Preface

Cardiorespiratory fitness is a health-related element of physical fitness. It expresses the ability of the circulatory and respiratory system to provide oxygen during physical activity. This is related to aerobic fitness. Aerobic fitness refers to the body's capacity to transport and use the oxygen taken in. Improving aerobic fitness is achieved and protected by low-intensity, long-term exercises. Improving aerobic fitness contributes not only to improving sporting performance and physical capacity, but also to improving mental and psychological performance. By increasing aerobic fitness, health risk factors are eliminated or reduced. Because aerobic exercise affects the cardiovascular system the most, it prevents or prolongs the occurrence of cardiorespiratory problems. There are numerous studies that demonstrate the positive effects of aerobic exercises on the cardiorespiratory system. Nowadays, in the prevention or treatment of cardiovascular and cardiorespiratory problems, exercise programs are frequently used. This is both a healthy and relatively inexpensive preventive/therapeutic method compared to other treatments. Another positive effect of improving cardiorespiratory fitness is on psychological structure. Chemical substances released during exercise have calming and depression-reducing effects. Maximal aerobic power (VO2max) is the level of oxygen use an individual can reach in one minute. Power, as it is used herein, means the capacity of the oxidative system. Maximal aerobic power is of great importance in endurance activities where energy is largely supplied from the aerobic system. For example, a person with a higher maximal aerobic strength is more successful in endurance activities. For nonathletes, the average amount of oxygen used per minute is between 3 and 4 liters. For endurance athletes, 5–6 liters are reported. The amount of oxygen a person uses per minute is his aerobic capacity. This score provides useful information about the capacity of the cardiorespiratory system. Every individual needs adequate heart respiration resistance for health and fitness. VO2max peaks at the age of 20 years, starting from childhood, and slowly decreases as a person ages. The aerobic capacity of women is 10–20% lower than that of men. Therefore, age and gender are considered for VO2max assessments of healthy adults. When the respiratory system is examined, the rib cage is smaller in women. The cross-sectional area of the lungs is less. Vital capacity is less, respiratory frequency is higher. Maximal respiration minute volume, maximal voluntary respiration, and maximum oxygen consumption are lower. Improving cardiorespiratory fitness level will help individuals lead healthier and more vigorous lives. In this context, this book adds new information and insights to the literature on cardiorespiratory fitness.

The book begins with an overview of pulmonary rehabilitation in chronic obstructive pulmonary disease by Girdhar et al., with an ever-expanding understanding of the disease and its rehabilitation. The next chapter by Prof. Cabrera et al. is about ischemic preconditioning. It describes the mechanisms involved in the protective effect of exercise-induced preconditioning on the cardiovascular system, skeletal muscle, and physical performance. The chapter by Prof. Kilani et al. focuses on the fetal-neonatal lifestyle basis of adult metabolic syndrome patients. The next chapter by Prof. Valkova and Prof. Grün et al. examines cardiorespiratory fitness and intellectual disability. This study includes analysis of cardiorespiratory fitness data of some athletes participating in the Special Olympics. The fifth chapter by

Dr. Nemanja Ćopić discusses whether certain lifestyles and habits influence the characteristics of body composition of young females in Serbia. The final chapter by Dr. Ribeiro et al. compares cognitive performance among elderly people who exercise with weights and those with a sedentary lifestyle. The results suggest that physical activity represents an important non-medicinal contribution to the evolution of cognitive performance. Overall, this book provides the reader with interesting and current data about cardiorespiratory fitness.

I want to thank all the authors of this book for their amazing works. I also wish to thank publishing process manager Mr. Gordan Tot, without whom I would not be able to edit this book.

I hope that this book will be useful for anyone who wants to read about new perspectives in cardiorespiratory fitness. I also hope that it will arouse a new and great inspiration for researchers working on sport science, medicine, rehabilitation, and training.

> **Dr. Hasan Sözen**  University of Ordu, Department of Physical Education and Sport, Ordu, Turkey

> > **1**

**Chapter 1**

Disease

**Abstract**

education

**1. Introduction**

dynamic hyperinflation [7].

Pulmonary Rehabilitation in

*Ankur Girdhar, Puneet Agarwal and Amita Singh*

Chronic Obstructive Pulmonary

With an ever-expanding understanding about chronic obstructive pulmonary disease (COPD), it has been realized that it is a respiratory disease with systemic manifestations. Systemic effects of COPD lead to cardiovascular co-morbidities, muscle wasting and osteoporosis that in turn lead to inactivity and physical deconditioning. This development has a direct impact on the health-related quality of life (HRQoL) of patients suffering from this respiratory disease. Pharmacological therapy leads to improvement in shortness of breath and has limited effect on the physical deconditioning. Latest research has shown an additive effect of pulmonary rehabilitation on improving the inactivity and overall HRQoL in COPD patients. Pulmonary rehabilitation (PR) is a comprehensive multimodality program that includes strength and endurance training, nutritional education and psychosocial support. This leads to a holistic approach to management of COPD which results in symptom improvement in patients and decreased utilization of heath care resources. There are several barriers to widespread adoption of pulmonary rehabilitation as a standard treatment. This includes availability, insurance coverage and patient compliance. With inclusion of pulmonary rehabilitation in respiratory society guidelines, there has been a renewed interest among both pulmonary specialist and community physicians. This chapter aims to provide exhaustive evidence based knowledge regarding pulmonary rehabilitation and its beneficial effect on COPD patients.

**Keywords:** rehabilitation, deconditioning, HRQoL, comprehensive, COPD, exercise,

Chronic obstructive pulmonary disease (COPD) is among the five leading causes

of death in developed world [1]. Prevalence of COPD is constantly increasing. COPD has a high impact on patients' wellbeing, healthcare utilization, and mortality [2] and causes a substantial and increasing economic and social burden [3, 4]. Cigarette smoking is clearly the predominant cause but other environmental agents including biomass fuel and air pollution may play a role as well. Common symptoms of COPD patients are chronic and progressive dyspnea, cough, and sputum production. These symptoms can be disabling and lead to activity limitation and ultimately inability to work and take care of themselves [5]. This vicious circle of inactivity that begins with breathlessness is because of peripheral muscle dysfunction [6], and
