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Is the voluntary control of exercise in man necessary for the ventilatory response?

The ventilatory response to electrically induced exercise (EEL) was studied in eighteen normal subjects and compared with the response to performing the same exercise voluntarily (EV). EEL was produced by surface electrode stimulation of the quadriceps and hamstring muscles so as to cause a pushing movement at 1 HZ against a spring load; this produced no pain or discomfort. Matching of EV to EEL was achieved by subjects copying a tension signal recorded during EEL and displayed on a storage oscilloscope. There were no differences between the resting states measured before either form of exercise. The ventilatory response (change in ventilation as a ratio of the change in CO2 elimination) was similar in the two types of exercise. The increases in ventilation and CO2 elimination were greater with EEL. Small but significant increases in the gas exchange ratio and serum lactate were found for EEL but not for EV, suggesting an increase in anaerobic metabolism in EEL. End-tidal PCO2 showed little change in either form of exercise. In some runs end-tidal PCO2 rose, but insufficiently to account for the ventilatory response as judged by the response to inhaled CO2. In two subjects arterial blood samples showed small and inconsistent changes in both Pa,CO2 and PaO2 for EV and EEL. pH and base excess changes also were consistent with more anaerobiosis with EEL compared to EV. The first ten breaths of exercise were used to study the on transient. In EV, expiratory duration shortened and ventilation increased significantly on the first breath but CO2 elimination did not increase until the second breath; in EEL, these variables did not change significantly until the second breath. For the remainder of the on transient the pattern of the ventilatory response was similar for EV and EEL. By the end of the on transient both EV and EEL had reached approximately 80% of their final steady-state values. These results suggest that a normal ventilatory response can occur in the absence of a drive to exercise from the cortex.

Adult↗

Target-flow inspiratory muscle training at home and during pulmonary rehabilitation in COPD patients with a ventilatory limitation during exercise.

The effects of a 10-week inspiratory muscle training (IMT) program at home were compared to IMT during a 10-week pulmonary rehabilitation program (PR) in 40 COPD patients with a ventilatory limitation of the exercise capacity. IMT was performed with a target-flow resistive device; the generated mouth pressure as well as the duty cycle were imposed. The mean age of the patients was 59, the mean FEV1 was 48% of predicted. In the training period the inspiratory muscle strength improved in both groups to the same degree. EMG fatigability of the diaphragm improved in the PR+ IMT group, but not in the IMT group. In the IMT group, the 12-min walking distance increased after the training period, but maximal workload (Wmax), VO2,max, and ADL scores did not change. In the PR + IMT group, however, Wmax, VO2,max, walking distance, and ADL scores improved significantly after the training period. Walking distance and ADL scores showed a significantly greater improvement in the PR + IMT group than in the IMT group. It is concluded that both isolated IMT and PR + IMT in COPD patients with a ventilatory limitation have a beneficial effect on inspiratory muscle strength, but PR + IMT improves the physical exercise capacity significantly more than IMT alone.

Activities of Daily Living↗

[Effect of voluntary regulation of the respiration on the functional state of the autonomic nervous system].

48 healthy persons have been observed to determine the influence of individually and differentially prescribed specific respiratory exercises on the vegetative nervous system state. The specific and controlled respiratory exercises were established to restore reliably a functional state of the vegetative nervous system. These respiratory exercises enable the sympathetic and parasympathetic nervous systems to regain the balance.

Adaptation, Physiological↗

Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy.

BACKGROUND AND PURPOSE: Previous investigations have demonstrated that a regimen of high-intensity inspiratory muscle training (IMT) resulted in changes in ventilatory function and exercise capacity in patients with chronic lung disease, although the effect of high-intensity IMT in subjects who are healthy is yet to be determined. The purpose of this study, therefore, was to examine whether high-intensity IMT resulted in changes in ventilatory function and exercise capacity in subjects who were healthy. SUBJECTS: Twenty subjects were randomly assigned to 2 groups. METHODS: The training group completed an 8-week program of IMT set at 80% of maximal effort. The control group did not participate in any form of training. Baseline and posttraining measures of body composition, pulmonary function, inspiratory muscle function (including maximal and sustained maximal inspiratory pressures [MIP and SMIP]), relaxed and contracted diaphragm thickness and thickening ratio (Tdi.rel, Tdi.cont, and TR), and exercise capacity were determined. RESULTS: The training group demonstrated significant increases in MIP, SMIP, Tdi.cont, TR, VC, total lung capacity, and exercise capacity compared with the control group, which demonstrated no change from baseline measurements at 8 weeks. DISCUSSION AND CONCLUSION: The findings of this study suggest that high-intensity IMT results in increased contracted diaphragm thickness and increased lung volumes and exercise capacity in people who are healthy.

