Correlation between inflection of heart rate/work performance curve and myocardial function in exhausting cycle ergometer exercise

Pattern of the heart rate performance curve in maximal graded treadmill running from 1100 healthy 18-65 Years old men and women: the 4HAIE study

Introduction: The heart rate performance curve (HRPC) in maximal incremental cycle ergometer exercise demonstrated three different patterns such as downward, linear or inverse versions. The downward pattern was found to be the most common and therefore termed regular. These patterns were shown to differently influence exercise prescription, but no data are available for running. This study investigated the deflection of the HRPC in maximal graded treadmill tests (GXT) of the 4HAIE study. Methods: Additional to maximal values, the first and second ventilatory thresholds as well as the degree and the direction of the HRPC deflection (k_HR) were determined from 1,100 individuals (489 women) GXTs. HRPC deflection was categorized as downward (k_HR < -0.1), linear (-0.1 ≤ k_HR ≤ 0.1) or inverse (k_HR > 0.1) curves. Four (even split) age- and two (median split) performance-groups were used to investigate the effects of age and performance on the distribution of regular (= downward deflection) and non-regular (= linear or inverse course) HR curves for male and female subjects. Results: Men (age: 36.8 ± 11.9 years, BMI: 25.0 ± 3.3 kg m^-2, VO_2max: 46.4 ± 9.4 mL min^-1. kg^-1) and women (age: 36.2 ± 11.9 years, BMI: 23.3 ± 3.7 kg m^-2, VO_2max: 37.4 ± 7.8 mL min^-1. kg^-1) presented 556/449 (91/92%) downward deflecting, 10/8 (2/2%) linear and 45/32 (7/6%) inverse HRPC´s. Chi-squared analysis revealed a significantly higher number of non-regular HRPC´s in the low-performance group and with increasing age. Binary logistic regression revealed that the odds ratio (OR) to show a non-regular HRPC is significantly affected by maximum performance (OR = 0.840, 95% CI = 0.754-0.936, p = 0.002) and age (OR = 1.042, 95% CI = 1.020-1.064, p < 0.001) but not sex. Discussion: As in cycle ergometer exercise, three different patterns for the HRPC were identified from the maximal graded treadmill exercise with the highest frequency of regular downward deflecting curves. Older subjects and subjects with a lower performance level had a higher probability to show a non-regular linear or inverted curve which needs to be considered for exercise prescription.

Pattern of the Heart Rate Performance Curve in Subjects with Beta-Blocker Treatment and Healthy Controls

(1): Heart rate performance curve (HRPC) in incremental exercise was shown to be not uniform, causing false intensity estimation applying percentages of maximal heart rate (HR_max). HRPC variations are mediated by β-adrenergic receptor sensitivity. The aim was to study age and sex dependent differences in HRPC patterns in adults with β-blocker treatment (BB) and healthy controls (C). (2): A total of 535 (102 female) BB individuals were matched 1:1 for age and sex (male 59 ± 11 yrs, female 61 ± 11 yrs) in C. From the maximum incremental cycle ergometer exercise a first and second heart rate (HR) threshold (Th1 and Th2) was determined. Based on the degree of the deflection (kHR), HRPCs were categorized as regular (downward deflection (kHR > 0.1)) and non-regular (upward deflection (kHR < 0.1), linear time course). (3): Logistic regression analysis revealed a higher odds ratio to present a non-regular curve in BB compared to C (females showed three times higher odds). The odds for non-regular HRPC in BB versus C decreased with older age (OR interaction = 0.97, CI = 0.94-0.99). Maximal and submaximal performance and HR variables were significantly lower in BB (p < 0.05). %HR_max was significantly lower in BB versus C at Th2 (male: 77.2 ± 7.3% vs. 80.8 ± 5.0%; female: 79.2 ± 5.1% vs. 84.0 ± 4.3%). %P_max at Th2 was similar in BB and C. (4): The HRPC pattern in incremental cycle ergometer exercise is different in individuals receiving β-blocker treatment compared to healthy individuals. The effects were also dependent on age and sex. Relative HR values at Th2 varied substantially depending on treatment. Thus, the percentage of Pmax seems to be a stable and independent indicator for exercise intensity prescription.

Agreement between heart rate deflection point and maximal lactate steady state in young adults with different body masses

We examined the agreement between heart rate deflection point (HRDP) variables with maximal lactate steady state (MLSS) in a sample of young males categorized to different body mass statuses using body mass index (BMI) cut-off points. One hundred and eighteen young males (19.9 ± 4.4 years) underwent a standard running incremental protocol with individualized speed increment between 0.3 and 1.0 km/h for HRDP determination. HRDP was determined using the modified Dmax method called S.Dmax. MLSS was determined using 2-5 series of constant-speed treadmill runs. Heart rate (HR) and blood lactate concentration (La) were measured in all tests. MLSS was defined as the maximal running speed yielding a La increase of less than 1 mmol/L during the last 20 min. Good agreement was observed between HRDP and MLSS for HR for all participants (±1.96; 95% CI = -11.5 to +9.2 b/min, ICC = 0.88; P < 0.001). Good agreement was observed between HRDP and MLSS for speed for all participants (±1.96; 95% CI = -0.40 to +0.42 km/h, ICC = 0.98; P < 0.001). The same findings were observed when participants were categorized in different body mass groups. In conclusion, HRDP can be used as a simple, non-invasive and time-efficient method to objectively determine submaximal aerobic performance in nonathletic young adult men with varying body mass status, according to the chosen standards for HRDP determination.

