Pulmonary Adaptations in Athletes [Autosaved].pptx

Pulmonary adaptations in athletes involve several physiological changes in the respiratory system due to regular and intensive training, enhancing both efficiency and capacity. These adaptations include increased lung volume and vital capacity, enabling a greater amount of air to be inhaled and exhaled with each breath, which is particularly beneficial for endurance athletes. The respiratory muscles, such as the diaphragm and intercostal muscles, become stronger and more enduring, reducing breathlessness during intense exercise. Enhanced gas exchange efficiency occurs as the number and effectiveness of alveoli increase, improving oxygen uptake and carbon dioxide removal. Athletes also exhibit a higher pulmonary diffusing capacity, facilitating more efficient oxygen transfer from the air into the bloodstream and carbon dioxide removal. Additionally, the ventilatory threshold is raised, allowing athletes to maintain higher exercise intensities for longer periods before experiencing significant respiratory fatigue. These adaptations are complemented by more efficient breathing patterns, with lower respiratory rates and deeper breaths, reducing the work of breathing and conserving energy. Collectively, these changes enable athletes to perform at higher intensities and for longer durations, significantly enhancing their endurance and overall athletic performance.

1. Pulmonary Adaptations in Athletes Presented by- Dr. Amit Prashar (PT) BPT,MSPT

2. Anatomy of Ventilation The process of transferring and exchanging lung air with outside air is known as pulmonary ventilation. As air enters the mouth and nose, it passes through the trachea and into the conductive sections of the ventilatory system, where it is filtered, nearly fully humidified, and temperature-regulated.

3. . PARTS OF VENTILATORY SYSTEM- 1. Conducting zones that includes- the trachea and terminal bronchioles 2. R espiratory zones includes bronchioles, alveolar ducts, and alveoli

4. Lung volume and capacities VOLUME- Static- TV- It is the amount of air that can be inhaled or exhaled during one respiratory cycle. 300-500mL. Can increase upto 50% on Exercise. IRV- It is the amount of air that can be forcibly inhaled after a normal tidal volume. 1900-3300 mL ERV- It is the volume of air that can be exhaled forcibly after exhalation of normal tidal volume. 700-1200ml. ERV reduced with obesity , ascites and after Upper abdominal surgery. RV- It is the volume of air remaining in the lungs after maximal exhalation. 1200 mL, It can't be measured by spirometry. CAPACITY- Inspiratory Capacity- (IRV+TV) Total Lung Capacity- (TV+IRV+ERV+RV) Vital Capacity-(TV+IRV+ERV) Functional Residual Capacity- (RV+ERV)

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6. . 2. Dynamic Lung volume- Measures Power component of pulmonary performance during different phases. It has time component. It depends upon two factors- 1. Max lung vol expired(FVC) 2. Speed of moving of air volume TYPES OF DYNAMIC LUNG VOLUME- 1. Forced Vital Capacity - max vol of air breathed out forcefully and rapidly after a max inspiration. FEV1- FORCED EXPIRATORY VOLUME IN 1 SEC= 80%OF FVC FEV2- FORCED EXPIRATORY VOLUME IN 2 SEC= 95%OF FVC FEV3 - FORCED EXPIRATORY VOLUME IN 1 SEC= 100%OF FVC Changes in case of conditions- 1. Obstructive lung disease(Bronchial Asthma) There is reduction of Fev1/ fvc value to 40% and Fvc is approx. normal 2. Restrictive lung disease(Emphysema) There is reduction in Fvc but normal fev1/ fvc ratio to 80-90%

7. . 2. Maximum Voluntary Ventilation- ventilatory capacity requires rapid, deep breathing for 15 seconds. Estimated by 15-second volume to the volume breathed for 1 minute. Nr value: Male-140 – 180 L/min Female- 80-120 l/min 3. Minute Ventilation - Normal quite breathing. Product of breathing rate and tidal volume. Normal value= 6L(12 breaths/min*0.5L) Any increase in depth and rate will lead to increase in MV. During exercise, in normal healthy 35-40 breaths/min while in elite athlete it reaches to 70 breaths/min , leading to increase in MV to 100 L/min. but TV rarely exceeds 55-60% of VC

