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Determinants of Expiratory Flow Limitation in Healthy Women during Exercise


Medicine & Science in Sports & Exercise: September 2011 - Volume 43 - Issue 9 - p 1666-1674
doi: 10.1249/MSS.0b013e318214679d
Basic Sciences

Purpose: Expiratory flow limitation (EFL) can occur in healthy young women during exercise. We questioned whether the occurrence and severity of EFL were related to aerobic fitness or anatomical factors.

Methods: Twenty-two healthy young (<40 yr) women performed a progressive cycle test to exhaustion. The subjects' maximum expiratory flow-volume curve was compiled from several effort-graded vital capacity maneuvers before and after exercise. The maximum expiratory flow-volume curve, along with inspiratory capacity maneuvers, was used to determine lung volumes and expiratory flows and to quantify EFL. To determine relative airway size, we used a ratio sensitive to both airway size and lung volume, called the dysanapsis ratio. The subjects were partitioned into two groups based upon the appearance of >5% EFL.

Results: Ten subjects showed EFL during exercise. Forced vital capacities (4.4 ± 0.4 vs 3.7 ± 0.4 L, P < 0.001) and forced expiratory flows for any given lung volume were significantly larger in the non-expiratory flow-limited (NEFL) group. The NEFL group's dysanapsis ratio was significantly larger than that of the EFL group (0.27 ± 0.06 vs 0.21 ± 0.04, respectively, P < 0.05), indicating larger airways in the NEFL group. There was no difference between the NEFL and EFL groups with respect to maximal aerobic capacity (50.8 ± 10.0 vs 46.7 ± 5.9 mL·kg−1·min−1, respectively, P = 0.264). At peak exercise, the NEFL group had a significantly higher end-expiratory lung volume than the EFL group (40.1% ± 4.8% vs 33.7% ± 5.7% FVC, respectively, P < 0.05).

Conclusions: We conclude that EFL in women can largely be explained by anatomical factors that influence the capacity to generate flow and volume during exercise rather than fitness per se.

School of Human Kinetics, The University of British Columbia, Vancouver, British Columbia, CANADA

Address for correspondence: A. William Sheel, Ph.D., 6108 Thunderbird Blvd., Vancouver, British Columbia, Canada V6T 1Z3; E-mail:

Submitted for publication November 2010.

Accepted for publication February 2011.

©2011The American College of Sports Medicine