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

Background Patients with COPD exhibit greater oxyhemoglobin desaturation during walking than with cycling. The purpose of this investigation was to investigate differences in ventilatory responses and gas exchange as proposed mechanisms for this observation. Methods Arterial blood gas and lactate levels were measured in 12 patients with COPD (aged 68 ± 6 years) during incremental treadmill and cycle exercise. The primary outcome to assess the ventilatory response to exercise was P ao2 . The primary outcome to assess impairment in exercise gas exchange was the difference between partial pressures of alveolar and arterial oxygen (P ao2 − Pa o2 ). Results Pa o2 in patients was significantly lower at peak exercise for treadmill walking (51.4 ± 6.8 mm Hg) compared with cycling (60.4 ± 10.7 mm Hg) ( P = .002). The initial increase in P ao2 with cycling occurred prior to the onset of the anaerobic threshold. At peak exercise, P ao2 was significantly higher with cycling compared with walking ( P = .004). The anaerobic threshold occurred at a lower oxygen consumption during cycling than walking ( P = .001), and peak lactate levels were higher with cycling ( P = .019). With progressive exercise, P ao2 − Pa o2 increased similarly during treadmill and cycle exercise. Conclusions The higher P ao2 during cycling minimized the magnitude of oxyhemoglobin desaturation compared with walking. The enhanced respiratory stimulation during cycling appears due to an initial neurogenic process, possibly originating in receptors of exercising muscles, and a subsequent earlier onset of anaerobic metabolism with higher lactate levels during cycling.