8. The figure shows increasing TV during in exercise results largely from encroachment on IRV, with smaller decrease in end-expiratory level. As exercise intensity increases, TV plateaus at about 60% of vital capacity; further increases in minute ventilation result from increases in breathing rate. These ventilatory adjustments occur unconsciously. Everyone develops a “style” of breathing by blending the breathing rate and TV, so alveolar ventilation matches alveolar perfusion

9. . Swimmers had significantly larger FVC (6.2±0.6 l, 109±9% pred) than the other groups (5.6±0.5 l, 106±13% pred, 5.5±0.8, 99% pred, the sportsmen and recreational groups, respectively). FEV1 and MVV were not different. While at peak exercise, all groups reached their ventilatory reserve (around 20%), the swimmers had a greater minute ventilation rate than the recreational group (146±19 vs 120±87 l/min), delivering this volume by breathing deeper and slower This occurred due to alternative breathing strategy to gain their V̇ E peak , at their peak exercise level opting to breathe slower and more deeply than the non-swimmers.

10. . Pulmonary function testing of elite breath-hold divers consistently showed higher vital capacity than predicted from population derived equations. The RV/TLC ratio is an important determinant of the depth a breath-hold diver may descend to without harm, but thoracic blood shift, and individual adaptations such as glossopharyngeal insufflation and exsufflation allow to reach considerably greater depths than previously deemed possible. 

11. . Illustration of physiological changes and health risks (boxed red) during the descent and ascent of a deep breath-hold dive. Some examplary depths are marked ( ∗ ) to indicate critical physiological challenges or records achieved. Of note, health risks are not related to certain depths but rather depth ranges during descent or ascent, respectively. paO 2  = arterial oxygen pressure; IPAVA = intrapulmonary arteriovenous anastomoses.

12. Valsalva Maneuver and its impact A Valsalva maneuver describes forced exhalation against a closed glottis. This usually occurs in weightlifting and sports that require rapid force generation for short duration. Impact- Abrupt increase in BP due to elevated intrathoracic and abdominal pressure forces blood from heart into arterial system. The inferior vena cava compresses as pressure within abdominal and thoracic cavities exceeds . Reduced venous return to heart leading to arterial bp and thus decreased brain’s blood supply, producing dizziness and even fainting.

13. There were two groups – Young athletes involved in endurance sports and non athletes. A modified version is done by expiring against a closed glottis and maintaining pressure of a mercury column at 40mm Hg by lying down face up and raising legs with the help of an assistant. This will elicit the cardiovascular responses described below but will not force air into the Eustachian tubes. Heart rate was significantly higher after Modified Valsalva Maneuver in athlete, while it was significantly lower in non athlete. No significant difference in heart rate between athlete & non athlete group before Modified Valsalva Maneuver. But there was significant difference heart rate between both groups after Modified Valsalva Maneuver. Significantly higher no. of Athletes showed increase t wave duration as compared to non athletes and Significantly higher no. of Athletes showed prolonged TP Segment as compared to non athletes Modified Valsalva Maneuver is good index of cardiovascular system. By regular practicing Modified Valsalva Maneuver subject can enhance the autonomic response. Modified Valsalva Maneuver indirectly help in increasing the cardiac output by increase in duration of ventricular filling time period.

