Search Results (23)

Breathing reserve (BR) is the remaining proportion of achievable minute ventilation that remains unutilized at total exhaustion during exercise. Previous studies have found a smaller BR in endurance-trained athletes compared to untrained controls. However, most of these studies have examined men. Given that women have a greater ventilatory limitation than stature-matched men, the present cross-sectional study aimed to investigate how this sex difference influences BR and lung function tests in endurance-trained females compared to matched, untrained females. To obtain further insight, we also aimed to investigate whether VO₂max serves as a predictor of BR. We examined 15 female elite runners and 15 healthy, matched female controls aged 24–33 years with regard to pulmonary function, MVV, V_Emax, BR, and VO₂max. The elite runner group had a median BR of 5%, while that of the controls was 21%, representing a significant difference. Lung function tests showed no differences between the two groups. A moderate association was found between VO₂max and BR. The female elite runners demonstrated a lower BR than the group of matched, untrained controls, which was lower than that found for male elite athletes in previous studies. This may indicate a greater ventilatory demand in female relative to male endurance athletes. Full article

Purpose: Post-COVID-19 syndrome (PCS) is characterized by low cardio-respiratory fitness (CRF). Recent research focuses on the role of autonomic nervous system dysfunction (AD) as a potential contributor to the diminished exercise performance. The aim is to determine the prevalence of AD—chronotropic insufficiency (CI) and abnormal heart rate recovery (HRR) in long-term PCS subjects and to analyse their association with exercise capacity. Patients and Methods: A total of 192 subjects with a history of SARS-CoV-2 infection were included. Chronic Fatigue Syndrome Questionnaire (CFSQ) was applied, and two symptomatic and asymptomatic emerged. Forty-seven had post-COVID complaints, persisting up to thirty months post-acute episode. CI and HRR were determined during the cardio-pulmonary exercise test (CPET). Results: Symptomatic subjects were divided into mild (20) and moderate-severe (27), depending on the CFSQ score; forty-eight PCS subjects without complaints served as a control group. Subjects with moderate-severe PCS showed lower peak VO2 (24.13 ± 6.1 mL/min/kg vs. 26.73 ± 5.9 mL/min/kg, vs. 27.01 ± 6.3 mL/min/kg), as compared to the mild/asymptomatic subjects. Diminished physical activity was established in 10 (37%) of the moderate-severe, 7 (35%) of the mildly symptomatic and 14 (29%) of the asymptomatic groups. The occurrence of AD in the mild/moderate-severe and control groups were, respectively, CI 35% vs. 81.5% vs. 12.5%. Abnormal HRR was, respectively, 20% vs. 33% vs. 8%. None of the subjects had depleted breathing reserve, dynamic hyperinflation, exercise bronchospasm or desaturation. Neither CI nor abnormal HRR correlated to peak O2. Conclusions: AD is present among long-term PCS subjects and may limit the cardio-respiratory response to exercise but is not independently associated with it. Assuming the multiorgan ANS innervation, it is highly probable that AD has diverse pathological pathways in the various PCS phenotypes and contributes differently by cerebral, cardiovascular, respiratory, peripheral or mixed pathways to the diminished neuro-cognitive and physical performance. Full article

