Manipulation of mechanical ventilatory constraint during moderate intensity exercise does not influence dyspnoea in healthy older men and women

Key Point Summary

The perceived intensity of exertional breathlessness (i.e. dyspnoea) is higher in older women than in older men, possibly due to sex‐difference respiratory system morphology. During exercise at a given absolute intensity or minute ventilation, older women have a greater degree of mechanical ventilatory constraint (i.e. work of breathing and expiratory flow limitation) than their male counterparts, which may lead to a greater perceived intensity of dyspnoea. Using a single‐blind randomized study design, we experimentally manipulated the magnitude of mechanical ventilatory constraint during moderate‐intensity exercise at ventilatory threshold in healthy older men and women. We found that changes in the magnitude of mechanical ventilatory constraint within the physiological range had no effect on dyspnoea in healthy older adults. When older men and women perform submaximal exercise at a moderate intensity, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea. We sought to determine the effect of manipulating mechanical ventilatory constraint during submaximal exercise on dyspnoea in older men and women. Methods: Eighteen healthy subjects (60‐80 y; 9 men, 9 women) completed two days of testing. On Day 1, subjects performed pulmonary function testing and a maximal incremental cycle exercise test. On Day 2, subjects performed three 6‐min bouts of cycling at ventilatory threshold, in a single‐blind randomized manner, while breathing: i) normoxic helium‐oxygen (HEL) to reduce the work of breathing (W_b) and alleviate expiratory flow limitation (EFL); ii) through an inspiratory resistance (RES) of ∼5 cmH₂O·l⁻¹·s⁻¹ to increase W_b; and iii) ambient air as a control (CON). Oesophageal pressure, diaphragm electromyography, and sensory responses (using the category‐ratio 10 Borg scale) were monitored throughout exercise. Results: During the HEL condition, there was a significant decrease in W_b (men: –21 ± 6%, women: –17 ± 10%) relative to CON (both p < 0.01). Moreover, if EFL was present during CON (4 men, 5 women), it was alleviated during HEL. Conversely, during the RES condition, W_b (men: 42 ± 19%, women: 50 ± 16%) significantly increased relative to CON (both p < 0.01). There was no main effect of sex on W_b (p = 0.59). Across conditions, women reported significantly higher dyspnoea intensity than men (2.9 ± 0.9 vs. 1.9 ± 0.8 Borg scale units, p < 0.05). Despite significant differences in the degree of mechanical ventilatory constraint between conditions, dyspnoea intensity was unaffected, independent of sex (p = 0.46). Conclusion: When older men and women perform submaximal exercise at a moderate intensity, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea.

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