Adult↗

Psychophysiological reactions associated with qigong therapy.

Qigong as a part of the traditional Chinese medicine is similar to western "meditation", Indian "Yoga" or Japanese "Zen", which can all be included in the category of traditional psychotherapy. A series of physiological and psychological effects occur in the course of Qigong training, but inappropriate training can lead to physical and mental disturbances. Physiological effects include changes in EEG, EMG, respiratory movement, heart rate, skin potential, skin temperature and finger tip volume, sympathetic nerve function, function in stomach and intestine, metabolism, endocrine and immunity systems. Psychological effects are motor phenomena and perceptual changes: patients experienced warmness, chilliness, itching sensation in the skin, numbness, soreness, bloatedness, relaxation, tenseness, floating, dropping, enlargement or constriction of the body image, a sensation of rising to the sky, falling off, standing upside down, playing on the swing following respiration, circulation of the intrinsic Qi, electric shock, formication, during Qigong exercise. Some patients experienced dreamland illusions, unreality and pseudohallucination. These phenomena were transient and vanished as the exercise terminated. Qigong deviation syndrome has become a diagnostic term and is now used widely in China.

Adult↗

Training children with asthma to use inhalation therapy equipment.

In Experiment I, four children with asthma were taught to use the intermittent positive-pressure breathing (IPPB) apparatus, a device that delivers bronchodilator medication to the lungs under positive pressure. Because these youngsters had not learned to use the device with repeated instructions, script with back-up reinforcement was introduced to train sequentially three responses - eye fixation, facial posturing, and diaphragmatic breathing - according to a multiple-baseline design. The procedures were effective in teaching appropriate use of the IPPB apparatus. Further, the children's use of the apparatus after training resulted in significantly more effective relief of asthma symptoms. In a second experiment, nurses were instructed in the application of the operant techniques used in the first study, and then served as experimenters in a partial replication of Experiment I. The data once again reflected a strong impact of the intervention program on IPPB responses.

Asthma↗

Effects of abdominal and thoracic breathing upon multiple-site electromyography and peripheral skin temperature.

Peripheral finger temperature, frontalis and upper trapezius EMG, and self-report of arousal were assessed for four subjects during abdominal and thoracic breathing in a single-subject reversal design. Two subjects displayed significant differences between abdominal and thoracic breathing conditions; one for frontalis EMG, trapezius EMG, and self-report of arousal and one for trapezius EMG. Two subjects showed no significant effects. All subjects reached performance criteria during training sessions. Abdominal breathing performance during reversals was 100% and 92% of sampled breath cycles for the two subjects who showed significant change, and 65% and 42% for the two subjects who showed none. Methodological issues for measurement of breathing patterns and peripheral skin temperature are discussed.

Abdominal Muscles↗

[Experience with VVI, QT time and activity-controlled pacemaker systems in patients with tranvenous ablation of atrioventricular conduction].

In 36 patients with atrial flutter, atrial fibrillation or supraventricular tachycardia, refractory to medical treatment, who underwent interruption of atrioventricular conduction by means of an electrode-catheter, i.e. His bundle ablation, various pacemakers were studied. In 22 patients (group I) a heart rate programmable VVI-pacemaker was implanted, in 7 patients (group II) an activity-mode pacemaker (Activitrax 8400, Fa. Medtronic) and in 7 patients (group III) a QT-mode pacemaker (Quintech 911, Fa. Vitatron). To study physical work capacity, exercise testing was performed using a bicycle ergometer in group I and group III and a treadmill in group II. Sixteen patients with VVI-mode pacing (72.7%) complained of shortness of breath during exercise in normal daily life, in comparison to only 2 patients in group II (28.6%) and 3 patients in group III (42.9%). The exercise test revealed a normal physical work capacity in only 3 out of 22 patients (13.6%) with a VVI-pacemaker, but a normal physical work capacity in all patients with activity-mode or QT-mode pacing. Heart rate during stress test in patients with an Activitrax-pacemaker increased more rapidly than in patients with a Quintech-pacemaker and also dropped more quickly in the Activitrax-group than in the Quintech-group after cessation of the stress test. It is important to note that pacemaker reprogramming was necessary in 1 out of 7 patients (14.3%) with activity-mode pacing and in 4 out of 7 patients (57.1%) with QT-mode pacing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Exercise performance in marathon runners with airway obstruction.

