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Am J Physiol Regul Integr Comp Physiol. 2019 Mar 1;316(3):R199-R209. doi: 10.1152/ajpregu.00290.2018. Epub 2019 Jan 2.

Effects of heavy-intensity priming exercise on pulmonary oxygen uptake kinetics and muscle oxygenation in heart failure with preserved ejection fraction.

Author information

1
College of Kinesiology, University of Saskatchewan , Saskatoon, SK , Canada.
2
College of Medicine, University of Saskatchewan , Saskatoon, SK , Canada.
3
School of Physical Therapy, University of Saskatchewan , Saskatoon, SK , Canada.
4
Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, College of Nursing and Health Innovation, University of Texas at Arlington , Arlington, Texas.

Abstract

Exercise intolerance is a hallmark feature in heart failure with preserved ejection fraction (HFpEF). Prior heavy exercise ("priming exercise") speeds pulmonary oxygen uptake (V̇o2p) kinetics in older adults through increased muscle oxygen delivery and/or alterations in mitochondrial metabolic activity. We tested the hypothesis that priming exercise would speed V̇o2p on-kinetics in patients with HFpEF because of acute improvements in muscle oxygen delivery. Seven patients with HFpEF performed three bouts of two exercise transitions: MOD1, rest to 4-min moderate-intensity cycling and MOD2, MOD1 preceded by heavy-intensity cycling. V̇o2p, heart rate (HR), total peripheral resistance (TPR), and vastus lateralis tissue oxygenation index (TOI; near-infrared spectroscopy) were measured, interpolated, time-aligned, and averaged. V̇o2p and HR were monoexponentially curve-fitted. TPR and TOI levels were analyzed as repeated measures between pretransition baseline, minimum value, and steady state. Significance was P < 0.05. Time constant (τ; tau) V̇o2p (MOD1 49 ± 16 s) was significantly faster after priming (41 ± 14 s; P = 0.002), and the effective HR τ was slower following priming (41 ± 27 vs. 51 ± 32 s; P = 0.025). TPR in both conditions decreased from baseline to minimum TPR ( P < 0.001), increased from minimum to steady state ( P = 0.041) but remained below baseline throughout ( P = 0.001). Priming increased baseline ( P = 0.003) and minimum TOI ( P = 0.002) and decreased the TOI muscle deoxygenation overshoot ( P = 0.041). Priming may speed the slow V̇o2p on-kinetics in HFpEF and increase muscle oxygen delivery (TOI) at the onset of and throughout exercise. Microvascular muscle oxygen delivery may limit exercise tolerance in HFpEF.

KEYWORDS:

heart failure with preserved ejection fraction; oxygen uptake kinetics; prior heavy exercise; tissue oxygenation index

PMID:
30601707
DOI:
10.1152/ajpregu.00290.2018
[Indexed for MEDLINE]

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