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Research ArticleOriginal Research

The Effect of Adding Noninvasive Ventilation to High-Intensity Exercise on Peripheral and Respiratory Muscle Oxygenation

Cássia da Luz Goulart, Flávia Rossi Caruso, Adriana S Garcia de Araújo, Sílvia Cristina Garcia de Moura, Aparecida Maria Catai, Polliana Batista dos Santos, Érika Z Kabbach, Ross Arena, Renata Gonçalves Mendes and Audrey Borghi-Silva
Respiratory Care March 2023, 68 (3) 320-329; DOI: https://doi.org/10.4187/respcare.10315
Cássia da Luz Goulart
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565–905, Sao Carlos, São Paulo, Brazil.
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Flávia Rossi Caruso
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565–905, Sao Carlos, São Paulo, Brazil.
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Adriana S Garcia de Araújo
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565–905, Sao Carlos, São Paulo, Brazil.
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Sílvia Cristina Garcia de Moura
Cardiovascular Physical Therapy Laboratory, Physiotherapy Department, Federal University of São Carlos, Rod Washington Luis, KM 235, Monjolinho, CEP: 13565–905, Sao Carlos, São Paulo, Brazil.
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Aparecida Maria Catai
Cardiovascular Physical Therapy Laboratory, Physiotherapy Department, Federal University of São Carlos, Rod Washington Luis, KM 235, Monjolinho, CEP: 13565–905, Sao Carlos, São Paulo, Brazil.
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Polliana Batista dos Santos
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565–905, Sao Carlos, São Paulo, Brazil.
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Érika Z Kabbach
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565–905, Sao Carlos, São Paulo, Brazil.
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Ross Arena
Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois.
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Renata Gonçalves Mendes
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565–905, Sao Carlos, São Paulo, Brazil.
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Audrey Borghi-Silva
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565–905, Sao Carlos, São Paulo, Brazil.
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Abstract

BACKGROUND: We sought to assess whether noninvasive ventilation (NIV) as an adjunct with high-intensity exercise (HIEx) is more effective than exercise alone or exercise + sham on respiratory and peripheral oxygenation and vascular function in subjects with coexisting COPD and heart failure (HF).

METHODS: On separate days, subjects performed incremental cardiopulmonary exercise testing and 3 constant load tests: HIEx, HIEx+NIV, and HIEx+sham (bi-level mode, Astral 150). Subjects were randomized with a 1:1 block allocation for the HIEx+NIV group and HIEx+sham group until the limit of tolerance (Tlim). Peripheral and respiratory oxygenation were assessed by oxyhemoglobin (O2Hb) and deoxyhemoglobin (Hb) using near-infrared spectroscopy in the respiratory and peripheral musculature. Vascular function was assessed by endothelial function using the flow-mediated vasodilation (FMD) method.

RESULTS: There was a significant increase in FMD (mm), FMD (%), and shear stress in the HIEx+NIV group when compared to HIEx or HIEx+sham (P < .05). Less extraction of O2 (Hb) in the peripheral and respiratory muscles was observed in the HIEx+NIV group (P < .05). We also found correlations between peripheral muscle oxygenation (O2Hb) at the moment 80% of Tlim (r = 0.71, P = .009) and peak of Tlim (100%) (r = 0.76, P = .004) with absolute FMD (mm) immediately after HIEx+NIV.

CONCLUSIONS: NIV as an adjunct to HIEx can acutely unload the respiratory musculature with better redistribution of available blood flow and beneficially modulate endothelial function. These results may influence the approach to cardiopulmonary rehabilitation in patients with coexisting COPD-HF.

  • blood flow muscle
  • heart failure
  • COPD
  • oxygenation

Footnotes

  • Correspondence: Audrey Borghi-Silva, Cardiopulmonary Physiotherapy Laboratory, Federal University of Sao Carlos, Rod Washington Luis, Km 235, Jardim Guanabara, 13565–905 Sao Carlos, São Paulo, Brazil. E-mail: audrey{at}ufscar.br
  • The authors have disclosed no conflicts of interest.

  • This study was supported by a research grant from Fundação de Amparo à Pesquisa do Estado de São Paulo, São Paulo, Brazil, process number 2015/26/501-1; and by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES-001) and CNPq: 141803/2019 -3.

  • Ms da Luz Goulart is a doctoral student supported by Fundação de Amparo à Pesquisa do Estado de São Paulo, São Paulo, Brazil, process number 2018/03233-0. Dr Borghi-Silva is an established investigator (level IB) of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

  • Copyright © 2023 by Daedalus Enterprises
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Respiratory Care: 68 (3)
Respiratory Care
Vol. 68, Issue 3
1 Mar 2023
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The Effect of Adding Noninvasive Ventilation to High-Intensity Exercise on Peripheral and Respiratory Muscle Oxygenation
Cássia da Luz Goulart, Flávia Rossi Caruso, Adriana S Garcia de Araújo, Sílvia Cristina Garcia de Moura, Aparecida Maria Catai, Polliana Batista dos Santos, Érika Z Kabbach, Ross Arena, Renata Gonçalves Mendes, Audrey Borghi-Silva
Respiratory Care Mar 2023, 68 (3) 320-329; DOI: 10.4187/respcare.10315

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The Effect of Adding Noninvasive Ventilation to High-Intensity Exercise on Peripheral and Respiratory Muscle Oxygenation
Cássia da Luz Goulart, Flávia Rossi Caruso, Adriana S Garcia de Araújo, Sílvia Cristina Garcia de Moura, Aparecida Maria Catai, Polliana Batista dos Santos, Érika Z Kabbach, Ross Arena, Renata Gonçalves Mendes, Audrey Borghi-Silva
Respiratory Care Mar 2023, 68 (3) 320-329; DOI: 10.4187/respcare.10315
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