Shortness of breath after exercise

Shortness of breath after physical activity is a fairly common phenomenon that occurs as a reaction of the body to increased activity. If the load is really intense or unusual, then shortness of breath is considered as a variant of the norm. If breathing is difficult even after normal physical activity - for example, after walking - then you can suspect the development of any pathology. Ignore this symptom is not recommended, regardless of the age at which it first appeared. [1]

Causes of the dyspnea after exercise

In some cases, shortness of breath after exercise is a physiologic reaction - that is, the body's normal response to more intense physical activity.

Among the likely causes of exercise-related dyspnea:

• running at a fast pace, sports training, swimming, intense exercise;
• rapid climbing of heights, running up and down stairs;
• hard physical work;
• severe emotional tension or stress associated with motor activity.

The most common root cause of shortness of breath after physical activity is a banal untrained organism. For example, if a person was previously hypodynamic, not engaged in sports, and then suddenly began to perform intensive exercises, then shortness of breath in this situation becomes a kind of adaptive mechanism that allows the body to prevent the development of hypoxia.

Many people have shortness of breath after exercise due to the fact that they started vigorous exercise immediately after eating. Although it is better to exercise not earlier than 1.5-2 h after a meal.

Far not always dyspnea associated with exertion is a physiological norm. Often the causes of the disorder are pathological conditions:

• intoxication, infectious-inflammatory processes, fever;
• anemia, tumor processes, metabolic disorders;
• obesity;
• pathology of the nervous system;
• Cardiovascular disorders, heart failure;
• respiratory disorders (inflammation of the lungs or bronchi, bronchial asthma, chronic obstructive pulmonary disease, etc.);
• Endocrine pathologies (diabetes mellitus, thyrotoxicosis).

Depending on the root cause of the appearance of shortness of breath after exercise, the symptom will be accompanied by other manifestations.

Risk factors

The main risk factors for dyspnea after exercise:

• bronchopulmonary diseases (pulmonary emphysema, obstructive lung disease, tuberculosis and its consequences, bronchiectasis, cystic fibrosis, etc.);
• cardiovascular pathologies (heart failure, hypertension, postinfarction, ischemic heart disease, cardiomyopathy, etc.);
• obesity, overweight;
• anemia;
• metabolic disorders, thyroid disease;
• smoking, drinking alcohol or using drugs;
• taking certain medications.

Groups at particular risk include the elderly, pregnant women, overweight or obese persons of any degree, and patients with chronic diseases.

Pathogenesis

Muscle work is one of the main stimulators of respiratory activity. With the inclusion of muscular load increases lung ventilation, breathing deepens and becomes more frequent. This response is due mainly to neurogenic factors. In addition, the respiratory process is stimulated by afferent impulse, which arrives in the central nervous system from the proprioreceptors of functioning muscles. Presumably, a certain role is also played by catecholamines, which contribute to increased activity of the sympathetic nervous system.

After a few minutes of moderate exercise, a steady state of pulmonary ventilation is established, in accordance with oxygen consumption and energy expenditure at a given load. An important role is given to feedback through chemoreceptors. When ventilation lags behind the degree of gas exchange, carbon dioxide and other metabolic products of functioning muscles accumulate in the bloodstream. Increased impulsation from chemoreceptors provides additional stimulation to the central mechanism, as a result of which there is a compensatory increase in ventilation. Thus, during exercise, a relatively normal gas composition and acid-base state of the blood is maintained.

Excessive or overexertion is accompanied by the accumulation of large amounts of anaerobic glycolysis products in the blood. As a result, chemoreceptors are stimulated, ventilation increases with outpacing oxygen consumption and carbon dioxide production. Against the background of metabolic acidosis, hypocapnia is formed, respiratory alkalosis occurs.

In case of excessive load, there may be a need for particularly intensive oxygen transport, which cannot always be provided by the gas-transport apparatus of the body. Such a state may exist for a short time due to the involvement of anaerobic energy sources and oxygen present in myoglobin. The ultimate aerobic capacity in a healthy person can be about 2-3 l per minute, with a maximum ventilatory volume during intense exercise of 100 to 120 l per minute.

