Ajar KOÇAK, Onur YILDIRIM, Ayhan COŞGUN, Mustafa Hamidullah TÜRKKANI

Orta yaşlı obez olmayan sağlıklı bireylerde sigara kullanımının egzersiz sırasındaki kardiyopulmoner modülasyon mekanizmaları üzerine etkileri

Amaçlar: Bu çalışmada, orta yaşlı obez olmayan sağlıklı bireylerde, sigara içmenin egzersiz sırasındaki çeşitli kardiyopulmoner modülasyon mekanizmaları üzerindeki etkilerinin değerlendirilmesi amaçlanmıştır. Yöntemler: Bu çalışmaya 243 (142 sigara içen ve 101 sigara içmeyen) katılımcı dahil edildi. Zorlu vital kapasite (FVC), zorlu ekspiryumun 1. saniyesinde çıkarılan hava hacmi (FEV1) ve FEV1/FVC oranı gibi solunum fonksiyon parametrelerinin yanı sıra ekokardiyografi kullanarak sistolik pulmoner arter basıncı (sPAP) istirahat ve egzersiz sırasında ölçüldü. Kalp atış hızı toparlanma indeksini (HRRI), kronotropik indeks (CI) ve egzersiz sırasında maksimum oksijen tüketim oranını (VO2max) değerlendirmek için egzersiz testi kullanıldı. Bulgular: Sigara içenlerde istirahat sPAP değerleri daha yüksek, FEV1, FVC ve FEV1/FVC değerleri daha düşüktü. Dinlenme değerleri ile karşılaştırıldığında; Sigara içenlerde FEV1 ve FEV1/FVC oranı egzersizin zirve noktasında anlamlı olarak azaldı (sırasıyla 2,66±0,54'e karşı 2,35±0,49, p<0,01 ve 81,57±8,21'e karşı 75,11±8,12, p<0,01). Ayrıca, tüm HRRI değerleri sigara içen grupta anlamlı olarak düşüktü. CI ve VO2max değerlerinde de benzer sonuçlar gözlendi (sırasıyla 0,67±0,21'e karşı 0,76±0,19, p<0,01 ve 34,91±4,63'e karşı 38,47±3,24, p<0,01). Tüm bu parametreler sigara kullanım süresi ile anlamlı şekilde ilişkili bulundu. Sonuç: Sigara kullanımı, sağlıklı bireylerin egzersiz kapasitesini azaltabilecek çeşitli etkilerle ilişkilidir. Bu etkiler erken dönemde ortaya çıkabildiği gibi, şiddetleri sigara kullanım süresi ile anlamlı olarak ilişkilidir.

Anahtar Kelimeler:

Sigara, egzersiz, kardiyopulmoner fonksiyon, kronotropik yetersizlik

Effects of smoking on the cardiopulmonary modulation during physical exercise in middle-aged non-obese healthy individuals

Objective: The aim of this study was to evaluate the overall effects of smoking and its duration on various cardiopulmonary modulation mechanisms during physical exercise in middle-aged non-obese healthy individuals. Materials and Methods: Two hundred forty-three (142 smokers and 101 non-smokers), middle-aged, non-obese, healthy individuals were evaluated in this cross-sectional study. Parameters of pulmonary function including forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and FEV1/FVC ratio were evaluated using a spirometer and systolic pulmonary artery pressure (sPAP) were measured by echocardiography on rest and during various levels of exercise. A treadmill exercise test was used to assess heart rate recovery index (HRRI), the chronotropic index (CI) and the maximum rate of oxygen consumption during exercise (VO2max). Results: Resting sPAP values were higher and FEV1, FVC and FEV1/FVC values were lower among smokers. As compared to resting values; FEV1 and FEV1/FVC ratio in smokers decreased significantly at peak exercise level (2.66±0.54 vs 2.35±0.49, p<0.01 and 81.57±8.21 vs 75.11±8.12, p<0.01 respectively). The HRRI values of all 1st, 2nd and 3rd minutes were significantly lower in the smoker group. Similar results were observed with CI and VO2max values (0.67±0.21 vs 0.76±0.19, p<0.01 and 34.91±4.63 vs 38.47±3.24, p<0.01 respectively). In addition, all mentioned parameters were significantly correlated with smoking duration. Conclusion: Smoking is associated with a variety of adverse effects that may eventually reduce the exercise capacity of healthy individuals. These effects can manifest at early stages, and their severity correlates significantly with smoking duration.

