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.

Keywords: Inspiratory muscles; ergospirometry; exercise testing; respiratory physiology.; twitch pressures.

Fig. (1).

Study protocol. HEET = heavy-intensity exercise testing; NIV = non-invasive ventilation; SB = spontaneous breathing; V’O_2max = maximal oxygen uptake.

Fig. (2).

Progression of twitch mouth pressures (TwPmo) for the two consecutive exercise protocols and recovery phase during spontaneous breathing (left panel) and during non-invasive ventilation (right panel). Data are presented as mean. T-bars represent 95% confidence interval of the mean. I-V represent consecutive measurements. HEET = heavy-intensity exercise testing; NIV = non-invasive ventilation; SB = spontaneous breathing.

Fig. (3).

Progression of twitch transdiaphragmatic pressures (TwPdi) for the two consecutive exercise protocols and recovery phase during spontaneous breathing (left panel) and during non-invasive ventilation (right panel). Data are presented as mean. T-bars represent 95% confidence interval of the mean. I-V represent consecutive measurements. HEET = heavy-intensity exercise testing; NIV = non-invasive ventilation; SB = spontaneous breathing.