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Articles in PresS, published online ahead of print January 11, 2002
J Appl Physiol, 10.1152/jap.00393.2000
Submitted on May 17, 2000
Accepted on December 11, 2001
1 Fondazione Don Gnocchi ONLUS, Pozzolatico, FI, Italy
2 Centro di Bioingegneria, Fondazione Don Gnocchi - Politecnico, Milano, Italy; Dipartimento di Bioingegneria, Politecnico di Milano, Milano, Italy
3 University of Geneva, Geneva, Switzerland
4 Fondazione Don Gnocchi ONLUS, Pozzolatico, FI, Italy; Westmead Hospital, Sydney, Australia
5 Clinica Medica III, Universita di Firenze, Firenze, Italy
6 Meakins-Christie Laboratories, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada
7 Fondazione Don Gnocchi ONLUS, Pozzolatico, FI, Italy; Clinica Medica III, Universita di Firenze, Firenze, Italy
8 Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
* To whom correspondence should be addressed. E-mail: aliverti{at}mail.cbi.polimi.it.
To understand how externally applied expiratory flow-limitation (EFL) leads to impaired exercise performance and dyspnea, we studied 6 healthy males during control incremental exercise to exhaustion (C) and with EFL at ~1LPS. We measured volume at the mouth (Vm), esophageal, gastric and transdiaphragmatic (Pdi) pressures, maximal exercise power (W'max) and the difference (<) in Borg scale ratings of breathlessness between C and EFL exercise. Opto-electronic plethysmography measured chest wall and lung volume (VL). From Campbell diagrams we measured alveolar (PA) and expiratory muscle (Pmus,e) pressures and from Pdi and abdominal motion, an index of diaphragmatic power (W'di). 4 subjects hyperinflated and 2 did not. EFL limited performance equally to 65% W'max with Borg = 9-10 in both. At EFL W'max, inspiratory time (Ti) ±SEM was 0.66s ±.08, expiratory time (Te), 2.12s±.26, Pmus,e ~40cmH2O and <VL- <Vm = 488.7ml ± 74.1. From PA and VL we calculated compressed gas volume (Vc) = 163.0ml±4.6. The difference, <VL- <Vm-Vc (estimated blood volume shift) was 326ml±66 or 7.2ml/cmH2O PA. The high Pmus,e, and long Te mimicked a Valsalva maneuver from which the short Ti did not allow recovery. Multiple stepwise linear regression revealed that the difference between C and EFL Pmus,e accounted for 70.3% of the variance in 
Borg. W'di added 12.5%. We conclude that high expiratory pressures cause severe dyspnea and the possibility of adverse circulatory events both of which would impair exercise performance.
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