Enhanced external counterpulsation on exercise tolerance in pneumoconiosis: Insights from comorbidity subgroups efficacy and predictors

  • Zhenhui Qin * Guangxi Zhuang Autonomous Region Institute For The Preventionand Treatment Of Occupational Disease, Oncology Department, Guangxi Zhuang Autonomous Region Workers’hospita, Nanning 530021, Guangxi, China
  • Weimin Xie Guangxi Zhuang Autonomous Region Institute For The Preventionand Treatment Of Occupational Disease, General Internal Medicine, Guangxi Zhuang Autonomous Region Workers’hospita, Nanning 530021, Guangxi, China
  • Ning Zhu Guangxi Zhuang Autonomous Region Institute For The Preventionand Treatment Of Occupational Disease, Pulmonary and Critical Care Medicine, Guangxi Zhuang Autonomous Region Workers’hospita, Nanning 530021, Guangxi, China
  • Xijuan Lin Guangxi Zhuang Autonomous Region Institute For The Preventionand Treatment Of Occupational Disease, Cardiovascular and Endocrinology Internal Medicine, Guangxi Zhuang Autonomous Region Workers’hospita, Nanning 530021, Guangxi, China
  • Tingting Deng Guangxi Zhuang Autonomous Region Institute For The Preventionand Treatment Of Occupational Disease, Pulmonary and Critical Care Medicine, Guangxi Zhuang Autonomous Region Workers’hospita, Nanning 530021, Guangxi, China
  • Ting Xu Guangxi Zhuang Autonomous Region Institute For The Preventionand Treatment Of Occupational Disease, General Internal Medicine, Guangxi Zhuang Autonomous Region Workers’hospita, Nanning 530021, Guangxi, China
Article ID: 4562
DOI: https://doi.org/10.18282/po4562
Keywords: pneumoconiosis; comorbidities; enhanced extracorporeal counterpulsation (EECP); exercise endurance; cardiorespiratory fitness

Abstract

Background: To investigate the efficacy of enhanced external counterpulsation (EECP) in improving exercise tolerance in patients with pneumoconiosis, focusing on differences in efficacy with and without lung disease comorbidities, and to identify key predictors of EECP efficacy. Patients and methods: Seventy patients with occupational pneumoconiosis were enrolled in a single-center randomized controlled trial, and were randomly divided into the conventional group (35 patients) and the EECP group (35 patients), and according to the presence or absence of lung disease comorbidities, subjects were divided into the subgroups with and without comorbidities. The conventional group received health management, medication, and individualized exercise prescription, while the EECP group received 1 h of EECP intervention per day for 5 weeks on top of the conventional treatment. Exercise tolerance indexes before and after treatment were assessed by cardiopulmonary exercise test (CPET), including AT-VO2Kg, Max-VO2Kg, AT-O2puls, Max-O2puls, AT-Load, AT-Mets and Max-Mets 7 indicators. Predictors of efficacy were analyzed by univariate and multivariate linear regression using post-treatment AT-VO2Kg as the main dependent variable. Results: Comparison of all CPETs between the EECP and non-EECP groups, and the comorbidity subgroup and the uncomplicated subgroup before treatment showed no statistically significant difference (P > 0.05), and the post-treatment AT-VO2Kg, Max-VO2Kg, AT-O2puls, Max-O2puls, and metabolic equivalents of the EECP group and the uncomplicated subgroup (AT-Mets, Max-Mets) were significantly improved compared with the control group (all P < 0.05), but no significant benefit was seen in the comorbidity subgroup (P > 0.05). Multiple regression analysis showed that comorbidity was a negative predictor of efficacy whereas pre-treatment AT-VO2Kg was a positive predictor. No safety adverse events occurred in either group. Conclusion: EECP safely and effectively improved exercise tolerance in patients with pneumoconiosis, and its efficacy was particularly significant in the comorbidity-free subgroup. The comorbidity subgroup failed to benefit significantly from the EECP intervention, and further analysis showed that comorbidity was an independent negative predictor limiting the treatment effect. In addition, pretreatment AT-VO2Kg served as a positive predictor of efficacy, suggesting that patients with higher baseline cardiorespiratory reserve had a superior benefit from EECP treatment.

Published
2025-08-18

Copyright (c) 2025 Zhenhui Qin, Weimin Xie, Ning Zhu, Xijuan Lin, Tingting Deng, Ting Xu

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

References

1. Li Y, Zhang X, Luo G, et al. Clinical analysis of the complication in cases of occupational pneumoconiosis. Chin Occup Med; 2019. doi: 10.11763/j.issn.2095-2619.2019.01.015

2. Cohen RA, Go LHT, Rose CS. Global Trends in Occupational Lung Disease. Semin Respir Crit Care Med. 2023; 44(3): 317-326. doi: 10.1055/s-0043-1766117

3. Occupational Lung Disease Group of Labor Hygiene and Occupational Diseases Branch of Chinese Preventive Medicine Association. Consensus of Chinese experts on pneumoconiosis treatment (2024). Journal of Environmental and Occupational Medicine. 2024; 41(1): 1-21. doi: 10.11836/JEOM23379

4. Vina J, Sanchis-Gomar F, Martinez-Bello V, et al. Exercise acts as a drug; the pharmacological benefits of exercise. British Journal of Pharmacology. 2012; 167(1): 1-12. doi: 10.1111/j.1476-5381.2012.01970.x

5. Hou X, Wei Z, Jiang X, et al. A comprehensive retrospect on the current perspectives and future prospects of pneumoconiosis. Front Public Health; 2025.

