Differential Influence of Physical Activity on Cardiopulmonary Performance and Stroke Volume Assessed at Cardiopulmonary Exercise Test in Pectus Excavatum: A Pilot Study.

Lorenzo Casatori,Antonio Messineo,Pietro Amedeo Modesti,Marco Ghionzoli,Alessio Pellegrino,Flavio Facchini,Alessandra Modesti

doi:10.3389/fphys.2022.831504

Abstract

BackgroundExercise training increases muscle VO2 by increasing O2 transport and O2 uptake while cardiac output increase might be limited by the conformation of the chest in subjects with pectus excavatum (PE).AimsThe aim of the present study was to investigate the influence of physical activity (PA) on functional parameters of cardiopulmonary performance and stroke volume obtained at Cardiopulmonary Exercise Test (CPET) in PE.Methods and ProceduresA cohort of adolescents (15 with PE and 15 age- and sex-matched healthy controls, HC) underwent Cardiopulmonary Exercise Test (CPET) and administration of the International Physical Activity Questionnaire – Short Form (IPAQ-SF) with estimation of weekly PA (METs h–1⋅week–1). Determinants of CPET parameters were investigated with multivariable linear regression analysis.ResultsAs expected, when compared to HC, PE had lower VO2 max (37.2 ± 6.6 vs. 45.4 ± 6.4 mL⋅kg–1⋅min–1, p < 0.05), and VO2/HR max (O2 pulse, 12.1 ± 2.4 vs. 16.2 ± 3.6 mL⋅min–1⋅bpm–1, p < 0.05). Importantly, physical activity level was a predictor of VO2 max (adjusted for sex, body mass index, FEV1%, and presence of PE, β = 0.085; 95% Cl 0.010 to 0.160, p = 0.029) whereas O2 pulse was independent from PA level (β = 0.035; 95% Cl −0.004 to 0.074).ConclusionPhysical activity is a determinant of VO2 max (cardiopulmonary performance), whereas it appears not to affect O2 pulse (a measure of stroke volume at peak exercise) related to constrained diastolic filling in PE.

Highlights

Pectus excavatum (PE) is the most common congenital chest wall deformity of childhood
The International Physical Activity Questionnaire-Short Form (IPAQ-SF) is a valid (r = 0.67) and reliable tool (Craig et al, 2003), that is recommended for assessing physical activity (PA) in young and middle-aged adults (15–69 years) [Mannocci et al (2018); The International Physical Activity Questionnaire, Available from: Guidelines for Data Processing and Analysis of the International Physical Activity (IPAQ, 2021)]
No difference was observed between patients and controls in the level of habitual activity; more precisely, in the PE group, time spent per week in vigorous or moderate PA, as well as the total metabolic equivalent (MET) h−1·week−1 were not significantly different from those in the healthy control (HC) group (Table 1)

Summary

Introduction

Pectus excavatum (PE) is the most common congenital chest wall deformity of childhood. Outward appearance can become a major problem in adolescence, especially for those who show visible disfigurement (Steinmann et al, 2011). This can be reflected in choosing clothing or in avoiding social and sporting activities (Ji et al, 2011; Alaca and Yüksel, 2021). In the most serious cases the dislocated sternum may compress heart and lungs with a resultant stroke volume reduction, primarily caused by constrained diastolic filling Both the limitation of physical activities and anatomical alterations result in real physiologic impairment with a reduction in exercise capacity and VO2 max, predominately because of impaired cardiovascular performance, rather than ventilatory limitation (Malek et al, 2003; Cavestri et al, 2010). Exercise training increases muscle VO2 by increasing O2 transport and O2 uptake while cardiac output increase might be limited by the conformation of the chest in subjects with pectus excavatum (PE)

Methods

Results

Discussion

Conclusion