The structures and mechanics that come together to create pacing are numerous however many of them fall into the following categories.
Movement Impetus is the desire of the player to continue on through the levels of the game.
A well designed game would have good pacing not only in the overall game (the Arc), but would use the same pacing in the Scene and Action portions of the game. Portal's most well known example of stimulating Movement Impetus is the famous "cake" reward. Star Wars IV: A New Hope is the cited example in the Extra Credits episode showing an excellent example in pacing. Science, Technology and Medicine open access publisher.Publish, read and share novel research. The Impact of Obesity and Metabolic Syndrome in COPDFrancesco Sava1, Francois Maltais and Paul Poirier[1] Centre de recherche de l'Institut de cardiologie et de pneumologie de Quebec, Universite Laval, Quebec, Canada1. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report.
Sharp JT, Henry JP, Sweany SK, Meadows WR, Pietras RJ: Effects of Mass Loading the Respiratory System in Man.
Collins LC, Hoberty PD, Walker JF, Fletcher EC, Peiris AN: The effect of body fat distribution on pulmonary function tests. Schachter LM, Salome CM, Peat JK, Woolcock AJ: Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Farebrother M1974, McHardy GJ, Munro JF: Relation between pulmonary gas exchange and closing volume before and after substantial weight loss in obese subjects. Babb TG, DeLorey DS, Wyrick BL, Gardner PP: Mild obesity does not limit change in end-expiratory lung volume during cycling in young women. Babb TG, Buskirk ER, Hodgson JL: Exercise end-expiratory lung volumes in lean and moderately obese women.
O’Donnell DE, Revill SM, Webb KA: Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease.
O’Donnell DE, Webb KA: Exertional breathlessness in patients with chronic airflow limitation. Ries AL, Kaplan RM, Limberg TM, Prewitt LM: Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease.
Much like how a book has plot buildup, climaxes and resting places, pacing can be drawn out in a similar way. Pacing can be increased by increasing the threat level by introducing enemies or encroaching danger.
Some ways to improve the player's movement impetus it to create objectives & rewards ahead or to introduce a threat from behind. The difference between this and threat level is that the threat level is often rooted in game mechanics whereas tension uses atmosphere design. High Tempo gameplay often requires split-second decisions and reflexes, something that many First Person Shooters have. It also created a good buildup of tension through the use of the environment itself such as the scribbled messages in some of the "hidden" rooms the player encountered.
Exponential relation between BMI and both functional residual capacity (FRC) and expiratory reserve volume (ERV). IntroductionObesity is becoming more and more prevalent in the world and has many recognized impacts on different body systems. A well paced game would catch the player's attention and keep them involved with the experience all the way to the satisfying climax and ending. A high threat level can be an overwhelming army of enemies that can take out the player with one wrong move. A high buildup of tension would be a single unknown creature hidden in the shadows that keeps a player questioning their every move even though game mechanic-wise nothing would happen to them until they reach the scripted climax. On the other end, Low Tempo gameplay usually involves puzzles or things that require contemplation. The escalation of threat level with the introduction of water, energy balls, turrets, a single rocket launcher and neurotoxin kept the player on their toes when solving the portal puzzles. At rest, respiration is performed at lower lung volumes but with increasing ventilation, expiratory patterns tend to be closer.

Chronic obstructive pulmonary disease (COPD) is also very common and affects different systems but mainly the respiratory system. B : During exercise, dynamic hyperinflation is reduced in the obese subject although still present. Definition of obesityThe definition of obesity is based on body mass index (BMI) which is the ratio of body mass in kilograms to the square of the height in meters.
This definition, although being simple and easily applicable to everyday clinical contexts, is somewhat simplistic in the sense that it does not take into account either body mass distribution or fat vs. These variables have important impact on the respiratory physiology and on the chronic obstructive pulmonary disease (COPD).3.
This has led the scientific community to talk about this phenomenon in terms of “obesity epidemic”, since the condition has recently been recognized as a disease [7].4.
Effects of obesity on respiratory physiology at restObesity has many different effects on respiratory physiology at rest. Lung volumes and respiratory mechanicsThe best described effect of obesity is the reduction of the end-expiratory lung volume and functional residual capacity [2,8].
End-expiratory lung volume is the volume left in the lung at the end of a normal expiration and under most circumstances. In the obese subject, reduction of the resting respiratory system volume at functional residual capacity is caused by the extra weight of the thoracic wall and the abdomen which reduces significantly the respiratory system compliance [10].
There is an exponential relationship between BMI and both functional residual capacity and end-expiratory lung volume [2]. So, with a preserved total lung capacity and residual volume, decreased functional residual capacity has two physiologic corollaries: 1) decreased expiratory reserve volume and, 2) increased inspiratory capacity [1]. Figure 1.Exponential relation between BMI and both functional residual capacity (FRC) and expiratory reserve volume (ERV). Adapted from [2].Although airways are narrower and more reactive than normal weight subjects, both maximal ventilatory capacity and expiratory volumes are preserved in the obese subject. OxygenationAs functional residual capacity gets lower, it draws near the residual volume so much that, in some subjects, each tidal volume breath results in alveolar collapsing at the lung bases. Importance of body mass distributionFat mass distribution is of paramount importance when considering the effects of obesity on respiratory physiology. Waist size and waist-to-hip ratio is more closely related to the previously described changes than BMI alone [16,17].
Studies using dual X-ray absorptiometry (DEXA) allowed establishing that upper body fat, as opposed to lower body fat, is linked to reductions of functional residual capacity and expiratory reserve volume [18].
It thus seems that upper body mass is the main determinant of the lower lung volumes observed in the obese subject and that, because of the interdependence of the thoracic and abdominal cavity in terms of volume and pressure, the location of fat mass within the upper body is not an important determinant of lung volumes.5.
Oxygen consumptionBoth oxygen consumption (VO2) and carbon dioxide production (VCO2) are increased for a given workload in the obese individual [3]. This higher metabolic expenditure is due to the higher energy demand caused by the extra body mass that obese subjects have to carry around.
Also, decreased respiratory system compliance increases significantly the work of breathing [19]. Lung volumes during exerciseAs already mentioned, obese patients’ tidal volume is very close to their residual volume at rest. During exercise however, functional residual capacity increases to normal levels allowing the expansion in tidal volume to accommodate the increasing ventilatory demand in a fashion that is similar to healthy subject. Ventilation and dyspnea relationshipFor a given workload, obese subjects feel more dyspnea than non-obese subjects. Because of the increased metabolic cost associated with obesity, ventilation is higher for a given workload [3]. How frequently obesity and COPD coexist in the same subjectIt was traditionally thought that COPD patients were less likely to be obese.
The rationale was that systemic inflammation in the more advanced stages of disease would lead to cachexia [23] rather than overweight. The main physiologic changes in COPDThe main characteristics of COPD are limitation of expiratory flow and hyperinflation. At rest, FEV1 and the ratio of FEV1 to forced vital capacity are decreased while functional residual capacity, end-expiratory lung volume, total lung capacity and residual volume are elevated.
The main consequence of lower expiratory flows is a limitation in maximal ventilatory capacity [27].

