Exercise & Sats

Nervous1

New member
Hi Everybody,

How low do your sats drop when you exercise? My PFTs are usually really good - 88-92% when I'm not sick.

Last year I did pulmonary rehab (basically riding stationary bikes and walking on treadmills while having your sats monitored). My sats almost never went lower than 94% even when I had my heartrate up to 145 or 150, unless I was after an infection.

I got tired of going to the hospital and riding bikes with the 70+ COPDers, and started exercising on my own using a pulse oxymeter that I calibrated with the one in the hospital. I started doing intervals of walking/jogging using the pulse oxymeter. I notice that even if I'm not coughing stuff up, there are times when I'm feeling "icky" but no obvious symptoms when my sats drop as low as 73% while I'm jogging. When I see it drop I stop jogging and switch to walking until it goes back up to 95%.

Do any of you with good PFTs experience this?

How low should I let it drop before I switch to walking?

Sue
 

Julie Desch

New member
You should not let your sats drop below 90%. Definitely start walking when they approach this. Some say 92%. I'd be very cautious about this.
 

Nervous1

New member
Thanks Cris and Julie for your advise. I'll be more careful about not letting it drop below 90%.
My docs don't believe that this happens, because tests in the hospital don't reproduce it. However, I definitely see it fairly regularly when I'm not feeling great even when there's no phlegm.
 

Melissa75

Administrator
I did a bunch of searches, trying to see what level of oxygen saturation is okay when doing intense workouts. I like for some of my workout to be at my personal HR max 165+ (not "fat burning" nor "aerobic" but anaerobic). I have no idea what my sats are at these points (during certain songs of zumba, or when I do a hard bouldering route), but based on my very heavy panting and slight quease, I know they're not 99%.

This says that anaerobic sprints can get a person under 95%, women in particular.
http://www.ncbi.nlm.nih.gov/pubmed/20204812
That is considered "significant." So 73% sounds bad, but I would suggest you do a test on a bike, where the measurements are more accurate. See how high you can get your HR, and see what you O2 is at that HR.

This talks about O2 sat measurement issues during exercise.
http://www.lakesidepress.com/pulmonary/books/physiology/chap12_1.htm

Here is the section:

PULSE OXIMETRY

Apart from measurement of heart rate, probably the most commonly measured exercise variable is oxygen saturation by pulse oximetry (SpO2). This is because exercise oximetry is so widely used to assess need for supplemental oxygen in patients with dyspnea, whether or not they are being considered for exercise training. Such a test may consist of nothing more than walking the patient in the hospital corridor while measuring finger pulse oximetry.

Whatever the purpose for exercising a patient, it is essential to screen for exercise-induced hypoxemia, because it may be the cause of symptoms and is treatable. Above 85% true oxygen saturation, SpO2 is accurate to within about +/- 3% of the blood oxygen saturation as measured with a co-oximeter (SaO2) (Escourrou 1990). However, there are several potential pitfalls to using pulse oximetry for exercise testing, including improper capture of pulse, inaccuracy at very low levels of SaO2, intravenous dyes, skin pigment, and poor signal response. In a review of 10 studies utilizing both ear and finger pulse oximetry during exercise, Mengelkoch, et. al. found that only 67% of the pulse oximeters studied were considered accurate when SaO2 was > 85% in non-smokers (Mengelkoch 1995). However, the current generation of finger pulse oximeters appear to be more accurate than the older ear-probe equipped models (Mengelkoch 1995). It is interesting that most of the studies reviewed used cycle ergometry, since it produces less oximetry artifact than a treadmill.