Keywords:

Smoking, physical exercise, cardiopulmonary function, chronotropic incompetence,

PDF

___

World Health Organization. WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. World Health Organization, 2011. Available from:https://apps.who.int/iris/handle/10665/44616.
Powell R, Davidson D, Divers J, et al. Genetic ancestry and the relationship of cigarette smoking to lung function and per cent emphysema in four race/ethnic groups: a cross-sectional study. Thorax. 2013;68(7):634-642.
Banks E, Joshy G, Korda RJ, et al. Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study. BMC Med. 2019;17(1):128.
Shepherd JT. Circulatory response to exercise in health. Circulation. 1987;76(6 Pt 2):VI3-VI10.
Bove AA. Pulmonary aspects of exercise and sports. Methodist Debakey Cardiovasc J. 2016;12(2):93-97.
Papathanasiou G, Georgakopoulos D, Papageorgiou E, et al. Effects of smoking on heart rate at rest and during exercise, and on heart rate recovery, in young adults. Hellenic J Cardiol. 2013;54(3):168-177.
Lauer MS, Pashkow FJ, Larson MG, Levy D. Association of cigarette smoking with chronotropic incompetence and prognosis in the Framingham Heart Study. Circulation. 1997;96(3):897-903.
Rodríguez-Fernández A, Sanchez-Sanchez J, Ramirez-Campillo R, Nakamura FY, Rodríguez-Marroyo JA, Villa-Vicente JG. Relationship between repeated sprint ability, aerobic capacity, intermittent endurance, and heart rate recovery in youth soccer players. J Strength Cond Res. 2019;33(12):3406-3413.
Smarz K, Tysarowski M, Zaborska B, et al. Chronotropic incompetence limits aerobic exercise capacity in patients taking beta-blockers: real-life observation of consecutive patients. Healthcare (Basel). 2021;9(2):212.
Furlanetto KC, Mantoani LC, Bisca G, et al. Reduction of physical activity in daily life and its determinants in smokers without airflow obstruction. Respirology. 2014;19(3):369-375.
Helgerud J, Høydal K, Wang E, et al. Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc. 2007;39(4):665-671.
Yuan YM, Luo L, Guo Z, et al. Activation of the renin-angiotensin-aldosterone system (RAAS) in the lung of smoking-induced pulmonary arterial hypertension (PAH) rats. JRAAS 2015;16(2):249-253.
Khalil MA. Smoking as a risk factor for intraoperative hypoxemia during one-lung ventilation. J Anesth. 2013;27(4):550-556.
Bossone E, Naeije R. Exercise-induced pulmonary hypertension. Heart Fail Clin. 2012;8(3):485-495.
Lin YH, Chen YC, Tseng YC, Tsai ST, Tseng YH. Physical activity and successful aging among middle-aged and older adults: a systematic review and meta-analysis of cohort studies. Aging. 2020;12(9):7704-7716.
Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-3731.
Currie PJ, Seward JB, Chan KL, et al. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol. 1985;6(4):750-756.
Engeseth K, Hodnesdal C, Grundvold I, et al. Temporal reduction in chronotropic index predicts risk of cardiovascular death among healthy middle-aged men: a 28-year follow-up study. J Am Heart Assoc. 2016;5(12):e004555.
Romer LM, Polkey MI. Exercise-induced respiratory muscle fatigue: implications for performance. J Appl Physiol (1985). 2008;104(3):879-888.
Wüst RC, Morse CI, de Haan A, Rittweger J, Jones DA, Degens H. Skeletal muscle properties and fatigue resistance in relation to smoking history. Eur J Appl Physiol. 2008;104(1):103-110.
Tantisuwat A, Thaveeratitham P. Effects of smoking on chest expansion, lung function, and respiratory muscle strength of youths. J Phys Ther Sci. 2014;26(2):167-170.
Twisk JW, Staal BJ, Brinkman MN, Kemper HC, van Mechelen W. Tracking of lung function parameters and the longitudinal relationship with lifestyle. Eur Respir J. 1998;12(3):627-634.
Gomes R, Luís F, Tavares A, Sousa N, Correia S, Reis M. Respiratory functional evaluation and pulmonary hyperinflation in asymptomatic smokers: Preliminary study. Rev Port Pneumol (2006). 2015;21(3):126-131.
Barutcu I, Esen AM, Kaya D, et al. Cigarette smoking and heart rate variability: dynamic influence of parasympathetic and sympathetic maneuvers. Ann Noninvasive Electrocardiol. 2005;10(3):324-329.
Hellsten Y, Nyberg M. Cardiovascular adaptations to exercise training. Compr Physiol. 2015;6(1):1-32.
Astrand PO, Rodahl K, Dahl HA, Stromme SB. Textbook of work physiology. Physiological basis of Exercise. Champagne,IL: Human Kinetics; 2003. pp.134-176.
Myers J, Tan SY, Abella J, Aleti V, Froelicher VF. Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality. Eur J Cardiovasc Prev Rehabil. 2007;14(2):215-221.
Hawkins MN, Raven PB, Snell PG, Stray-Gundersen J, Levine BD. Maximal oxygen uptake as a parametric measure of cardiorespiratory capacity. Med Sci Sports Exerc. 2007;39(1):103-107.
Keusch S, Hildenbrand FF, Bollmann T, et al. Tobacco smoke exposure in pulmonary arterial and thromboembolic pulmonary hypertension. Respiration. 2014;88(1):38-45.
Vaillancourt M, Chia P, Sarji S, et al. Autonomic nervous system involvement in pulmonary arterial hypertension. Respir Res. 2017;18(1):201.