Background/Objectives: Hepatocyte-specific contrast agent (Gd-EOB-DTPA) can improve the detection of liver lesions during MRI-guided thermal ablation. This study aimed to assess the impact of contrast agent administration on the delineation of the ablation zone during therapy monitoring. Methods: From 2010 to 2020, 358 patients with primary and secondary hepatic malignancies underwent MRI-guided thermoablation. A total of 27 patients with 30 liver lesions received Gd-EOB-DTPA during the procedure to improve target lesion visibility (Group 1), while 30 patients with 30 lesions underwent MRI-guided thermoablation without contrast administration (Group 2). T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences were used for intraprocedural imaging, and post-procedural control imaging involved intravenous Gadobutrol administration in both groups. The contrast-to-noise ratio (CNR) was assessed for three key structures: the target lesion before applicator placement, the ablation zone during unenhanced therapy monitoring, and the ablation zone in contrast-enhanced control imaging. A statistical comparison of CNR values between the two groups was performed using the non-parametric Wilcoxon test (p < 0.05). Results: The CNR of lesions in group 1 significantly increased following the administration of Gd-EOB-DTPA. During therapy monitoring, the ablation zone in group 2 exhibited a significantly higher CNR compared to group 1 (median: 7.9 vs. 2.1; p < 0.001). Similarly, at the contrast-enhanced final control, the CNR of the ablation zone remained significantly greater in group 2 than in group 1 (median: 7.7 vs. 2.0; p < 0.001). Conclusions: The administration of a hepatocyte-specific contrast agent (Gd-EOB-DTPA) prior to intervention improves the visualization of liver lesions that are poorly demarcated but significantly reduces the contrast of the ablation zone during intra- and post-procedural imaging. Therefore, its use should be reserved for cases in which the target lesion cannot be sufficiently delineated without contrast. Full article

Background: Heart failure with reduced ejection fraction (HFrEF) frequently coexists with chronic obstructive pulmonary disease (COPD), and both conditions share symptoms such as exertional dyspnea. The cardiopulmonary exercise test (CPET) is an essential tool for assessing ventilatory and cardiovascular function and plays a key role in the differential diagnosis of dyspnea. However, the impact of exercise modality on the ventilatory and cardiovascular parameters obtained remains unclear in these groups. Our aim is to compare the oxygen consumption (V^·O₂) and breathing reserve (BR) values obtained from CPET on a treadmill and a cycle ergometer in patients with HFrEF-COPD and those with HFrEF alone. Methods: A prospective observational study included 65 patients with HFrEF (LVEF ≤ 40%), 18 of whom had COPD. Two CPETs were performed, the first on a treadmill and the second 48–72 h later on a cycle ergometer. Results: In the group with HFrEF-COPD, peak oxygen consumption (VO₂/kg) and maximum ventilation (VE) values were significantly higher on the treadmill (20 ± 5 vs. 17 ± 4 mL/kg/min, p < 0.001 and 55 ± 19 vs. 45 ± 11 L/min, p < 0.001, respectively), while breathing reserve (BR%) was lower on the treadmill (16 ± 21 vs. 33 ± 20, p < 0.001). Compared to the HFrEF group, patients with HFrEF-COPD had a lower BR in both exercise modalities (p = 0.01). Conclusions: Treadmill CPET demonstrates greater oxygen consumption and a more pronounced ventilatory response. BR is consolidated as a differential parameter in ventilatory limitation. The choice of exercise modality should be considered based on the underlying pathologies and the objective of the test. Full article

Background and Objectives: Pneumothorax is a medical condition characterized by the accumulation of air in the pleural cavity, leading to lung collapse. While cigarette smoking is a well-known risk factor, the role of electronic cigarettes is less understood. This systematic review aimed to evaluate the outcomes of vaping-associated pneumothorax, in addition to its clinical features and management strategies, by compiling published case reports and case series. Materials and Methods: The choice to use case reports and case series was due to the limited availability of other types of studies on this emerging condition, as vaping-associated pneumothorax is relatively rare and primarily reported in isolated cases. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of six databases for case reports and case series. Data extraction and quality assessment were performed independently by multiple reviewers. Results: Seven case reports and four case series with a total number of 16 patients were included. Most patients were young, underweight men who presented with chest pain and shortness of breath. Conventional cigarette and cannabis use were commonly reported alongside vaping. The main treatment was the insertion of a chest tube, with surgical interventions reserved for severe cases. Patients who were treated non-surgically exhibited a higher recurrence rate. Additionally, specific symptoms such as chest pain radiating to the ipsilateral shoulder were associated with a higher recurrence rate. Conclusions: Clinicians should be vigilant for pneumothorax in at-risk individuals, consider targeted screening for symptomatic vapers, and prioritize early surgical intervention in recurrent cases to reduce complications. Further research is needed to understand the pathophysiology of vaping-associated spontaneous pneumothorax and optimal management strategies. Full article

