Can an 86-year-old woman with advanced lung disease be a world class athlete?

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Abstract

We describe the case of an 86-year-old woman with advanced obstructive lung disease (forced expiratory volume in 1 s/forced vital capacity ratio (FEV1/FVC) = 34%) who remains capable of superior athletic performance. Detailed pulmonary function testing was performed to characterize this patient's baseline respiratory impairment. An incremental symptom limited cycle exercise test was performed to characterize her sensory, ventilatory, cardiovascular and respiratory mechanical responses to exercise. Despite significant respiratory mechanical constraints, her peak cycle work rate and oxygen uptake were 177 and 175% predicted, respectively, and she achieved this while experiencing only moderate exertional dyspnea. She holds numerous world and national masters swim records despite her substantial objective respiratory impairment and continues to compete and set records to this day. We propose that lifelong participation in rigorous endurance training resulted in desensitization to dyspnea and has led to important cardiorespiratory adaptations that may have counterbalanced the known negative effects of obstructive lung disease on exercise performance and dyspnea.

Highlights

► We present the case of an elderly female athlete with advanced airflow obstruction. ► She experiences substantial mechanical ventilatory constraints during exercise. ► She has superior athletic performance despite her severe ventilatory limitation. ► Lifelong exercise training can counteract the negative effects of lung disease.

Introduction

In older patients with chronic airflow limitation as a result of asthma, chronic obstructive pulmonary disease (COPD) alone or in combination, the normal age-related decline in lung function is amplified. Thus, mechanical ventilatory constraints and the attendant respiratory discomfort become the proximate factors limiting exercise. These collective negative influences on exercise performance may be even further exaggerated in elderly women with COPD compared with age-matched men, due to their naturally smaller lungs, airways and respiratory musculature (Guenette et al., 2011).

In this context, we present the unusual case of an 86-year-old female athlete with advanced chronic airflow limitation who retains superior athletic ability despite this handicap. In order to gain insight into our patient's remarkable preservation of exercise performance in the face of her age and severe respiratory impairment, we assessed her ventilatory, sensory, cardiovascular and respiratory mechanical responses to laboratory exercise testing. For illustrative purposes, we also compared her responses to incremental cycle exercise to those of two elderly women: one with COPD of similar severity and a second physically active woman with no prior lung disease.

Section snippets

Case report

A physically active woman was first referred to a respirology clinic in 1998 for evaluation of breathing difficulty at the age of 73 years. She reported the development of acute dyspnea and wheezing after exposure to mold in a friend's basement 11 months previously. She is a life-long non-smoker but was exposed to substantial second-hand smoke for 30 years in the home. Past medical history includes ‘bronchitis’ once/year for several years. Her respiratory symptoms were triggered primarily by

Discussion

We present the case of an 86-year-old female athlete who, despite severe respiratory mechanical constraints caused by chronic airflow limitation, experienced little perceived respiratory discomfort during exercise and had a peak aerobic capacity (V˙O2peak) and cycle work rate in excess of 170% predicted, based on established prediction equations (Jones, 1988). We propose that lifelong participation in rigorous endurance training resulted in greater tolerance of respiratory discomfort and

Conclusion

It is clear that exercise intolerance in COPD is multi-factorial given the vastly heterogeneous nature of this disease. However, it is well established that ventilatory abnormalities represent a key contributing factor to exercise limitation and dyspnea in patients with advanced airflow limitation. The present case report demonstrates that it is possible to have substantial ventilatory impairment during exercise without a corresponding negative effect on exercise performance and dyspnea. It is

Disclosure of funding

J.G. was supported by the John Alexander Stewart Fellowship (Department of Medicine, Queen's University) and postdoctoral fellowships from the Natural Sciences and Engineering Research Council of Canada, the Canadian Thoracic Society and the Canadian Lung Association.

Conflicts of interest

J.G. and K.W. have no conflicts of interest to report. D.O. has received research funding via Queen's University from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck, Novartis, Nycomed and Pfizer; and has served on speakers bureaus, consultation panels and advisory boards for AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Nycomed and Pfizer. MDL has received research funding via Queen's University from Mpex Pharmaceuticals and Ception Therapeutics; and has served on speaker

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