Cinética de recuperação das respostas metabólicas e cardiovasculares após exercício de carga constante em pacientes com IC com e sem DPOC associada: efeitos da ventilação não invasiva

Abstract

Exercise intolerance is a multifactorial hallmark of both heart failure (HF) and chronic obstructive pulmonary disease (COPD). Following submaximal exercise, oxygen uptake (V̇O2) recovery kinetics seems to be limited by O2 delivery to exercising muscles. Interventions that target increasing skeletal muscle O2 delivery and/or reducing O2 demand might increase exercise tolerance and speed metabolic responses during exercise recovery. Therefore, two studies were performed and aimed to investigate the influence of co-existing HF and COPD on V̇O2, heart rate and cardiac output recovery kinetics after constant-load exercise test (CLET) and to explore the effects of non-invasive positive pressure ventilation (NIPPV) on exercise recovery kinetics in patients with co-existing HF and COPD. The first one, titled “Central haemodynamics and oxygen uptake recovery kinetics during high and moderate intensity exercise: the negative impact of co-existing heart failure and chronic obstructive pulmonary disease”, included 9 HF-COPD and 10 HF patients who underwent two CLET at moderate and high loads. The results suggest that the combination of HF and COPD may further impair exercise recovery kinetics, compared to HF alone. The second study, entitled “Noninvasive ventilation accelerates oxygen uptake recovery kinetics in patients with combined HF and COPD”, included the same patients who were submitted to a high-CLET with NIPPV. The results showed that NIPPV accelerated the V̇O2 recovery kinetics to a greater extent in patients with co-existing HF and COPD compared to HF alone. Hence, the recovery profile assessment after submaximal CLET might be helpful to comprehend the pathophysiologic characteristics that contribute to symptoms, such as dyspnea and fatigue, and exercise intolerance. NIPPV should be considered when the objective is to apply high-intensity interval exercise training as an adjunct intervention during cardiopulmonary rehabilitation program.