The aim of this study was to evaluate the effect of a 4-week respiratory muscle training (RMT) intervention versus continuous positive airway pressure (CPAP) on cardiorespiratory parameters and cognitive function in patients with OSA. Twenty-eight male patients with OSA were divided into two groups (RMT_group n = 14 and CPAP_group n = 14) and we recorded cardiopulmonary parameters and completed the questionnaires for cognitive impairment (MoCA) and sleep quality (PSQI) before and after 4 weeks. We observed differences before and after the intervention in cardiopulmonary parameters: RMT_group: breathing reserve (p < 0.001) and oxygen breathing (p = 0.002), at the end of the exercise test and pulse-respiratory quotient at rest (p < 0.001), end of exercise (p = 0.020), and recovery (p < 0.001), mean arterial pressure (RMT_groupp = 0.035, CPAP_groupp = 0.032); cognitive function assessment: RMT_group: 7% improvement in MoCA_score (p < 0. 001). and in the attention–working memory domain by 13% (p = 0.001), CPAP_group: improvement in the short-term memory recall domain by 28% (p = 0.001) and in the visuospatial domain by 18% (p = 0.027); sleep quality scores: RMT_group: 22% improvement in PSQI_score (p = 0.013), and 50% reduction in ‘cannot breathe comfortably’ domain (p = 0.013), CPAP_group: 31% increase in ‘waking in the middle of the night or early in the morning’ domain (p = 0.044). Our findings support the implementation of RMT programs in patients with OSA as an effective and beneficial practice to promote exercise and reduce symptoms of sleep disturbance. Full article

Objective: To investigate the cut-off value of the breathing reserve for predicting a decline in cardiorespiratory fitness (CRF) among healthy middle-aged Chinese individuals. Methods: Healthy middle-aged individuals who underwent cardiopulmonary exercise testing (CPET) at the Peking University Third Hospital from May to October 2021 were selected. The study included 321 participants, with an average age of 48.8 ± 5.7 years. They were divided into two groups based on the peak oxygen uptake (VO₂peak): the adequate CRF group and the CRF decline group. Multivariate logistic regression analysis was used to explore the factors influencing CRF. Results: In the male CRF decline group, heart rate, alanine aminotransferase, end-tidal partial pressure of carbon dioxide (PETCO₂), and breathing reserve (BR%) were significantly higher, while the oxygen uptake at the anaerobic threshold (VO₂@AT) was lower. An elevated BR% was independently associated with CRF decline (OR = 1.111, 95% CI: 1.068–1.156). The female CRF decline group had significantly higher FEV1/FVC and BR% and significantly lower age, fasting glucose, hemoglobin, and VO₂@AT compared to the adequate CRF group. Elevated BR% was independently associated with CRF decline (OR = 1.086, 95% CI: 1.038–1.137). The receiver operating characteristic (ROC) curve for the males showed an area under the curve (AUC) of 0.769 (95% CI: 0.703–0.827) with an appropriate BR% cut-off value of 49.9%, sensitivity of 59.9%, and specificity of 77.8%. For the females, the ROC curve displayed an AUC of 0.694 (95% CI: 0.607–0.773) with an appropriate BR% cut-off value of 57.0%, sensitivity of 58.7%, and specificity of 86.0%. Conclusions: The breathing reserve was independently associated with CRF. The appropriate cut-off values for BR% to predict CRF decline were 49.9% for the males and 57.0% for the females. Full article

