty patients (aged 62+/-1 yrs; forced expiratory volume in one second/forced vital capacity (FEV1/FVC) 36+/-2%) were trained 30 min daily for 6 days a week during 10 weeks, with either 30% (Group 1) or 10% (Group 2) of peak maximal inspiratory pressure (PI,max) as a training load. Exercise performance was evaluated by the distance walked in 6 min (6MWD) and by changes in oxygen consumption (V'O2) and minute ventilation (V'E) during a progressive exercise test. Changes in PI,max and dyspnoea were also measured. Results showed a significant increment in peak PI,max in both groups, whereas dyspnoea and 6MWD improved only in Group 1 (p<0.05 and p<0.01, respectively). No increment in maximal workload or in peak V'O2 was observed in either group. Patients in Group 1, however, showed a reduction in V'E and V'O2 for the same exercise. A correlation between changes in V'E and V'O2 during a workload of 75 kpm x min(-1) was observed in Group 1 (r=0.92; p<0.001). We conclude that inspiratory muscle training using a load of 30% peak maximal inspiratory pressure, improves dyspnoea, increases walking capacity and reduces the metabolic cost of exercise.

Breathing Exercises↗

Dyssynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction.

Some patients with chronic airflow obstruction experience dyspnea with mild arm exercise but not with more-intense leg exercise. To investigate why these patients have limited endurance during arm exertion, we studied ventilatory responses to exercise with unsupported arms in 12 patients with chronic airflow obstruction (mean [+/- SD] forced expiratory volume in one second, 0.68 +/- 0.28 liters). Unloaded leg cycling was also studied for comparison. In the five patients who had the most severe airflow obstruction, arm exercise was limited by dyspnea after 3.3 +/- 0.7 minutes, and dyssynchronous thoracoabdominal breathing developed. In the other seven patients, arm exercise was limited by the sensation of muscle fatigue after 6.1 +/- 2.0 minutes (P less than 0.05), and dyssynchronous breathing did not occur. None of the 12 patients had dyssynchronous breathing during unloaded leg cycling. Maximal transdiaphragmatic pressure, a measure of diaphragmatic fatigue, declined similarly after arm and leg exercise in both groups. During unsupported arm work, the accessory muscles of inspiration help position the torso and arms. We hypothesize that the extra demand placed on these muscles during arm exertion leads to early fatigue, an increased load on the diaphragm, and dyssynchronous thoracoabdominal inspirations. This sequence may contribute to dyspnea and limited endurance during upper-extremity exercise.

Adult↗

[Orthodontic treatment in mouth breathing].

Patients with severe alterations of the maxillary growth pattern, due to long term predominant oral respiration, primarily need orthopaedic appliances, rather than common orthodontic mechanics. In cases of maxillary transversal deficiency, rapid expansion is indicated to recover an adequate width. Such treatment improves the ability for nasal ventilation. When the maxilla is sagittally underdeveloped, a facial mask is used to protract the entire maxilla. Other ways of treatment include oral screens, partial glossectomy, myofunctional therapy and respiratory gymnastics. Finally orthodontic treatment can be planned to correct irregularities of the teeth and residual malocclusions.

Activator Appliances↗

Breathing in man during steady-state exercise on the bicycle at two pedalling frequencies, and during treadmill walking.

1. The breathing pattern, that is the changes in tidal volume (VT), and in inspiratory (TI) and expiratory (TE) durations, has been studied as ventilation increases in exercise. 2. Five healthy subjects were studied in steady-state exercise on a bicycle ergometer, breathing air, at two speeds of pedalling and at six different loads. The pattern was recorded for single breaths. Two of the subjects were also studied while walking on a treadmill with four combinations of speed and gradient. 3. In bicycle exercise, as the CO2 output increased mean VT increased, and mean TI and TE decreased, the absolute decrease in TI being small. The pedalling speed did not affect these relationships. 4. Individual breath durations showed no tendency to group around multiples of the period of rotation of the pedals. 5. In treadmill exercise, no clear influence of stride rate on respiratory rate could be found. The pattern was similar to that found in bicycle exercise. Again no grouping could be found. 6. No evidence of an effect of frequency of limb movement on breathing pattern in submaximal exercise has been found. The selection of breathing pattern seems to be unrelated to the nature of the stimulus but closely geared to the metabolic needs of the body.

Adolescent↗

Inspiratory resistance versus general physical training in patients with chronic obstructive pulmonary disease.