Intensity Thresholds and Maximal Lactate Steady State in Small Muscle Group Exercise

The aim of our study is to determine the first (LTP₁) and the second (LTP₂) lactate turn points during an incremental bicep curl test and to verify these turn points by ventilatory turn points (VT₁ and VT₂) and constant-load exercise tests. Twelve subjects performed a one-arm incremental bicep curl exercise (IET) after a one repetition maximum (1RM) test to calculate the step rate for the incremental exercise (1RM/45). Workload was increased every min at a rate of 30 reps/min until maximum. To verify LTPs, VT₁ and VT₂ were determined from spirometric data, and 30 min constant-load tests (CL) were performed at 5% P_max below and above turn points. Peak load in IET was 5.3 ± 0.9 kg (La_max: 2.20 ± 0.40 mmol·L⁻¹; HR_max: 135 ± 15 b·min⁻¹; VO_2max: 1.15 ± 0.30 L·min⁻¹). LTP₁ was detected at 1.9 ± 0.6 kg (La: 0.86 ± 0.36 mmol·L⁻¹; HR 90 ± 13 b·min⁻¹; VO₂: 0.50 ± 0.05 L·min⁻¹) and LTP₂ at 3.8 ± 0.7 kg (La: 1.38 ± 0.37 mmol·L⁻¹; 106 ± 10 b·min⁻¹; VO₂: 0.62 ± 0.11 L·min⁻¹). Constant-load tests showed a lactate steady-state in all tests except above LTP₂, with early termination after 16.5 ± 9.1 min. LTP₁ and LTP₂ could be determined in IET, which were not significantly different from VT₁/VT₂. Constant-load exercise validated the three-phase concept, and a steady-state was found at resting values below VT₁ and in all other tests except above LTP₂. It is suggested that the three-phase model is also applicable to small muscle group exercise.

Heart Rate Performance Curve Is Dependent on Age, Sex, and Performance

Introduction: The Heart Rate Performance Curve (HRPC) is neither linear nor uniform and related to ß1-adrenoceptor sensitivity. As aging and exercise influence ß1-adrenoceptors we suggested age, sex and performance effects on the HRPC. Aim of the study was to examine the effects of aging on the deflection of the HRPC in maximal incremental cycle ergometer exercise (CE) in a large cohort of healthy subjects.

Methods: Heart rate (HR) data of 2,980 men (51 ± 15 years) and 1,944 women (52 ± 14 years) were classified into age groups (≤20 up to >80 years). We analyzed age and performance (P_low 25%-quartile and P_high 75%-quartile of age predicted power) effects on HR_max and on the degree (k) and the type (regular downward deflection k > 0.1, linear −0.1 ≤ k ≤ 0.1 and atypical upward deflection k < −0.1) of the HRPC.

Results:k-values decreased significantly with age in men and women and were significantly higher in women. Atypical HRPC's increased by a linear trend from ≤20 to 70 years (m) respectively 80 years (w) from 10 to 43% (m) and 9 to 30% (w). HR_max of all age groups was lower in P_low and overall number of atypical HRPC's was 21% (m) and 16% (w) higher compared to P_high.

Conclusion: Aging increased the number of atypical HRPC's with upward deflection in CE tests, which influences exercise intensity prescription especially when using fixed percentages of HR_max. Changes in HRPC's were affected by sex and performance, where women generally and subjects with higher performance presented less atypical HRPC's even at older age.

Exercise-based cardiac rehabilitation is associated with a normalization of the heart rate performance curve deflection

The heart rate (HR) rises with increased power output, whereby in most healthy individuals, the slope of HR levels off with higher intensity. This corresponds to a downward deflection of the heart rate performance curve (HRPC). Conversely, in patients after myocardial infarction, an upward HRPC deflection is frequently observed that is especially pronounced in patients with compromised left ventricular ejection fraction. To investigate whether regular endurance training during cardiac rehabilitation might normalize HRPC, data of 128 male patients were analyzed. All patients performed three exercise tests: at baseline, after 6 weeks, and after 1 year. Ninety‐six patients exercised regularly according to guidelines for 1 year (training group, TG), and 32 stopped after 6 weeks (control group, CG). Similarly, upward‐deflected HRPCs were observed at baseline and after 6 weeks in both groups. After 1 year, TG patients had less upward‐deflected HRPCs compared with CG ones, corresponding to a partial normalization. Greater changes in HRPC deflection were associated with larger improvements in cardiorespiratory fitness. Our results might indicate improved myocardial function due to long‐term rehabilitation. Further, HRPC alterations over time should be considered when prescribing exercise intensities using a target HR, as deflection flattening might render the intensity of corresponding exercise insufficient.

