Intermittent versus equivalent constant-load cycle training in COVID-19 patients

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Costa e Silva, I. Sucena, L. Cirnes, J.C. Machado, S. Campainha, A. Barroso" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Costa e Silva" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Sucena" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Cirnes" ] 3 => array:2 [ "nombre" => "J.C." "apellidos" => "Machado" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Campainha" ] 5 => array:2 [ "nombre" => "A." 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Araújo, A. Esquinas, A. Carrillo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Araújo" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Esquinas" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Carrillo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043722000174?idApp=UINPBA00004E" "url" => "/25310437/0000002800000004/v1_202206021014/S2531043722000174/v1_202206021014/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Intermittent versus equivalent constant-load cycle training in COVID-19 patients" "tieneTextoCompleto" => true "saludo" => "Dear Editor" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "312" "paginaFinal" => "314" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Vitacca, I. Vogiatzis, B. Salvi, L. Bertacchini, M. Venturelli, M. Paneroni" "autores" => array:6 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Vitacca" "email" => array:1 [ 0 => "michele.vitacca@icsmaugeri.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0001" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Vogiatzis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0002" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "Salvi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Bertacchini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Venturelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0003" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Paneroni" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane (Brescia), Italy" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Department of Sport, Exercise and Rehabilitation; Faculty of Health and Life Sciences. Northumbria University, Newcastle, UK" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy" "etiqueta" => "c" "identificador" => "aff0003" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Michele Vitacca MD FERS, Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (Brescia), Italy" ] ] ] ] "textoCompleto" => "While the need to implement evidence-based training following COVID-19 is imperative, no consensus exists as to how such programmes should be designed.<a class="elsevierStyleCrossRefs" href="#bib0001">1-3</a> Between 20 July 2020 and 30 April 2021, we assessed tolerability and safety of high-intensity constant-load exercise (CLE) and high-intensity intermittent exercise (IE) in 14 patients presenting pneumonia and acute respiratory failure (ARF) (mean age: 63±13 years) with ongoing symptomatic COVID-19 from 4 to 12 weeks following the infection. Anthropometric data, body mass index (BMI), and the number of comorbidities were recorded. Patients undertook spirometry (FEV1, FVC, FEV1/FVC, transfer factor for Carbon Monoxide (DLCO), blood gases in room air (PaO2, PaCO2, pH), functional status (the Short Physical Performance Battery-SPPB test and the 6-minute walking distance [6MWD: in meters and as a percentage of predicted]), an incremental cardiopulmonary exercise test (CPET) [assessing oxygen uptake (VO2), carbon dioxide output (VCO2), oxygen uptake at the anaerobic threshold (AT), respiratory exchange ratio (RER), minute ventilation (VE), tidal volume (VT) and respiratory rate] using a portable metabolimeter; transcutaneous carbon dioxide tension (TcCO2) was also recorded continuously. In this crossover study (Ethics Committee approval on 30 June 2020, Procotol No. 2449CE), training exercise intensity was balanced to provide the same average work rate for IE and CLE modalities. CLE was set at 70% of peak work rate (WRpeak) and IE consisted of one minute of exercise at 100% WRpeak, alternated with one minute at 40% WRpeak, to the limit of tolerance (Tlim). Dyspnea and leg muscle discomfort (1-10 Borg scale), heart rate and safety were assessed. Of the 220 consecutively admitted patients at the Respiratory Rehabilitative Unit - ICS Maugeri of Lumezzane (BS) - as inpatient and outpatient between 20 July 2020 and 30 April 2021, 14 patients were eligible for the study. We excluded from this study 63 patients presenting symptoms for less than four weeks following infection, 35 patients with more than 12 weeks following infection, 44 clinically unstable patients, 20 patients with severe orthopedic diseases, 15 patients with cognitive impairment, 29 patients with previous severe heart disease (congestive heart disease, severe aortic stenosis, atrial fibrillation). We did not successively exclude patients for technical reasons or missing data.<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a> shows the study population and cardiorespiratory function at peak exercise; two patients presented mitral valve insufficiency and one chronic atrial fibrillation, while two patients suffered from mild COPD. At study entry, patients showed breathlessness (71.4%), fatigue (64.3%), cough (14.4%), palpitations (21.4%) and pain (35.7%), respectively. Patients presented the following lung function data: FEV1 % predicted (prd): 83.2±15.7, FVC, % prd: 79.1±15.8., FEV1/FVC: 84.1±8.5, DLCO % prd: 56.7±26.6, PaO2: 73.7±11.8 mmHg, PaCO2: 36.9±3.01 mmHg. We reported no adverse events for either of the two modalities. We detected no ECG abnormalities during or after IE or CLE. At peak exercise, WRpeak and V̇O2peak were reduced below normal predicted levels. Premature metabolic acidosis was evident by the low fraction of predicted normal VO2 when the anaerobic threshold (AT) was detected (AT at 48±9% VO2 prd). Overall, respiratory reserve was not exhausted in patients with COVID-19. Ventilatory equivalents for VO2 (VE/VO2) and VCO2 (VE/VCO2), and transcutaneous carbon dioxide tension (TcCO2) were compatible with exercise hyperventilation (<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>). A recent study in survivors from COVID-19 pneumonia has suggested that exercise hyperventilation after COVID-19 is frequent and principally due to enhanced chemoreflex sensitivity rather than increased VD/VT.