While evaluating lung function prior to four long-distance races (20-100 km), we found that nine of 127 marathon runners (7.1%) had airway obstruction (mean FEV1/FVC, 63.3%). Since obstruction to air flow may limit exercise performance, we compared selected cardiorespiratory parameters during exercise on a cycle ergometer in runners with airway obstruction (RAO), nine non-athletic control subjects (CON), and nine marathon runners with normal lung function (RNL). As the chemical drive to breath affects exercise hyperpnea, the ventilatory responses to hypercapnia and hypoxia were measured. All RAO were males with a mean age of 35.6 yr (range of 20-44 yr). Eight of nine RAO had a significant increase in flow rates after inhalation of isoproterenol. In the RAO and CON groups exercise ventilation was similar when oxygen consumption (VO2) was less than 2.0 l/min; as VO2 exceeded this level, significantly greater ventilation was required by the RAO. Carbon dioxide production was highest in RAO, intermediate in CON, and lowest in RNL. There was no significant difference in the mean ventilatory responses among CON, RAO, and RNL. Despite pulmonary dysfunction, the RAO achieved moderate-to-high levels of exercise performance.

Adult↗

Physiologically and subjectively acceptable breathing resistance in divers' breathing gear.

To determine acceptable levels of breathing resistance in divers' gear, 6 subjects were exposed to varying levels of breathing resistance under demanding and realistic conditions. The immersed air-breathing subjects exercised in the prone position at 60% of their maximum oxygen uptake for 25 min in a hyperbaric chamber at 1.45 and 6.8 atm abs (145 and 690 kPa, 4.5 and 57 msw, 15 and 190 fsw). The breathing resistance ranged from minimal to 8-12 cmH2O (0.8-1.2 kPa).liter-1.s at flow rates of 2-3 liter/s. The higher resistance levels interfered with the respiration in terms of end-tidal PCO2 and dyspnea scores. There were considerable individual differences, and changes in one parameter were typically not paralleled by changes in the other. None of maximal voluntary ventilation, forced expiratory volume, expiratory reserve volume, vital capacities, or oxygen uptake was influenced by resistance. We set the maximum allowable end-tidal PCO2 at 60 mmHg and maximum dyspnea score at 1.0 on a scale from 0 (none) to 3 (severe). Based on these criteria we concluded that the external work of breathing should not exceed 1.5-2.0 J/liter in the ventilation range 30 to 75 liter/min BTPS.

Adult↗

Effects of inspiratory muscle training on exercise responses in normoxia and hypoxia.

The purpose of this study was to determine the effects of inspiratory muscle training (IMT) on exercise in hypoxia (H) and normoxia (N). A 4-week IMT program was implemented with 12 healthy subjects using an inspiratory muscle trainer set at either 15% (C; n=5) or 50% (IMT; n=7) maximal inspiratory mouth pressure (PImax). Two treadmill tests (85% VO2max) to exhaustion and measures of diaphragm thickness (Tdi) and function were completed before and after training in H and N. Significant increases of 8-12% and 24.5+/-3.1% in Tdi and PImax, respectively, were seen in the IMT group. Time to exhaustion remained unchanged in all conditions. Inspiratory muscle fatigue (downward arrowPImax) following exercise was reduced approximately 10% (P<0.05) in IMT after both N and H. During H, IMT reduced (P<0.05) VO2 by 8-12%, cardiac output by 14+/-2%, ventilation by 25+/-3%; and increased arterial oxygen saturation by 4+/-1% and lung diffusing capacity by 22+/-3%. Ratings of perceived exertion and dyspnea were also significantly reduced. These data suggest that IMT significantly improves structural and functional physiologic measures in hypoxic exercise.

