Blood shifts between body compartments during submaximal exercise with induced expiratory flow limitation in healthy humans

External expiratory flow limitation (EFLe) can he applied in healthy subjects to mimic the effects of chronic obstructive pulmonary disease during exercise. At maximal exercise intensity, EFLe leads to exercise intolerance owing to respiratory pump dysfunction limiting venous return. We quantified blood shifts between body compartments to determine whether such effects can be observed during submaximal exercise, when the load on the respiratory system is milder. Ten healthy men (25.2 +/- 3.2 years of age, 177.3 +/- 5.4 cm in height and weighing 67.4 +/- 5.8 kg) exercised at 100 W (similar to 40% of maximal oxygen uptake) while breathing spontaneously (CTRL) or with EFLe. We measured respiratory dynamics with optoelectronic plethysmography, oesophageal (P-es) and gastric (P-ga) pressures with balloon catheters, and blood shifting between body compartments with double body plethysmography. During exercise, EFLe resulted in the following changes: (i) greater intra-breath blood shifts between the trunk and the extremities [518 +/- 221 (EFLe) vs. 224 +/- 60 ml (CTRL); P < 0.001] associated with lower P-es during inspiration (r = 0.53, P 0.001) and higher P-ga during expiration (r = 0.29, P < 0.024); and (ii) a progressive pooling of blood in the trunk over time (similar to 700 ml after 3 min of exercise; P < 0.05), explained by a predominant effect of lower inspiratory P-es (r = 0.54, P < 0.001) over that of increased P-ga. It follows that during submaximal exercise, EFLe amplifies the respiratory pump mechanism, with a prevailing contribution from lower inspiratory P-es over increased expiratory P-ga, drawing blood into the trunk. Whether these results can be replicated in chronic obstructive pulmonary disease patients remains to be determined.