Pathophysiological adaptations to walking and cycling in primary pulmonary hypertension

G. Valli, C. D. Vizza, P. Onorati, R. Badagliacca, R. Ciuffa, R. Poscia, F. Brandimarte, F. Fedele, P. Serra, P. Palange

Research output: Contribution to journalArticlepeer-review


Exercise tolerance inversely correlates with the severity of the disease in patients with idiopathic pulmonary arterial hypertension (IPAH). Cycling and walking protocols are commonly utilized in the evaluation of exercise intolerance in IPAH, but little information exists on possible diVerences in ventilatory and gas exchange adaptations to these exercise modalities. In a group of patients with moderate to severe IPAH (n = 13), we studied the ventilatory, cardiovascular and gas exchange adaptations to maximal incremental walking (W) and maximal incremental cycling (C). During W, compared to C, the ventilatory equivalents for CO 2 output (V′E/V′CO 2) were signiWcantly higher either expressed as the rate of increment (56 ± 5 vs. 45 ± 3; P <0.0001) or as the absolute values at anaerobic threshold (AT) and at peak exercise. At AT, the increase in V′E/V′CO 2 during W was associated with a signiWcant lower value of end-tidal carbon dioxide. At peak W, compared to peak C, dyspnea sensation was higher and arterial oxygen saturation (SpO 2) was lower (87 ± 2 vs. 91 ± 2, P <0.001). In patients with IPAH the physiologic information obtained with W are diVerent from those obtained with C. Tolerance to W exercise is limited by high ventilatory response and dyspnea sensation. W should be used to assess the degree of lung gas exchange in efficiency and arterial O 2 desaturation during exercise.

Original languageEnglish
Pages (from-to)417-424
Number of pages8
JournalEuropean Journal of Applied Physiology
Issue number4
Publication statusPublished - Mar 2008


  • Exercise
  • Gas exchange
  • IPAH
  • Shuttle walking test
  • Ventilatory efficiency

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Orthopedics and Sports Medicine
  • Physiology (medical)
  • Physiology
  • Physical Therapy, Sports Therapy and Rehabilitation


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