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Published in: European Journal of Applied Physiology 3/2022

01-03-2022 | Original Article

Inhaled nitric oxide does not improve maximal oxygen consumption in endurance trained and untrained healthy individuals

Authors: Andrew R. Brotto, Devin B. Phillips, Victoria L. Meah, Bryan A. Ross, Desi P. Fuhr, Rhys I. Beaudry, Sean van Diepen, Michael K. Stickland

Published in: European Journal of Applied Physiology | Issue 3/2022

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Abstract

Purpose

Previous work suggests that endurance-trained athletes have superior pulmonary vasculature function as compared to untrained individuals, which may contribute to their greater maximal oxygen uptake (\(\dot{\text{V}}\)O2max). Inhaled nitric oxide (iNO) reduces pulmonary vascular resistance in healthy individuals, which could translate into greater cardiac output and improved \(\dot{\text{V}}\)O2max, particularly in untrained individuals. The purpose of the study was to examine whether iNO improved \(\dot{\text{V}}\)O2max in endurance trained and untrained individuals.

Methods

Sixteen endurance-trained and sixteen untrained individuals with normal lung function completed this randomized double-blind cross-over study over four sessions. Experimental cardiopulmonary exercise tests were completed while breathing either normoxia (placebo) or 40 ppm of iNO, on separate days (order randomized). On an additional day, echocardiography was used to determine pulmonary artery systolic pressure at rest and during sub-maximal exercise (60 Watts) while participants breathed normoxia or iNO.

Results

Right ventricular systolic pressure was significantly reduced by iNO during exercise (Placebo: 34 ± 7 vs. iNO: 32 ± 7; p = 0.04). \(\dot{\text{V}}\)O2max was greater in the endurance trained group (Untrained: 3.1 ± 0.7 vs. Endurance: 4.3 ± 0.9 L min−1; p < 0.01), however, there was no effect of condition (p = 0.79) and no group by condition interaction (p = 0.68). Peak cardiac output was also unchanged by iNO in either group.

