Speeding of pulmonary VO2 on-kinetics by light-to-moderate- intensity aerobic exercise training in chronic heart failure: Clinical and pathophysiological correlates

Alessandro Mezzani, Bruno Grassi, Andrew M. Jones, Andrea Giordano, Ugo Corrà, Simone Porcelli, Silvia Della Bella, Adriano Taddeo, Pantaleo Giannuzzi

Research output: Contribution to journalArticle

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Abstract

Background: Pulmonary VO2 on-kinetics during light-to-moderate-intensity constant-work-rate exercise, an experimental model mirroring energetic transitions during daily activities, has been shown to speed up with aerobic exercise training (AET) in normal subjects, but scant data are available in chronic heart failure (CHF). Methods and results: Thirty CHF patients were randomized to 3 months of light-to-moderate-intensity AET (CHF-AET) or control (CHF-C). Baseline and end-protocol evaluations included i) one incremental cardiopulmonary exercise test with near infrared spectroscopy analysis of peak deoxygenated hemoglobin + myoglobin concentration changes (Δ[deoxy(Hb + Mb)]) in vastus lateralis muscle, ii) 8 light-to-moderate- intensity constant-work-rate exercise tests for VO2 on-kinetics phase I duration, phase II τ, and mean response time (MRT) assessment, and iii) circulating endothelial progenitor cell (EPC) measurement. Reference values were obtained in 7 age-matched normals (N). At end-protocol, phase I duration, phase II τ, and MRT were significantly reduced (- 12%, - 22%, and - 19%, respectively) and peak VO2, peak Δ[deoxy(Hb + Mb)], and EPCs increased (9%, 20%, and 98%, respectively) in CHF-AET, but not in CHF-C. Peak Δ[deoxy(Hb + Mb)] and EPCs relative increase correlated significantly to that of peak VO2 (r = 0.61 and 0.64, respectively, p <0.05). Conclusions: Light-to-moderate-intensity AET determined a near-normalization of pulmonary VO2 on-kinetics in CHF patients. Such a marked plasticity has important implications for AET intensity prescription, especially in patients more functionally limited and with high exercise-related risk. The AET-induced simultaneous improvement of phase I and phase II, associated with an increase of peak peripheral oxygen extraction and EPCs, supports microcirculatory O2 delivery impairment as a key factor determining exercise intolerance in CHF.

Original languageEnglish
Pages (from-to)2189-2195
Number of pages7
JournalInternational Journal of Cardiology
Volume167
Issue number5
DOIs
Publication statusPublished - Sep 1 2013

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Heart Failure
Exercise
Lung
Exercise Test
Reaction Time
Near-Infrared Spectroscopy
Myoglobin
Quadriceps Muscle
Prescriptions
Reference Values
Hemoglobins
Theoretical Models
Oxygen

Keywords

  • Chronic heart failure
  • Endothelial progenitor cells
  • Exercise training
  • Near infrared spectroscopy
  • Peak oxygen consumption
  • VO on-kinetics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Speeding of pulmonary VO2 on-kinetics by light-to-moderate- intensity aerobic exercise training in chronic heart failure : Clinical and pathophysiological correlates. / Mezzani, Alessandro; Grassi, Bruno; Jones, Andrew M.; Giordano, Andrea; Corrà, Ugo; Porcelli, Simone; Della Bella, Silvia; Taddeo, Adriano; Giannuzzi, Pantaleo.

In: International Journal of Cardiology, Vol. 167, No. 5, 01.09.2013, p. 2189-2195.

Research output: Contribution to journalArticle

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abstract = "Background: Pulmonary VO2 on-kinetics during light-to-moderate-intensity constant-work-rate exercise, an experimental model mirroring energetic transitions during daily activities, has been shown to speed up with aerobic exercise training (AET) in normal subjects, but scant data are available in chronic heart failure (CHF). Methods and results: Thirty CHF patients were randomized to 3 months of light-to-moderate-intensity AET (CHF-AET) or control (CHF-C). Baseline and end-protocol evaluations included i) one incremental cardiopulmonary exercise test with near infrared spectroscopy analysis of peak deoxygenated hemoglobin + myoglobin concentration changes (Δ[deoxy(Hb + Mb)]) in vastus lateralis muscle, ii) 8 light-to-moderate- intensity constant-work-rate exercise tests for VO2 on-kinetics phase I duration, phase II τ, and mean response time (MRT) assessment, and iii) circulating endothelial progenitor cell (EPC) measurement. Reference values were obtained in 7 age-matched normals (N). At end-protocol, phase I duration, phase II τ, and MRT were significantly reduced (- 12{\%}, - 22{\%}, and - 19{\%}, respectively) and peak VO2, peak Δ[deoxy(Hb + Mb)], and EPCs increased (9{\%}, 20{\%}, and 98{\%}, respectively) in CHF-AET, but not in CHF-C. Peak Δ[deoxy(Hb + Mb)] and EPCs relative increase correlated significantly to that of peak VO2 (r = 0.61 and 0.64, respectively, p <0.05). Conclusions: Light-to-moderate-intensity AET determined a near-normalization of pulmonary VO2 on-kinetics in CHF patients. Such a marked plasticity has important implications for AET intensity prescription, especially in patients more functionally limited and with high exercise-related risk. The AET-induced simultaneous improvement of phase I and phase II, associated with an increase of peak peripheral oxygen extraction and EPCs, supports microcirculatory O2 delivery impairment as a key factor determining exercise intolerance in CHF.",
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AU - Mezzani, Alessandro

