Relationship between workload and symptoms during the ergometric test in patients with interstitial lung disease and healthy individuals

Authors

DOI:

https://doi.org/10.33448/rsd-v11i9.31863

Keywords:

Interstitial Lung Diseases; Exercise Test; Dyspnea; Muscular Fatigue.

Abstract

Introduction: Interstitial lung diseases (ILD) present similar clinical characteristics such as dyspnea and exercise intolerance. These characteristics are accentuated during physical exertion, although this has not yet been investigated in depth in this population. Aims: To compare the subjective sensation of dyspnea and fatigue by workload during exercise testing (ET) between patients with ILD and healthy subjects. Methods: The individuals performed the CPET on a cycle ergometer with an incremental protocol. At each stage of the test, the sensation of exertion was collected using the Borg scale of dyspnea (D) and fatigue (F). The slopes of the D and F curves by stage in the test were compared using linear regression using the Zar method (F test). Results: 37 patients with ILD and 29 controls were studied. The ILD group had a lower maximum load (60[40-80] vs healthy 120[100-160]; (P<.0001) and greater symptoms at the end of the test for D (P=0.02), but not for F (P=0.23) when compared to the control. Also, the ILD group presented more symptoms per watt (i.e. Borg/Watts) in ET compared to the control group for D (8x10-2±7x10-2 vs 2x10-2 ± 2x10-2; P=0.0007), and F (1x10-1± 9x10-2 vs 3x10-2 ± 1x10-2; P=0.001). D and F symptoms per watt (P<0.05 between curves). Conclusion: Patients with ILD have lower maximal exercise capacity and appear to have a more pronounced increase in D and F sensation per workload during ET.

References

Antoniou, K. M., Margaritopoulos, G. A., Tomassetti, S., Bonella, F., Costabel, U., & Poletti, V. (2014). Interstitial lung disease. European Respiratory Review, 23(131), 40–54. https://doi.org/10.1183/09059180.00009113

Atkins C.P., Gilbert D., Brockwell C., Robinson S., W. A. M. (2016). Fatigue in sarcoidosis and idiopathic pulmonary fibrosis: differences in character and severity between diseases. Sarcoidosis Vasc Diffuse Lung Dis, 33, 130–138.

Barratt, S. L., Pauling, J. D., Davis, R., & Sharp, C. (2020). The prognostic value of cardiopulmonary exercise testing in interstitial lung disease : a systematic review. ERJ Open Res, April. https://doi.org/10.1183/23120541.00027-2020

Bonini, M., & Fiorenzano, G. (2017). Exertional dyspnoea in interstitial lung diseases : the clinical utility of cardiopulmonary exercise testing. European Respiratory Review, 1–11. https://doi.org/10.1183/16000617.0099-2016

Borg, G. A. V. (1982). Psychophysical bases of perceived exertion. Plastic and Reconstructive Surgery, 14(5), 377–381.

Britto, R. R., Probst, V. S., Dornelas De Andrade, A. F., Samora, G. A. R., Hernandes, N. A., Marinho, P. E. M., Karsten, M., Pitta, F., & Parreira, V. F. (2013). Reference equations for the six-minute walk distance based on a Brazilian multicenter study. Brazilian Journal of Physical Therapy, 17(6), 556–563. https://doi.org/10.1590/S1413-35552012005000122

Chetta, A., Marangio, E., & Olivieri, D. (2004). Interstitial Lung Diseases. Respiration, 209–213. https://doi.org/10.1159/000077416

Datta, D., Normandin, E., & Zuwallack, R. (2015). Cardiopulmonary exercise testing in the assessment of exertional dyspnea. Annals of Thoracic Medicine, 10(2), 77–86. https://doi.org/10.4103/1817-1737.151438

De Castro Pereira, C. A., Sato, T., & Rodrigues, S. C. (2007). New reference values for forced spirometry in white adults in Brazil. Jornal Brasileiro de Pneumologia, 33(4), 397–406. https://doi.org/10.1590/s1806-37132007000400008

De Souza E Silva, C. G., & De Araújo, C. G. S. (2015). Sex-Specific Equations to Estimate Maximum Oxygen Uptake in Cycle Ergometry. Arquivos Brasileiros de Cardiologia, 105(4), 381–389. https://doi.org/10.5935/abc.20150089

Denis E. O’Donnell, Laurence K. L. Chau, K. A. W. (1998). Qualitative aspects of exertional dyspnea in patients with interstitial lung disease. American Physiological SocietySociety.