Different Heart Rate Patterns During Cardio-Pulmonary Exercise (CPX) Testing in Individuals With Type 1 Diabetes

To investigate the heart rate during cardio-pulmonary exercise (CPX) testing in individuals with type 1 diabetes (T1D) compared to healthy (CON) individuals. Fourteen people (seven individuals with T1D and seven CON individuals) performed a CPX test until volitional exhaustion to determine the first and second lactate turn points (LTP₁ and LTP₂), ventilatory thresholds (VT₁ and VT₂), and the heart rate turn point. For these thresholds cardio-respiratory variables and percentages of maximum heart rate, heart rate reserve, maximum oxygen uptake and oxygen uptake reserve, and maximum power output were compared between groups. Additionally, the degree and direction of the deflection of the heart rate to performance curve (k_HR) were compared between groups. Individuals with T1D had similar heart rate at LTP₁ (mean difference) -11, [(95% confidence interval) -27 to 4 b.min^-1], at VT₁ (-12, -8 to 33 b.min^-1) and at LTP₂ (-7, -13 to 26 b.min^-1), at VT₂ (-7, -13 to 28 b.min^-1), and at the heart rate turn point (-5, -14 to 24 b.min^-1) (p = 0.22). Heart rate expressed as percentage of maximum heart rate at LTP₁, VT₁, LTP₂, VT₂ and the heart rate turn point as well as expressed as percentages of heart rate reserve at LTP₂, VT₂ and the heart rate turn point was lower in individuals with T1D (p < 0.05). k_HR was lower in T1D compared to CON individuals (0.11 ± 0.25 vs. 0.51 ± 0.32, p = 0.02). Our findings demonstrate that there are clear differences in the heart rate response during CPX testing in individuals with T1D compared to CON individuals. We suggest using submaximal markers to prescribe exercise intensity in people with T1D, as the heart rate at thresholds is influenced by k_HR. Clinical Trial Identifier: NCT02075567 (https://clinicaltrials.gov/ct2/show/NCT02075567).

PONTOS DE TRANSIÇÃO DA FREQUÊNCIA CARDÍACA NA MARCHA ATLÉTICA

RESUMO Introdução: A frequência cardíaca fornece informações úteis para os treinamentos de marcha atlética. Objetivo: O objetivo do estudo foi analisar o comportamento da frequência cardíaca (FC) e seus pontos de inflexão (PIFC) e deflexão (PDFC) em teste progressivo de marcha atlética (TPMA) antes e depois de 20 sessões de treinamento. Métodos: Participaram 13 jovens atletas (12,46 ± 1,61 anos, 44,29 ± 10,25 kg, 157,93 ± 12,03 cm, 24,39 ± 7,60 %G). O TPMA foi realizado em uma pista oficial de atletismo, antes e depois do treinamento. Os dados de FC e carga foram plotados a cada minuto para identificação dos PIFC e PDFC. Resultados: A FC apresentou comportamento sigmoide, com identificação dos pontos de transição (PT), sendo no pré-treinamento: a) oito sujeitos PIFC (5,31 km·h-1; 125 bpm) e PDFC (7,63 km·h-1; 169 bpm); b) um sujeito somente PIFC (7,00 km·h-1; 149 bpm); c) um sujeito somente PDFC (8,00 km·h-1; 170 bpm); d) três sujeitos sem detecção de PT e no pós-treinamento: a) em 12 sujeitos PIFC (5,46 km·h-1; 125 bpm) e PDFC (7,75 km·h-1; 168 bpm); b) um sujeito somente PDFC (7,50 km·h-1; 184 bpm). O PIFC foi encontrado em carga significativamente inferior ao PDFC no pré (p < 0,001) e no pós-treinamento (p < 0,001). Quando comparamos o PIFC e o PDFC pré e pós, não encontramos diferença significativa, seja em relação à carga (p = 0,87 e p = 0,61) ou FC (p = 0,60 e p = 0,99). Conclusão: Conclui-se que a FC tem relação curvilínea com a carga, sendo possível detectar os seus pontos de transição em TPMA.

