9b28fed20acc6037ffc131628841778e jcm-14-08150.pdf afb2baf9535b55b7225c8f756989da7ede567567 jcm-14-08150.pdf 406e84dc53dbd5cf1469a90dba8fec279e4accb959c227d0159854828abb1f32 jcm-14-08150.pdf Title: Muscle Unloading During Exercise: Comparative Effects of Conventional Oxygen, NIV, and High-Flow Therapy on Neural Drive in Severe COPD Subject: Objectives: This study aimed to evaluate how non-invasive ventilation (NIV) and high-flow nasal cannula therapy (HFT) versus conventional oxygen therapy (COT) affect neural ventilatory drive during exercise in patients with severe chronic obstructive pulmonary disease (COPD). Methods: We conducted an experimental, controlled study with one arm and three different conditions for the same cohort. After initial testing on conventional oxygen therapy (COT), patients exercised under NIV and HFT in sequential days and a random order. Participants: Twenty patients (mean age 60 years old (SD 3.9), 6 female) with severe COPD (30% women) on home NIV as a bridge to lung transplantation were enrolled in this study, with a mean FEV1 of 19.78% predicted and marked hyperinflation. Protocol: Participants performed constant-load cycling exercises at 75% maximum tolerated workload under three conditions: COT, NIV, and HFT. Neuro-respiratory drive (NRD) was measured using surface parasternal and sternocleidomastoid electromyography, and mixed ANOVA was performed to analyze repeated measures across conditions. Results: In total, 20 patients were included in this study. NIV demonstrated superior performance, with 60% lower NRD compared to COT (488.81 V vs. 1180.63 V, p < 0.05). HFT showed intermediate effects (807.8 V). NIV also achieved greater reduction in respiratory rate (4.2 breaths/min), lower perceived exertion (Borg score decrease: 1.8 points), and more pronounced CO2 reduction (5.3 mmHg) compared to both COT and HFT. Conclusions: NIV significantly reduces NRD during exercise in severe COPD patients compared to HFT and COT. This supports its use as a valuable adjunct to pulmonary rehabilitation in severe COPD. Keywords: chronic obstructive pulmonary disease; exercise therapy; high-flow therapy; neural drive; non-invasive ventilation Author: Javier Sayas-Catalán, Victoria Villena Garrido, Cristina Lalmolda, Ana Hernández-Voth, Marta Corral-Blanco, Miguel Jiménez-Gómez, Laura González-Ramos and Manel Luján Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Tue Nov 18 12:56:05 2025 CET ModDate: Tue Nov 18 13:06:44 2025 CET Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1089112 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- YGQLYD+VnURWPalladioL Type 1 Custom yes yes yes 118 0 DIYAQA+URWPalladioL-Bold Type 1 Custom yes yes yes 119 0 CALXYC+URWPalladioL-Roma Type 1 Custom yes yes yes 120 0 YTNLDA+EURM10 Type 1 Builtin yes yes yes 121 0 TRVAHR+URWPalladioL-Ital Type 1 Custom yes yes yes 122 0 KRLUFH+CMSY10 Type 1 Builtin yes yes yes 197 0 XMAQEJ+EURB10 Type 1 Builtin yes yes yes 267 0 HYYHEA+CMBSY10 Type 1 Builtin yes yes yes 268 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 269 0 MXSMUU+PalatinoLinotype-Bold TrueType WinAnsi yes yes yes 251 0 TSCCOG+PalatinoLinotype-Roman TrueType WinAnsi yes yes yes 252 0 ELRQMK+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 253 0 MXSMUU+PalatinoLinotype-Bold TrueType WinAnsi yes yes yes 314 0 TSCCOG+PalatinoLinotype-Roman TrueType WinAnsi yes yes yes 315 0 WMSUEA+PalatinoLinotype-Italic TrueType WinAnsi yes yes yes 316 0 ELRQMK+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 317 0 TSCCOG+PalatinoLinotype-Roman TrueType WinAnsi yes yes yes 305 0 WMSUEA+PalatinoLinotype-Italic TrueType WinAnsi yes yes yes 306 0 ELRQMK+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 307 0 MAMHCL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 360 0 MAMHCJ+PalatinoLinotype TrueType WinAnsi yes yes no 361 0 MAMKCB+Wingdings CID TrueType Identity-H yes yes yes 362 0 MAMHPK+Arial TrueType WinAnsi yes yes no 363 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-03-11 04:08:02 CET RepresentationInformation: jcm-14-08150.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-03-10 19:12:49 CET Size: 1089112 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 541 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Population Item: Title: Ethical and Data Management Protocol Item: Title: Study Design Item: Title: Protocol Item: Title: Signal Recording Item: Title: Data Collection Item: Title: Statistical Analysis Item: Title: Results Children: Item: Title: Descriptive Analysis Item: Title: Comparative Study of Respiratory Variables Item: Title: Comparative Study of Neuroventilatory Variables Item: Title: Subgroup Analysis: Exercise Non-Limited Cohort (Patients Who Did Not Stop Pedalling, N = 7) Item: Title: Discussion Item: Title: Conclusions Item: Title: References Info: Title: Muscle Unloading During Exercise: Comparative Effects of Conventional Oxygen, NIV, and High-Flow Therapy on Neural Drive in Severe COPD Author: Javier Sayas-Catalán, Victoria Villena Garrido, Cristina Lalmolda, Ana Hernández-Voth, Marta Corral-Blanco, Miguel Jiménez-Gómez, Laura González-Ramos and Manel Luján Subject: Objectives: This study aimed to evaluate how non-invasive ventilation (NIV) and high-flow nasal cannula therapy (HFT) versus conventional oxygen therapy (COT) affect neural ventilatory drive during exercise in patients with severe chronic obstructive pulmonary disease (COPD). Methods: We conducted an experimental, controlled study with one arm and three different conditions for the same cohort. After initial testing on conventional oxygen therapy (COT), patients exercised under NIV and HFT in sequential days and a random order. Participants: Twenty patients (mean age 60 years old (SD 3.9), 6 female) with severe COPD (30% women) on home NIV as a bridge to lung transplantation were enrolled in this study, with a mean FEV1 of 19.78% predicted and marked hyperinflation. Protocol: Participants performed constant-load cycling exercises at 75% maximum tolerated workload under three conditions: COT, NIV, and HFT. Neuro-respiratory drive (NRD) was measured using surface parasternal and sternocleidomastoid electromyography, and mixed ANOVA was performed to analyze repeated measures across conditions. Results: In total, 20 patients were included in this study. NIV demonstrated superior performance, with 60% lower NRD compared to COT (488.81 V vs. 1180.63 V, p < 0.05). HFT showed intermediate effects (807.8 V). NIV also achieved greater reduction in respiratory rate (4.2 breaths/min), lower perceived exertion (Borg score decrease: 1.8 points), and more pronounced CO2 reduction (5.3 mmHg) compared to both COT and HFT. Conclusions: NIV significantly reduces NRD during exercise in severe COPD patients compared to HFT and COT. This supports its use as a valuable adjunct to pulmonary rehabilitation in severe COPD. 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