At the end of muscular exercise, lung ventilation decreases sharply, as neurogenic stimuli are switched off. For some time there is stimulation of chemoreceptors by underoxidized metabolic products present in the bloodstream - in particular, lactic and other organic acids. Oxygen deficiency is gradually alleviated.

As for pathological dyspnea after exercise, its appearance can be due to various complex reflex mechanisms, involving higher nervous structures. The immediate cause of this condition is a change in the level of oxygen and carbon dioxide in the blood. An increase in the concentration of carbon dioxide leads to a drop in pH and stimulates bulbar centers, central receptors localized in the medulla oblongata, as well as peripheral chemoreceptor arterial zones.

As part of the compensatory response, the respiratory center activates the bronchopulmonary mechanism, which causes the appearance of pathological dyspnea.

Epidemiology

Dyspnea after physical activity can accompany a variety of diseases. First of all, we are talking about pathologies of the respiratory and cardiovascular system. For example, the most common causes of the disorder are anemia, heart failure, bronchial asthma, metabolic acidosis, uremia and so on. Neurological pathologies, cardiomyopathies, thyroid diseases, etc. Are also involved.

According to statistical information, dyspnea after physical activity is the most common among people aged 38 to 70 years and makes, according to different data, from 6 to 27%. In the process of progression of the underlying disease increases and dyspnea. Eventually it reveals itself not only after exertion, but also at rest.

Most often shortness of breath after physical activity occurs in men aged 40-45 years. This disorder is especially common in people who are loaded for more than 10 hours a day, combine several jobs, have irregular schedules, have not rested for a long time, as well as those who start complex physical activity without prior preparation.

There are no separate statistics on dyspnea associated with physical activity. Nevertheless, a general trend can be traced: the disorder usually starts in able-bodied people, more often in men, against the background of an incorrect approach to training and the regimen of labor and rest. In many cases, this symptom is experienced by representatives of professions involving heavy work with constant muscle tension and overload.

Symptoms

Dyspnea after physical activity is a feeling of lack of air, which requires increased frequency and intensification of breathing movements. This phenomenon is not uncommon even for healthy people. However, if the symptom bothers often or constantly, it is necessary to consult doctors: it may be a pathology.

If against the background of motor activity is not enough air when breathing, but this does not cause any discomfort and normalizes for a few minutes, then there is nothing to worry about. As for pathological shortness of breath, it can be accompanied by other unfavorable signs:

• a feeling of pressure in the chest;
• pain behind the sternum;
• dizziness, blurred consciousness;
• wheezing, wheezing while breathing;
• cough without relief.

In advanced cases, difficulty in inhaling or exhaling can lead to the development of a choking attack.

In pathological dyspnea after physical activity, the nasolabial triangle area turns blue, sweating increases, andthe skin becomes pale. If the problem is related to cardiovascular disease, there may be chest pain, heart rhythm may be disturbed.

The symptoms of dyspnea after physical activity are primarily associated with hypoxia, i.e. Oxygen deficiency in tissues, or hypoxemia, i.e. Oxygen deficiency in the bloodstream. As a consequence of oxygen deprivation, the cerebral respiratory center is stimulated, which leads to a compensatory increase in respiratory rate. Depending on the provoking pathology, the problem may be both inhalation and exhalation, or both inhalation and exhalation at the same time.

Dyspnea can develop both during physical activity and immediately after it, or even a few hours later.

There are five degrees of dyspnea associated with physical exertion:

1. No dyspnea except during intense physical activity.
2. Breathing problems occur while running or climbing a mountain.
3. Breathing becomes difficult while walking, there is a need for periodic stops (to calm down and normalize the condition).
4. The need for stops is frequent, almost every 100 meters.
5. Dyspnea bothers not only after obvious physical exertion, but also during normal household activity (putting on clothes, moving around the apartment, etc.).

Respiratory distress as a symptom of respiratory failure occurs when the human respiratory system becomes unable to meet the needs of gas exchange in the body. This occurs against the background of increased tissue oxygen demand or oxygen deficiency (in some bronchopulmonary or cardiovascular pathologies).

Inhalation and/or exhalation problems and coughing are common reasons for patients to seek medical help. A sudden feeling of lack of air, associated feelings of fear and anxiety, agitation, increasing panic - these are quite dangerous symptoms that require urgent consultation and assistance from a medical professional.