Pontos de transição da frequência cardíaca em teste progressivo máximo

Foi realizada análise do comportamento da frequência cardíaca (FC) e identificação dos pontos de inflexão (PIFC) e de deflexão da FC (PDFC) em teste progressivo máximo, em sujeitos do sexo feminino e masculino. Vinte universitários foram submetidos ao teste em cicloergômetro. A FC foi monitorada para posterior análise e identificação dos pontos de transição (PT). A FC apresentou comportamento sigmóide, com identificação de PT em todos os sujeitos, sendo: a) em 65% PIFC (64 ± 27W; 29 ± 9%Pmáx e 126 ± 12bpm; 66 ± 5%FCmáx) e PDFC (177 ± 45W; 81 ± 10%Pmáx e 178 ± 8bpm; 93 ± 4%FCmáx); b) em 30% apenas PIFC (80 ± 32W; 36 ± 14%Pmáx e 125 ± 13bpm; 66 ± 5%FCmáx) e c) em 5% o PDFC isolado (103W; 57%Pmáx e 150bpm; 82%FCmáx). O PIFC foi encontrado em carga significativamente inferior ao PDFC, sem diferenças na carga e FC relativas entre os sexos.

Analysis of heart rate deflection points to predict the anaerobic threshold by a computerized method

Many studies have used the heart rate deflection points (HRDPs) during incremental exercise tests, because of their strong correlation with the anaerobic threshold. The aim of this study was to evaluate the profile of the HRDPs identified by a computerized method and compare them with ventilatory and lactate thresholds. Twenty-four professional soccer players (age, 22 ± 5 years; body mass, 74 ± 7 kg; height 177 ± 7 cm) volunteered for the study. The subjects completed a Bruce-protocol incremental treadmill exercise test to volitional fatigue. Heart rate (HR) and alveolar gas exchange were recorded continuously at ≥1 Hz during exercise testing. Subsequently, the time course of the HR was fit by a computer algorithm, and a set of lines yielding the lowest pooled residual sum of squares was chosen as the best fit. This procedure defined 2 HRDPs (HRDP1 and HRDP2). The HR break points averaged 43.9 ± 5.9 and 89.7 ± 7.5% of the VO2peak. The HRDP1 showed a poor correlation with ventilatory threshold (VT; r = 0.50), but HRDP2 was highly correlated to the respiratory compensation (RC) point (r = 0.98). Neither HRDP1 nor HRDP2 was correlated with LT1 (at VO2 = 2.26 ± 0.72 L·min(-1); r = 0.26) or LT2 (2.79 ± 0.59 L·min(-1); r = 0.49), respectively. LT1 and LT2 also were not well correlated with VT (2.93 ± 0.68 L·min(-1); r = 0.20) or RC (3.82 ± 0.60 L·min(-1); r = 0.58), respectively. Although the HR deflection points were not correlated to LT, HRDP2 could be identified in all the subjects and was strongly correlated with RC, consistent with a relationship to cardiorespiratory fatigue and endurance performance.

Value of the Application of the Heart Rate Performance Curve in Sports

The heart rate performance curve (HRPC) has been shown to be nonlinearly related to work load. This phenomenon has been used to determine a defection point and to be related to the lactate anaerobic threshold. The original method was heavily criticized, and the method was challenged by several authors. However, some authors also demonstrated a high value for this method’s application in various sports conditions. Unfortunately, the HRPC was shown to be not uniform and three different patterns were found. Basic investigations have shown a dependence of the HR-defection on beta1-receptor sensitivity, which gave a plausible explanation of the phenomenon. Important details regarding the testing protocol and the method of turn point determination are given in this review. As a conclusion, we may state that based on numerous studies the method is plausible and valid to determine aerobic exercise performance in various laboratory ergometer and specific sports-related field conditions. Standard protocol conditions adjusted to the exercise performance level of subjects and a computer-supported determination of turn points are necessary to obtain reliable results. Large-scale investigations to validate the heart rate turn point with maximal lactate steady state are still needed. However, from the available literature, the application of this noninvasive method can be recommended to determine aerobic exercise performance in various sports. This noninvasive test is easy to perform repeatedly, which gives interesting possibilities for the monitoring of training adaptation in the short term, such as altitude training or specifc taper forms.

Teste de Conconi adaptado para bicicleta aquática

A prática regular de exercícios físicos tem sido considerada um dos mecanismos que auxiliam a melhoria de padrões da saúde e de qualidade de vida. Em conseqüência do crescimento da procura por academias de ginástica, as atividades físicas no meio líquido, com destaque para a bicicleta aquática, têm aumentado nos últimos anos. No entanto, há ainda carência de métodos para a avaliação e prescrição do treinamento aeróbio neste tipo de equipamento. O objetivo deste estudo foi propor uma adaptação do teste de Conconi et al. (1982) para bicicleta aquática. Foram testados 27 participantes (24 ± 6 anos, 171 ± 8cm, 66 ± 12kg) 15 do sexo masculino e 12 do feminino. Os participantes foram submetidos a um teste progressivo, realizado em bicicleta aquática, com carga inicial de 50RPM e incremento de 3RPM a cada minuto, até a exaustão. A FC foi registrada durante todo o teste. Para análise dos dados, foi utilizada estatística descritiva e o teste "t" de Student (P < 0,05) para comparação entre os sexos. O ponto de deflexão da FC (PDFC) foi identificado em 85% dos sujeitos. Não houve diferença significativa na FCmáx (181 ± 12 e 181 ± 10BPM), PDFC (162 ± 10 e 172 ± 9BPM) e no %PDFCrpm (91 ± 4 e 90 ± 3%RPMmáx) entre os sexos masculino e feminino respectivamente. Por outro lado, RPMmáx (81 ± 6 e 72 ± 5RPM), %PDFC (90 ± 5 e 93 ± 3%FCmáx) e PDFCrpm (74 ± 6 e 66 ± 4RPM) foram significativamente diferentes. Assim, conclui-se que o teste de Conconi pode ser realizado em bicicleta aquática.

