The Effect of Eccentric Cycling on Cerebral and Muscle Tissue Oxygenation in Patients with Pulmonary Hypertension and Healthy Individuals: A Randomized Controlled Crossover Trial

Background: Eccentric cycling exercise (ECC) offers a low-metabolic-demand approach to exercise, potentially making it valuable for patients with pulmonary vascular disease (PVD). The aim of this study was to investigate how quadriceps and frontal cortex oxygenation, assessed by near-infrared spectroscopy (NIRS), differs during ECC compared to concentric cycling exercise (CON) in patients with PVD and in healthy individuals. Methods: This randomized controlled crossover trial involved patients with PVD, defined as either pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH), and healthy volunteers. Participants performed both CON and ECC at identical submaximal work rates, following a stepwise incremental protocol. NIRS was used to continuously monitor tissue oxygenation and surrogates for blood volume changes in the quadriceps and frontal cortex. Results: A total of 57 participants were included, 33 PVD patients (19 with PAH and 14 with CTEPH; 13 women; mean age: 50 ± 15 years) and 24 healthy volunteers (14 women; 50 ± 14 years). In PVD patients, at end-exercise, cerebral tissue oxygenation (CTO) was significantly higher during ECC compared to CON (6.10%; 95% CI: 1.85 to 10.42; p < 0.01), whereas muscle tissue oxygenation (MTO) was similar. In healthy individuals, at end-exercise, CTO was similar during ECC and CON, whereas MTO was significantly higher (2.60%; 95% CI: 0.03 to 5.17; p = 0.047). There were no significant differences in CTO and MTO between patients with PVD and healthy individuals. Discussion: In this randomized controlled crossover trial, patients with PVD exhibited higher CTO during ECC compared to CON, which may indicate altered cerebral oxygen extraction and hemodynamic responses potentially related to impaired vascular function. In contrast, healthy individuals demonstrated higher MTO during ECC, likely reflecting improved muscular oxygen utilization and efficiency due to the mechanical and metabolic characteristics of eccentric exercise.