6. Ambari AM, Lilihata G, Zuhri E, et al. External Counterpulsation Improves Angiogenesis by Preserving Vascular Endothelial Growth Factor-A and Vascular Endothelial Growth Factor Receptor-2 but Not Regulating MicroRNA-92a Expression in Patients with Refractory Angina. Front Cardiovasc Med; 2021. doi: 10.3389/fcvm.2021.761112

7. Zhang Y, Chen Z, Mai Z, et al. Acute Hemodynamic Responses to Enhanced External Counterpulsation in Patients with Coronary Artery Disease. Front Cardiovasc Med; 2021. doi: 10.3389/fcvm.2021.721140

8. Yang H, Song L, Ning X, et al. Enhanced external counterpulsation ameliorates endothelial dysfunction and elevates exercise tolerance in patients with coronary artery disease. Front Cardiovasc Med; 2022. doi: 10.3389/fcvm.2022.997109

9. Zhao M, Huang Y, Li L, et al. Enhanced External Counterpulsation Efficacy on Exercise Endurance in COPD Patients and Healthy Subjects: A Pilot Randomized Clinical Trial. International Journal of Chronic Obstructive Pulmonary Disease. 2020. doi: 10.2147/COPD.S225566

10. Castranova V. Role of nitric oxide in the progression of pneumoconiosis. Biochemistry (Mosc). 2004; 69(1): 32-7. doi: 10.1023/b:biry.0000016348.34175.53

11. Michaels AD, Accad M, Ports TA, Grossman W. Left ventricular systolic unloading and augmentation of intracoronary pressure and Doppler flow during enhanced external counterpulsation. Circulation. 2002; 106(10): 1237-42. doi: 10.1161/01.cir.0000028336.95629.b0

12. Braith RW, Conti CR, Nichols WW, et al. Enhanced external counterpulsation improves peripheral artery flow-mediated dilation in patients with chronic angina: a randomized sham-controlled study. Circulation. 2010; 122(16): 1612-1620. doi: 10.1161/CIRCULATIONAHA.109.923482

13. Sardina PD, Martin JS, Avery JC, Braith RW. Enhanced external counterpulsation (EECP) improves biomarkers of glycemic control in patients with non-insulin-dependent type II diabetes mellitus for up to 3 months following treatment. Acta Diabetologica. 2016; 53(5): 745-52. doi: 10.1007/s00592-016-0866-9

14. Melin M, Montelius A, Rydén L, et al. Effects of enhanced external counterpulsation on skeletal muscle gene expression in patients with severe heart failure. Clinical Physiology and Functional Imaging. 2018; 38(1): 118-127. doi: 10.1111/cpf.12392

15. Xiong L, Tian G, Wang L, et al. External Counterpulsation Increases Beat-to-Beat Heart Rate Variability in Patients with Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases. 2017; 26(7): 1487-1492. doi: 10.1016/j.jstrokecerebrovasdis.2017.03.007

16. Brum PC, Bacurau AV, Medeiros A, et al. Aerobic exercise training in heart failure: impact on sympathetic hyperactivity and cardiac and skeletal muscle function. Brazilian Journal of Medical and Biological Research. 2011; 44(9): 827-835. doi: 10.1590/s0100-879x2011007500075

17. Ahlbom M, Hagerman I, Ståhlberg M, et al. Increases in Cardiac Output and Oxygen Consumption During Enhanced External Counterpulsation. Heart, Lung and Circulation. 2016; 25(11): 1133-1136. doi: 10.1016/j.hlc.2016.04.013

18. Simons SO, Heptinstall AB, Marjenberg Z, et al. Temporal Dynamics of Cardiovascular Risk in Patients with Chronic Obstructive Pulmonary Disease During Stable Disease and Exacerbations: Review of the Mechanisms and Implications. International Journal of Chronic Obstructive Pulmonary Disease. 2024; 19: 2259-2271. doi: 10.2147/COPD.S466280

19. Oriano M, Amati F, Gramegna A, et al. Protease-Antiprotease Imbalance in Bronchiectasis. International Journal of Molecular Sciences. 2021; 22(11): 5996. doi: 10.3390/ijms22115996

20. Mohammadnabi N, Shamseddin J, Emadi M, et al. Mycobacterium tuberculosis: The Mechanism of Pathogenicity, Immune Responses, and Diagnostic Challenges. Journal of Clinical Laboratory Analysis. 2024. doi: 10.1002/jcla.25122