Oral magnesium therapy, exercise heart rate, exercise tolerance, and myocardial function in coronary artery disease patients

BACKGROUND

Previous studies have demonstrated that in patients with coronary artery disease (CAD) upward deflection of the heart rate (HR) performance curve can be observed and that this upward deflection and the degree of the deflection are correlated with a diminished stress dependent left ventricular function. Magnesium supplementation improves endothelial function, exercise tolerance, and exercise induced chest pain in patients with CAD.

PURPOSE

We studied the effects of oral magnesium therapy on exercise dependent HR as related to exercise tolerance and resting myocardial function in patients with CAD.

METHODS

In a double blind controlled trial, 53 male patients with stable CAD were randomised to either oral magnesium 15 mmol twice daily (n = 28, age 61+/-9 years, height 171+/-7 cm, body weight 79+/-10 kg, previous myocardial infarction, n = 7) or placebo (n = 25, age 58+/-10 years, height 172+/-6 cm, body weight 79+/-10 kg, previous myocardial infarction, n = 6) for 6 months. Maximal oxygen uptake (VO2max), the degree and direction of the deflection of the HR performance curve described as factor k<0 (upward deflection), and the left ventricular ejection fraction (LVEF) were the outcomes measured.

RESULTS

Magnesium therapy for 6 months significantly increased intracellular magnesium levels (32.7+/-2.5 v 35.6+/-2.1 mEq/l, p<0.001) compared to placebo (33.1+/-3.1.9 v 33.8+/-2.0 mEq/l, NS), VO2max (28.3+/-6.2 v 30.6+/-7.1 ml/kg/min, p<0.001; 29.3+/-5.4 v 29.6+/-5.2 ml/kg/min, NS), factor k (-0.298+/-0.242 v -0.208+/-0.260, p<0.05; -0.269+/-0.336 v -0.272+/-0.335, NS), and LVEF (58+/-11 v 67+/-10%, p<0.001; 55+/-11 v 54+/-12%, NS).

CONCLUSION

The present study supports the intake of oral magnesium and its favourable effects on exercise tolerance and left ventricular function during rest and exercise in stable CAD patients.

Beta1-adrenoceptor mediated origin of the heart rate performance curve deflection

PURPOSE

The deflection of the HR performance curve (HRPC) has been described as an objective marker of submaximal exercise performance. HR response to incremental cycle ergometer exercise is shown to be neither linear nor uniform and a physiological explanation of the deflection phenomenon is lacking. We hypothesized that differences in the beta1-adrenoceptor site are the source of these differences. The aim of the study was to investigate the influence of the highly selective beta1-adrenoceptor (beta1-AR) antagonist bisoprolol (Bi) on the HRPC in young healthy male subjects with different HR response patterns.

METHODS

Sixteen subjects were treated in randomized order with Bi or a placebo (Pl) in two separate trials. HR response during incremental cycle ergometer exercise was compared between the two trials. Blood lactate concentration (La) and ventilatory variables were measured throughout both tests.

RESULTS

Bi changed the direction of the HRPC more in subjects with a regular, s-shaped response pattern under placebo than those with a nonregular or linear pattern. The influence of Bi on the HR at the second lactate turn point was significantly related (R = 0.78; P < 0.001) to the pattern of the HRPC in Pl conditions.

CONCLUSION

We suggest that differences between the subjects with regular s-shaped versus nonregular HRPC may be due to differences at the beta1-AR site. The origin of the HRPC deflection is mediated in part by the beta1-AR sensitivity.

Heart rate deflection point as a strategy to defend stroke volume during incremental exercise