First signs

Heart failure is characterized by these basic symptoms:

• intermittent shortness of breath, suffocation;
• increased fatigue, discomfort after physical activity;
• edema (including ascites);
• the appearance of excess weight (including that associated with edema).

Left ventricular heart failure is characterized by signs indicating blood stasis in the small circle of circulation:

• suffocation is observed after physical activity or at night, dyspnea increases rapidly;
• the patient is forced into a sitting position;
• cough at first dry, then begins to secrete sputum of pinkish color, foam;
• there's wheezing, his breathing is labored.

Right ventricular failure is characterized by signs of blood stasis in the great circle of circulation:

• the neck veins are swollen;
• heart rate increases;
• there's swelling;
• lowers blood pressure.

Classic signs of respiratory failure:

• skin lividity;
• tachycardia;
• shortness of breath;
• lowering blood pressure;
• pain in the head, depression of consciousness;
• insomnia at night and drowsiness during the day;
• weakness, unmotivated fatigue;
• memory and concentration disorders.

In some cases, respiratory pathology can be complicated by heart failure.

Diagnostics of the dyspnea after exercise

Dyspnea after physical activity can appear both in healthy people with intense, excessive activity, and in many cardiac, infectious and pulmonary diseases, ranging from colds to myocardial infarction. To identify the problem and subsequently prescribe the correct treatment, it is necessary to conduct a comprehensive diagnosis, exclude the possible development of chronic obstructive pulmonary disease, bronchial asthma, pulmonary emphysema, bronchiectatic disease, as well as cardiologic, hematologic, neurologic and oncologic pathologies.

In which cases a diagnosis is required:

• If shortness of breath forces a person to limit normal physical activity;
• if, in addition to shortness of breath, there are other unpleasant symptoms;
• if breathing is difficult and the problem does not gradually go away, but only worsens;
• if there's a fever, a cough.

During the medical appointment, the doctor conducts an examination, listens to complaints. If necessary, he may invite other specialists (pulmonologist, cardiologist, infectious disease specialist, hematologist, oncologist, etc.) for consultation. Then the doctor prescribes the necessary laboratory and instrumental studies.

Laboratory diagnostics may include the following tests:

• general clinical blood examination (detailed analysis, COE, leukocyte formula);
• blood biochemistry (indicators of total protein, urea, ALT, creatinine, alkaline phosphatase, AST, glutamintransferase, total bilirubin, C-reactive protein);
• heart failure marker determination (brain natriuretic peptide NT);
• study of thyroid hormonal activity;
• General analysis and sputum culture (if available).

Functional and instrumental diagnostics:

• Chest X-ray;
• chest CT scan;
• assessment of external respiratory function (spirometry, bronchodilator tests);
• testing with a six-minute walk;
• pulse oximetry;
• Provocative testing with methacholine (a bronchoconstrictor);
• Echocardiography;
• electrocardiography.

After these studies may require a second consultation of specialists of narrow profile, after which the attending physician makes a final diagnosis, determines the tactics of management of the patient and treatment of the underlying pathology, which caused dyspnea after exercise.

Differential diagnosis

Analyzing the patient's complaints and anamnesis, it is necessary to listen carefully to how the patient himself describes his sensations, the rate of development of the problem, variability depending on the position of the body and external factors (temperature, humidity in the room, etc.). Abrupt and gradual onset of dyspnea has different causes, and the sudden increase in previously small breathing difficulties can indicate both the progression of the underlying disease and the development of another pathology. Among the diseases that can cause shortness of breath after exercise, most often considered:

• heart failure (including painless myocardial infarction);
• Pneumonia;
• pulmonary embolism;
• bronchoobstructive syndrome;
• foreign body aspiration;
• hyperventilation syndrome;
• Ketoacidosis (metabolic acidosis).

Most of these pathologies are not difficult to diagnose. The only exception is pulmonary embolism, which is often manifested only by dyspnea and tachycardia with decreased saturation.

In practice, doctors most often encounter chronic dyspnea after physical activity. In such a situation, differentiation is made between cardiac, pulmonary, pulmonary-cardiac and other diseases. During the collection of anamnesis, it is important to pay attention to cardiovascular risk factors and occupational characteristics of the patient.

