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Original Research: COPD |

Mechanism of Greater Oxygen Desaturation During Walking Compared With Cycling in Patients With COPDMechanism of Oxygen Desaturation During Exercise

Donald A. Mahler, MD, FCCP; Alex H. Gifford, MD; Laurie A. Waterman, MS; Joseph Ward, RCPT; Sasa Machala, MD; John C. Baird, PhD
Author and Funding Information

From the Section of Pulmonary and Critical Care Medicine (Drs Mahler, Gifford, Machala, and Baird), Dartmouth Medical School; and the Pulmonary Function and Cardiopulmonary Exercise Laboratories (Ms Waterman and Mr Ward), Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Psychological Applications (Dr Baird), South Pomfret, VT.

Correspondence to: Donald A. Mahler, MD, FCCP, One Medical Center Dr, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756-0001; e-mail: Donald.a.mahler@hitchcock.org


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):351-358. doi:10.1378/chest.10-2415
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Published online

Background:  Patients with COPD exhibit greater oxyhemoglobin desaturation during walking than with cycling. The purpose of this investigation was to investigate differences in ventilatory responses and gas exchange as proposed mechanisms for this observation.

Methods:  Arterial blood gas and lactate levels were measured in 12 patients with COPD (aged 68 ± 6 years) during incremental treadmill and cycle exercise. The primary outcome to assess the ventilatory response to exercise was Pao2. The primary outcome to assess impairment in exercise gas exchange was the difference between partial pressures of alveolar and arterial oxygen (Pao2 − Pao2).

Results:  Pao2 in patients was significantly lower at peak exercise for treadmill walking (51.4 ± 6.8 mm Hg) compared with cycling (60.4 ± 10.7 mm Hg) (P = .002). The initial increase in Pao2 with cycling occurred prior to the onset of the anaerobic threshold. At peak exercise, Pao2 was significantly higher with cycling compared with walking (P = .004). The anaerobic threshold occurred at a lower oxygen consumption during cycling than walking (P = .001), and peak lactate levels were higher with cycling (P = .019). With progressive exercise, Pao2 − Pao2 increased similarly during treadmill and cycle exercise.

Conclusions:  The higher Pao2 during cycling minimized the magnitude of oxyhemoglobin desaturation compared with walking. The enhanced respiratory stimulation during cycling appears due to an initial neurogenic process, possibly originating in receptors of exercising muscles, and a subsequent earlier onset of anaerobic metabolism with higher lactate levels during cycling.

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