Ferrazza, A. M., Martolini, D., Valli, G., & Palange, P. (2009). Cardiopulmonary exercise testing in the functional and prognostic evaluation of patients with pulmonary diseases. Respiration, 77(1), 3–17. https://doi.org/10.1159/000186694

Herdy, A. H., Ritt, L. E. F., Stein, R., de Araújo, C. G. S., Milani, M., Meneghelo, R. S., Ferraz, A. S., Hossri, C., de Almeida, A. E. M., da Silva, M. M. F., & Serra, S. M. (2016). Cardiopulmonary exercise test: Background, applicability and interpretation. Arquivos Brasileiros de Cardiologia, 107(5), 467–481. https://doi.org/10.5935/abc.20160171

Holland, A. E. (2010). RExercise limitation in interstitial lung disease - Mechanisms, significance and therapeutic options. Chronic Respiratory Disease, 7(2), 101–111. https://doi.org/10.1177/1479972309354689

Holland, A. E., Spruit, M. A., Troosters, T., Puhan, M. A., Pepin, V., Saey, D., McCormack, M. C., Carlin, B. W., Sciurba, F. C., Pitta, F., Wanger, J., MacIntyre, N., Kaminsky, D. A., Culver, B. H., Revill, S. M.,

Hernandes, N. A., Andrianopoulos, V., Camillo, C. A., Mitchell, K. E., … Singh, S. J. (2014). An official European respiratory society/American thoracic society technical standard: Field walking tests in chronic respiratory disease. European Respiratory Journal, 44(6), 1428–1446. https://doi.org/10.1183/09031936.00150314

Hopkinson, N. S., Tennant, R. C., Dayer, M. J., Swallow, E. B., Hansel, T. T., Moxham, J., & Polkey, M. I. (2007). A prospective study of decline in fat free mass and skeletal muscle strength in chronic obstructive pulmonary disease. Respiratory Research, 8, 1–8. https://doi.org/10.1186/1465-9921-8-25

Hughes, J. M. B., Lockwood, D. N. A., Jones, H. A., & Clark, R. J. (1991). DlCO/Q̇ and diffusion limitation at rest and on exercise in patients with interstitial fibrosis. Respiration Physiology, 83(2), 155–166. https://doi.org/10.1016/0034-5687(91)90025-E

Kahlmann V, Moor CC, W. M. (2020). Managing Fatigue in Patients With Interstitial Lung Disease. Chest, 158(5), 2026–2033.

Lama, V. N., & Martinez, F. J. (2004). Resting and exercise physiology in interstitial lung diseases. Clin Chest Med, 25, 435–453. https://doi.org/10.1016/j.ccm.2004.05.005

Layton, A. M., Armstrong, H. F., Kim, H. P., Meza, K. S., D’Ovidio, F., & Arcasoy, S. M. (2017). Cardiopulmonary exercise factors predict survival in patients with advanced interstitial lung disease referred for lung transplantation. Respiratory Medicine, 126, 59–67. https://doi.org/10.1016/j.rmed.2017.03.022

Macintyre, N., Crapo, R. O., Viegi, G., Johnson, D. C., Grinten, C. P. M. Van Der, Brusasco, V., Burgos, F., Casaburi, R., Coates, A., Enright, P., Gustafsson, P., Hankinson, J., Jensen, R., Mckay, R., Miller, M. R., Navajas, D., Pedersen, O. F., Pellegrino, R., & Wanger, J. (2005). Standardisation of the single-breath determination of carbon monoxide uptake in the lung. European Respiratory Journal, 26(4), 720–735. https://doi.org/10.1183/09031936.05.00034905