Adaptation, Physiological↗

The effects of acute severe arterial hypoxemia on the electrocardiogram during exercise.

Sixteen healthy, active men were studied to determine the effects of severe arterial hypoxemia on the electrocardiograms during exercise. The electrocardiograms were all normal at maximum heart rate while the subject breathed ambient air. During maximal exercise breathing ten percent oxygen (mean arterial oxygen pressure [Po2] of 31 mm Hg), only one of the 16 had ST segment changes suggestive of ischemia. These were not present on a repeated study. The widely held view that systemic hypoxemia causes ischemic changes on the electrocardiogram was not confirmed in this study.

Acute Disease↗

Gastric emptying in soldiers during and after field exercise in the heat measured with the [13C]acetate breath test method.

The effects of exercise on gastric emptying remain controversial, with some workers reporting that heavy exercise inhibits it to varying degrees whereas others report no effects up to an intensity of 70% maximal oxygen consumption (VO2max). The state of hydration of the subjects and the environmental conditions may influence the rate of gastric emptying during exercise. To understand further the effects of a 3-h, 16-km walk/run carrying 30 kg of equipment under field conditions at 39 degrees C, we estimated gastric emptying using a [13C]acetate breath test method. Breath samples were collected at intervals after giving 150 mg of [13C]acetate. The effects of giving a standard volume (530 ml) of water or dextrose (7.5 g x 100 ml(-1)) with electrolytes or fructose/corn solids (7.5 g 100 ml(-1)) at rest before exercise were compared with those of exercise and of recovery after exercise with or without extra fluids (400 ml each 20 min). At rest, after a standard 530-ml load, gastric emptying times [mean (SE)] were: 37 (2) min (water), 46 (3) min (dextrose/electrolytes) and 47 (5) min (fructose/corn solids) and were significantly slower (P < 0.05) than those occurring after extra fluid ingestion, i.e. 32 (3), 39 (2) and 41 (3) min respectively. After a standard 530-ml load, emptying times during exercise were almost identical to those at rest but, during exercise, extra fluid speeded up gastric emptying more than at rest to 24 (2), 26 (1) and 27 (5) min (P < 0.05) respectively. During resting recovery without extra fluids, gastric emptying was significantly slowed to 60 (2), 71 (5) and 78 (3) min, respectively. Although emptying times during recovery from exercise with extra fluid were faster [49 (6), 55 (2) and 58 (4) min, respectively], they were still slower than before exercise. The results suggest that: (1) extra fluid increases gastric emptying more during exercise than at rest, and (2) gastric emptying during resting recovery from exercise is slower than at rest before exercise whether or not fluid has previously been taken.

Acetates↗

Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: a randomized trial.

OBJECTIVES: This study sought to evaluate the effects of inspiratory muscle training in inspiratory muscle strength, as well as in functional capacity, ventilatory responses to exercise, recovery oxygen uptake kinetics, and quality of life in patients with chronic heart failure (CHF) and inspiratory muscle weakness. BACKGROUND: Patients with CHF may have reduced strength and endurance in inspiratory muscles, which may contribute to exercise intolerance and is associated with a poor prognosis. METHODS: Thirty-two patients with CHF and weakness of inspiratory muscles (maximal inspiratory pressure [Pi(max)] <70% of predicted) were randomly assigned to a 12-week program of inspiratory muscle training (IMT, 16 patients) or to a placebo-inspiratory muscle training (P-IMT, 16 patients). The following measures were obtained before and after the program: Pi(max) at rest and 10 min after maximal exercise; peak oxygen uptake, circulatory power, ventilatory oscillations, and oxygen kinetics during early recovery (VO2/t-slope); 6-min walk test; and quality of life scores. RESULTS: The IMT resulted in a 115% increment Pi(max), 17% increase in peak oxygen uptake, and 19% increase in the 6-min walk distance. Likewise, circulatory power increased and ventilatory oscillations were reduced. The VO2/t-slope was improved during the recovery period, and quality of life scores improved. CONCLUSIONS: In patients with CHF and inspiratory muscle weakness, IMT results in marked improvement in inspiratory muscle strength, as well as improvement in functional capacity, ventilatory response to exercise, recovery oxygen uptake kinetics, and quality of life.

Breathing Exercises↗