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1 Dipartimento di Medicina Clinica, University of Rome "La Sapienza," and 2 Consiglio Nazionale delle Ricerche, 00185 Rome, Italy
To test the hypothesis that in chronic
obstructive pulmonary disease (COPD) patients the ventilatory and
metabolic requirements during cycling and walking exercise are
different, paralleling the level of breathlessness, we studied nine
patients with moderate to severe, stable COPD. Each subject underwent
two exercise protocols: a 1-min incremental cycle ergometer exercise
(C) and a "shuttle" walking test (W). Oxygen uptake
(
O2), CO2
output (CO2), minute ventilation (E), and heart rate (HR)
were measured with a portable telemetric system. Venous blood lactates
were monitored. Measurements of arterial blood gases and pH were
obtained in seven patients. Physiological dead space-tidal volume ratio
(VD/VT) was computed. At peak exercise, W vs. C
O2,
E, and HR values were similar, whereas
CO2 (848 ± 69 vs. 1,225 ± 45 ml/min; P < 0.001) and lactate (1.5 ± 0.2 vs. 4.1 ± 0.2 meq/l; P < 0.001) were lower, 
E/CO2
(35.7 ± 1.7 vs. 25.9 ± 1.3; P < 0.001) and
HR/O2 values (51 ± 3 vs. 40 ± 4; P < 0.05) were significantly
higher. Analyses of arterial blood gases at peak exercise revealed
higher VD/VT and lower arterial partial
pressure of oxygen values for W compared with C. In COPD, reduced
walking capacity is associated with an excessively high ventilatory
demand. Decreased pulmonary gas exchange efficiency and arterial
hypoxemia are likely to be responsible for the observed findings.
exercise; chronic obstructive pulmonary disease; pulmonary gas exchange; ventilatory demand
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