TY - JOUR
T1 - Posttraumatic Stress Disorder Is Associated With a Decrease in Anaerobic Threshold, Oxygen Pulse, and Maximal Oxygen Uptake
AU - McMahon, Michael J.
AU - Holley, Aaron B.
AU - Warren, Whittney A.
AU - Collen, Jacob F.
AU - Sherner, John H.
AU - Zeman, Joseph E.
AU - Morris, Michael J.
N1 - Funding Information:
Author contributions: M. J. McMahon co-wrote and edited the manuscript, and performed the statistical analysis; A. B. H. co-created the database, co-wrote and edited the manuscript, designed the analysis, and is the guarantor of the paper; W. A. W. J. H. S. and J. E. Z. contributed intellectual content and edited the manuscript; J. F. C. co-created the database and edited the manuscript; and M. J. Morris designed the study and data collection, co-created the database, contributed to intellectual content, and edited the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: M. J. Morris is on the speaker bureau for Janssen Pharmaceuticals and GlaxoSmithKline. None declared (M. J. McMahon, A. B. H. W. A. W. J. F. C. J. H. S. J. E. Z.). Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Other contributions: The views reflected in this article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or the US Government. Additional information: The e-Appendixes can be found in the Supplemental Materials section of the online article. FUNDING/SUPPORT: Funding was received through the US Army Medical Research and Materiel Command Defense Health Program Joint Program Committee-5.
Publisher Copyright:
© 2021 American College of Chest Physicians
PY - 2021/9
Y1 - 2021/9
N2 - Background: Posttraumatic stress disorder (PTSD) has been linked to respiratory symptoms and functional limitations, but the mechanisms leading to this association are poorly defined. Research Question: What is the relationship between PTSD, lung function, and the cardiopulmonary response to exercise in combat veterans presenting with chronic respiratory symptoms? Study Design and Methods: This study prospectively enrolled military service members with respiratory symptoms following deployment to southwest Asia. All participants underwent a comprehensive evaluation that included pulmonary function testing and cardiopulmonary exercise testing. Pulmonary function test variables and cardiopulmonary response to exercise were compared in subjects with and without PTSD by using multivariable linear regression to adjust for confounders. Results: A total of 303 participants were included (PTSD, n = 70; non-PTSD, n = 233). Those with PTSD had a greater frequency of current respiratory symptoms. There were no differences in measures for airway disease or lung volumes, but patients with PTSD had a reduction in diffusing capacity that was eliminated following adjustment for differences in hemoglobin levels. Participants with PTSD had a lower anaerobic threshold (23.9 vs 26.4 cc/kg per minute; P = .004), peak oxygen pulse (19.7 vs 18.5 cc/beat; P = .03), and peak oxygen uptake (34.5 vs 38.8 cc/kg per minute; P < .001). No significant difference was observed in gas exchange, respiratory reserve, or effort at peak exercise between participants with and without PTSD. Interpretation: A diagnosis of PTSD was associated with a reduced anaerobic threshold, oxygen pulse, and peak oxygen uptake. This objective reduction in cardiopulmonary work is independent of baseline lung function, was not associated with abnormalities in gas exchange or respiratory reserve, and may be related to deconditioning.
AB - Background: Posttraumatic stress disorder (PTSD) has been linked to respiratory symptoms and functional limitations, but the mechanisms leading to this association are poorly defined. Research Question: What is the relationship between PTSD, lung function, and the cardiopulmonary response to exercise in combat veterans presenting with chronic respiratory symptoms? Study Design and Methods: This study prospectively enrolled military service members with respiratory symptoms following deployment to southwest Asia. All participants underwent a comprehensive evaluation that included pulmonary function testing and cardiopulmonary exercise testing. Pulmonary function test variables and cardiopulmonary response to exercise were compared in subjects with and without PTSD by using multivariable linear regression to adjust for confounders. Results: A total of 303 participants were included (PTSD, n = 70; non-PTSD, n = 233). Those with PTSD had a greater frequency of current respiratory symptoms. There were no differences in measures for airway disease or lung volumes, but patients with PTSD had a reduction in diffusing capacity that was eliminated following adjustment for differences in hemoglobin levels. Participants with PTSD had a lower anaerobic threshold (23.9 vs 26.4 cc/kg per minute; P = .004), peak oxygen pulse (19.7 vs 18.5 cc/beat; P = .03), and peak oxygen uptake (34.5 vs 38.8 cc/kg per minute; P < .001). No significant difference was observed in gas exchange, respiratory reserve, or effort at peak exercise between participants with and without PTSD. Interpretation: A diagnosis of PTSD was associated with a reduced anaerobic threshold, oxygen pulse, and peak oxygen uptake. This objective reduction in cardiopulmonary work is independent of baseline lung function, was not associated with abnormalities in gas exchange or respiratory reserve, and may be related to deconditioning.
KW - cardiopulmonary function
KW - dyspnea
KW - exercise testing
UR - http://www.scopus.com/inward/record.url?scp=85112639463&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2021.03.057
DO - 10.1016/j.chest.2021.03.057
M3 - Article
C2 - 33844979
AN - SCOPUS:85112639463
SN - 0012-3692
VL - 160
SP - 1017
EP - 1025
JO - Chest
JF - Chest
IS - 3
ER -