The effect of inspiratory muscle training (IMT) three times daily for 6 weeks was compared with that of general physical training (PT) (stair climbing) in 10 out-patients with severe chronic obstructive pulmonary disease (COPD). PT improved 12 min walking distance (12MWD) by 19% (1-28), stair climbing ability (SCA) over four floors at maximum speed by 11% (3-50), maximum oxygen uptake by 10% (2-33), inspiratory flow by 85% (19-113) and improved an index of breathlessness by 44% (3-786). During IMT, 12MWD and SCA decreased by 8% (0-33) and 10% (0-161), respectively, and the other variables decreased by 6-10%. No changes were seen in ventilation during maximum exercise, in maximum inspiratory and expiratory pressures, or in variables measured during spirometry. Thus work capacity can be improved by training in COPD maybe because of an increase in inspiratory flow rate, but without a change in maximum exercise ventilation.

Aged↗

Cardiac and respiratory responses to exercise in adolescent idiopathic scoliosis.

Twenty girls, aged 11-15 years, with adolescent idiopathic scoliosis were studied before spinal fusion was performed. Each underwent a range of lung function tests and a standardised progressive exercise test on a bicycle ergometer. The resting lung function tests showed reduced peak flow rates, lung volumes, and maximum voluntary ventilation. The maximum oxygen uptake was slightly diminished but maximum exercise ventilation was normal. The latter was achieved by using a greater than normal fraction of the vital capacity in tidal breathing while exercising. Mild hyperventilation during submaximal exercise and a trend towards an exercise tachycardia with increasing body weight were observed.

Adolescent↗

Lung volume reduction surgery improves maximal O2 consumption, maximal minute ventilation, O2 pulse, and dead space-to-tidal volume ratio during leg cycle ergometry.

Early experience suggests that lung volume reduction surgery improves exercise tolerance as measured by the 6-min walk distance in patients with emphysema. To identify the physiologic mechanism(s) by which lung volume reduction surgery improved exercise, we performed progressive cardiopulmonary exercise testing, including rest and peak exercise blood gas determinations, on 21 consecutive patients before and 3 mo after lung volume reduction surgery. Maximal work (median, range, % change) increased 17.5 watts (-13 to +44 watts, 46%, p < 0.05), maximal oxygen consumption increased 0.16 L/min (-0.17 to +0.48, 25%, p < 0.05), maximal ventilation increased 6.6 L/min (-7 to +26 L/min, 27%, p < 0.05), and the dead space/tidal volume ratio at peak exercise decreased 0.07 (-0.22 to +0.09, 12%, p < 0.05), exclusively as a result of an increase in the tidal volume. After lung volume reduction surgery heart rate decreased at the point of isowatt exercise, from 115 to 111 beats/min (p < 0.05). No difference was observed in the other physiologic variables measured at isowatt exercise. In 13 patients exercised while breathing room air, the alveolar-to-arterial O2 difference increased, and the arterial O2 tension decreased from rest to peak exercise both before and after the operation, but significant changes in this response were not observed after surgery. The primary problem limiting exercise performance in these patients was the limited ventilatory capacity as 16 and 13 of the 21 subjects developed acute respiratory acidemia at peak exercise before and after surgery, respectively. Lung volume reduction surgery in patients with severe emphysema improved maximal ventilation, thereby improving maximal exercise performance.

Exercise Test↗

Influences of breathing patterns on respiratory sinus arrhythmia in humans during exercise.

Persistence of respiratory sinus arrhythmia (RSA) has been described in humans during intense exercise and attributed to an increase in ventilation. However, the direct influence of ventilation on RSA has never been assessed. The dynamic evolution of RSA and its links to ventilation were investigated during exercise in 14 healthy men using an original modeling approach. An evolutive model was estimated from the detrended and high-pass-filtered heart period series. The instantaneous RSA frequency (FRSA, in Hz) and amplitude (ARSA, in ms) were then extracted from all recordings. A(RSA) was calculated with short-time Fourier transform. First, measurements of FRSA and ARSA were performed from data obtained during a graded and maximal exercise test. Influences of different ventilation regimens [changes in tidal volume (VT) and respiratory frequency (FR)] on ARSA were then tested during submaximal [70% peak O2 consumption (VO2peak)] rectangular exercise bouts. Under graded and maximal exercise conditions, ARSA decreased from the beginning of exercise to 61.9 +/- 3.8% VO2peak and then increased up to peak exercise. During the paced breathing protocol, normoventilation (69.4 +/- 8.8 l/min), hyperventilation (81.8 +/- 8.3 l/min), and hypoventilation (56.4 +/- 6.2 l/min) led to significantly (P < 0.01) different ARSA values (3.8 +/- 0.5, 4.6 +/- 0.8, and 2.9 +/- 0.5 ms, respectively). In addition, no statistical difference was found in ARSA when ventilation was kept constant, whatever the FR-VT combinations. Those results indicate that RSA persists for all exercise intensities and increases during the highest intensities. Its persistence and increase are strongly linked to both the frequency and degree of lung inflation, suggesting a mechanical influence of breathing on RSA.

Adult↗