Relationship between ventilatory pattern and peak VO2 and area M regulates the respiratory system during exercise

Makoto Murata, Hitoshi Adachi, Taisuke Nakade, Yasuyuki Kobayashi, Piergiuseppe Agostoni

Research output: Contribution to journalArticlepeer-review


Background: Exertional dyspnea is a major symptom of heart failure. We investigated the tidal volume (TV)-the respiratory rate (RR) regulation according to the peak O2 uptake (VO2) during cardiopulmonary exercise testing (CPET) for clarifying exercise ventilatory pattern. Methods: We enrolled 1111 patients (66 ± 13 years old, 68% men) who had undergone CPET at our hospital. We investigated the relationship between TV and RR and drew the TV/height-RR figure according to the %peak VO2. Results: During exercise, TV was greater, illustrated as higher %peak VO2. However, RR was weakly correlated with %peak VO2. Adjusted with age, height, sex, each point of RR, and %peak VO2, TV during exercise highly correlated with age, height, each point of RR, and % peak VO2 (R = 0.726 to 0.821, p < 0.01). In the figure, regardless of the %peak VO2, TV/height and RR values were linearly related at rest, as well as at the point of anaerobic threshold, respiratory compensation, and peak exercise point, with each of these lines converging onto a single area (area M). The TV-RR slope values at early phase were also lower at lower %peak VO2. Conclusions: We identified three ventilatory regularities during exercise. First, TV increases as greater %peak VO2. Second, the line relating TV/height and RR at each reference point during the incremental exercise test converged onto area M. Finally, the TV-RR slope at the early exercise phase was lower in patients with a lower %peak VO2. These ventilatory regularities may assist in elucidating the excise ventilatory pattern and help the diagnosis of exertional dyspnea.

Original languageEnglish
Pages (from-to)521-528
Number of pages8
JournalJournal of Cardiology
Issue number5
Publication statusPublished - Nov 2020


  • Area M
  • Cardiopulmonary exercise testing
  • Exercise ventilatory pattern
  • O uptake
  • TV-RR slope

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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