AU - Grassi, Bruno

AU - Jones, Andrew M.

AU - Giordano, Andrea

AU - Corrà, Ugo

AU - Porcelli, Simone

AU - Della Bella, Silvia

AU - Taddeo, Adriano

AU - Giannuzzi, Pantaleo

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N2 - Background: Pulmonary VO2 on-kinetics during light-to-moderate-intensity constant-work-rate exercise, an experimental model mirroring energetic transitions during daily activities, has been shown to speed up with aerobic exercise training (AET) in normal subjects, but scant data are available in chronic heart failure (CHF). Methods and results: Thirty CHF patients were randomized to 3 months of light-to-moderate-intensity AET (CHF-AET) or control (CHF-C). Baseline and end-protocol evaluations included i) one incremental cardiopulmonary exercise test with near infrared spectroscopy analysis of peak deoxygenated hemoglobin + myoglobin concentration changes (Δ[deoxy(Hb + Mb)]) in vastus lateralis muscle, ii) 8 light-to-moderate- intensity constant-work-rate exercise tests for VO2 on-kinetics phase I duration, phase II τ, and mean response time (MRT) assessment, and iii) circulating endothelial progenitor cell (EPC) measurement. Reference values were obtained in 7 age-matched normals (N). At end-protocol, phase I duration, phase II τ, and MRT were significantly reduced (- 12%, - 22%, and - 19%, respectively) and peak VO2, peak Δ[deoxy(Hb + Mb)], and EPCs increased (9%, 20%, and 98%, respectively) in CHF-AET, but not in CHF-C. Peak Δ[deoxy(Hb + Mb)] and EPCs relative increase correlated significantly to that of peak VO2 (r = 0.61 and 0.64, respectively, p <0.05). Conclusions: Light-to-moderate-intensity AET determined a near-normalization of pulmonary VO2 on-kinetics in CHF patients. Such a marked plasticity has important implications for AET intensity prescription, especially in patients more functionally limited and with high exercise-related risk. The AET-induced simultaneous improvement of phase I and phase II, associated with an increase of peak peripheral oxygen extraction and EPCs, supports microcirculatory O2 delivery impairment as a key factor determining exercise intolerance in CHF.

AB - Background: Pulmonary VO2 on-kinetics during light-to-moderate-intensity constant-work-rate exercise, an experimental model mirroring energetic transitions during daily activities, has been shown to speed up with aerobic exercise training (AET) in normal subjects, but scant data are available in chronic heart failure (CHF). Methods and results: Thirty CHF patients were randomized to 3 months of light-to-moderate-intensity AET (CHF-AET) or control (CHF-C). Baseline and end-protocol evaluations included i) one incremental cardiopulmonary exercise test with near infrared spectroscopy analysis of peak deoxygenated hemoglobin + myoglobin concentration changes (Δ[deoxy(Hb + Mb)]) in vastus lateralis muscle, ii) 8 light-to-moderate- intensity constant-work-rate exercise tests for VO2 on-kinetics phase I duration, phase II τ, and mean response time (MRT) assessment, and iii) circulating endothelial progenitor cell (EPC) measurement. Reference values were obtained in 7 age-matched normals (N). At end-protocol, phase I duration, phase II τ, and MRT were significantly reduced (- 12%, - 22%, and - 19%, respectively) and peak VO2, peak Δ[deoxy(Hb + Mb)], and EPCs increased (9%, 20%, and 98%, respectively) in CHF-AET, but not in CHF-C. Peak Δ[deoxy(Hb + Mb)] and EPCs relative increase correlated significantly to that of peak VO2 (r = 0.61 and 0.64, respectively, p <0.05). Conclusions: Light-to-moderate-intensity AET determined a near-normalization of pulmonary VO2 on-kinetics in CHF patients. Such a marked plasticity has important implications for AET intensity prescription, especially in patients more functionally limited and with high exercise-related risk. The AET-induced simultaneous improvement of phase I and phase II, associated with an increase of peak peripheral oxygen extraction and EPCs, supports microcirculatory O2 delivery impairment as a key factor determining exercise intolerance in CHF.

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KW - Endothelial progenitor cells

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KW - Near infrared spectroscopy

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