<a class="elsevierStyleCrossRef" href="#bib0004">4</a> We observed a mild reduction in arterial oxygen saturation (SpO2). Arterial blood pressure was normal, whereas the mean heart rate reached approximately 80% of predicted normal value. Sensations of breathlessness and leg discomfort were indicative of severe symptoms. The predominant symptom for stopping exercise was breathlessness (6/14), leg discomfort (2/14) or both dyspnoea and leg discomfort (6/14). Exercise endurance time was not different between IE compared to CLE (p = 0.1594, <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>). The average cycling work rate did not differ between IE and CLE. The same was also the case for VO2 and for both ventilatory equivalents (<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>). At the limit of cycling tolerance, none of the ventilatory or cardiovascular responses differed between IE and CLE (<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>) and there was no difference in the intensity of breathlessness or leg discomfort between the two modalities. The ventilatory reserve, reflected by the ratio of VE/maximal voluntary ventilation (VE/MVV), did not differ between IE and CLE.  During CLE and IE 36% and 21% of patients, respectively, ended the test with a HR greater than 80% of maximal predicted. Forty-three percent of patients ended CLE and 50% ended IE with a decrease in SpO2 greater than 4%, compatible with exercise-induced arterial oxygen desaturation. The fraction of patients who reasoned dyspnoea as the limiting factor was identical between IE and CLE corresponding to 57%. The fraction of patients who stopped exercise because of leg discomfort was relatively low for IE (n=2, 14%) and for CLE (n=3; 21%). Both dyspnoea and leg discomfort as the limiting factors were reported by n=4 for IE (29%) and n=3 for CLE (22%). At exercise iso-time and the limit of tolerance during IE and CLE protocols, VE, SPO2 and VO2 did not differ (<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>). Moreover, symptoms for breathlessness, leg discomfort, heart rate or blood pressure measurements were not different during IE and CLE protocols.<elsevierMultimedia ident="tbl0001"></elsevierMultimedia><elsevierMultimedia ident="tbl0002"></elsevierMultimedia>The lack of adverse events occurring during exercise modalities was in line with previous studies on COVID-19 survivors.<a class="elsevierStyleCrossRef" href="#bib0005">5</a> Moreover, several studies on other ‘high risk’ patients’ groups (e.g., such as ischemic heart disease and heart failure) showed that high-intensity exercise is considered safe.<a class="elsevierStyleCrossRef" href="#bib0006">6</a>,<a class="elsevierStyleCrossRef" href="#bib0007">7</a> Recent studies in COVID-19 survivors<a class="elsevierStyleCrossRef" href="#bib0004">4</a>,<a class="elsevierStyleCrossRef" href="#bib0008">8</a> have attributed early metabolic acidosis to myopathic changes occurring for medications administered during the hospital stay (e.g., steroids) as well as because of the potential direct or indirect myopatic damage from COVID-19 rather than muscle disuse.<a class="elsevierStyleCrossRef" href="#bib0007">7</a> Hence, several opinion papers and guidelines favour low-intensity exercise with gradual increases in intensity, mostly due to safety concerns.<a class="elsevierStyleCrossRef" href="#bib0002">2</a>,<a class="elsevierStyleCrossRef" href="#bib0003">3</a> Early experiences of rehabilitation in post-COVID-195 individuals show that low-to-moderate intensity of exercise in this population is safe and effective in improving exercise tolerance and peripheral muscle strength. Accordingly, our study was designed to investigate the safety and tolerability of high-intensity (continuous or interval) exercise in this population.Individuals with ongoing symptomatic COVID-19 could successfully and safely undertake high-intensity exercise performed continuously or intermittently. These findings are relevant both for a better understanding of consequences of COVID-19 on exercise tolerance. They also provide a clearer suggestion to survivors on how they should undertake regular exercise when expecting to resume their previous lifestyle.AcknowledgmentsThe authors thank Laura Comini and Adriana Olivares for technical assistance. This work was supported by the “Ricerca Corrente” Funding scheme of the Ministry of Health, Italy.Author contributionsMP (Guarantor) had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. MV, IV, MP and MVe contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript. BS, LB contributed to data collection and interpretation. All Authors reviewed the manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0001" "titulo" => "Acknowledgments" ] 1 => array:2 [ "identificador" => "sec0002" "titulo" => "Author contributions" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-11-23" "fechaAceptado" => "2022-02-15" "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Legend: Results are expressed as mean± Standard Deviation; BMI, body mass index; SPPB, Short Physical Performance Battery; 6MWD, six minute walking distance; CPET, cardiopulmonary exercise test; WRpeak, maximum load in watts at peak exercise; VO2, oxygen uptake; VE, ventilation; SpO2, peripheral oxygen saturation; TcCO2, transcutaneous carbon dioxide tension; VO2-AT, oxygen uptake at the anaerobic threshold; RER, respiratory exchange ratio; VE/VO2; ventilatory equivalent for VO2, VE/VCO2, ventilatory equivalent for VCO2; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR, heart rate." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Measures \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0003"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Patients, n \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0004"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0005"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">63.1±12.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0007"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">BMI, kg/m2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">28.0±5.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Male, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">11 (78.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Comorbidities \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">None, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">9 (64.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Cardiac, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">3 (20.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Respiratory, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">2 (14.