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Lung function in relation to exercise capacity in health and disease
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. (Klinisk fysiologi)ORCID iD: 0000-0002-5970-5836
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Exercise capacity (EC) is widely recognized as a strong and independent predictor of mortality and disease progression in various diseases, including cardiovascular and pulmonary diseases. Furthermore, it is generally accepted that exercise capacity in healthy individuals and in patients suffering from cardiovascular diseases is mainly limited by the maximum cardiac output.

Objectives: This thesis investigated the impact of different lung function indices on EC in healthy individuals, patients with cardiovascular disease (e.g., pulmonary hypertension (PH)) and patients with pulmonary disease (e.g., chronic obstructive pulmonary disease (COPD)).

Methods: The present thesis is based on cross-sectional and longitudinal analyses of patients suffering from COPD, attending pulmonary rehabilitation at Uppsala University Hospital (studies I and II), and healthy men enrolled in the “Oslo ischemia study” (study IV). Study III is a cross-sectional study of patients suffering from PH attending the San Giovanni Battista University Hospital in Turin. EC was assessed using a bicycle ergometer in studies I and IV, with 12-minute walk tests (12MWT) in study II and with 6-minute walk tests (6MWT) in study III. Extensive pulmonary function tests, including diffusing capacity of the lung (DLCO), were performed in studies I-III and dynamic spirometry was used to assess lung function in study IV.

Results: DLCO is more closely linked to decreased levels of EC than airway obstruction in COPD patients. Furthermore, the decline in 12MWT over a 5-year period was mainly explained by deterioration in DLCO in COPD patients. Spirometric parameters indicating airway obstruction significantly related to EC and exercise-induced desaturation in PH patients. A significant, but weak association between lung function parameters and EC was found in healthy subjects and this association is strengthened with increasing age.

Conclusion: DLCO is the strongest predictor of low EC and EC decline in COPD. In PH, airway obstruction is strongly related to reduced 6MWT. Therefore, extensive analysis of lung function, including measurements of diffusing capacity, along with standard assessment of airway obstruction, gives a more comprehensive assessment of the functional exercise capacity in patients suffering from pulmonary hypertension or COPD. Lung function is also significantly linked to EC even in healthy subjects, lacking evident cardiopulmonary diseases.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , 78 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1295
Keyword [en]
Exercise capacity, Exercise test, Lung function, Spirometri, Diffusion capacity, COPD, Pulmonary hypertension
National Category
Respiratory Medicine and Allergy
Research subject
Clinical Physiology
Identifiers
URN: urn:nbn:se:uu:diva-313237ISBN: 978-91-554-9804-7 (print)OAI: oai:DiVA.org:uu-313237DiVA: diva2:1066399
Public defence
2017-03-10, Enghoffsalen, Akademiska sjukhuset, Ing 50, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-02-14 Created: 2017-01-18 Last updated: 2017-02-27
List of papers
1. Impaired Carbon Monoxide Diffusing Capacity is the Strongest Predictor of Exercise Intolerance in COPD
Open this publication in new window or tab >>Impaired Carbon Monoxide Diffusing Capacity is the Strongest Predictor of Exercise Intolerance in COPD
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2013 (English)In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 10, no 2, 180-185 p.Article in journal (Refereed) Published
Abstract [en]

Background: Exercise intolerance is a hallmark of chronic obstructive pulmonary disease (COPD) and forced expiratory volume in one second (FEV1) is the traditional metric used to define the severity of COPD. However, there is dissociation between FEV1 and exercise capacity in a large proportion of subjects with COPD. The aim of this study was to investigate whether other lung function parameters have an additive, predictive value for exercise capacity and whether this differs according to the COPD stage. Methods: Spirometry, body plethysmography and diffusing capacity for carbon monoxide (DLCO) were performed on 88 patients with COPD GOLD stages II-IV. Exercise capacity (EC) was determined in all subjects by symptom-limited, incremental cycle ergometer testing. Results: Significant relationships were found between EC and the majority of lung function parameters. DLCO, FEV1 and inspiratory capacity (IC) were found to be the best predictors of EC in a stepwise regression analysis explaining 72% of EC. These lung function parameters explained 76% of EC in GOLD II, 72% in GOLD III and 40% in GOLD IV. DLCO alone was the best predictor of exercise capacity in all GOLD stages. Conclusions: Diffusing capacity was the strongest predictor of exercise capacity in all subjects. In addition to FEV1, DLCO and IC provided a significantly higher predictive value regarding exercise capacity in COPD patients. This suggests that it is beneficial to add measurements of diffusing capacity and inspiratory capacity when clinically monitoring COPD patients.