An avoidable pitfall of pulse oximetry can occur when there is excess carboxyhemoglobin. In contrast to blood co-oximeters, which utilize four wavelengths of light to separate out oxyhemoglobin from reduced hemoglobin, methemoglobin (MetHb) and carboxyhemoglobin (COHb), pulse oximeters utilize only two wavelengths of light (Powers 1989; Principles of Pulse Oximetry 1991). As a result, pulse oximeters measure COHb and part of any MetHb along with oxyhemoglobin, and combine the three into a single reading, the SpO2. (MetHb absorbs both wavelengths of light emitted by pulse oximeters, so that SpO2 is not affected as much by MetHb as for a comparable level of COHb). Powers, et. al. showed that in subjects who smoked and had COHb levels of >4%, pulse oximeters significantly overestimated SaO2 (Powers 1989).

Whereas excess methemoglobin is an uncommon finding clinically, excess carboxy-hemoglobin is present in all cigarette and cigar smokers. A resting SpO2 should be correlated with a measured SaO2 and (if a blood co-oximeter is available), COHb and methemoglobin levels. If the measured SaO2 does not agree with SpO2, the fact should be noted, reason(s) sought, and then accounted for during the exercise test. If a measured SaO2 cannot be correlated with SpO2, exercise testing should not be done in current smokers, so as to avoid falsely high SaO2 readings. (The half-life of CO breathing ambient air is about 6 hours, so 24 hours after smoking cessation the CO level should be normal, i.e., less than 2.5%.)

Carbon monoxide can also be measured in exhaled air as ppm (parts per million) and correlated with a blood carboxyhemoglobin level (e.g., 10 ppm roughly equals 2% COHb). Also, if a co-oximeter is available, carboxyhemoglobin can be reliably measured on a venous blood sample; the value is the same as arterial. If venous COHb is elevated, its value can be subtracted from the SpO2 to get a truer reading of the patient's SaO2. Attention to CO is important if one is to obtain accurate estimation of the patient's blood oxygen status.

Finally, here is a complicated study, but I think it is interesting. It talks about how doing anaerobic (short intense bursts) exercise should be emphasized as well as aerobic exercise. Lung function was not correlated with ability to do anaerobic exercise, nutritional status/muscle mass was, and higher anaerobic tolerance is associated with easier daily life tasks (stairs, carrying things).

http://ajrccm.atsjournals.org/content/157/4/1145.full

So, you can get your HR up, build muscle, and takes breaks btw to keep your o2 sats up. I know a couple people who post here and lift weights have talked about this.
 

TarHeelBlue2007

New member
Hi Sue,

A few thoughts...
(1) your pulse oximeter might be out of calibration (you had said you calibrated it w/ the hospital one...how long ago was that?)
(2) your pulse oximeter might be cheap (don't know what you have) and thus may not accurately measure once it gets out of the near-normal range.
(3) if you're jogging, it might be getting interference...maybe sweat on your finger or just the bouncing/impact as you run...check out "pulse oximetry: limitations" in wikipedia. can assess this using a bike or ask a friend to run w/ you and check their sats :)
 

Nervous1

New member
Thanks everyone for your comments and advise. Went to the clinic and saw a doctor who was very helpful. When the drop in SATs wasn't reproduced in the standard "walk the hall for 6 minutes test", he had me run up and down the stairs for a couple of minutes and the drop was immediate and he saw it with his own eyes. Since the SATs went back up quite quickly after I stopped, he wasn't sure what to make of it though and also began questioning how accurate the pulse oxymeters are when moving around. However, I've done the same in the past and not had the SATs drop both in the hospital and at home. So, he is sending me for a combined lung and heart stress test, and an echocardiogram.

In answer to your questions about my pulse oxymeter ... It's a Nonin, which is the same brand used by the hospital. I checked it against the hospital's and it is accurate.

Thanks for all your support and the information you provided. It will be interesting to see the results of the upcoming tests. I am of course a bit nervous about it, and am hoping that the result is that the pulse oxymeters can't be relied on rather than there is a serious problem with my lungs/heart.
 