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0019"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Diabetes, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 (7.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">9 (65.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Days since acute hospitalisation, n \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">54.6± 22.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Functional status \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0027"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">SPPB, score \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">9.9±1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6MWD, m \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">411.4±111.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6MWD, % of predicted \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">77.3±17.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Physiological responses at the limit of tolerance during the CPET \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0035"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">WRpeak, Watts \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">87.1±31.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">WRpeak, % predicted \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">59.4±22.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0039"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">VO2peak, ml/kg/min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">12.7±4.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">VO2peak, % of predicted \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">57.6±16.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">VCO2peak, ml/kg/min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13.0±4.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">VO2-AT, ml/kg/min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">10.6±3.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0047"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">VO2-AT, % VO2peak predicted \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">48.2±9.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">VE/VO2 peak \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">50.4±10.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0051"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">VE/VCO2 peak \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40.6±9.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0053"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">RER peak \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.1±0.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0055"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">TcCO2 peak, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.4±5.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">VEpeak, l/min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">46.8±20.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0059"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">VE/MVV, % \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">42.5±17.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">SBPpeak, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">171.8±26.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0063"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">DBPpeak, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">96.6±14.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">SpO2peak, % \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">92.5±3.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0067"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">HRpeak, beats/min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">124.3±2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">HRpeak, % of predicted \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">79.0±10.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Borg dyspnea at peak exercise, score \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">7.4±2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Borg Leg discomfort at peak exercise, score \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">5.8±3.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2926390.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic, anthropometric and clinical characteristics." ] ] 1 => array:8 [ "identificador" => "tbl0002" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Legend: Results are expressed as mean± Standard Deviation; VO2, oxygen uptake; VE, minute ventilation; arterial oxygen saturation; TcCO2, transcutaneous carbon dioxide; CPET, cardiopulmonary exercise test; RER, respiratory exchange ratio; VE/VO2, ventilatory equivalent for VO2; VE/VCO2, ventilatory equivalent for VCO2; BP, blood pressure; HR, heart rate." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0075"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0076"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tlim_CLE \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0077"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tlim_IE \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0078"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0079"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Cycling responses \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0083"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Work rate, Watts \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">59.6±23.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">60.0±23.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.4845 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0087"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Endurance time, min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">12.7±8.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">14.7±9.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.1594 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Cadence, rpm \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">60.2±7.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">59.1±7.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.9150 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0095"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Total work, kJ \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">45.9±31.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">54.3±40.