Disability and impairment in asbestosis and asbestos-related diffuse pleural disease
Dorsett D. Smith in The Health Effects of Asbestos, 2015
Exercise intolerance is a condition in which the individual is unable to perform a physical exercise at the intensity or the duration that would be expected from someone of their age, sex, height, race, and general physical condition. The inability to perform exercise is generally related either to a cardiovascular, respiratory, neurological, or peripheral muscle disorder. When the inability to perform exercise is caused by impaired function of one or more of the major physiological systems, namely the respiratory, the cardiovascular, or the peripheral muscle metabolic system, the result is the amplification of the perceptions of respiratory discomfort, either alone or typically in conjunction with peripheral muscle discomfort/fatigue. In patients with chronic lung diseases, dyspnea sensations are exaggerated during exercise, secondary to the reduced breathing efficiency that results from the deteriorating ventilatory mechanics on the one hand and the increased ventilatory requirements on the other hand.
Respiratory limitations to exercise
John W. Dickinson, James H. Hull in Complete Guide to Respiratory Care in Athletes, 2020
The structure of the lungs (e.g. large surface area and thin blood-gas barrier to maximise diffusion of gases), airways (e.g. richly innervated by β2 adrenergic receptors to improve laminar airflow) and respiratory muscles (e.g. high oxidative capacity to prevent fatigue) are well suited to their function – a concept known as symmorphosis. However, no bodily system is without limitation. A respiratory-related threat to arterial O2 content (CaO2) and convective O2 transport may exist under certain conditions of exercise in both healthy athletic humans and in those with respiratory disease. As will be described in the later chapters in this book, both upper and lower airway disorders such as exercise-induced laryngeal obstruction (EILO), asthma and exercise-induced bronchoconstriction (EIB) respectively, may impair respiratory function and lead to exercise limitation. This chapter will examine and summarise how several conditions may impact the respiratory system and lead to exercise intolerance.
Oxidative Stress and Exercise Tolerance in Cystic Fibrosis
James N. Cobley, Gareth W. Davison in Oxidative Eustress in Exercise Physiology, 2022
Oxidative stress is a key contributor to the pathogenesis of several diseases and is a common phenotype in people with CF. Although a moderate level of ROS is essential in keeping the optimal function and energy production in the cell, an excess accumulation can cause damage to the cells and result in the loss of pulmonary, cardiovascular, and skeletal muscle function. Exercise intolerance is also a distinguishing characteristic in CF and routine exercise testing has great clinical prognostic value. Although pulmonary dysfunction may not play a key role, the mechanisms that contribute to exercise intolerance in CF, to date, have yet to be fully elucidated. Indeed, there is evidence to support the negative role that oxidative stress has on cardiovascular and skeletal muscle function. Accordingly, elevated systemic oxidative stress may likely impact the function of many biological systems, contributing to exercise intolerance in people with CF.
Stress echocardiography in valvular heart disease
Published in Expert Review of Cardiovascular Therapy, 2018
Sveeta Badiani, Peter Waddingham, Guy Lloyd, Sanjeev Bhattacharyya
The MV orifice area and trans-mitral gradient is dynamic. Exercise in patients with mitral stenosis with restricted MV orifice increases heart rate leading to a reduction in diastolic filling time and increase in trans-mitral gradient which in turn causes an exponential increase in left atrial and pulmonary capillary pressure [65,66]. In addition, left atrial compliance modulates the hemodynamic effect of mitral stenosis on the pulmonary vasculature and PASP [67]. These physiological changes explain symptom onset on exercise in mitral stenosis quantified as moderate at rest. However, left atrial pressure and symptoms of dyspnea are determined by more than just the degree of MV stenosis. Exercise intolerance may often be multifactorial particularly in elderly patients. Additional factors include restrictive lung function and chronotropic incompetence. Limited stroke volume reserve may also play a part and needs to be considered [66].
Determinants of exercise capacity in children and adolescents with severe therapy-resistant asthma
Published in Journal of Asthma, 2022
Cláudia Silva Schindel, Daniele Schiwe, João Paulo Heinzmann-Filho, Mailise Fátima Gheller, Natália Evangelista Campos, Paulo Márcio Pitrez, Márcio Vinícius Fagundes Donadio
Although aerobic fitness, as an isolated factor, does not differ between mild-to-moderate asthmatics and healthy children, the interaction between habitual physical activity levels and exercise tolerance may impact asthmatic patients (12). In the present study, VO2peak and ventilatory efficiency were significantly correlated with resting HR. This finding may be of clinical and prognostic relevance because individuals with good aerobic fitness tend to have lower resting HR (42), and HR measurement is a simple and inexpensive procedure. In addition, healthy adolescents with higher levels of habitual physical activity also present lower resting HR (44). Other determinant factors that may contribute to exercise intolerance include the concern that physical exertion might trigger bronchial obstruction and obesity. In a study examining the relationships among asthma severity, level of physical activity, aerobic fitness, and body weight in asthmatic children, asthma severity was not associated with oxygen consumption, but there was a strong association of aerobic fitness with perceived competence in physical activity, weight gain, and greater medication needs (6). The elevated heart rate found in the present study, both at rest and at the AT, may indicate deconditioning, although other possible influencing factors, as anxiety levels in patients with asthma, cannot be ruled out.
Current practice in atrial septal defect occlusion in children and adults
Published in Expert Review of Cardiovascular Therapy, 2020
Wail Alkashkari, Saad Albugami, Ziyad M. Hijazi
Most children with an ASD present with a murmur and are asymptomatic. Occasionally infants may present with breathlessness, recurrent chest infections, and even congestive heart failure. Failure to thrive is an uncommon presentation [13]. Adults with an ASD typically have a prolonged asymptomatic course. Symptom onset is insidious, most often occurring in the third or fourth decade. Women may become symptomatic earlier specially during the physiologic demands of pregnancy or labor [6]. Most of the symptoms initially related to exertion and this is related to decrease in cardiac output due to the shunting. These symptoms may include, shortness of breath, fatigue, and exercise intolerance. Palpitations may indicate the development of atrial arrhythmias such as atrial fibrillation and this is due to atrial stretch. Ultimately, they will suffer from right-sided congestive heart failure, with peripheral edema [5]. Syncope may indicate ventricular arrhythmias but also can be related to low cardiac output, heart failure, and/or PAH. In the absence of other CHD or lung disease, cyanosis indicates the development of severe PAH and Eisenmenger syndrome. Cyanosis can occur in the presence of severe TR and/or RV failure especially during exercise. Paradoxical emboli are well-known complications and it may occur even with small defects [14].
Related Knowledge Centers
- Exercise
- Fatigue
- Myocardial Infarction
- Shortness of Breath
- Syndrome
- Vomiting
- Nausea
- Pain
- Myalgia
- Physical Activity
- Shortness of Breath