Objectives: We aimed to describe the cardiopulmonary function during exercise and the health-related quality of life (HRQoL) in patients with a history of COVID-19 pneumonia, stratified by chest computed tomography (CT) findings at baseline. Methods: Among 77 consecutive patients with COVID-19 who were discharged from the Pulmonology Ward between March 2020 and April 2021, 28 (mean age 54.3 ± 8.6 years, 8 females) agreed to participate to the current study. The participants were analyzed in two groups based on pulmonary involvement (PI) at baseline chest CT applying a threshold of 25%. A consequent artificial intelligence (AI)-guided total opacity score (TOS) was calculated in a subgroup of 22 patients. A cardiopulmonary exercise test (CPET) was conducted on average 8.4 (±1.9) months after discharge from the hospital. HRQoL was defined using the short-form (SF-36) questionnaire. The primary outcome was exercise intolerance that was defined as a peak oxygen uptake (V′O_2peak) < 80% predicted. Secondary outcomes were ventilatory limitation, defined as breathing reserve < 15%, circulatory limitation, defined as oxygen pulse predicted below 80%, and deconditioning, defined as exercise intolerance in the absence of ventilatory and circulatory limitations. Other secondary outcomes included the SF-36 domains. Results: In all, 15 patients had at least 25% PI (53.6%) at baseline chest CT. Exercise intolerance was observed in ten patients (35.7%), six due to deconditioning and four due to circulatory limitation; none had ventilatory limitation. AI-guided TOS was 30.1 ± 24.4% vs. 6.1 ± 4.8% (p < 0.001) at baseline, and 1.7 ± 3.0% vs. 0.2 ± 0.7% (nonsignificant) at follow-up in high and low PI groups, respectively. The physical functioning (PF) domain score of the SF-36 questionnaire was 66.3 ± 19.4 vs. 85.0 ± 13.1 in high and low PI groups, respectively (p = 0.007). Other SF-36 domains did not differ significantly between the groups. A high PI at baseline was inversely correlated with V′O_2peak (standardized β coefficient = −0.436; 95% CI −26.1; −0.7; p = 0.040) and with PF scores (standardized β coefficient −0.654; 95% CI −41.3; −7.6; p = 0.006) adjusted for age, sex, body mass index and lung diffusion capacity. Conclusions: One-third of participants experienced exercise intolerance eight months after COVID-19 pneumonia. A higher PI at baseline was significantly associated with exercise intolerance and PF. Notwithstanding, the radiological PI was resolved, and the exercise intolerance was mainly explained not by ventilatory limitation but by circulatory limitation and deconditioning. Full article

According to World Health Organization (WHO) data, 16% of people are affected by infertility across the globe. One underlying factor is the age-related decline of ovarian reserve (DOR), which can lead to a higher chance of infertility and has no widely accepted treatment currently. Specific supplements and moderate exercise have been shown to improve fertility; however, there is no consensus to date on the type of exercise providing the best results. Our goal is to develop a novel exercise program combined with natural supplements for the improvement of fertility. We also propose a single-centered, randomized, open-label clinical trial using our newly developed exercise in the intervention group, compared to walking and no exercise in the other groups, to investigate the benefits of this exercise program in the future. In this study, we developed a structured, novel combination of exercises focusing on the pelvic and ovarian regions, core strengthening and improvement of blood circulation in this region. The 70 min full body “reproductive gymnastics”, includes strengthening, stretching, and relaxation exercises combined with yoga-inspired moves and diaphragmatic breathing with meditation elements to activate the parasympathetic pathway and stress relief. We believe we can improve fertility through the combination of natural supplements and our targeted, moderate physiotherapy program in women with DOR. Full article