14. Movement of Gas in Air and Fluid

15. Oxygen Transport in Blood The blood transports oxygen in two ways: 1. In physical solution— dissolved in the fluid portion of the blood(average adult’s total blood volume equals about 5 L, 15 mL of oxygen dissolves for transport in the fluid portion of the blood 2. Combined with hemoglobin (Hb)— in loose combination with the iron–protein Hb molecule in the red blood cel l.( Hb increases the blood’s oxygen-carrying capacity 65 to 70 times above that normally dissolved in plasma. For each liter of blood, Hb temporarily “captures” about 197 mL of oxygen.) Factors affecting shifting of curve- Temperature Ph Myoglobin and Muscle Oxygen Storage- Each myoglobin contains 1 iron atom . Myoglobin facilitates oxygen transfer to the mitochondria, notably at the start of exercise and during intense exercise when cellular PO2 decreases considerably. The graph shows rectangular hyperbola shape unlike S shaped as Hb, thereby allowing more Hb. This makes myoglobin retain oxygen at low pressures much more readily than Hb. Oxygen- Hb Dissociation Curve

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17. Factors affecting Ventilation-

18. Adaptations in Pulmonary ventilation w.r.t types of Exercise

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25. , Physical training is considered as the cornerstone of pulmonary rehabilitation to improve exercise tolerance and muscle function. Furthermore, a key finding of a meta-analysis of randomized clinical trials was that resistance training may indeed improve respiratory function in patients with COPD due to a fall in ventilatory demand during exercise and improved ventilatory capacity by increases in maximum minute ventilation Therefore CRF(VO2max) is the strongest independent predictor of future life expectancy in both healthy and cardiorespiratory-diseased individuals.

26. . This study examine associations between activity behaviours and respiratory responses to acute psychological stress. Hours of daily sedentary behavior, but not MVPA, were associated with respiratory responses to acute psychological stress, including positive associations with BF responses, and negative links with PetCO2, VT, V˙CO2, and RER responses. This is the first study to explore associations between device-assessed activity behaviours (sedentary behaviour and MVPA) and respiratory responses to acute psychological stress. In fully adjusted models with both sedentary behaviour and MVPA (and covariates) included, daily hours of sedentary behaviour were positively associated with BF responses to stress (and BF under resting conditions), and negatively associated with VT, PetCO2, V˙CO2, and RER stress responses. There was no link between sedentary behaviour and V˙ E or V˙O2 stress reactivity. MVPA was not related to responses to stress for any respiratory outcome.

27. . The narrative review focuses on the psychological and physiological effects of two types of breathing, different from autonomous and spontaneous breathing: slow voluntary breathing(4-10 bpm) and fast voluntary breathing(>20 bpm). The respiratory frequency takes on two diametrically opposite characteristics in terms of optimal performance. Slow breathing can benefit athletes in a variety of ways, not just physically but mentally as well. It can help improve cardiovascular fitness, reduce stress and anxiety, and improve overall health and well-being. It can help athletes maintain focus and concentration during training and competition. Rapid breathing can have a significant impact on an individual’s mental state and well-being. It can cause feelings of anxiety, panic, dizziness, and lightheadedness and trigger a stress response in the body

28. . Numerous studies have demonstrated that slow-paced breathing can reduce sympathetic nervous system activity, decrease blood pressure, and enhance heart rate variability. In contrast, fast-paced breathing can activate the sympathetic nervous system, increase heart rate, and elevate blood pressure .

29. a systematic review and meta-analysis in order to determine the factors that affect the change in endurance performance after RMT in healthy subjects. The key finding of this analysis is that RMT improves performance in healthy subjects, independently of the type of RMT and exercise modality. Less fit individuals seem to benefit more from RMT than highly trained athletes, and improvements are greater with longer exercise durations.

30. SPB is a technique used to decrease overall activation and trigger relaxation [17]. It involves timed inhalation and exhalation periods (“paced”), at a rate of around six cycles per minute ( cpm ), which is at least half as slow than the spontaneous breathing rate, normally ranging between 12 and 20 cpm . It involves strengthening of the baroreflex , the action on pulmonary afferents, as well as specific oscillations in brain networks involved in emotion reflex. Heart rate variability (HRV), the variation in the time intervals between adjacent heart beats is a non-invasive indicator of CVA(Cardiac vagal activity). The respiratory pause, we hypothesized that a brief post-inhalation and post-exhalation respiratory pause may potentially produce a bradycardia and reduce the demands on respiratory muscles, therefore resulting in a greater increase in CVA.

