Abstract
IntroductionThe physiological response during the endurance shuttle walk test (ESWT), the cycle endurance test (CET) and the incremental shuttle walk test (ISWT) remains unknown in PAH. We tested the hypothesis that endurance tests induce a near-maximal physiological demand comparable to incremental tests. We also hypothesized that differences in respiratory response during exercise would be related to the characteristics of the exercise tests.MethodsWithin two weeks, twenty-one PAH patients (mean age: 54(15) years; mean pulmonary arterial pressure: 42(12) mmHg) completed two cycling exercise tests (incremental cardiopulmonary cycling exercise test (CPET) and CET) and three field tests (ISWT, ESWT and six-minute walk test (6MWT)). Physiological parameters were continuously monitored using the same portable telemetric device.ResultsPeak oxygen consumption (VO2peak) was similar amongst the five exercise tests (p = 0.90 by ANOVA). Walking distance correlated markedly with the VO2peak reached during field tests, especially when weight was taken into account. At 100% exercise, most physiological parameters were similar between incremental and endurance tests. However, the trends overtime differed. In the incremental tests, slopes for these parameters rose steadily over the entire duration of the tests, whereas in the endurance tests, slopes rose sharply from baseline to 25% of maximum exercise at which point they appeared far less steep until test end. Moreover, cycling exercise tests induced higher respiratory exchange ratio, ventilatory demand and enhanced leg fatigue measured subjectively and objectively.ConclusionEndurance tests induce a maximal physiological demand in PAH. Differences in peak respiratory response during exercise are related to the modality (cycling vs. walking) rather than the progression (endurance vs. incremental) of the exercise tests.
Highlights
The physiological response during the endurance shuttle walk test (ESWT), the cycle endurance test (CET) and the incremental shuttle walk test (ISWT) remains unknown in Pulmonary arterial hypertension (PAH)
Following the paradigm set by other chronic conditions such as chronic obstructive pulmonary disease (COPD) in which endurance tests are more sensitive to clinical changes following therapeutic intervention than the CPET and 6MWT [12,13,14,15], endurance tests including the endurance shuttle walk test (ESWT) and the cycle endurance test (CET) have been proposed in PAH
The objective of this study was to compare the physiological response during endurance (ESWT and CET) and incremental (incremental shuttle walk test (ISWT) and CPET) exercise tests
Summary
The physiological response during the endurance shuttle walk test (ESWT), the cycle endurance test (CET) and the incremental shuttle walk test (ISWT) remains unknown in PAH. Numerous exercise abnormalities have been described in PAH These include considerable reduction of peak oxygen consumption (VO2peak), oxygen pulse (VO2/HR) and end-tidal carbon dioxide partial pressure (PETCO2), abnormal increase in the ventilatory equivalent for carbon dioxide (VE/VCO2), exercise-induced hypoxemia and early anaerobic threshold [2,3,4]. Following the paradigm set by other chronic conditions such as chronic obstructive pulmonary disease (COPD) in which endurance tests are more sensitive to clinical changes following therapeutic intervention than the CPET and 6MWT [12,13,14,15], endurance tests including the endurance shuttle walk test (ESWT) and the cycle endurance test (CET) have been proposed in PAH Whether these tests induce clinically relevant and similar cardiorespiratory response compared to exercise tests currently used in PAH remains unknown
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