The purpose of this study was to examine whether the heart rate (HR) deflection point (HRDP) in the HR-power relationship is concomitant with the maximal stroke volume (SV(max)) value achievement in endurance-trained subjects. Twenty-two international male cyclists (30.3 +/- 7.3 yr, 179.7 +/- 7.2 cm, 71.3 +/- 5.5 kg) undertook a graded cycling exercise (50 W every 3 min) in the upright position. Thoracic impedance was used to measure continuously the HR and stroke volume (SV) values. The HRDP was estimated by the third-order curvilinear regression method. As a result, 72.7% of the subjects (HRDP group, n = 16) presented a break point in their HR-work rate curve at 89.9 +/- 2.8% of their maximal HR value. The SV value increased until 78.0 +/- 9.3% of the power associated with maximal O(2) uptake (Vo(2 max)) in the HRDP group, whereas it increased until 94.4 +/- 8.6% of the power associated with Vo(2 max) in six other subjects (no-HRDP group, P = 0.004). Neither SV(max) (ml/beat or ml.beat(-1).m(-2)) nor Vo(2 max) (ml/min or ml.kg(-1).min(-1)) were different between both groups. However, SV significantly decreased before exhaustion in the HRDP group (153 +/- 44 vs. 144 +/- 40 ml/beat, P = 0.005). In the HRDP group, 62% of the variance in the power associated with the SV(max) could also be predicted by the power output at which HRDP appeared. In conclusion, in well-trained subjects, the power associated with the SV(max)-HRDP relationship supposed that the HR deflection coincided with the optimal cardiac work for which SV(max) was attained.

Lactic acidosis, potassium, and the heart rate deflection point in professional road cyclists

OBJECTIVE

To determine the influence of lactic acidosis, the Bohr effect, and exercise induced hyperkalaemia on the occurrence of the heart rate deflection point (HRDP) in elite (professional) cyclists.

METHODS

Sixteen professional male road cyclists (mean (SD) age 26 (1) years) performed a ramp test on a cycle ergometer (workload increases of 5 W/12 s, averaging 25 W/min). Heart rate (HR), gas exchange parameters, and blood variables (lactate, pH, P(50) of the oxyhaemoglobin dissociation curve, and K(+)) were measured during the tests.

RESULTS

A HRDP was shown in 56% of subjects at about 88% of their maximal HR (HRDP group; n = 9) but was linear in the rest (No-HRDP group; n = 7). In the HRDP group, the slope of the HR-workload regression line above the HRDP correlated inversely with levels of K(+) at the maximal power output (r = -0.67; p<0.05).

CONCLUSIONS

The HRDP phenomenon is associated, at least partly, with exercise induced hyperkalaemia.

%HRmax target heart rate is dependent on heart rate performance curve deflection

The percent of maximal heart rate (%HRmax) model is widely used to determine training intensities in healthy subjects and patients when prescribing training intensities in these groups of subjects.

PURPOSE

The aim of the study was to investigate the influence of the time course of the heart rate performance curve (HRPC) on the accuracy of target training heart rate.

METHODS

Sixty-two young healthy male subjects performed an incremental cycle ergometer exercise test until voluntary exhaustion. Subjects were then divided into four groups according to the time course of the HRPC. Groups were classified in regular HR response (kHR2 > 0.2), indifferent HR response (0 < kHR2 < 0.2), linear HR response (kHR2 = 0), and inverted HR response (kHR2 < 0). The first and the second lactate turn point (LTP1, LTP2) as well as the heart rate turn point (HRTP) were determined as submaximal markers of performance. Linear regression lines were calculated for HR in the three regions of energy supply defined by LTP1 and LTP2.

RESULTS

HR at LTP1 and HRmax was not significantly different between all four groups. HR at LTP2 was dependent on the time course of the HRPC and was significantly lower (P < 0.05) as kHR2 decreased. Power output and blood lactate concentration at LTP1, LTP2 and maximal workload (Pmax) were not significantly different between the groups.

CONCLUSION

From our data, we conclude that target training HR detected by means of the %HRmax method may be overestimated in cases where the HR response is not regular, as it was found in many of our subjects.

Physical activity and exercise training prescriptions for patients

The dominant outcome from exercise prescription is an increase in various markers of exercise capacity. A very large group of studies have demonstrated that the VO2max is increased in response to exercise performed according to well-accepted principles of exercise prescription. Other markers of exercise capacity, such as the VT, also improve substantially following exercise training. Finally, improvement in exercise capacity is generally related to improved quality of life, particularly in patients with exercise capacity limited by various disease processes. Beyond the specific physiologic gains from training, exercise contributes to a better overall clinical outcome. Although there are few data conclusively demonstrating that exercise independently causes favorable changes in other risk factors, it should be recognized that exercise can contribute indirectly to modulation of other risk factors. Exercise represents positive health advice. Since most of our other recommendations to patients are in the nature of negative advice (e.g., don't smoke, don't eat high-fat foods), and since people are infamous for ignoring negative advice, the value of using a positive recommendation that may indirectly lead the patient to discontinue bad behaviors can hardly be overstated.