Meyer, K. C. (2014). Diagnosis and management of interstitial lung disease. Translational Respiratory Medicine 2014, 2(4), 1–13. https://doi.org/10.1038/sj.bjc.6602064

Miller, M. R., Crapo, R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., Enright, P., Grinten, C. P. M. Van Der, Gustafsson, P., Jensen, R., Johnson, D. C., Macintyre, N., Mckay, R., Navajas, D., Pedersen, O. F., Pellegrino, R., Viegi, G., & Wanger, J. (2005). General considerations for lung function testing. European Respiratory Journal, 26(1), 153–161. https://doi.org/10.1183/09031936.05.00034505

Miller, M. R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., Crapo, R., Enright, P., Grinten, C. P. M. Van Der, Gustafsson, P., Jensen, R., Johnson, D. C., Macintyre, N., Mckay, R., Navajas, D., Pedersen, O. F., Pellegrino, R., Viegi, G., & Wanger, J. (2005). Standardisation of spirometry. Eur Respir J, 26(2), 319–338. https://doi.org/10.1183/09031936.05.00034805

Mohsenifar, Z., Collier, J., Belman, M. J., & Koerner, S. K. (1992). Isolated reduction in single-breath diffusing capacity in the evaluation of exertional dyspnea. Chest, 101(4), 965–969. https://doi.org/10.1378/chest.101.4.965

Molgat-seon, Y., Schaeffer, M. R., & Ryerson, C. J. (2019). E x e rc i s e P a t h o p h y s i o l o g y in Interstitial Lung Disease. Clinics in Chest Medicine, 40(2), 405–420. https://doi.org/10.1016/j.ccm.2019.02.011

Molgat-seon, Y., Schaeffer, M. R., Ryerson, C. J., Guenette, J. A., Domnik, N. J., & Valli, G. (2020). Cardiopulmonary Exercise Testing in Patients With Interstitial Lung Disease. Front Physiol, 11(July), 1–8. https://doi.org/10.3389/fphys.2020.00832

Neder, J. A., Andreoni, S., Lerario, M. C., & Nery, L. E. (1999). Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Brazilian Journal of Medical and Biological Research, 32(6), 719–727. https://doi.org/10.1590/S0100-879X1999000600007

Neder, J. A., Nery, L. E., Castelo, A., Andreoni, S., Lerario, M. C., Sachs, A., Silva, A. C., & Whipp, B. J. (1999). Prediction of metabolic and cardiopulmonary responses to maximum cycle ergometry: A randomised study. European Respiratory Journal, 14(6), 1304–1313. https://doi.org/10.1183/09031936.99.14613049

Nishiyama, O., Taniguchi, H., Kondoh, Y., Kimura, T., Ogawa, T., Watanabe, F., & Arizono, S. (2005). Quadriceps weakness is related to exercise capacity in idiopathic pulmonary fibrosis. Chest, 127(6), 2028–2033. https://doi.org/10.1378/chest.127.6.2028

Panagiotou, M., Polychronopoulos, V., & Strange, C. (2016). Respiratory and lower limb muscle function in interstitial lung disease. Chronic Respiratory Disease, 13(2), 162–172. https://doi.org/10.1177/1479972315626014

Pereira, A., Shitsuka, D., Parreira, F., & Shitsuka, R. (2018). Metodologia de pesquisa cientifíca. In Metodologia da Pesquisa Científica. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1. Acesso em: 28 março 2020.

Phillips, D. B., Collins, S., & Stickland, M. K. (2020). Measurement and Interpretation of Exercise Ventilatory Efficiency. Frontiers in Physiology, 11(June). https://doi.org/10.3389/fphys.2020.00659

Rabinovich RA, Louvaris Z, Raste Y, et al. (2013). Validity of physical activity monitors during daily life in patients with COPD. Eur Respir J., 42(5), 1205–1215.