Nervous1

New member
Thanks everyone for your comments and advise. Went to the clinic and saw a doctor who was very helpful. When the drop in SATs wasn't reproduced in the standard "walk the hall for 6 minutes test", he had me run up and down the stairs for a couple of minutes and the drop was immediate and he saw it with his own eyes. Since the SATs went back up quite quickly after I stopped, he wasn't sure what to make of it though and also began questioning how accurate the pulse oxymeters are when moving around. However, I've done the same in the past and not had the SATs drop both in the hospital and at home. So, he is sending me for a combined lung and heart stress test, and an echocardiogram.

In answer to your questions about my pulse oxymeter ... It's a Nonin, which is the same brand used by the hospital. I checked it against the hospital's and it is accurate.

Thanks for all your support and the information you provided. It will be interesting to see the results of the upcoming tests. I am of course a bit nervous about it, and am hoping that the result is that the pulse oxymeters can't be relied on rather than there is a serious problem with my lungs/heart.
 

Nervous1

New member
Update - I had the combined lung/heart stress test today. The results were very, very good. It was done on a stationary bike, and I used my pulse oxymeter in parallel to the official one being used for the test. They both showed the same numbers, and my blood oxygen never went lower than 98%.

That's obviously great news. However, since my SATs didn't drop according to my pulse oxymeter either ... does this mean that there truly isn't a problem? When I got home I went out and ran around the block (regular slow jog) and my pulse oxymeter went down into the low 80s. Simple logic says that one of the following must be the case ...

1) The jogging is causing artifacts causing the pulse oxymeter to not be accurate. (It didn't do this in the past though.)
2) Jogging is a more intense / different effort than the stationary bike, and I do have some type of issue that was not replicated in the stress test on the bike
3) Even a healthy person has drops like this when they run (pretty sure this isn't the case)

Do I just chuck to pulse oxymeter and assume everything is fine?
 

Melissa75

Administrator
edited to add: I am so happy your tests came out well!

1)
My opinion is that #1 is the issue: the oxymeter is inaccurate for jogging, which is too bouncy.

2)
I agree that jogging is more intense than the bike, but this is usually represented in your heartrate as well.
Here's what I mean (and what happens to me). If I am on a bike, I have trouble getting my HR over 130 (same for elliptical machines). My legs burn and just can't work that muscle group hard enough to raise my HR any higher. If I get on the treadmill, however, and jog at a fairly slow pace, right away my HR is 130 and I am panting. This is because because my heart and lungs are working hard to supply more of my muscles with oxygen. My muscles (and lungs) don't stop me from taking my HR up to 140-60 on the treadmill, so that is where I head for the 30 minutes I am there.

Sooooo, given this totally anecdotal experience of mine, I think you should ride the bike, see how high you get your HR and check your oxygen at THAT HR. Then get on the treadmill and see where your O2 is when you are at the SAME HR as the bike. For example, if you're 120 hr/98 o2 on the bike, and get up to 120 HR jogging and check your O2. If it is 80 or something really low, then I think you can safely say the oxymeter doesn't work with jogging. In the absence of a heart defect, which you have checked, your heart would beat faster rather than let your O2 drop to 80.

To doubletest my test, though, you could try jogging much harder, get your HR up past the biking levels, and then get OFF the treadmill and test your O2 while you are completely still. You will see what your real 02 level is at a higher HR. I am pretty sure your O2 would not rise so fast from stopping running for the 15 seconds is takes to be still. Just don't look at the level until your are still.

3) The study I linked to above in this thread seemed to mark 95 O2 as significant. Other reading says 90 is acceptable. Everything seemed to say that the whole point of your heart pounding and you breathing fast and hard during exercise is so your body can keep your blood oxygen level in that ideal 95-100 range. A few articles mentioned how top athletes may who train at the limits of their bodies and go below these numbers, but an efficiency thing is happening with their red blood cell transport (VO2 max).

I'd love people with shaky O2 levels to comment on how they feel when they drop below 95 or 90. My experience with pneumonia is that going lower than 95 feels really breathless. My experience with pushing myself too hard with exercise is that it makes me feel bad: think fainting from low bp (track) and throwing up (the first swim-team practice of the summers).