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.1580 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Metabolic and ventilatory responses \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0103"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">VO2, ml/kg/min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">12.3±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">11.9 ±3.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.6494 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">VO2, % VO2peak \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">94.6±18.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">95.6±24.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.8676 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">RER \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.9±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.9±0.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.4513 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0115"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">VE, L/min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">46.9±22.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">44.3±16.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.5767 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0119"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">VE/MVV, % \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">41.4± 2.9 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">41.5±19.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.9927 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0123"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">VE/VO2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">47.6±8.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">47.1±10.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.8157 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0127"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">VE/VCO2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">52.0± 9.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">50.6± 10.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.2317 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0131"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Ti, sec \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.7± 0.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.7±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.6128 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0135"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Ti/Ttot \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.4±0.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.4±0.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.8041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0139"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Bf, breaths/min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35.9±6.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0141"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36.1±7.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.8970 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0143"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">SpO2, % \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">92.9±3.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">92.3±3.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.1788 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0147"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">TcCO2, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">33.4±4.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">32.5±4.5 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.2289 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0151"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Cardiovascular and symptoms responses \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0155"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Mean BP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">119.9±18.7 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">113.1±8.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.1494 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0159"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">HR, beats/min \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">117.1±17.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">114.6 ±13.4 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.4712 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0163"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">HR, % of predicted \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">74.7±8.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">73.4±8.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.5681 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0167"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Borg dyspnea, score \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6.6±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0169"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6.4±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.3456 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0171"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Borg leg discomfort, score \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">5.0±3.0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4.3±3.3 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.2206 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2926389.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Responses at the limit of tolerance (Tlim) to constant-load exercise (CLE) and interval exercise (IE) protocols." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "NICE guideline on long covid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M Sivan" 1 => "S. 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Letter to the Editor

Intermittent versus equivalent constant-load cycle training in COVID-19 patients

M. Vitaccaa,

Corresponding author

michele.vitacca@icsmaugeri.it

Corresponding author at: Michele Vitacca MD FERS, Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (Brescia), Italy

, I. Vogiatzisb, B. Salvia, L. Bertacchinia, M. Venturellic, M. Paneronia

a Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane (Brescia), Italy

b Department of Sport, Exercise and Rehabilitation; Faculty of Health and Life Sciences. Northumbria University, Newcastle, UK

c Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall">While the need to implement evidence-based training following COVID-19 is imperative&#44; no consensus exists as to how such programmes should be designed&#46;<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1-3</span></a> Between 20 July 2020 and 30 April 2021&#44; we assessed tolerability and safety of high-intensity constant-load exercise &#40;CLE&#41; and high-intensity intermittent exercise &#40;IE&#41; in 14 patients presenting pneumonia and acute respiratory failure &#40;ARF&#41; &#40;mean age&#58; 63&#177;13 years&#41; with ongoing symptomatic COVID-19 from 4 to 12 weeks following the infection&#46; Anthropometric data&#44; body mass index &#40;BMI&#41;&#44; and the number of comorbidities were recorded&#46; Patients undertook spirometry &#40;FEV<span class="elsevierStyleInf">1</span>&#44; FVC&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; transfer factor for Carbon Monoxide &#40;DLCO&#41;&#44; blood gases in room air &#40;PaO<span class="elsevierStyleInf">2</span>&#44; PaCO<span class="elsevierStyleInf">2</span>&#44; pH&#41;&#44; functional status &#40;the Short Physical Performance Battery-SPPB test and the 6-minute walking distance &#91;6MWD&#58; in meters and as a percentage of predicted&#93;&#41;&#44; an incremental cardiopulmonary exercise test &#40;CPET&#41; &#91;assessing oxygen uptake &#40;VO<span class="elsevierStyleInf">2</span>&#41;&#44; carbon dioxide output &#40;VCO<span class="elsevierStyleInf">2</span>&#41;&#44; oxygen uptake at the anaerobic threshold &#40;AT&#41;&#44; respiratory exchange ratio &#40;RER&#41;&#44; minute ventilation &#40;V<span class="elsevierStyleInf">E</span>&#41;&#44; tidal volume &#40;V<span class="elsevierStyleInf">T</span>&#41; and respiratory rate&#93; using a portable metabolimeter&#59; transcutaneous carbon dioxide tension &#40;TcCO<span class="elsevierStyleInf">2</span>&#41; was also recorded continuously&#46; In this crossover study &#40;Ethics Committee approval on 30 June 2020&#44; Procotol No&#46; 2449CE&#41;&#44; training exercise intensity was balanced to provide the same average work rate for IE and CLE modalities&#46; CLE was set at 70&#37; of peak work rate &#40;WRpeak&#41; and IE consisted of one minute of exercise at 100&#37; WRpeak&#44; alternated with one minute at 40&#37; WRpeak&#44; to the limit of tolerance &#40;Tlim&#41;&#46; Dyspnea and leg muscle discomfort &#40;1-10 Borg scale&#41;&#44; heart rate and safety were assessed&#46; Of the 220 consecutively admitted patients at the Respiratory Rehabilitative Unit - ICS Maugeri of Lumezzane &#40;BS&#41; - as inpatient and outpatient between 20 July 2020 and 30 April 2021&#44; 14 patients were eligible for the study&#46; We excluded from this study 63 patients presenting symptoms for less than four weeks following infection&#44; 35 patients with more than 12 weeks following infection&#44; 44 clinically unstable patients&#44; 20 patients with severe orthopedic diseases&#44; 15 patients with cognitive impairment&#44; 29 patients with previous severe heart disease &#40;congestive heart disease&#44; severe aortic stenosis&#44; atrial fibrillation&#41;&#46; We did not successively exclude patients for technical reasons or missing data&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a> shows the study population and cardiorespiratory function at peak exercise&#59; two patients presented mitral valve insufficiency and one chronic atrial fibrillation&#44; while two patients suffered from mild COPD&#46; At study entry&#44; patients showed breathlessness &#40;71&#46;4&#37;&#41;&#44; fatigue &#40;64&#46;3&#37;&#41;&#44; cough &#40;14&#46;4&#37;&#41;&#44; palpitations &#40;21&#46;4&#37;&#41; and pain &#40;35&#46;7&#37;&#41;&#44; respectively&#46; Patients presented the following lung function data&#58; FEV<span class="elsevierStyleInf">1</span> &#37; predicted &#40;prd&#41;&#58; 83&#46;2&#177;15&#46;7&#44; FVC&#44; &#37; prd&#58; 79&#46;1&#177;15&#46;8&#46;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#58; 84&#46;1&#177;8&#46;5&#44; DLCO &#37; prd&#58; 56&#46;7&#177;26&#46;6&#44; PaO<span class="elsevierStyleInf">2</span>&#58; 73&#46;7&#177;11&#46;8 mmHg&#44; PaCO<span class="elsevierStyleInf">2</span>&#58; 36&#46;9&#177;3&#46;01 mmHg&#46; We reported no adverse events for either of the two modalities&#46; We detected no ECG abnormalities during or after IE or CLE&#46; At peak exercise&#44; WRpeak and V&#775;O<span class="elsevierStyleInf">2</span>peak were reduced below normal predicted levels&#46; Premature metabolic acidosis was evident by the low fraction of predicted normal VO<span class="elsevierStyleInf">2</span> when the anaerobic threshold &#40;AT&#41; was detected &#40;AT at 48&#177;9&#37; VO<span class="elsevierStyleInf">2</span> prd&#41;&#46; Overall&#44; respiratory reserve was not exhausted in patients with COVID-19&#46; Ventilatory equivalents for VO<span class="elsevierStyleInf">2</span> &#40;V<span class="elsevierStyleInf">E</span>&#47;VO<span class="elsevierStyleInf">2</span>&#41; and VCO<span class="elsevierStyleInf">2</span> &#40;V<span class="elsevierStyleInf">E</span>&#47;VCO<span class="elsevierStyleInf">2</span>&#41;&#44; and transcutaneous carbon dioxide tension &#40;TcCO<span class="elsevierStyleInf">2</span>&#41; were compatible with exercise hyperventilation &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46; A recent study in survivors from COVID-19 pneumonia has suggested that exercise hyperventilation after COVID-19 is frequent and principally due to enhanced chemoreflex sensitivity rather than increased V<span class="elsevierStyleInf">D</span>&#47;V<span class="elsevierStyleInf">T</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> We observed a mild reduction in arterial oxygen saturation &#40;SpO<span class="elsevierStyleInf">2</span>&#41;&#46; Arterial blood pressure was normal&#44; whereas the mean heart rate reached approximately 80&#37; of predicted normal value&#46; Sensations of breathlessness and leg discomfort were indicative of severe symptoms&#46; The predominant symptom for stopping exercise was breathlessness &#40;6&#47;14&#41;&#44; leg discomfort &#40;2&#47;14&#41; or both dyspnoea and leg discomfort &#40;6&#47;14&#41;&#46; Exercise endurance time was not different between IE compared to CLE &#40;p&#160;&#61;&#160;0&#46;1594&#44; <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46; The average cycling work rate did not differ between IE and CLE&#46; The same was also the case for VO<span class="elsevierStyleInf">2</span> and for both ventilatory equivalents &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46; At the limit of cycling tolerance&#44; none of the ventilatory or cardiovascular responses differed between IE and CLE &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41; and there was no difference in the intensity of breathlessness or leg discomfort between the two modalities&#46; The ventilatory reserve&#44; reflected by the ratio of V<span class="elsevierStyleInf">E</span>&#47;maximal voluntary ventilation &#40;V<span class="elsevierStyleInf">E</span>&#47;MVV&#41;&#44; did not differ between IE and CLE&#46;&#160; During CLE and IE 36&#37; and 21&#37; of patients&#44; respectively&#44; ended the test with a HR greater than 80&#37; of maximal predicted&#46; Forty-three percent of patients ended CLE and 50&#37; ended IE with a decrease in SpO<span class="elsevierStyleInf">2</span> greater than 4&#37;&#44; compatible with exercise-induced arterial oxygen desaturation&#46; The fraction of patients who reasoned dyspnoea as the limiting factor was identical between IE and CLE corresponding to 57&#37;&#46; The fraction of patients who stopped exercise because of leg discomfort was relatively low for IE &#40;n&#61;2&#44; 14&#37;&#41; and for CLE &#40;n&#61;3&#59; 21&#37;&#41;&#46; Both dyspnoea and leg discomfort as the limiting factors were reported by n&#61;4 for IE &#40;29&#37;&#41; and n&#61;3 for CLE &#40;22&#37;&#41;&#46; At exercise iso-time and the limit of tolerance during IE and CLE protocols&#44; V<span class="elsevierStyleInf">E</span>&#44; SPO<span class="elsevierStyleInf">2</span> and VO<span class="elsevierStyleInf">2</span> did not differ &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46; Moreover&#44; symptoms for breathlessness&#44; leg discomfort&#44; heart rate or blood pressure measurements were not different during IE and CLE protocols&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0004" class="elsevierStylePara elsevierViewall">The lack of adverse events occurring during exercise modalities was in line with previous studies on COVID-19 survivors&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> Moreover&#44; several studies on other &#8216;high risk&#8217; patients&#8217; groups &#40;e&#46;g&#46;&#44; such as ischemic heart disease and heart failure&#41; showed that high-intensity exercise is considered safe&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Recent studies in COVID-19 survivors<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> have attributed early metabolic acidosis to myopathic changes occurring for medications administered during the hospital stay &#40;e&#46;g&#46;&#44; steroids&#41; as well as because of the potential direct or indirect myopatic damage from COVID-19 rather than muscle disuse&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Hence&#44; several opinion papers and guidelines favour low-intensity exercise with gradual increases in intensity&#44; mostly due to safety concerns&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Early experiences of rehabilitation in post-COVID-19<span class="elsevierStyleSup">5</span> individuals show that low-to-moderate intensity of exercise in this population is safe and effective in improving exercise tolerance and peripheral muscle strength&#46; Accordingly&#44; our study was designed to investigate the safety and tolerability of high-intensity &#40;continuous or interval&#41; exercise in this population&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">Individuals with ongoing symptomatic COVID-19 could successfully and safely undertake high-intensity exercise performed continuously or intermittently&#46; These findings are relevant both for a better understanding of consequences of COVID-19 on exercise tolerance&#46; They also provide a clearer suggestion to survivors on how they should undertake regular exercise when expecting to resume their previous lifestyle&#46;</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Acknowledgments</span><p id="para0006" class="elsevierStylePara elsevierViewall">The authors thank Laura Comini and Adriana Olivares for technical assistance&#46; This work was supported by the &#8220;Ricerca Corrente&#8221; Funding scheme of the Ministry of Health&#44; Italy&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Author contributions</span><p id="para0007" class="elsevierStylePara elsevierViewall">MP &#40;Guarantor&#41; had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis&#44; including and especially any adverse effects&#46; MV&#44; IV&#44; MP and MVe contributed substantially to the study design&#44; data analysis and interpretation&#44; and the writing of the manuscript&#46; BS&#44; LB contributed to data collection and interpretation&#46; All Authors reviewed the manuscript&#46;</p></span></span>"
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          "leyenda" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Legend&#58;</span> Results are expressed as mean&#177; Standard Deviation&#59; BMI&#44; body mass index&#59; SPPB&#44; Short Physical Performance Battery&#59; 6MWD&#44; six minute walking distance&#59; CPET&#44; cardiopulmonary exercise test&#59; WRpeak&#44; maximum load in watts at peak exercise&#59; VO<span class="elsevierStyleInf">2</span>&#44; oxygen uptake&#59; V<span class="elsevierStyleInf">E</span>&#44; ventilation&#59; SpO<span class="elsevierStyleInf">2</span>&#44; peripheral oxygen saturation&#59; TcCO<span class="elsevierStyleInf">2</span>&#44; transcutaneous carbon dioxide tension&#59; VO<span class="elsevierStyleInf">2</span>-AT&#44; oxygen uptake at the anaerobic threshold&#59; RER&#44; respiratory exchange ratio&#59; V<span class="elsevierStyleInf">E</span>&#47;VO<span class="elsevierStyleInf">2</span>&#59; ventilatory equivalent for VO<span class="elsevierStyleInf">2</span>&#44; V<span class="elsevierStyleInf">E</span>&#47;VCO<span class="elsevierStyleInf">2</span>&#44; ventilatory equivalent for VCO<span class="elsevierStyleInf">2</span>&#59; SBP&#58; systolic blood pressure&#59; DBP&#58; diastolic blood pressure&#59; HR&#44; heart rate&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Measures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0003"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Patients&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0004"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0005"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">63&#46;1&#177;12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">BMI&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">28&#46;0&#177;5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Male&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">11 &#40;78&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">None&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">9 &#40;64&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Cardiac&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3 &#40;20&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Respiratory&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Diabetes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;7&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Hypertension&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">9 &#40;65&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Days since acute hospitalisation&#44; n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">54&#46;6&#177; 22&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Functional status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SPPB&#44; score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;9&#177;1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6MWD&#44; m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">411&#46;4&#177;111&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6MWD&#44; &#37; of predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">77&#46;3&#177;17&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Physiological responses at the limit of tolerance during the CPET&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">WRpeak&#44; Watts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;1&#177;31&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">WRpeak&#44; &#37; predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">59&#46;4&#177;22&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">VO<span class="elsevierStyleInf">2</span>peak&#44; ml&#47;kg&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12&#46;7&#177;4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">VO<span class="elsevierStyleInf">2</span>peak&#44; &#37; of predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">57&#46;6&#177;16&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">VCO<span class="elsevierStyleInf">2</span>peak&#44; ml&#47;kg&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13&#46;0&#177;4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">VO<span class="elsevierStyleInf">2</span>-AT&#44; ml&#47;kg&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10&#46;6&#177;3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">VO<span class="elsevierStyleInf">2</span>-AT&#44; &#37; VO<span class="elsevierStyleInf">2</span>peak predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">48&#46;2&#177;9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">V<span class="elsevierStyleInf">E</span>&#47;VO<span class="elsevierStyleInf">2</span> peak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">50&#46;4&#177;10&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">V<span class="elsevierStyleInf">E</span>&#47;VCO<span class="elsevierStyleInf">2</span> peak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">40&#46;6&#177;9&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RER peak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;1&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">TcCO<span class="elsevierStyleInf">2</span> peak&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">37&#46;4&#177;5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">V<span class="elsevierStyleInf">E</span>peak&#44; l&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&#46;8&#177;20&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">V<span class="elsevierStyleInf">E</span>&#47;MVV&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">42&#46;5&#177;17&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SBPpeak&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">171&#46;8&#177;26&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">DBPpeak&#44; mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">96&#46;6&#177;14&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">SpO<span class="elsevierStyleInf">2</span>peak&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">92&#46;5&#177;3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">HRpeak&#44; beats&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">124&#46;3&#177;2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">HRpeak&#44; &#37; of predicted&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">79&#46;0&#177;10&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Borg dyspnea at peak exercise&#44; score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;4&#177;2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Borg Leg discomfort at peak exercise&#44; score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;8&#177;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; anthropometric and clinical characteristics&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Legend&#58;</span> Results are expressed as mean&#177; Standard Deviation&#59; VO<span class="elsevierStyleInf">2</span>&#44; oxygen uptake&#59; V<span class="elsevierStyleInf">E</span>&#44; minute ventilation&#59; arterial oxygen saturation&#59; TcCO<span class="elsevierStyleInf">2</span>&#44; transcutaneous carbon dioxide&#59; CPET&#44; cardiopulmonary exercise test&#59; RER&#44; respiratory exchange ratio&#59; V<span class="elsevierStyleInf">E</span>&#47;VO<span class="elsevierStyleInf">2</span>&#44; ventilatory equivalent for VO<span class="elsevierStyleInf">2</span>&#59; V<span class="elsevierStyleInf">E</span>&#47;VCO<span class="elsevierStyleInf">2</span>&#44; ventilatory equivalent for VCO<span class="elsevierStyleInf">2</span>&#59; BP&#44; blood pressure&#59; HR&#44; heart rate&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0075"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0076"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tlim&#95;CLE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0077"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tlim&#95;IE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0078"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0079"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Cycling responses</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0083"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Work rate&#44; Watts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">59&#46;6&#177;23&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">60&#46;0&#177;23&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;4845&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0087"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Endurance