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PubMed1976

[Natural and mechanical respiration therapy for chronic respiratory insufficiency (author's transl)].

Respiratory therapy of ventilation disorders involves a redistribution of the work of the respiratory musculature from above downwards, relieving the auxiliary musculature, increasing the excursion of the lower part of the thorax and relaxation of the diaphragm. It is pointless to provide respiratory techniques for use as exercises only when the body is in a state of rest; suitable respiratory techniques must rather be of the pattern of spontaneous respiratory movement which keeps control in stress situations also. The patient must learn to recognise the limit of his own pulmonary functional capacity, so that he can reduce the work load in good time before it is reached. Respiratory therapy is increased even more by passive positive pressure respiration which enables passive inspiration, sparing inspiratory respiratory work, with active exercise therapy in the expiratory phase, and which can be combined with inhalation treatment.

Adolescent↗
PubMed1994

Exercise-induced hypoxemia in older athletes.

To determine whether exercise induces hypoxemia in highly trained older "master" athletes (MA), as it does in certain elite endurance-trained young athletes (YA), 10 MA (65.3 +/- 2.6 yr), 10 control subjects (CS; 68.3 +/- 2.2 yr), and 10 endurance-trained YA (23.3 +/- 1.1 yr) performed an incremental exercise test. During testing, blood samples for arterial blood gas analysis were drawn during the last 20 s of each load. Lung exchanges were measured using a breath-by-breath automated exercise device. Exercise-induced hypoxemia (EIH) appeared in all MA and 8 of 10 YA, whereas there were no changes in the blood gases of CS. In MA, arterial PO2 decreased significantly from 40% of maximal O2 uptake onward and was associated with a significant increase in the ideal alveolar-arterial O2 difference from 60% onward. The MA also showed a lower ventilation for a given absolute load compared with CS. In all subjects arterial PCO2 rose slightly but significantly during the work, but this increase was most marked in MA. The EIH differed between MA and YA in the following ways: 1) all MA showed a drop in arterial PO2 during exercise, 2) this drop appeared earlier and was significantly greater for a given load in MA, and 3) EIH appeared at a lower level of training regimen in MA. This hypoxemia was at first isolated, probably at least partially due to relative hypoventilation, and then was associated with a widened ideal alveolar-arterial O2 difference, which may have been due to an increase in extravascular lung water.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[The value of physical therapy with VRP 1-Desitin ("Flutter")].

UNLABELLED: Preliminary examinations with an innovative device for physiotherapy, VRP 1-Desitin ("Flutter"), in patients suffering from chronic mucus retention and bronchial collapse gave encouraging results. Therefore, we tried to confirm these findings and to evaluate the use of this new physiotherapy. It is based on oscillations of air in the respiratory tract during expiration (rate about 2 to 32 Hertz) diminishing adhesiveness of bronchial mucus and bronchial collapse. Pressure and flow changing depend on the position of mouth-piece and effort of breathing. In order to establish the efficiency of the VRP 1 a comparing investigation was initiated. 20 patients with cystic fibrosis, aged 7 to 28 years, performed physiotherapy with VRP 1 and autogenic drainage (AD), respectively, in a randomized order one after another, each physiotherapy taking twenty minutes. The expectorated sputum was weighed by means of a precision balance. Mean values during VRP 1 treatment were 5.0 g (range 0 to 12.0 g), during AD 4.8 g (range 0 to 11.7 g). There was no statistical difference (p < 0.05). The results were not influenced by the order of physiotherapy. CONCLUSIONS: VRP 1 physiotherapy is as effective as AD with respect to sputum elimination. In opposite to other methods not requiring a helping person it is simple to teach and to learn. It may be performed by young children (> or = 3 years) and adults, also in combination with inhalation. Thus, VRP 1 appears to be a real enrichment in physiotherapy.

Adolescent↗
PubMed2005

Inhaled beta-agonists improve lung function but not maximal exercise capacity in cystic fibrosis.