During breathing, the human thorax is expanded or contracted during inspiration and expiration. The morphology of the thorax seems to be determinant for endurance efforts. This study aims to analyse the variation of the thorax cross-sections during running exercises at different intensities and the influence of thorax morphology. Twenty-two athletes were captured using a motion capture system (13 reflective markers) while they performed an incremental running test. Three captures of each subject were performed at different intensities (45%, 70%, and 85% of HRR (heart rate reserve)) and three morphology groups were made by splitting their thoracic index. The results showed a significant increase in the anteroposterior and mediolateral cross-sections when the intensity of the exercise is also increased. No differences were found in the cross-sections due to the morphology of the thorax. However, subjects with a deeper thorax showed a different behaviour as they increased their anteroposterior cross-section during higher intensities, while flatter thorax subjects did not perform in the same way. This could be explained as compensation for the morphological disadvantage that a deeper ribcage shape suffers when developing endurance efforts. More investigations regarding thorax kinematics are needed for a better understanding of breathing disorders and physical activities. Full article

Chest deformities in children with scoliosis may result in cardiopulmonary disorders, lowering cardiopulmonary capacity levels. However, results regarding the dependence of cardiopulmonary capacity on the severity level of scoliosis remain controversial. We aimed to use dynamic cardiopulmonary exercise testing (CPET) to investigate exercise capacity in reference to spinal deformity in patients with mild or moderate idiopathic scoliosis by means of multivariate analyses. Methods: We included 92 children and adolescents aged 10–17 years with mild and moderate idiopathic scoliosis and 94 healthy peers. The study consisted of three parts: (1) medical record analyses; (2) anthropometric measurements; and (3) CPET. Results: Our results revealed that the mean VO_2peak and VO_2peak/kg values of the participants with scoliosis were 0.27 L/min and 0.37 mL/min/kg lower than their healthy peers, respectively, regardless of age and gender. Furthermore, the occurrence of scoliosis correlates with a mean decrease in minute ventilation volume by 10.10 L/min, tidal volume by 0.11 L, breathing frequency by 3.78 bpm, and breathing reserve by 14.34%, regardless of the age and gender of the participants. Children and adolescents with mild-to-moderate scoliosis during CPET exhibit a lower ventilation capacity and lower VO₂ max than healthy adolescents matched in age but their cardiorespiratory fitness parameters do not depend on the Cobb angle value and the angle rotation of the primary spinal curvature. Conclusions: Physical therapy and activity should be recommended to prevent cardiorespiratory failure in later life in patients with scoliosis. This study may also provide CPET reference values for healthy children and adolescents with scoliosis. Full article

Before revascularization, moyamoya patients require hemodynamic evaluation. In this study, we evaluated the scoring system Prior Infarcts, Reactivity and Angiography in Moyamoya Disease (PIRAMID). We also devised a new scoring system, MRI-Based Assessment of Risk for Stroke in Moyamoya Angiopathy (MARS-MMA), and compared the scoring systems with respect to the capability to predict impaired [¹⁵O]water PET cerebral perfusion reserve capacity (CPR). We evaluated 69 MRI, 69 DSA and 38 [¹⁵O]water PET data sets. The PIRAMID system was validated by ROC curve analysis with neurological symptomatology as a dependent variable. The components of the MARS-MMA system and their weightings were determined by binary logistic regression analysis. The comparison of PIRAMID and MARS-MMA was performed by ROC curve analysis. The PIRAMID score correlated well with the symptomatology (AUC = 0.784). The MARS-MMA system, including impaired breath-hold-fMRI, the presence of the Ivy sign and arterial wall contrast enhancement, correlated slightly better with CPR impairment than the PIRAMID system (AUC = 0.859 vs. 0.827, Akaike information criterion 140 vs. 146). For simplified clinical use, we determined three MARS-MMA grades without loss of diagnostic performance (AUC = 0.855). The entirely MRI-based MARS-MMA scoring system might be a promising tool to predict the risk of stroke. Full article