When I do zumba, I'm red-faced, veins popping out on my forehead, and so sweaty my whole shirt is drenched. For some songs, I breathe so hard I know I am pushing "bad." Thankfully, Zumba teachers have been taught to cycle songs and intensity so that people push and regroup over and over. And thankfully, I know to rein it in when I feel dizzy and am taking as deep and as fast of breaths as I possibly can.
 

Nervous1

New member
Hi Melissa,

You're great!! Thanks for your support and you wonderful ideas and insight.

Yesterday I put my pulse oxymeter on my 12 year old son and made him run as fast as he could around the block with it on. It went down to 94% but not lower. Also got my hubby, who's overweight and really out of shape, to try it as well. He had 96% standing still, and when he jogged a littlle his pulse went up to 145 and his blood oxygen to 97%. After these statistically insignificant experiments, I was still baffled why when I jogged it immediately went down to 81% and stayed there as I jogged.

Well, today I tried your experiment Melissa .... (suspense) .... and you're absolutely right.

When I jog letting the pulse ox do continuous monitoring, the SpO2 goes down drastically even though the pulse seems correct. However, if I stop moving it shows between 95-99%. In fact, if I don't use it continuously but rather put it on occassionally while running it shows between 95-99%.

In short, these finger pulse oxymeters are not very accurate when used for continuous monitoring while jogging. For spot checking though it does seem much more accurate, even while moving.

Thanks to you all for all your support, and especially to you Melissa for helping me solve this mystery!!!
 

Melissa75

Administrator
Well, aren't we a pair of scientists! :)

Great idea to get your husband and son to try it. I do wonder why they didn't have the same amount of artifact as you...and I love that your husband's O2 actually went UP with exercise (obviously there is a margin of error), but still! Maybe that will inspire him.

My husband and I went on a 2.5 mile jog together in June, his first in several years, and I kicked his butt. Of course, now he is going on seven-mile runs and I still do three at most. Plus I've an ankle problem (thank you, flouroquinolone antibiotics) that has kept me from anything but top-rope rock climbing for a couple weeks. Okay, whining over.

I'm so glad you figured this out. In rereading what I wrote, I am still left trying to understand what goes on when people's blood oxygen level drops on a chronic basis. I think the heart does what it can but is simply overtaxed--which might explain why nighttime levels go down first.

I read some COPD sites, and there was talk about different perceptions/manifestations of low O2: blue bloaters (chronic bronchitis) vs. pink puffers (emphysema). The pink puffers tend to manifest better O2 levels but work very hard for it, and the blue bloaters don't always look like they are struggling but they can be bad off.
http://pathlabmed.typepad.com/surgical_pathology_and_la/2009/12/pink-puffer-versus-blue-bloater.html
Kinda interesting. Not sure how it applies to bronchiectasis, though I would think we have more in common with chronic bronchitis/blue bloaters.
 
D

Deb

Guest
I have been doing intense workouts for about a year now (CrossFit). Over time I have built my lung function up and no longer fight the constant battle of my sats dropping too low. My heart rate gets as high as 180's but my sat stays at or above 90. If it drops it would be for a short time. After the workout my sat and heart rate go back to normal fairly quickly. Much faster than they used to.
In addition to CF I also have just one lung now. These workouts are the best thing I have ever done. My lung function is higher now than it was before my surgery.
Keep an eye on your heart rate and sats, but don't dwell on them too much. And the more you work out the more they will improve. ie: there was a time when my sats dropped just doing a 6 minute walk
 

Melissa75

Administrator
Deb, That is awesome to hear. Congrats on such great improvement in your endurance / cardiovascular health and lung function. And props for doing it after having a lung removed. I know that would have made me spooked about pushing myself at least at first.
 

Gemmy

Banned
Sometimes people do just run low on their O2 levels. do you have or have a family history of COPD, Emphysema, or any other lung disorders?
 
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