BACKGROUND: To investigate the effects of inhaled beta-agonists on sub-maximal and maximal exercise capacity, breathing pattern, dyspnoea, leg-discomfort and spirometry in patients with cystic fibrosis (CF). OBJECTIVES: Eight patients performed two maximal incremental cycle-ergometry tests on separate days with inhaled placebo or salbutamol (600 microg) administered before each test in a randomized, double-blind, placebo-controlled crossover trial. Primary outcomes were exercise duration (Exdur) in seconds (s) and maximal oxygen uptake (VO2max) in litres/minute (L/min). Forced expiratory volume in 1 s (FEV1) was measured immediately pre-inhaler, post-inhaler and post-exercise. Dyspnoea and leg-discomfort were assessed post-exercise. RESULTS: Within-day FEV1 comparisons demonstrated that the placebo test day FEV1 improved significantly post-exercise (0.11 L, p<0.05) and the salbutamol test day FEV1 improved significantly post-inhaler (0.22 L, p<0.001) and post-exercise (0.07 L, p<0.01). Between-day FEV1 comparisons demonstrated significant improvements in post-inhaler (0.17 L, p<0.05) and post-exercise (0.13 L, p<0.05) FEV1 following salbutamol. Sub-maximal and maximal exercise showed no significant difference as shown by Exdur (547+/-154 s vs. 529+/-127 s) and VO2max (1.9+/-0.5 L/min vs. 1.9+/-0.6 L/min). No significant change in breathing pattern, dyspnoea or leg-discomfort was detected. The study had a power of 92% to detect a 10% improvement in Exdur. CONCLUSIONS: In adults with CF, salbutamol improves post-exercise FEV1 and is safe when administered immediately before exercise but does not improve exercise capacity, exercise-induced dyspnoea or leg-discomfort.

Administration, Inhalation↗
PubMed2003

A longitudinal study of antenatal changes in lung function tests and importance of postpartum exercises in their recovery.

A study of changes in lung function tests during pregnancy was undertaken in fifty pregnant women beginning from third month of gestation. Fifty nonpregnant age and height matched women formed the controls. Forced Vital Capacity (FVC), Timed Vital Capacity (FEV1), Inspiratory Capacity (IC), Expiratory Reserve Volume (ERV) and peak Expiratory Flow Rate (PEFR) were performed in each month of pregnancy. However ten subjects were not available for follow-up during postpartum period. Remaining forty women were divided into two groups of twenty each. Group I performed daily graded active exercises to strengthen the anterior abdominal wall muscles. Group II women did not perform any exercises. It was observed that the antenatal changes in percent FVC and FEV1 were insignificant, but the decline in ERV and PEFR were very highly significant (P < 0.001) and the increment in IC was significant (P < 0.05). In the postpartum period the percentage variation of values in group I was less than 5% from controls (P > 0.05) and in group II it was 15-20% from controls (P < 0.05), resulting in a significant variation in group II women as compared to the controls. It is concluded that there are adaptive changes in lung functions in the antenatal period. We stress the importance of regular graded active exercises in the postpartum period for the speedy recovery of these changes.

Adult↗
PubMed1975

Severe steady state exercise at sea level and altitude in Olympic oarsmen.

Respiratory and metabolic functions were studied at rest and during exercise in 13 Olympic oarsmen at peak of training at sea level and after one month's residence at 2350 m. At sea level each subject completed two severe five minute treadmill runs at 5 mph on a 20% incline inspiring 21% O2 for one run and 16% O2 for the other. Two more runs at the same speed and incline were carried out at altitude with F102's of 21% and 28%. Pulmonary function tests were carried out at sea level and altitude and steady state diffusion capacity was determined during rest and exercise while breathing 21% O2. Heart rates were monitored by direct electrocardiography. At altitude significant increases were found in MVV (10%), FEV1 (6%), MMEF (15%) and PF (9%) but not in VC. A rise of the DLCO during exercise from 64.8 to 75.4 ml/min/mm Hg was largely the result of increased ventilation. The response to acute hypoxia (16% O2) and to chronic hypoxia were as follows: VE from 113 to 135/122 1/min; VE/O2 from 2.55 to 3.14/3.08 1/100ml; and PETCO2 from 40 to 36/34 mm Hg. The effect of chronic hypoxia could be abolished by acute normoxia (28%O2) within five minutes; VE returned to 99 l/min, VE/Vo2 to 2.46 1/100 ml, and PETCO2 to 40 mm Hg. Vo2 for the standard exercise (5 mph - 20% grade) for normoxic and acute hypoxic conditions were similar; 4421 and 4301 ml/min, but this variable decreased significantly upon chronic altitude exposure; 3966 ml/min. This decrement in Vo2 was attributed in part to a lower work of breathing.