Dyspnea at relatively low physical load may indicate a decrease in the vital capacity of the lungs, which occurs in pulmonary edema, advanced stages of interstitial pathologies, or hyperstimulation of the respiratory center (occurs in acidosis, panic attacks). If the participation of accessory muscles in the respiratory process is detected, then we can suspect the presence of bronchial obstruction or a marked decrease in pulmonary elasticity. Physical examination often reveals symptoms of certain diseases, which are characterized, including dyspnea. In particular, in case of swollen neck veins, it may be a case of increased pressure in the right atrium, i.e. Right ventricular insufficiency.

In most cases, diagnosis is possible already at the stage of collecting complaints, history and examination of the patient. In complex situations, additional instrumental diagnostics is prescribed, including chest radiography. Thanks to X-ray, it is possible to detect an increase in the size of the heart chambers, pulmonary infiltration, pleural effusion or signs of bronchial obstruction. Electrocardiography is indicated for most patients, as well as evaluation of external respiration. It is important to consider such possible causes of dyspnea after exertion as anemia, obesity, thyroid disorders, neuromuscular pathologies. For this purpose, mainly laboratory diagnostics is used.

If, except for dyspnea, there are no other clinical symptoms, or they are vague, or there are concomitant cardiac pathologies, the patient is prescribed a stress test, spiroergometry. This study helps to assess the quality of gas exchange in the lungs during exercise: oxygen consumption, carbon dioxide production, minute volume of lung ventilation.

Dyspnea after exercise is a fairly common complaint that brings patients to doctors' appointments. The practice of a step-by-step approach, which is based on a comprehensive assessment of complaints, symptoms and additional examination, makes it possible to determine the cause of the disorder in most cases already in the outpatient setting.

Treatment of the dyspnea after exercise

Many people believe that shortness of breath after exercise is just a temporary symptom that does not indicate the presence of any serious pathology. However, this symptom does not treat itself: it is important to find and neutralize the underlying cause of breathing problems.

Treatment tactics are selected on an individual basis, taking into account the cause of the unpleasant symptom. An important role is also played by lifestyle changes, which involves avoiding bad habits, regular performance of exercises of special therapeutic exercise. Patients with hypoxemia are prescribed sessions of oxygen therapy.

It is possible to use etiotropic, pathogenetic, symptomatic drug therapy with drugs from these categories:

• Bronchial dilators are divided into short-acting inhaled beta-adrenomimetics, as well as prolonged beta2-agonists and methylxanthines. Bronchodilators of the first group are used for rapid relief of dyspnea after exercise, and the second group is used as part of the main treatment in the interictal periods.
• Expectorants are effective in chronic bronchitis, chronic obstructive pulmonary disease. Thanks to them, it is possible to activate the secretion of sputum, optimize the patency of the bronchi. Often expectorants are combined with mucolytics.
• Antibacterial agents are appropriate for acute and chronic inflammatory processes of the respiratory tract that are of bacterial origin. The choice of an appropriate antibiotic is based on the results of sputum culture.
• Cardiotonic agents are indicated in cardiac pathologies. Cardiac muscle preload is eliminated with peripheral vasodilators and diuretics.
• Glucocorticosteroid drugs are indicated in severe respiratory disorders. Inhaled forms of hormonal agents are prescribed for patients with bronchial asthma.
• Cytostatics are prescribed to patients with oncological pathology, tumor processes in the bronchopulmonary system. Radiation therapy is used as an adjunct.

What should I do for severe shortness of breath?

The causes of shortness of breath after physical activity can be many, ranging from overexertion and lack of training to severe pathologies. Special attention should be paid to severe shortness of breath, in case of which it is necessary to consult a doctor.

In ordinary domestic circumstances, you can try to help yourself in the following ways:

• Assume a supine position and breathe deeply through the nose, holding the breath for a few seconds on each inhalation and exhaling slowly through the mouth.
• Take a sitting position with back support, try to relax as much as possible, bring your lips together "tube", inhale through the nose, hold your breath, then exhale through the "tube" on the count of "one-two-three-four", repeat many times for 10 minutes.
• Try to find as comfortable a position as possible to relax and breathe easier:
  • sitting down, leaning forward, resting your head on a surface (e.g., a table);
  • lean your back against a wall or tree;
  • rest your hands on a table or bench;
  • lie down or take a semi-recumbent position.
• Use a fan to fan your face, unbutton constricting clothing.
• Drink water (peppermint infusion, ginger tea, etc.).