Although the study of the menstrual cycle influence on endurance exercise has recently increased, there is a lack of literature studying its influence on females’ cardiorespiratory recovery. Thus, the aim of the present work was to assess menstrual cycle influence on post-exercise recovery following a high intensity interval exercise in trained females. Thirteen eumenorrheic endurance-trained females performed an interval running protocol in three menstrual cycle phases: early follicular phase (EFP), late follicular phase (LFP), and mid-luteal phase (MLP). The protocol consisted of 8 × 3-min bouts at 85% of their maximal aerobic speed (vVO2peak) with a 90-s rest between bouts and a final 5-min active recovery at 30% vVO2peak. All variables were averaged every 15 s, obtaining 19 moments during recovery (time factor). To analyze the effects of the menstrual cycle on the final active cardiorespiratory recovery, an ANOVA for repeated measures was performed. ANOVA showed an effect on menstrual cycle phase on ventilation (EFP: 1.27 ± 0.35; LFP: 1.19 ± 0.36; MLP: 1.27 ± 0.37), breathing frequency (EFP: 35.14 ± 7.14; LFP: 36.32 ± 7.11; MLP: 37.62 ± 7.23), and carbon dioxide production (EFP: 1120.46 ± 137.62; LFP: 1079.50 ± 129.57; MLP: 1148.78 ± 107.91). Regarding the interaction results (phase x time), ventilation is higher at many of the recovery times during the MLP, with less frequent differences between EFP and LFP (F = 1.586; p = 0.019), while breathing reserve is lower at many of the recovery times during MLP, with less time differences between EFP and LFP (F = 1.643; p = 0.013). It seems that the menstrual cycle affects post-exercise recovery specially during the MLP, rising ventilation and lowering breathing reserve, giving rise to an impaired ventilatory efficiency. Full article

Ketosis is a metabolic disorder associated with high production and low energy intake in dairy cows. Fat reserves are mobilized, and gluconeogenesis occurs. Traditionally, rapid tests for blood, milk or urine are used to detect increased ketone body levels in case of ketosis. Breath analysis is relatively new and relevant for the development of automatic sensor systems for early warning. This study aims to determine whether and when a postpartum rise in ketone bodies occurs in breath with elevated blood β-hydroxybutyrate (BHB) in cows at risk of ketosis. Postpartum breath, blood, urine and milk samples were taken daily until day 7, with one prepartum sample excluding milk, and ketone body concentrations were determined. Concentrations of blood BHB were 0.4–2.6 mmol/L (lab) and 0.3–3.1 mmol/L (rapid test), breath acetone was 2.3–20.0 ppm, urine acetoacetate 0–8 mmol/L and milk BHB 0–500 µmol/L. A rise in blood BHB was related to that in urine acetoacetate and milk BHB and followed by a rise in breath acetone. However, breath acetone levels of ketotic and non-ketotic cows were similar. We conclude that rising ketone bodies can be detected in blood, urine, milk and breath, but to use breath analysis as an alternative to rapid tests, longitudinal sampling is needed. Full article

Aging and family history of type 2 diabetes (T2D) are known risk factors of T2D. Younger first-degree relatives (FDR) of T2D patients have shown early metabolic alterations, which could limit exercise’s ability to prevent T2D. Thus, the objective was to determine whether exercise metabolism was altered during submaximal exercise in FDR postmenopausal women. Nineteen inactive postmenopausal women (control: 10, FDR: 9) aged 60 to 75 years old underwent an incremental test on a cycle ergometer with intensity ranging from 40 to 70% of peak power output. Participants consumed 50 mg of ¹³C-palmitate 2 h before the test. At the end of each stage, glucose, lactate, glycerol, non-esterified fatty acids and ¹³C-palmitate were measured in plasma, and ¹³CO₂ was measured in breath samples. Gas exchanges and heart rate were both monitored continuously. There were no between-group differences in substrate oxidation, plasma substrate concentrations or ¹³C recovered in plasma or breath. Interestingly, despite exercising at a similar relative intensity to control, FDR were consistently at a lower percentage of heart rate reserve. Overall, substrate plasma concentration and oxidation are not affected by family history of T2D in postmenopausal women and therefore not a participating mechanism in the altered response to exercise previously reported. More studies are required to better understand the mechanisms involved in this response. Full article