Adult↗
PubMed2004

The effects of different inspiratory muscle training intensities on exercising heart rate and perceived exertion.

This study investigated the relationship between the intensity of an inspiratory muscle training programme and its effect on respiratory muscle strength, exercising heart rate, and ratings of perceived exertion. A total of 66 subjects were randomly assigned to one of three groups. One group trained at 100% of maximum inspiratory pressure (MIP) for 6 weeks (MAX, n=22). A second group performed 6 weeks of inspiratory muscle training at 80% of MIP (SUB, n=21) and a third control group received no inspiratory training (CON, n=23). Both the MAX and SUB training groups improved MIP relative to the control group [32 (19) cmH(2)O, P=0.01; 37 (25) cmH(2)O, P=0.001, respectively]. A significant decrease in heart rate [-6 (9) beats min(-1), P=0.02] and rating of perceived exertion [-0.5 (1.4), P=0.04] was observed for the MAX group only. It is concluded that 6 weeks of both MAX and SUB training were sufficient to improve inspiratory muscle strength. However, exercising heart rate and perceived exertion decreased with MAX training only.

Adaptation, Physiological↗
PubMed1993

[An increased risk of kinesitherapy in silent myocardial ischemia?].

The effect of three-week standardized physical training on exercise-induced ischaemia was investigated in patients with silent ischaemia after myocardial infarction. 24-hour monitoring and exercise ECGs before and after the period of physical training, were undertaken in 32 men (mean age 53.6 +/- 8.1 years) with angiographically proven coronary heart disease. The protocol of the standardized exercise included bicycle ergometry, gymnastics, breathing and movement exercises, as well as nonstandardized walking or hiking. Following the training period the number of ischaemic episodes fell from 90 to 72 for the group as a whole and that of the asymptomatic episodes from 79 to 64. The number and severity of ventricular arrhythmias were similar during silent and symptomatic ischaemia. There was a significant increase in duration of exercise until reaching the ischaemia threshold (mean exercise duration 4.7 +/- 2.1 vs 5.9 +/- 2.5 min; P = 0.0007). There was no increased risk concerning ventricular arrhythmias.

Cardiac Complexes, Premature↗
PubMed1985

Prediction of ventilation at maximal exercise in chronic air-flow obstruction.

In chronic air-flow obstruction (CAO), inspiratory mechanics constitute a potential mechanism of compensation for limitation of expiratory air flow. We sought to determine whether assessment of inspiratory function could improve our ability to predict ventilation at maximal exercise (Ve max) in patients with CAO. Resting inspiratory and expiratory pulmonary function studies from 20 patients with ventilatory limitation of exercise due to CAO provided data for development of a new regression model for Ve max. Maximal exercise was quantitated from breath-by-breath analysis of exercise responses at cycle ergometry with work increments of 25 watts each min to tolerance. Multiple regression analysis by 3 methods gave identical results. A 2-variable formula containing peak inspiratory flow rate (PIFR) and the forced expiratory volume in one second (FEV1) correlated strongly with Ve max (r = 0.967) in the formula Ve max (L/min) = 21.34 FEV1 (L) + 6.28 PIFR (L/s) +3.94 (95% Cl = +/- 18 L/min). This model was significantly different from published models containing FEV1 alone (p = 0.0002) and was not improved by additional variables. Similar formulas derived for emphysematous and bronchitic clinical types of CAO did not exhibit significantly different slope and intercept coefficients. Both PIFR and FEV1 correlated strongly with tidal volume at maximal exercise. The PIFR also correlated well with resting peak inspiratory airway pressure (r = 0.775). We conclude that consideration of PIFR in addition to FEV1 can improve our clinical ability to predict Ve max in patients with CAO.

Adult↗
PubMed2005

Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation.

