title: Non-invasive ventilation applied for recovery from exercise-induced diaphragmatic fatigue.
abstract: BACKGROUND
  Exercise-induced diaphragmatic fatigue (DF) is conventionally considered to reflect impaired diaphragm function resulting from load imposed on the diaphragm during exercise and is known to be reduced by the application of non-invasive ventilation (NIV) during heavy-intensity exercise testing (HEET). On that physiological condition NIV applied for diaphragm unloading during recovery from exercise should be capable of accelerating recovery from DF and therewith prolonging exercise time to exhaustion and limiting the development of DF during a subsequent HEET compared to recovery during spontaneous breathing.
  
  
  METHODS
  Seven highly-trained subjects (V'O(2max) 62.7±7.8 ml/kg/min) performed four HEET at 85% V'O(2max) with 60 min of recovery during I spontaneous breathing and II NIV between two HEET.
  
  
  RESULTS
  Twitch transdiaphragmatic pressure (TwPdi) during supramaximal magnetic phrenic nerve stimulation decreased (p<0.04) following first HEET and subsequently completely recovered (p>0.2) during I and II. Following second HEET TwPdi comparably decreased (I 0.24±0.21 vs II 0.32±0.29 kPa; p=0.17). Exercise time to exhaustion during second HEET was equal during I and II (I 514±49 vs II 511±92 s; p=0.88).
  
  
  CONCLUSIONS
  In conclusion, NIV applied for diaphragm unloading during recovery following HEET does neither affect recovery from DF nor subsequent exercise performance thereby providing further evidence that DF might reflect post-exercise diaphragm shielding rather than impaired diaphragm function.
authors.affiliation: Department of Pneumologya, University Hospital Freiburg, Killianstrasse 5, D-79106 Freiburg, Germany. hans-joachim.kabitz@uniklinik-freiburg.de
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Kabitz
authors.forename: David
authors.initials: D
authors.lastname: Walker
authors.forename: Stephan
authors.initials: S
authors.lastname: Prettin
authors.forename: Stephan
authors.initials: S
authors.lastname: Walterspacher
authors.forename: Florian
authors.initials: F
authors.lastname: Sonntag
authors.forename: Michael
authors.initials: M
authors.lastname: Dreher
authors.forename: Wolfram
authors.initials: W
authors.lastname: Windisch