Radtke, T., Crook, S., Kaltsakas, G., Louvaris, Z., Berton, D., Urquhart, D. S., Kampouras, A., Rabinovich, R. A., Verges, S., Kontopidis, D., Boyd, J., Tonia, T., Langer, D., De Brandt, J., Goërtz, Y. M. J., Burtin, C., Spruit, M. A., Braeken, D. C. W., Dacha, S., … Hebestreit, H. (2019). ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases. European Respiratory Review, 28(154). https://doi.org/10.1183/16000617.0101-2018

Raghu, G., Remy-Jardin, M., Myers, J. L., Richeldi, L., Ryerson, C. J., Lederer, D. J., Behr, J., Cottin, V., Danoff, S. K., Morell, F., Flaherty, K. R., Wells, A., Martinez, F. J., Azuma, A., Bice, T. J., Bouros, D., Brown, K. K., Collard, H. R., Duggal, A., … Wilson, K. C. (2018). Diagnosis of idiopathic pulmonary fibrosis An Official ATS/ERS/JRS/ALAT Clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 198(5), e44–e68. https://doi.org/10.1164/rccm.201807-1255ST

Rajala K., Lehto J.T., Sutinen E., Kautiainen H.,Myllarniemi M., S. T. (2017). mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis. ERJ Open Res, 3.

Ramadurai, D., Riordan, M., Graney, B., Churney, T., Olson, A. L., & Swigris, J. J. (2018). The impact of carrying supplemental oxygen on exercise capacity and dyspnea in patients with interstitial lung disease. Respiratory Medicine, 138(February), 32–37. https://doi.org/10.1016/j.rmed.2018.03.025

Robert O. Crapo, A. H. M. (1981). Standardized single breath normal values for carbon monoxide diffusing capacity. The American Review of Respiratory, 123(2), 185–189.

Robles, P. G., Mathur, S., Janaudis-Fereira, T., Dolmage, T. E., Goldstein, R. S., & Brooks, D. (2011). Measurement of peripheral muscle strength in individuals with chronic obstructive pulmonary disease: A systematic review. Journal of Cardiopulmonary Rehabilitation and Prevention, 31(1), 11–24. https://doi.org/10.1097/HCR.0b013e3181ebf302

Senanayake, S. P., Harrison, K., Hilldrup, S., & Lewis, M. (2020). Influence of Rehabilitation on Oxygen Uptake Kinetics during High Intensity Exercise in Patients with Idiopathic Pulmonary Fibrosis. Open Journal of Respiratory Diseases, 10(04), 59–74. https://doi.org/10.4236/ojrd.2020.104007

Vainshelboim, B., Oliveira, J., Fox, B. D., Adir, Y., Ollech, J. E., & Kramer, M. R. (2016). Physiological profile and limitations in exercise in idiopathic pulmonary fibrosis. Journal of Cardiopulmonary Rehabilitation and Prevention, 36(4), 270–278. https://doi.org/10.1097/HCR.0000000000000177

Wanger, J., Clausen, J. L., Coates, A., Pedersen, O. F., Brusasco, V., Burgos, F., Casaburi, R., Crapo, R., Enright, P., Grinten, C. P. M. Van Der, Gustafsson, P., Hankinson, J., Jensen, R., Johnson, D., Macintyre, N., Mckay, R., Miller, M. R., Navajas, D., Pellegrino, R., & Viegi, G. (2005). Standardisation of the measurement of lung volumes. ERJ, 26(3), 511–522. https://doi.org/10.1183/09031936.05.00035005

Wasserman, K., Hansen, J., & Sue, D. (1991). Facilitation of Oxygen Consumption by Lactic Acidosis During Exercise. Physiology, 6(1), 29–34. https://doi.org/10.1152/physiologyonline.1991.6.1.29

Published

13/07/2022

How to Cite

BERTIN, L. D.; JORGE, M. P.; FAN, O. G.; GOIS JUNIOR, E. .; ZAMBOTI, C. L.; KRINSKI, G. G.; PIMPÃO, H. A.; PITTA, F.; CAMILLO, C. A. Relationship between workload and symptoms during the ergometric test in patients with interstitial lung disease and healthy individuals . Research, Society and Development, [S. l.], v. 11, n. 9, p. e38011931863, 2022. DOI: 10.33448/rsd-v11i9.31863. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/31863. Acesso em: 16 nov. 2024.

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Section

Health Sciences