title: Noninvasive ventilation improves the cardiovascular response and fatigability during resistance exercise in patients with heart failure.
abstract: OBJECTIVE
  Noninvasive ventilation may improve cardiovascular function and exercise performance. We evaluated the physiologic impact of noninvasive ventilation during isokinetic knee extension resistance exercise in patients with heart failure.
  
  
  METHODS
  This clinical trial included 10 male compensated patients with ischemic heart failure (age, 57 ± 9.1 years; ejection fraction, 28.5 ± 5.8%). Subjects underwent 2 bouts of exercise on an isokinetic dynamometer, separated by 72 hours of rest. The resistance exercise was concentric knee extension, at a speed of 60°/s. Five sets of 10 repetitions were performed during the 2 exercise bouts, and each set was separated by 2 minutes of rest. Subjects were administered either bilevel positive airway pressure ventilation (BV) or sham ventilation 20 minutes before and during the 2 exercise sessions in a randomized fashion. Heart rate, systolic blood pressure, and diastolic blood pressure were measured at rest, during exercise, and into recovery. Changes in peak torque (ΔPT), total work (ΔTW), and power (ΔPw) between the fifth and first sets were also measured.
  
  
  RESULTS
  Compared with the sham intervention, BV significantly decreased heart rate, systolic blood pressure, and diastolic blood pressure at rest and during exercise (P < .01). There were no significant differences in these variables during recovery. Bi-level positive airway pressure ventilation also significantly reduced ΔPT, ΔTW, and ΔPw compared with the sham intervention (P < .01).
  
  
  CONCLUSIONS
  Bi-level positive airway pressure ventilation significantly improved the cardiovascular response and fatigability during resistance exercise in patients with heart failure. These results suggest that use of BV during exercise training may be beneficial in this population with chronic disease.
authors.affiliation: Division of Physical Therapy and Health Sciences and Technologies (Messrs da Silva and Campos; Drs Lima, G. B. Cipriano, Martins; and G. Cipriano, and Ms da Silva) and Physical Education College (Dr Bottaro), University of Brasilia, Brasilia, Brazil); Ergometry and Sports Medicine Department, Heart Institute of Distrito Federal, Brasilia, Brazil (Mr da Silva and Dr Lima); Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago (Dr Arena); and Laboratory of Exercise Physiopathology, Department of Cardiology, Hospital de Clínicas, Porto Alegre, RS, Brazil (Dr Chiappa).
authors.forename: Vinicius Z Maldaner
authors.initials: VZ
authors.lastname: da Silva
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lima
authors.forename: Graziella B
authors.initials: GB
authors.lastname: Cipriano
authors.forename: Marianne Lucena
authors.initials: ML
authors.lastname: da Silva
authors.forename: Filippe V
authors.initials: FV
authors.lastname: Campos
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.forename: Wagner Rodrigues
authors.initials: WR
authors.lastname: Martins
authors.forename: Gaspar
authors.initials: G
authors.lastname: Chiappa
authors.forename: Martim
authors.initials: M
authors.lastname: Bottaro
authors.forename: Gerson
authors.initials: G
authors.lastname: Cipriano
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005221:Fatigue / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods*; D010101:Oxygen Consumption; D016896:Treatment Outcome