31. Findings showed that adopting a respiratory pattern with a longer exhalation phase triggered higher CVA in comparison to respiratory patterns with longer inhalation than exhalation, or with equal duration of both phases. No changes in CVA were provoked by a respiratory pause.

32. The present study aimed to investigate the impact of ETM use in athletes on several hematological and physiological indicators(lung function, aerobic capacity) among cyclists, runners, and swimmers, by experimental approach. The participants (N = 44) were divided into ( i ) an experimental group wearing ETMs (n = 22; aged 21.24 ± 0.14 years old) and (ii) a control group not wearing ETMs (n = 22; aged 21.35 ± 0.19 years old). Both groups underwent 8 weeks of high-intensity cycle ergometer interval training . PROCEDURE- To familiarize the participants, all subjects completed two trial workouts. In the first session, the experimental group was required to wear an ETM for 10 min while sitting in a chair to familiarize them with how their breathing would be affected by the mask. Then, the experimental group was asked to ride on the mechanically braked cycle ergometers for 10 min at a pace of their own choosing. In the first practice session, the control group was also asked to ride the cycle ergometers for a 10 min period at a pace of their own choosing. In the second practice session, both groups were asked to complete five rounds of 30 s of cycling at peak PO, interspaced by 90 s of active recovery between intervals. ETMs were worn by the experimental group in these practice sessions, while the control group did not wear ETMs.

33. The subjects completed an 8-week HIIT cycle ergometer program. The training sessions were held twice a week; each session lasted 35 min. The workout include 10 min of warm up, 20 min of HIIT and 5 min of cool down. 20 min HIIT section featured 10 reps of 30 s at PPO(peak power output). CONCLUSION- The current study highlighted that the use of ETMs by the experimental group significantly improved the post-test pulmonary functions and hematological indicators compared to the control group. Training using ETMs at appropriate resistive breathing levels appears to be a safe and cost-effective way of enhancing performance in healthy athletes without costly altitude training.

34. The research was conducted with 31 boy and 11 girl archers aged 9-12 . The forced vital capacity (FVC), forced expiration volume in one second (FEV1), FEV1/FVC, peak expiratory flow (PEF), maximum voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) of the archers were measured . In this study, pulmonary functions and respiratory muscle strength were compared with an 18-meter shooting performance to examine the relationship between the two, and a positively significant relationship was found between FVC, FEV1 parameters and shooting scores (p<0.05 )

35. The present study seeks to determine the relationship between breathing pattern and performance or score of shooting. Twelve archers, volunteered to participate in this study. Breathing pattern was assessed in terms of bits per minute, where larger values indicate larger amounts of air in the lung cavity and vice versa, using ZEPHYR Bio-Harness devices . Breathing pattern were analyzed at the following three phases; ( i ) setup, (ii) aiming, and (iii) release. Participants shot 12 arrows to a 30-m target. The result showed a significant relationship between breathing pattern with shooting performance for both groups.

36. Regression analysis indicated that a significant relationship occurred between breathing pattern and shooting performance for both parties. Skilled archers recorded a lower value (r 2 = 0.118, p\0.05) compared to the unskilled (r 2 = 0.201, p\0.05 ). The relationship between breathing pattern during the release phase was only significant for the skilled group, and the results indicated a positive relationship. This indicated that by increasing the air capacity simultaneously increases the shooting performance of the athletes. As for the unskilled group, the setup, aiming and release phases did show a significant relationship between breathing pattern and shooting performance. In conclusion, the breathing pattern does impose an effect towards shooting performance. Irregular breathing patterns especially during the release phase partially affect the outcome of shooting in both skilled and unskilled groups

