Noninvasive Ventilation Before Maximum Exercise Test Increases Exercise Tolerance in Subjects With Heart Failure: A Crossover Study

• Published in: Archives of physical medicine and rehabilitation Vol. 98; no. 5; pp. 849 - 855
• Main Authors: Carvalho, Larissa de Andrade, MSc, Brandão, Daniella Cunha, PhD, Campos, Shirley Lima, PhD, Vidal, Tainá Maria de Souza, MSc, Remígio, Maria Inês, PhD, Martins, Sílvia Marinho, PhD, Dornelas de Andrade, Armèle, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Adult; Aged; Cross-Over Studies; Exercise test; Exercise Test - methods; Exercise Tolerance - physiology; Female; Heart failure; Heart Failure - rehabilitation; Heart Rate; Humans; Male; Middle Aged; Noninvasive ventilation; Noninvasive Ventilation - methods; Oxygen Consumption; Physical Medicine and Rehabilitation; Rehabilitation; Respiratory Function Tests; Single-Blind Method; Heart failure; CPET; V ˙ o 2peak; peak oxygen uptake; Noninvasive ventilation; NIV; Rehabilitation; Exercise test; cardiopulmonary exercise testing; HF; V˙o2peak
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2016.09.129

Abstract Objective To evaluate the effect of noninvasive ventilation (NIV) on exercise performance in individuals with heart failure (HF). Design Crossover, blind, randomized controlled trial with allocation concealment. Setting University-based research laboratory. Participants Participants (N=24) with New York Heart Association class II and III left heart failure and with a mean age of 51.8±10.2 years (women: n=8; men: n=16). Interventions Ventilatory support attached to the face of the individual via a facemask prior to cardiopulmonary exercise test (CPET) was administered at 2 pressure levels for 30 minutes. Inspiratory pressure of 15cmH2 O and expiratory pressure of 5cmH2 O were applied. Main Outcome Measures Maximal oxygen uptake, maximum heart rate, variation between the initial and maximum heart rates, CPET duration, and recovery time oxygen consumption. Results Differences were observed in maximal oxygen consumption (nonintervention phase: 18.3±4.4mL·kg−1 ·min−1 vs NIV phase: 20.6±4.9mL·kg−1 ·min−1 , P =.01), heart rate (nonintervention phase: 127.3±20.9 beats per minute vs NIV phase: 134.7±19.5 beats per minute, P =.04), and heart rate variation (nonintervention phase: 63.3%±19.3% vs NIV phase: 69.7%±16.6%, P =.02). Moreover, differences in cardiopulmonary exercise time (nonintervention phase: 7.4±1.5min vs NIV phase: 8.3±1.7min, P =.01) and oxygen consumption recovery time (nonintervention phase: 2.8±1.0min vs NIV phase: 2.4±0.8min, P =.01) were observed. Conclusions NIV elicited beneficial effects in the HF population that included increased exercise tolerance, recovery time optimization, and improved chronotropic and respiratory reserves.