Conclusion

Despite a reduction in right ventricular systolic pressure, the lack of change in \(\dot{\text{V}}\)O2max with iNO suggests that the pulmonary vasculature does not limit \(\dot{\text{V}}\)O2max in young healthy individuals, regardless of fitness level.
Literature
go back to reference Borg GAV (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381CrossRef Borg GAV (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377–381CrossRef
go back to reference Charloux A, Lonsdorfer-Wolf E, Richard R, Lampert E, Oswald-Mammosser M, Mettauer B, Geny B, Lonsdorfer J (2000) A new impedance cardiography device for the non-invasive evaluation of cardiac output at rest and during exercise: comparison with the “direct” Fick method. Eur J Appl Physiol 82(4):313–320. https://doi.org/10.1007/s004210000226CrossRefPubMed Charloux A, Lonsdorfer-Wolf E, Richard R, Lampert E, Oswald-Mammosser M, Mettauer B, Geny B, Lonsdorfer J (2000) A new impedance cardiography device for the non-invasive evaluation of cardiac output at rest and during exercise: comparison with the “direct” Fick method. Eur J Appl Physiol 82(4):313–320. https://​doi.​org/​10.​1007/​s004210000226CrossRefPubMed
go back to reference Chen HI, Li HT (1993) Physical conditioning can modulate endothelium-dependent vasorelaxation in rabbits. Arterioscler Thromb 13(6):852–856CrossRef Chen HI, Li HT (1993) Physical conditioning can modulate endothelium-dependent vasorelaxation in rabbits. Arterioscler Thromb 13(6):852–856CrossRef
go back to reference Frostell CG, Blomqvist H, Hedenstierna G, Lundberg JO, Zapol WM (1993) Inhaled nitric oxide selectively reverses human hypoxic pulmonary vasoconstriction without causing systemic vasodilation. Anesthesiology 78:8CrossRef Frostell CG, Blomqvist H, Hedenstierna G, Lundberg JO, Zapol WM (1993) Inhaled nitric oxide selectively reverses human hypoxic pulmonary vasoconstriction without causing systemic vasodilation. Anesthesiology 78:8CrossRef
go back to reference Ghofrani HA, Reichenberger F, Kohstall MG, Mrosek EH, Seeger T, Olschewski H, Seeger W, Grimminger F (2004) Sildenafil increased exercise capacity during hypoxia at low altitudes and at Mount Everest base camp: a randomized, double-blind, placebo-controlled crossover trial. Ann Intern Med 141(3):169–177CrossRef Ghofrani HA, Reichenberger F, Kohstall MG, Mrosek EH, Seeger T, Olschewski H, Seeger W, Grimminger F (2004) Sildenafil increased exercise capacity during hypoxia at low altitudes and at Mount Everest base camp: a randomized, double-blind, placebo-controlled crossover trial. Ann Intern Med 141(3):169–177CrossRef
go back to reference Gledhill N, Cox D, Jamnik R (1994) Endurance athletes’ stroke volume does not plateau: major advantage is diastolic function. Med Sci Sports Exerc 26(9):1116–1121CrossRef Gledhill N, Cox D, Jamnik R (1994) Endurance athletes’ stroke volume does not plateau: major advantage is diastolic function. Med Sci Sports Exerc 26(9):1116–1121CrossRef
go back to reference Johnson RL Jr, Hsia CC (1994) Functional recruitment of pulmonary capillaries. J Appl Physiol 76(4):1405–1407CrossRef Johnson RL Jr, Hsia CC (1994) Functional recruitment of pulmonary capillaries. J Appl Physiol 76(4):1405–1407CrossRef
go back to reference Kovacs G, Maier R, Aberer E, Brodmann M, Scheidl S, Hesse C, Troester N, Salmhofer W, Stauber R, Fuerst FC, Thonhofer R, Ofner-Kopeinig P, Gruenig E, Olschewski H (2010) Assessment of pulmonary arterial pressure during exercise in collagen vascular disease: echocardiography vs right-sided heart catheterization. Chest 138(2):270–278. https://doi.org/10.1378/chest.09-2099CrossRefPubMed Kovacs G, Maier R, Aberer E, Brodmann M, Scheidl S, Hesse C, Troester N, Salmhofer W, Stauber R, Fuerst FC, Thonhofer R, Ofner-Kopeinig P, Gruenig E, Olschewski H (2010) Assessment of pulmonary arterial pressure during exercise in collagen vascular disease: echocardiography vs right-sided heart catheterization. Chest 138(2):270–278. https://​doi.​org/​10.​1378/​chest.​09-2099CrossRefPubMed
go back to reference Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1–39. https://doi.org/10.1016/j.echo.2014.10.003CrossRefPubMed Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1–39. https://​doi.​org/​10.​1016/​j.​echo.​2014.​10.​003CrossRefPubMed
go back to reference Lewthwaite H, Benedetti A, Stickland MK, Bourbeau J, Guenette JA, Maltais F, Marciniuk DD, O’Donnell DE, Smith BM, Tan WC, Jensen D, Can CCRG, the Canadian Respiratory Research N (2020) Normative peak cardiopulmonary exercise test responses in Canadian adults aged >/=40 years. Chest 158(6):2532–2545. https://doi.org/10.1016/j.chest.2020.06.074CrossRef Lewthwaite H, Benedetti A, Stickland MK, Bourbeau J, Guenette JA, Maltais F, Marciniuk DD, O’Donnell DE, Smith BM, Tan WC, Jensen D, Can CCRG, the Canadian Respiratory Research N (2020) Normative peak cardiopulmonary exercise test responses in Canadian adults aged >/=40 years. Chest 158(6):2532–2545. https://​doi.​org/​10.​1016/​j.​chest.​2020.​06.​074CrossRef