Keyword
Chronic obstructive lung disease, exercise tests, lung function tests, diffusing capacity, spirometry, inspiratory capacity
National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-199449 (URN)10.3109/15412555.2012.734873 (DOI)000316954500009 ()
Available from: 2013-05-08 Created: 2013-05-06 Last updated: 2018-01-11
2. Impaired Carbon Monoxide Diffusing Capacity is the strongest lung function predictor of decline in 12 minute-walking distance in COPD: a 5-year follow-up study
Open this publication in new window or tab >>Impaired Carbon Monoxide Diffusing Capacity is the strongest lung function predictor of decline in 12 minute-walking distance in COPD: a 5-year follow-up study
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2015 (English)In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 12, no 3, 240-248 p.Article in journal (Refereed) Published
Abstract [en]

Background:

The purpose of this study was to evaluate the longitudinal relationship between functional exercise capacity, assessed through standardized 12-minute walk test (12 MWT), and various lung function parameters obtained using spirometry, body plethysmography and diffusing capacity (DLco) measurements in patients with COPD.

Methods:

Spirometry, body plethysmography and DLco-measurements were performed at baseline in 84 subjects with moderate to very severe COPD and at follow-up visit (n = 34) after 5 years. Functional exercise capacity was determined using standardized 12MWT.

Results:

Patients were characterized at baseline by FEV1 of 1.2 ± 0.4 L (41 ± 13% predicted), RV of 3.4 ± 1.0 L (187 ± 58% predicted) and DLco of 3.8 ± 1.2 mmol/min/kPa (51 ± 16% predicted). A decrease of 12MWD was found between baseline and follow-up (928 ± 193 m vs. 789 ± 273 m, p < 0.001). DLco and 12MWD at baseline were the only independent predictors of 12MWD at follow-up in a multiple logistic regression model that also included all other lung function parameters, gender, age and BMI. Decline in 12MWD was mainly explained by deterioration in DLco. Furthermore, DLco value at baseline had the highest explanatory value for the loss in 12MWD after 5 years (R2 = 0.18, p = 0.009).

Conclusions:

In a 5-year longitudinal study, DLco-measurements at baseline were the most important predictors of declining exercise capacity in COPD patients. These results suggest that integration of DLco in the clinical workup provides a more comprehensive assessment in patients with COPD.

National Category
Respiratory Medicine and Allergy Physiology
Identifiers
urn:nbn:se:uu:diva-232523 (URN)10.3109/15412555.2014.948991 (DOI)000357245600003 ()25208266 (PubMedID)
Available from: 2014-09-19 Created: 2014-09-19 Last updated: 2018-01-11
3. Lung function in relation to six-minute walk test in pulmonary hypertension
Open this publication in new window or tab >>Lung function in relation to six-minute walk test in pulmonary hypertension
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(English)Manuscript (preprint) (Other academic)
National Category
Respiratory Medicine and Allergy
Research subject
Clinical Physiology
Identifiers
urn:nbn:se:uu:diva-313225 (URN)
Available from: 2017-01-18 Created: 2017-01-18 Last updated: 2017-01-18
4. Longitudinal analysis of the association between lung function and exercise capacity in healthy Norwegian men
Open this publication in new window or tab >>Longitudinal analysis of the association between lung function and exercise capacity in healthy Norwegian men
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(English)Manuscript (preprint) (Other academic)
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-313223 (URN)
Available from: 2017-01-18 Created: 2017-01-18 Last updated: 2017-01-18

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