37. The purpose of this paper was to understand which differences long-term swimming training can cause on trunk mechanics during breathing and how these differences are related to the years of swimming training. The variations and coordination among trunk compartments were considered as target movement patterns. The control group consisted of 15 male participants, selected from university students, physically active, but non-athletes and non-swimmers. The swimmer group was composed by 15 male athletes, who covered at least 50,000 m month–1 in the last three years PROCEDURE- experimental setup, the volunteer was asked to perform two different breathing tasks: Quiet Breathing (QB) and Vital Capacity (VC). In quiet breathing, each subject freely chose his breathing frequency and breathed normally during about 60 s . In vital capacity, each subject performed at least four breathing cycles, consisting of maximal inhaling followed by maximal exhaling. RESULT- The results showed that the volume variation is significantly higher in the superior and inferior abdomen in the swimmer group than in control group. The increase in lung volume was due to an adaptive growth of the respiratory muscles caused by the swim practice, leading to physical wider chest, containing more no. of alveoli than size of alveoli.

38. CONCLUSION- We can conclude that there is a significant change in the strategy of thoraco -abdominal compartment recruitment between the groups. The swimmers exhibited an optimised breathing pattern with a greater variation and coordination of the abdominal region, which increases with the years of training. Theoretically, this result is important because it improves knowledge about the possible effect of training on breathing patterns.

39. This review was done to summarize lung function characteristics of athletic swimmers and discuss mechanisms explaining these changes while putting forward the lack of a clear under-standing of the precise physiological factors implicated . There is evidence that swimmers have better expiratory flows and increased baseline lung volumes than non-athletes or non-swimmers. Although these features can result from changes in lung development following intense training over the years, the contribution of a genetic predisposition and positive selection cannot be totally excluded.

40. The objective of this systematic review was to evaluate the results obtained with inspiratory muscle training (IMT) in intermittent sports modalities, intending to determine whether its implementation would be adequate and useful in intermittent sports. A search in the Web of Science (WOS) and Scopus databases was conducted, following the Preferred Reporting Elements for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality of the articles was assessed using the PEDro (Physiotherapy Evidence Database) scale . In all interventions, a training device based on pressure thresholds was used without using isocapnic hyperpnea or resisted flow. The initial effort intensity was very similar in all studies, between 40–60% of the MIP, except for one article that used 80% of the MIP from the beginning.

41. Three types of intervention were used, namely: (a) IMT in a chronic protocol (n = 7) (b ) in an acute protocol before the evaluation test (n = 2) (c ) with a combination of chronic and acute protocols (n = 1) . The chronic intervention procedure lasted between five and twelve weeks so that no homogeneity can be seen in them. Acute training studies made up 40% of the MIP, thirty inspirations, and two sessions before the test. The number of weekly sessions was heterogeneous. Although two sessions of the inspiratory muscle warm-up were always performed before the test. RESULT- A significant increase in MIP was obtained in all studies, ranging from an improvement of 8% to 33%. The RPE and rate of perceived dyspnea (RPB) significantly decreased in the studies investigated. Nine of the ten articles showed a significant improvement in performances for their respective assessment tests, referring to a reduction in sprinting time, a greater recovery capacity, and a greater distance covered or speed in sprinting.

42. The present study aimed to determine the effect of high intensity interval training (HIIT) in hypoxia on maximal oxygen uptake (VO2max) compared with HIIT in normoxia with a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-accordant meta-analysis and meta-regression . Studies which measured VO2max following a minimum of 2 weeks intervention featuring HIIT in hypoxia versus HIIT in normoxia were included and included running, cycling, swimming, or multi-component training. From 119 originally identified titles, nine studies were included (n = 194 participants).

43. The main findings were threefold- Firstly, HIIT in hypoxia increased VO2max more than HIIT in normoxia . Secondly, meta-regression analysis suggested no relationship between intervention duration in weeks and Standard mean difference(SMD) Lastly, meta-regression analysis similarly suggested there was no relationship between effective FiO2(fraction of inspired O2) and SMD.

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