time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12&#46;7&#177;8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">14&#46;7&#177;9&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;1594&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Cadence&#44; rpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">60&#46;2&#177;7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">59&#46;1&#177;7&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;9150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0095"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Total work&#44; kJ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">45&#46;9&#177;31&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">54&#46;3&#177;40&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;1580&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Metabolic and ventilatory responses</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0103"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>VO<span class="elsevierStyleInf">2</span>&#44; ml&#47;kg&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">12&#46;3&#177;3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">11&#46;9 &#177;3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;6494&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>VO<span class="elsevierStyleInf">2</span>&#44; &#37; VO<span class="elsevierStyleInf">2</span>peak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">94&#46;6&#177;18&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">95&#46;6&#177;24&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;8676&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>RER&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;9&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;9&#177;0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;4513&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0115"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>V<span class="elsevierStyleInf">E</span>&#44; L&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&#46;9&#177;22&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">44&#46;3&#177;16&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;5767&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>V<span class="elsevierStyleInf">E</span>&#47;MVV&#44; &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">41&#46;4&#177; 2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">47&#46;6&#177;8&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">47&#46;1&#177;10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>V<span class="elsevierStyleInf">E</span>&#47;VCO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">52&#46;0&#177; 9&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">50&#46;6&#177; 10&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Ti&#44; sec&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">0&#46;6128&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Ti&#47;Ttot&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;4&#177;0&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;4&#177;0&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;8041&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Bf&#44; breaths&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">35&#46;9&#177;6&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">92&#46;9&#177;3&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>TcCO<span class="elsevierStyleInf">2</span>&#44; mmHg&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">33&#46;4&#177;4&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">32&#46;5&#177;4&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">117&#46;1&#177;17&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;5681&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Borg dyspnea&#44; score&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&#46;6&#177;2&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">6&#46;4&#177;2&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;3456&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0171"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Borg leg discomfort&#44; score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;0&#177;3&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;2206&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Responses at the limit of tolerance &#40;Tlim&#41; to constant-load exercise &#40;CLE&#41; and interval exercise &#40;IE&#41; protocols&#46;</p>"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "NICE guideline on long covid"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M Sivan"
                            1 => "S&#46; Taylor"
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                    0 => array:2 [
                      "doi" => "10.1136/bmj.m4938"
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                        "tituloSerie" => "BMJ &#40;Clin Res Ed&#41;"
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                      "titulo" => "Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis&#58; the Italian position paper"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M Vitacca"
                            1 => "M Carone"
                            2 => "EM Clini"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000508399"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiration"
                        "fecha" => "2020"
                        "volumen" => "99"
                        "paginaInicial" => "493"
                        "paginaFinal" => "499"
                        "link" => array:1 [
                          0 => array:2 [
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "RM Barker-Davies"
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                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1136/bjsports-2020-102596"
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                        "fecha" => "2020"
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                          "autores" => array:3 [
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Article information

ISSN: 25310437
Original language: English

DOI:10.1016/j.pulmoe.2022.02.005

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Year/Month	Html	Pdf	Total

2024 October	47	18	65
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2024 July	107	38	145
2024 June	114	49	163
2024 May	92	44	136
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2024 February	84	35	119
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2022 December	805	46	851
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