The consequence of higher functional residual capacity and residual volume is reduction in the respiratory capacity (IC).
During exercise, rising lung volumes lead to a decreased inspiratory capacity and respiration occurs at higher lung volumes [4].During exercise, the lower inspiratory capacity constraints the expansion in tidal volume in such a way that the increased ventilatory demand is more dependent upon the progression of the respiratory rate. This breathing pattern characterized by a rapid and shallow breathing shortens expiration, preventing full expiration to occur [4]. The increased airway resistance also contributes to this phenomenon leading to gas retention and dynamic hyperinflation [30].Because of dynamic hyperinflation, COPD subjects breathe at higher lung volumes during exercise (closer to total lung capacity), in a less compliant portion of the volume-pressure relationship of the respiratory system. Work of breathing is increased in this situation and the resulting tidal volume for a given respiratory effort is decreased, a phenomenon being referred to as neuro-mechanical uncoupling. The final results of these physiological abnormalities for the patients is increased dyspnea perception [31].Another important systemic consequence of COPD is limb muscle atrophy which is observed especially in the more advanced stages of the disease [23,32]. Total as well as lower limb muscle mass is decreased leading to fatigue during exercise [33].
In fact, some COPD subjects are not primarily limited by dyspnea but by leg fatigue during exercise [34]. Effect of obesity on COPD at restObesity and COPD have various influences on respiratory physiology, some are similar and some are opposite.The relationship between BMI and either functional residual capacity or expiratory reserve volume are not affected by the presence of airflow obstruction [1].
However, obese COPD patients are less hyperinflated compared to their lean counterparts [1].
These changes seem beneficial to COPD subjects, counteracting some of the deleterious effects of the disease. However, as previously mentioned, oxygen consumption is higher for a given workload for obese subjects, leading to higher ventilatory demand. Exercise tolerance of the obese patients with COPDThe effects of obesity on exercise tolerance in patients with COPD have not been studied extensively.
In one study, obese patients with COPD had higher exercise capacity and were less dyspneic for a given ventilation during cycling exercise [1].
These effects were felt to be related to lower operating lung volumes and reduced dynamic hyperinflation [3]. Other studies have reported marked decreases in exercise tolerance during a 6-minutes walking test [36] but not during a cycling endurance test [37] in obese patients with COPD. It thus appears that obese patients with COPD perform better when cycling than in weight bearing activities such as walking [35].7.
Rehabilitation as a therapeutic intervention in COPDPulmonary rehabilitation is a multidisciplinary intervention focusing on exercise training and patient education and self-management [38]. The exercise component is essential if the goal of rehabilitation is to improve exercise tolerance and reduce dyspnea [39]. It is recommended for patients experiencing persisting symptoms despite maximal pharmacologic therapy [38]. Rehabilitation can be provided in an outpatient setting or at home, with comparable benefits on exercise tolerance, dyspnea, quality of life and exacerbations [40]. Specific exercise limitationsObese patients with COPD entering a rehabilitation program typically have a reduced exercise tolerance. In one study, their cycling capacity was comparable to lean patients with COPD while their walking capacity was reduced.
Walking is more representative of daily activities, so it is felt that patients with COPD subjects that are also obese are more limited than their non-obese counterparts.
Obese patients with COPD usually show similar improvements in exercise capacity than non-obese although they are less likely to achieve clinically significant improvements during walking [24]. These observations are important because identifying obese patients as having specific exercise limitations can help tailoring the rehabilitation program to their specific needs. Although obesity is associated with more functional impairment, quality of life of obese COPD subjects is not different than their non obese counterparts and improves to a similar extent with rehabilitation [24]. Good opportunity to adopt healthier lifestylesThe fact that upon entering pulmonary rehabilitation, obese COPD patients have a reduced walking capacity suggests that weight loss could be beneficial to improve their functional status.

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