A review of the concept of the heart rate deflection point

The heart rate deflection point (HRDP) is a downward or upward change from the linear HR-work relationship evinced during progressive incremental exercise testing. The HRDP is reported to be coincident with the anaerobic threshold. In 1982, Conconi and colleagues suggested that this phenomenon could be used as a noninvasive method to assess the anaerobic threshold. These researchers developed a field test to assess the HRDP, which has become popularised as the 'Conconi test'. Concepts used to define and assess the anaerobic threshold as well as methodological procedures used to determine the HRDP are diverse in the literature and have contributed to controversy surrounding the HRDP concept. Although the HRDP may be assessed in either field or laboratory settings, the degree of HR deflection is highly dependent upon the type of protocol used. The validity of HRDP to assess the anaerobic threshold is uncertain, although a high degree of relationship exists between HRDP and the second lactate turnpoint. The HRDP appears to be reliable when a positive identification is made; however, not all studies report 100% reproducibility. Although the physiological mechanisms explaining the HRDP are unresolved, a relationship exists between the degree and direction of HRDP and left ventricular function. The HRDP has potential to be used for training regulation purposes. Clinically, it may be incorporated to set exercise intensity parameters for cardiac rehabilitation.

Left ventricular function during interval and steady state exercise

PURPOSE

Interval training (INT) is a commonly used method of exercise training in both athletic and clinical populations. Although we generally understand left ventricular (LV) function during steady state (SS) exercise, there are no data regarding LV function during INT.

METHODS

We studied eight healthy, physically active volunteers during upright cycle ergometry during 15 min of both SS and INT, at the same average power output (90% individual anaerobic threshold), using first pass radionuclide ventriculography. During INT (60s/60s), measures of LV function were made during work (220 W) after 4 and 12 min and during recovery (120 W) after 7 and 15 min. These were compared with the average of four temporally matched measures made during SS (170 W).

RESULTS

During INT, LV ejection fraction increased from rest (67 +/- 6%) to 77 +/- 5, 80 +/- 5, 77 +/- 5 and 79 +/- 4% after 4, 7, 12, and 15 min, respectively. During SS, LV ejection fraction was not significantly different at rest (70 +/- 4%) or during exercise (76 +/- 4, 79 +/- 4, 80 +/- 3, and 81 +/- 3%) after 4, 7, 12, and 15 min, respectively. Other measures of LV function (HR, BP, LV volumes, cardiac output, systemic vascular resistance, peak emptying, and filling rates) were likewise similar during temporally matched measurements during INT and SS.

CONCLUSIONS

Although there were the expected transitions of ejection fraction with work and recovery, the overall hemodynamic picture during INT was very similar to SS. These data suggest that LV function during INT is not substantially different to that during SS.

The heart rate turn point reliability and methodological aspects

PURPOSE

The aim of the study was to test protocol variations on the heart rate performance curve (HRPC) and the heart rate turn point (HRTP) according to Conconi et al. (1996). Respiratory gas exchange variables were used to define three phases of energy supply (I, II, III).

METHODS

Eighteen healthy young male subjects performed 4 tests (T1-T4). T1: initial speed of 6 km x h(-1) followed by increments of 0.6 km x h(-1) every 60 s. Subjects were than randomized for the next three tests. T2: initial speed 5.6 km x h(-1) followed by increments of 0.2 km x h(-1) every 20 s; T3: similar to T2, in the second half of phase III acceleration (S) was increased. T4: like T2, at the beginning of phase III, S was increased. No differences were found in the degree of the deflection of the HRPC expressed as factor kHR between T1 (0.228 +/- 0.225) and T2 (0.248 +/- 0.231) but a significant increase was found in T3 (0.533 +/- 0.248) and T4 (0.770 +/- 0.258).

RESULTS

The modifications of the protocol (T3 and T4) systematically influenced the deflection of the HRPC, but kHR was highly reproducible in all tests. Eleven subjects showed degrees of deflection in the HRPC in all tests. There were no significant differences for S, HR, and VO2 at the HRTP. An HRTP was not found in seven subjects in neither T1 or T2; however, in T3 and T4, these seven subjects showed a deflection of HRPC resulting from the protocol. The HRTP was found to be dependent on the start of the acceleration in phase III. In cases with a linear time course in the HRPC in T1 and T2, in T3 an HRTP was found at 15.6 km x h(-1) and in T4 at 13.6 km x h(-1) , respectively.

CONCLUSION

The Conconi test protocol with an accelerated increase in S in the final phase of the test has a major influence on the occurrence of the HRTP in cases of near linear HRPC.

The heart rate performance curve and left ventricular function during exercise in patients after myocardial infarction

PURPOSE

The aim of the study was to investigate the heart rate turn point (HRTP) in the time course of the heart rate performance curve (HRPC) in patients after myocardial infarction, and the relationship between the HRTP, the left ventricular function, and the second lactate turn point (LTP2).

METHODS

We studied the degree and the direction of the HRPC and the left ventricular ejection fraction (LVEF) in 49 male patients 57 +/- 8 d after their first posterior wall infarction (MI). An incremental cycle ergometer test was performed and three phases of energy supply were defined (I: aerobic; II: aerobic-anaerobic transition; III: anaerobic) via blood lactate LA concentration. HRTP and LVEF-turn points (LVEFTP) were assessed by linear turn point analysis. The degree and direction of the deflection of HRPC were described as factor k (k > 0.1: downward deflection; -0.1 < k < 0.1: linear time curse; k < -0.1: upward deflection). The LVEF was determined by RNA. The difference between Pmax and LTP2 was calculated for LVEF (delta LVEF).