If shortness of breath is not eliminated by such methods, and even worsens and becomes stronger, it is necessary to immediately call an ambulance doctor. Before the arrival of the ambulance, you should take a sitting or semi-sitting position, provide a supply of fresh air.

Complications and consequences

Systematic overload, chronic fatigue, shortness of breath can lead to serious health problems. This disappointing symptom also affects daily activities: labor productivity deteriorates, interest in work is lost, previously habitual activities are difficult, anxiety and insecurity appear. Negative emotions begin to dominate, ranging from high irritability to hopelessness and apathy.

The consequences may be different:

• sleep disturbances;
• head and muscle pain;
• tachycardia, arrhythmia;
• weakness, fatigue;
• depressed and depressed;
• a drop in immunity.

Cardiovascular apparatus often "responds" to the load by increasing blood pressure, heart attack, stroke. It is important to realize that breathing difficulties do not occur "out of the blue", but indicate the presence of other, sometimes hidden, health problems - in particular, pathologies of the cardiovascular system and lungs.

In itself, shortness of breath after physical activity aggravates cardiological problems, can provoke the development of serious disorders of cardiac function. Therefore, people who feel shortness of breath regularly or frequently, should definitely visit a doctor.

In what situations is shortness of breath particularly dangerous:

• if there's a choking sensation;
• if pain behind the sternum occurs at the same time as difficulty breathing in or out;
• if intense cold sweats and severe weakness appear at the same time;
• if there are no objective reasons for dyspnea after physical activity (it has not happened before);
• If shortness of breath has become a regular occurrence or more frequent than before;
• if your body temperature is elevated at the same time.

Quite often, sudden shortness of breath after physical activity is one of the first signs of myocardial infarction.

Prevention

The best solution is to prevent the possible occurrence of shortness of breath after physical activity in advance. Specialists give some advice on this subject:

• If you decide to take up sports seriously, at least for the first time, you should have an experienced trainer with you. Tell him or her about your sensations and abilities, your general health and any suspicious symptoms related to training.
• Prioritize a moderate training load, without overexertion or risks.
• Write down a training diary, note in it how you feel, the number and specifics of the exercises performed, and your body's reaction. As the load increases, monitor your condition in order to identify symptoms and adjust physical activity in time to prevent shortness of breath, among other things.
• Combine periods of exertion with rest for recovery. It is important to understand that regular rest is not a sign of weakness in an athlete, but an opportunity to restore functionality.
• Vary the intensity of sports and activity. Increase the amount of activity gradually.
• Eat well, make sure you get enough calories and nutrients from your food. Adjust your eating habits, avoid prolonged fasts and mono-diets.
• Consume enough water, avoid alcoholic and caffeine-containing beverages.
• Eliminate smoking from your life, including secondhand smoke.
• Develop stress resilience, change your priorities to reduce the impact of stressors.

Healthy rest, avoidance of bad habits, good nutrition, mental stability - these are important components of prevention of shortness of breath after physical activity. Both hypodynamia and excessive overload adversely affect the condition of the body, so it is advisable to develop a training program together with a trainer, which would combine different types of exercises, taking into account your level of fitness, health and goals.

Light but monotonous activity tires faster than heavier but varied labor. In addition, monotonous activity is locally overloaded: the muscles of certain parts of the body become tired. To prevent this, you should rest regularly during work, 5-10 minutes a day, and definitely at night.

If still over time there is shortness of breath after physical activity, it is necessary to necessarily consult a doctor in order to timely identify and neutralize the cause of this violation.

Literature

• Shlyakhto, E. V. Cardiology: national guide / ed. By E. V. Shlyakhto. - 2nd ed., revision and supplement. - Moscow: GEOTAR-Media, 2021
• Chuchalin, A. G. Pulmonology / edited by A. G. Chuchalin. G. - Moscow : GEOTAR-Media, 2020. - 768 с. - ISBN 978-5-9704-5323-0
• Alexandra Vasilieva: Dyspnea: don't miss an alarming symptom! Nevsky Prospect, 2003.