Psychophysical Differences in Ventilatory Awareness and Breathlessness between Athletes and Sedentary Individuals.

Olivia K Faull,Pete J Cox,Kyle T S Pattinson

doi:10.3389/fphys.2016.00231

Abstract

Purpose: Breathlessness is a complex set of symptoms that are comprised of both sensory and affective (emotional) dimensions. While ventilation is now understood to be a potential limiter to performance in highly-trained individuals, the contribution of breathlessness-anxiety in those nearing maximal ventilation during intense exercise has not yet been considered as a limiter to performance.Methods: In this study, we compared the physiology and psychology of breathlessness in 20 endurance athletes with 20 untrained age- and sex-matched sedentary controls. Subjects completed baseline spirometry and anxiety questionnaires, an incremental exercise test to exhaustion and a steady-state hypercapnic ventilatory response test, with concurrent measures of breathlessness intensity and breathlessness-anxiety.Results: Compared with sedentary subjects, athletes reported equivalent breathlessness intensity but greater breathlessness-anxiety at maximal exercise (athletes vs. sedentary (mean ± SD): breathlessness intensity (0–100%) 80.7 (22.7) vs. 72.5 (17.2), p = 0.21; breathlessness-anxiety (0–100%), 45.3 (36.3) vs. 22.3 (20.0), p = 0.02). Athletes operated at higher proportions of their maximal ventilatory capacity (MVV) (athletes vs. sedentary (mean ventilation ± SD; % MVV): 101.6 (27.2) vs. 73.7 (30.1), p = 0.003). In the athletes there was a positive linear correlation between ventilation and breathlessness score during the hypercapnic challenge that was not observed in the sedentary controls.Conclusion: The results of this study indicate that whilst operating at high proportions of maximal ventilation, breathlessness-anxiety becomes increasingly prominent in athletes. Our results suggest that ventilatory perception pathways may be a target for improved athletic performance in some individuals.

Highlights

Breathlessness is the frightening sensation of not getting enough air
Both work rate and VO2 were greater in athletes at both anaerobic threshold and maximal exercise, and the anaerobic threshold of athletes was at a greater percentage of their maximum
While there was no difference in breathlessness intensity values at maximal exercise between the groups, athletes rated significantly higher in breathlessness-anxiety than sedentary subjects (Figure 2)

Summary

Introduction

Breathlessness is the frightening sensation of not getting enough air. A recent model of breathlessness describes multiple sensory dimensions that include work/effort, air hunger and chest tightness (Schwartzstein et al, 1990; Lansing et al, 2000, 2009). As discussed by Lansing et al (2009), breathlessness has both sensory components (often related to the strength or intensity of Psychophysiology of Breathlessness in Athletes the sensation) and affective or emotional components that relate to how unpleasant or worrying the sensation feels, and to the resulting associated anxiety (termed breathlessness-anxiety in this paper). These sensory and affective components may operate independently in the face of changes in ventilation (von Leupoldt and Dahme, 2005; Banzett et al, 2008). Functional brain imaging is beginning to reveal the brain mechanisms by which affective and emotional processes contribute to breathlessness (Herigstad et al, 2011, 2015; Hayen et al, 2013) and how peripheral respiratory input is integrated with higher consciousness (Ezra et al, 2015; Faull et al, 2015, 2016)

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Conclusion