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. 2020 Mar:274:103365.
doi: 10.1016/j.resp.2019.103365. Epub 2019 Dec 30.

Multidimensional aspects of dyspnea in obese patients referred for cardiopulmonary exercise testing

Bryce N Balmain  1 , Kyle Weinstein  2 , Vipa Bernhardt  3 , Rubria Marines-Price  4 , Andrew R Tomlinson  5 , Tony G Babb  6
Affiliations

Multidimensional aspects of dyspnea in obese patients referred for cardiopulmonary exercise testing

Bryce N Balmain et al. Respir Physiol Neurobiol. 2020 Mar.

Abstract

We investigated the contributions of obesity on multidimensional aspects of dyspnea on exertion (DOE) in patients referred for clinical cardiopulmonary exercise testing (CPET). Ratings of perceived breathlessness (RPB, Borg scale 0-10) were collected in obese (BMI ≥ 30; n = 47) and nonobese (BMI ≤ 25; n = 27) patients during two (one lower: ∼30 W; and one higher: ∼50 W) 4-6 min constant load cycling bouts. Multidimensional dyspnea profiles (MDP) were collected in the final 26 obese and 14 nonobese patients of the sample. RPB was greater (p = 0.05) in obese (3.3 ± 2.2 vs 2.4 ± 1.4) at lower work rates, but similar at higher work rates (4.9 ± 2.2 vs 4.4 ± 1.8). MDP sensory score including unpleasantness was 4.3 ± 2.2 in obese vs 2.5 ± 1.9 in nonobese (p < 0.001). The affective score was 1.9 ± 2.2 vs 0.7 ± 0.7, respectively (p < 0.01). Breathing sensations including 'air hunger', 'effort', and 'breathing at lot' were greater (p < 0.05) in obese, making these patients more frustrated/angry (p < 0.05). Obesity should be considered as a potential independent influencing factor that provokes DOE and unpleasantness when assessing breathlessness during CPET.

Keywords: Breathlessness; Cardiorespiratory fitness; Exercise; Obesity; Shortness of breath.

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Conflict of interest statement

Declaration of Competing Interest Dr. Balmain has no conflicts of interest to disclose. Mr. Weinstein has no conflicts of interest to disclose. Dr. Bernhardt has no conflicts of interest to disclose. Dr. Marines-Prince has no conflicts of interest to disclose. Dr. Tomlinson has no conflicts of interest to disclose. Dr. Babb has no conflicts of interest to disclose.

Figures

Fig. 1.
Fig. 1.
Frequency plots outlining the primary and secondary reasons for exercise intolerance or dyspnea on exertion. Cardiova=cardiovascular; Decondit=deconditioned; Multifac=multifactorial; Neuromus=neuromuscular; Respirat=respiratory; Behavior=Behavioral.
Fig. 2.
Fig. 2.
The relationship between V̇O2 and workload (top), V̇E and workload(middle), and V̇E and V̇CO2 (bottom). V̇O2=oxygen uptake; V̇E=minute ventilation; V̇CO2=carbon dioxide. *p < 0.05; †p < 0.01.
Fig. 3.
Fig. 3.
Top: RPB (0–10 Borg Scale) at rest, submaximal work rates, and peak exercise for nonobese and obese patients; Bottom: Relationship between RPB (0–10 Borg scale) and V̇E (, L/min) for nonobese and obese patients. RPB=rating of perceived breathlessness; V̇E=minute ventilation. *p < 0.05.
Fig. 4.
Fig. 4.
Sensory dimensions of dyspnea including unpleasantness (left) and affective dimensions of dyspnea (right) recorded from a visual analog scale (VAS 0–10) for obese and nonobese patients. *p < 0.05; †p < 0.01.
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