Exercise-induced Respiratory Muscle Work: Effects on Blood Flow, Fatigue and Performance

In healthy subjects, heavy intensity endurance exercise places substantial demands on the respiratory muscles as breathing frequency, ventilation and the work of breathing rise over time. In the highly trained subject working at high absolute work rates, the ventilatory demand often causes varying degrees of expiratory flow limitation, sometimes accompanied by lung hyperinflation and, therefore, increased elastic work of breathing. Time-dependant increases in effort perceptions for both dyspnea and limb discomfort accompany these increased ventilatory demands. Similar responses to endurance exercise but at much lower exercise intensities also occur in patients with COPD and CHF. Note that these responses significantly influence exercise performance times in both health and disease. This effect was demonstrated by the marked reductions in the rate of rise of effort perceptions and the enhanced exercise performance times elicited by unloading the respiratory muscles using pressure support ventilation or proportional assist mechanical ventilation. In healthy fit subjects, unloading the inspiratory work of breathing by about one half increased performance by an average of 14% (Harms et al. 2000), and in CHF and COPD patients performance time more than doubled with respiratory muscle unloading (O’Donnell et al. 2001). Why are effort perceptions of limb discomfort markedly reduced and exercise performance increased when the respiratory muscles are unloaded? Our hypothesis is shown in Fig. 1.