BACKGROUND: Respiratory muscle endurance training (hyperpnea training) has been shown to have beneficial effects in patients with COPD. STUDY OBJECTIVES: The purpose of this study was to determine whether hyperpnea training, when added to an endurance exercise training program, would lead to additional benefits compared with endurance training alone in patients with COPD. SETTING AND PARTICIPANTS: Patients with COPD entering an 8-week outpatient pulmonary rehabilitation program. Fifteen patients (mean [+/- SE] FEV1, 45 +/- 6% predicted) were randomized to combined therapy, and 14 patients (mean FEV1, 44 +/- 4% predicted) were randomized to endurance training. METHODS: Peak exercise capacity, exercise endurance time during constant workload cycle exercise, 6-min walk distance, quality of life as measured by the chronic respiratory questionnaire, respiratory muscle strength and endurance, and quadriceps fatigability were measured before and after endurance or combined training. RESULTS: After rehabilitation, peak exercise capacity, exercise endurance time, 6-min walk distance, and quality of life all increased in both groups, but there was no significant difference in the extent of improvement between groups. Mean respiratory muscle endurance increased to a significantly greater extent in the combined therapy group (17.5 +/- 2.7 vs 8.5 +/- 2.5 min, respectively; p = 0.02). Respiratory muscle strength was significantly increased, and quadriceps fatigability was significantly reduced after rehabilitation in the combined therapy group but not in the endurance training group, but the difference between groups did not reach statistical significance. CONCLUSION: The endurance of the respiratory muscles can be improved by specific training beyond that achieved by endurance training alone in patients with COPD. However, this improvement did not translate into additional improvement in quality of life or exercise performance.

Aged↗
PubMed2003

Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients.

Supplemental oxygen improves exercise tolerance of normoxemic and hypoxemic chronic obstructive pulmonary disease (COPD) patients. We determined whether nonhypoxemic COPD patients undergoing exercise training while breathing supplemental oxygen achieve higher intensity and therefore improve exercise capacity more than patients breathing air. A double-blinded trial was performed involving 29 nonhypoxemic patients (67 years, exercise SaO2 > 88%) with COPD (FEV1 = 36% predicted). All exercised on cycle ergometers for 45 minutes, 3 times per week for 7 weeks at high-intensity targets. During exercise, they received oxygen (3 L/minute) (n = 14) or compressed air (3 L/minute) (n = 15). Both groups had a higher exercise tolerance after training and when breathing oxygen. However, the oxygen-trained group increased the training work rate more rapidly than the air-trained group. The mean +/- SD work rate during the last week was 62 +/- 19 W (oxygen-trained group) and 52 +/- 22 W (air-trained group) (p < 0.01). After training, endurance in constant work rate tests increased more in the oxygen-trained group (14.5 minutes) than in the air-trained group (10.5 minutes) (p < 0.05). At isotime, the breathing rate decreased four breaths per minute in the oxygen-trained group and one breath per minute in the air-trained group (p = 0.001). We conclude that supplemental oxygen provided during high-intensity training yields higher training intensity and evidence of gains in exercise tolerance in laboratory testing.

Aged↗
PubMed1979

The effects of sudden airway hypercapnia on the initiation of exercise hyperpnoea in man.

1. In three healthy individuals, the first breath of cycle ergometer exercise was characterized by increases of minute ventilation (VE) and pulmonary capillary CO2 output (VCO2), with little change of end-tidal PCO2, suggesting a concomitant increase of pulmonary blood flow (Q) and preservation of V/Q status. Functional residual capacity fell, depleting lung gas stores of O2 and CO2. 2. The following hypothesis purporting to account for the initiation of exercise hyperpnoea was examined (Filley, 1976): (a) assuming pulmonary capillary plasma to remain unexposed to carbonic anhydrase, its slow alkalinization consequent upon CO2 exchange causes a more acid plasma to enter the pulmonary veins if Q increases abruptly, as at exercise onset; (b) the fall of pulmonary venous plasma pH stimulates an intrapulmonary chemoreflux to elicit a proportionate hyperpnoea, so preserving arterial isocapnia; (c) the initial hyperpnoea should therefore be abolished if pulmonary capillary VCO2 is suppressed at exercise onset, as the absence of pulmonary capillary plasma alkalinization should sever the postulated intrapulmonary humoral link between Q and VE. 3. In the present study, while abrupt CO2 inhalation (approximately 6% in air) at exercise onset abolished pulmonary capillary VCO2 during the first breath of exercise, the initial hyperpnoea was unaffected. This observation argues against the hypothesis that exercise hyperpnoea is initiated by an intrapulmonary chemoreflex which detects perfusion-related changes in pulmonary venous plasma pH.

Adolescent↗