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The Role of Moderate Aerobic Exercise as Determined by Cardiopulmonary Exercise Testing in ALS.

ABSTRACT: Introduction:The efficacy of cardiopulmonary exercise testing (CPET) to determining exercise intensity has not been established in Amyotrophic Lateral Sclerosis (ALS). We studied this intervention. Methods:We included 48 ALS patients randomized in 2 groups: G1 (n = 24), exercise intensity leveled by CPET; G2 (n = 24), standard care limited by fatigue, during 6 months. ALS functional scale (ALSFRS-R) and forced vital capacity (FVC) were performed every 3 months; CPET was done at admission (T1) and 6 months later (T2). We registered oxygen uptake, carbon dioxide output, and ventilation at anaerobic threshold and at peak effort. Primary outcome was functional change. We used parametric statistics for comparisons and multiple regression analyses to identify independent predictors of functional decline. Results:At T1 both groups were identical, except for higher FVC in G1 (p = 0.02). At T2, ALSFRS-R was higher (p = 0.035) in G1. Gas exchange variables at T2 did not change in G1 but had significant differences in G2 (p < 0.05). Multiregression analyses showed the Spinal ALSFRS-R slope and Intervention group (p < 0.001) as significant predictors of ALSFRS-R at T2. Conclusion:Aerobic exercise defined by CPET is feasible and can improve functional outcome in ALS. This trial is registered with Clinical trials.gov ID: NCT03326622.

SUBMITTER: Braga ACM

PROVIDER: S-EPMC5832023 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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The Role of Moderate Aerobic Exercise as Determined by Cardiopulmonary Exercise Testing in ALS.

Braga Anna Caroline Marques ACM Pinto Anabela A Pinto Susana S de Carvalho Mamede M

Neurology research international 20180131

<h4>Introduction</h4>The efficacy of cardiopulmonary exercise testing (CPET) to determining exercise intensity has not been established in Amyotrophic Lateral Sclerosis (ALS). We studied this intervention.<h4>Methods</h4>We included 48 ALS patients randomized in 2 groups: G1 (<i>n</i> = 24), exercise intensity leveled by CPET; G2 (<i>n</i> = 24), standard care limited by fatigue, during 6 months. ALS functional scale (ALSFRS-R) and forced vital capacity (FVC) were performed every 3 months; CPET ...[more]

PMID: 29666705

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Project description:Background and Objectives: Obstructive sleep apnea (OSA) is associated with daytime somnolence, cognitive impairment and high cardiovascular morbidity and mortality. Obesity, associated cardiovascular comorbidities, accelerated erythropoiesis and muscular mitochondrial energetic dysfunctions negatively influence exercise tolerance in moderate-severe OSA patients. The cardiopulmonary exercise testing (CPET) offers an integrated assessment of the individual's aerobic capacity and helps distinguish the main causes of exercise limitation. The purpose of this study is to evaluate the aerobic capacity of OSA patients, before and after short-term continuous positive airway pressure (CPAP). Materials and Methods: Our prospective study included 64 patients with newly diagnosed moderate-severe OSA (apnea hypopnea index (AHI) 39.96 ± 19.04 events/h) who underwent CPET before and after CPAP. Thirteen patients were unable to tolerate CPAP or were lost during follow-up. Results: 49.29% of our patients exhibited a moderate or severe decrease in functional capacity (Weber C or D). CPET performance was influenced by gender but not by apnea severity. Eight weeks of CPAP induced significant improvements in maximal exercise load (? = 14.23 W, p = 0.0004), maximum oxygen uptake (? = 203.87 mL/min, p = 0.004), anaerobic threshold (? = 316.4 mL/min, p = 0.001), minute ventilation (? = 5.1 L/min, p = 0.01) and peak oxygen pulse (? = 2.46, p = 0.007) as well as a decrease in basal metabolic rate (BMR) (? = -8.3 kCal/24 h, p = 0.04) and average Epworth score (? = -4.58 points, p < 0.000001). Conclusions: Patients with moderate-severe OSA have mediocre functional capacity. Apnea severity (AHI) was correlated with basal metabolic rate, resting heart rate and percent predicted maximum effort but not with anaerobic threshold or maximum oxygen uptake. Although CPET performance was similar in the two apnea severity subgroups, short-term CPAP therapy significantly improved most CPET parameters, suggesting that OSA per se has a negative influence on effort capacity.

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The Role of Moderate Aerobic Exercise as Determined by Cardiopulmonary Exercise Testing in ALS.

Publications

The Role of Moderate Aerobic Exercise as Determined by Cardiopulmonary Exercise Testing in ALS.

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