go back to reference Phillips DB, Brotto AR, Ross BA, Bryan TL, Wong EYL, Meah VL, Fuhr DP, van Diepen S, Stickland MK, Canadian Respiratory Research N (2021) Inhaled nitric oxide improves ventilatory efficiency and exercise capacity in patients with mild COPD: a randomized-control cross-over trial. J Physiol. https://doi.org/10.1113/JP280913CrossRef Phillips DB, Brotto AR, Ross BA, Bryan TL, Wong EYL, Meah VL, Fuhr DP, van Diepen S, Stickland MK, Canadian Respiratory Research N (2021) Inhaled nitric oxide improves ventilatory efficiency and exercise capacity in patients with mild COPD: a randomized-control cross-over trial. J Physiol. https://​doi.​org/​10.​1113/​JP280913CrossRef
go back to reference Reuschlein PS, Reddan WG, Burpee J, Gee JB, Rankin J (1968) Effect of physical training on the pulmonary diffusing capacity during submaximal work. J Appl Physiol 24(2):152–158CrossRef Reuschlein PS, Reddan WG, Burpee J, Gee JB, Rankin J (1968) Effect of physical training on the pulmonary diffusing capacity during submaximal work. J Appl Physiol 24(2):152–158CrossRef
go back to reference Richard R, Lonsdorfer-Wolf E, Charloux A, Doutreleau S, Buchheit M, Oswald-Mammosser M, Lampert E, Mettauer B, Geny B, Lonsdorfer J (2001) Non-invasive cardiac output evaluation during a maximal progressive exercise test, using a new impedance cardiograph device. Eur J Appl Physiol 85(3–4):202–207. https://doi.org/10.1007/s004210100458CrossRefPubMed Richard R, Lonsdorfer-Wolf E, Charloux A, Doutreleau S, Buchheit M, Oswald-Mammosser M, Lampert E, Mettauer B, Geny B, Lonsdorfer J (2001) Non-invasive cardiac output evaluation during a maximal progressive exercise test, using a new impedance cardiograph device. Eur J Appl Physiol 85(3–4):202–207. https://​doi.​org/​10.​1007/​s004210100458CrossRefPubMed
go back to reference Roughton FJ, Forster RE (1957) Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries. J Appl Physiol 11(2):290–302CrossRef Roughton FJ, Forster RE (1957) Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries. J Appl Physiol 11(2):290–302CrossRef
go back to reference Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23(7):685–713. https://doi.org/10.1016/j.echo.2010.05.010 (quiz 688–786)CrossRefPubMed Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23(7):685–713. https://​doi.​org/​10.​1016/​j.​echo.​2010.​05.​010 (quiz 688–786)CrossRefPubMed
go back to reference Sheel AW, Edwards MR, Hunte GS, McKenzie DC (2001) Influence of inhaled nitric oxide on gas exchange during normoxic and hypoxic exercise in highly trained cyclists. J Appl Physiol 90(3):926–932CrossRef Sheel AW, Edwards MR, Hunte GS, McKenzie DC (2001) Influence of inhaled nitric oxide on gas exchange during normoxic and hypoxic exercise in highly trained cyclists. J Appl Physiol 90(3):926–932CrossRef
go back to reference Tanaka H, Monahan KD, Seals DR (2001) Age-predicted maximal heart rate revisited. J Am Coll Cardiol 37(1):153–156CrossRef Tanaka H, Monahan KD, Seals DR (2001) Age-predicted maximal heart rate revisited. J Am Coll Cardiol 37(1):153–156CrossRef
go back to reference Weissmann N, Peters DM, Klopping C, Kruger K, Pilat C, Katta S, Seimetz M, Ghofrani HA, Schermuly RT, Witzenrath M, Seeger W, Grimminger F, Mooren FC (2014) Structural and functional prevention of hypoxia-induced pulmonary hypertension by individualized exercise training in mice. Am J Physiol Lung Cell Mol Physiol 306(11):L986-995. https://doi.org/10.1152/ajplung.00275.2013CrossRefPubMed Weissmann N, Peters DM, Klopping C, Kruger K, Pilat C, Katta S, Seimetz M, Ghofrani HA, Schermuly RT, Witzenrath M, Seeger W, Grimminger F, Mooren FC (2014) Structural and functional prevention of hypoxia-induced pulmonary hypertension by individualized exercise training in mice. Am J Physiol Lung Cell Mol Physiol 306(11):L986-995. https://​doi.​org/​10.​1152/​ajplung.​00275.​2013CrossRefPubMed
Metadata
Title
Inhaled nitric oxide does not improve maximal oxygen consumption in endurance trained and untrained healthy individuals
Authors
Andrew R. Brotto
Devin B. Phillips
Victoria L. Meah
Bryan A. Ross
Desi P. Fuhr
Rhys I. Beaudry
Sean van Diepen
Michael K. Stickland
Publication date
01-03-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Applied Physiology / Issue 3/2022
Print ISSN: 1439-6319
Electronic ISSN: 1439-6327
DOI
https://doi.org/10.1007/s00421-021-04866-3

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