For Aaron Pearlman, M.D., an otolaryngologist at NewYork-Presbyterian and Weill Cornell Medicine, a frequent patient complaint is that breathing issues hinder the ability to exercise. “People say they aren’t achieving their maximal exercise potential because they feel like they can’t breathe properly through their nose,” he says.
Often, a deviated nasal septum is the culprit. This common condition affects up to 80% of the population, typically causing blockages that make it difficult to breathe through one or both nostrils. It can also lead to nosebleeds, noisy breathing during sleep, or an externally crooked nose.
To correct a deviated septum, otolaryngologists perform septoplasty to realign the septum to midline, which is frequently combined with inferior turbinate reduction (ITR), a surgical procedure to relieve chronic nasal congestion. “With ITR, you try to resect some of the bone within the turbinate,” Dr. Pearlman says. “If it heals just a little bit thinner and the septum is a little bit straighter, you get better airflow through the nose.”
In his clinic, Dr. Pearlman observed that many of his patients reported improved exercise capacity alongside better breathing after undergoing the procedures. However, given the lack of data supporting the anecdotal observation, he designed a prospective study examining exercise capacity in patients before and after septoplasty with ITR; the results were recently published in The Laryngoscope. “Clinicians have asked this question before, but there wasn’t a study that partnered with an exercise physiologist to try to answer this question,” says Dr. Pearlman. “My goal was to show that there was objective evidence of improvement in performance.”
In the most vigorous stage of exercise, lactate and heart rate were statistically lower, which suggests that patients were exercising a little bit more easily.
— Dr. Aaron Pearlman
Measuring Exercise Tolerance
Dr. Pearlman collaborated with colleagues from NewYork-Presbyterian and Weill Cornell Medicine and the Hospital for Special Surgery to investigate both subjective and objective measures of exercise performance.
The study evaluated exercise tolerance in 13 patients pre-operatively and three months post-operatively using treadmill or bicycle exercise physiology testing. Measurements were recorded for 12 of the 13 participants during four-minute stages of testing. “At each stage, the intensity of the effort was increased and various measurements were taken,” says Dr. Pearlman. “We did that until the point where the patients couldn’t go on. Each patient was able to complete six stages.”
Key measurements included heart rate, respiratory rate, maximum oxygen consumption relative to body weight (VO2), blood lactate, rating of perceived exertion (RPE), tidal volume (Vt), and peak nasal inspiratory flow (PNIF) rate. Participants also completed several pre- and post-operative surveys, including the Nasal Obstruction and Septoplasty Effectiveness (NOSE) instrument and the Sinonasal Outcome Test (SNOT-22), which assessed patient-reported outcomes and quality of life.
Study Results
All participants showed significant improvement in exercise capacity post-operatively. During the highest exertion stage (stage six), participants demonstrated a statistically significant decrease in heart rate (177.3 vs. 171.7 beats per minute) and lactate levels (5.84 vs. 4.71 millimoles per liter) compared to their pre-operative baseline. “In the most vigorous stage, lactate and heart rate were statistically lower, which suggests that patients were exercising a little bit more easily,” says Dr. Pearlman.
Now there’s data to back up what we were seeing anecdotally — that patients can exercise with greater ease — and that may translate into better performance or achieving some exercise goals that they felt they couldn’t before.
— Dr. Aaron Pearlman
Objective nasal airflow, measured by PNIF, improved by an average of 47%. Participants also reported a lower RPE during mid-to high-intensity stages (stages three, four, and six) as well as improvements on all subjective measures for nasal obstruction and general sinonasal quality of life, as measured by the NOSE and SNOT-22 questionnaires.
However, respiratory rate, VO2, and Vt remained unchanged. “What this tells us is that even if you don’t find a difference in some measures, patients are still perceiving their exercise as being easier at difficult stages,” says Dr. Pearlman.
Despite the small sample size, Dr. Pearlman believes the study has important clinical implications for counseling patients about surgery. “I can tell them that their complaint of feeling obstructed and limited in their exercise potential is likely to improve with septoplasty and ITR,” he says. “Now there’s data to back up what we were seeing anecdotally — that they can exercise with greater ease — and that may translate into better performance or achieving some exercise goals that they felt they couldn’t before.”