RESULTS

An HRTP could be found in 44 and a LVEFTP in 47 cases. The HRTP occurred at 85 +/- 17 Watt (W), which correlated (r = 0.95; P < 0.001) with the LTP2 (84 +/- 17 W) and the LVEFTP (84 +/- 17 W, r = 0.93; P < 0.001). From LTP2 to Pmax a significant decrease in LVEF was found. There was a correlation between the percentage of HRmax at the HRTP and k (r = 0.70), as well as delta LVEF (r = 0.56).

CONCLUSIONS

To prevent myocardial overloading, it seems to be useful to determine the HRTP, which indicate the workload where LVEF decreases.

Physiological and pathological aspects of exercise left ventricular function

Measures of left ventricular function during exercise provide information that is more accurate than the exercise ECG in the diagnosis of coronary artery disease, supportive of the data provided by myocardial perfusion studies, and of great prognostic significance. We review basic methods for evaluating left ventricular function during exercise and responses to various types of exercise, including incremental exercise and exercise training conditions. Additionally, we review changes in both incremental exercise test responses and responses to training in various pathological conditions. Case reports are included to illustrate the utility of measuring left ventricular function during exercise.

Parasympathetic receptor blockade and the heart rate performance curve

Parasympathetic receptor blockade and the heart rate performance curve. Med. Sci Sports Sci., Vol. 30. No. 2, pp. 229-233, 1998. The aim of the present study was to investigate the influence of parasympathetic receptor blockade on the heart rate performance curve (HRPC). Twenty healthy male subjects performed a first cycle ergometer test (F), showing a HRPC deflection of varying degree and direction. Subjects then in random order performed two additional cycle ergometer tests, one with atropine (A) and the other with placebo (P). Two lactate turn points (LTP1, and LTP2) were determined by means of linear regression turn point analysis. The degree and direction of the deflection of the HRPC was calculated mathematically as factor kHR (kHR>0 = downsloping of HPRC; kHR<0 = upsloping of HRPC). In comparison with that in F and P, HR in A was significantly higher at rest, LTP1, LTP2, and during recovery, but not at Power(max). An upsloping deflection of the HRPC was seen in only five cases in F and P, whereas in A 10 cases were observed (P < 0.05). In A, kHR was significantly lower than in F and P. A significant correlation for kHR was found among F, P, and A. Independent from parasympathetic receptor blockade and the HR at Power(max), the HR at LTP2 was lower in cases with negative kHR (upsloping). In A as well as in P a significant correlation was observed between kHR and HR at LTP2. The individual time course of HRPC is reproducible and may be independent of parasympathetic activity.

The Conconi test in not valid for estimation of the lactate turnpoint in runners

Conconi et al. (1982) reported that an observed deviation from linearity in the heart rate-running velocity relationship determined during a field test in runners coincided with the 'lactate threshold'. The aim of this study was to assess the validity of the original Conconi test using conventional incremental and constant-load laboratory protocols. Fourteen trained male distance runners (mean +/-s: age 22.6 +/- 3.4 years; body mass 67.6 +/- 4.8 kg; peak VO2 66.3 +/- 4.7 ml kg-1 min-1) performed a standard multi-stage test for determination of lactate turnpoint and a Conconi test on a motorized treadmill. A deviation from linearity in heart rate was observed in nine subjects. Significant differences were found to exist between running velocity at the lactate turnpoint (4.39 +/- 0.20 m s-1) and at deviation from linear heart rate (5.08 +/- 0.25 m s-1) (P < 0.01), and between heart rate at the lactate turnpoint (172 +/- 10 beats min-1) and at deviation from linearity (186 +/- 9 beats min-1) (P < 0.01). When deviation of heart rate from linearity was evident, it occurred at a systematically higher intensity than the lactate turnpoint and at approximately 95% of maximum heart rate. These results were confirmed by the physiological responses of seven subjects, who performed two constant-velocity treadmill runs at 0.14 m s-1 below the running velocity at the lactate turnpoint and that at which the heart rate deviated from linearity. For the lactate turnpoint trial, the prescribed 30 min exercise period was completed by all runners (terminal blood lactate concentration of 2.4 +/- 0.5 mM), while the duration attained in the trial for which heart rate deviated from linearity was 15.9 +/- 6.7 min (terminal blood lactate concentration of 8.1 +/- 1.8 mM). We concluded that the Conconi test is invalid for the non-invasive determination of the lactate turnpoint and that the deviation of heart rate from linearity represents the start of the plateau at maximal heart rate, the expression of which is dependent upon the specifics of the Conconi test protocol.

Heart rate performance curve during incremental cycle ergometer exercise in healthy young male subjects

In 1992 Conconi et al. (20) presented an indirect and noninvasive method for the determination of anaerobic threshold (AnT) in an incremental field test for runners. This noninvasive method for the determination of anaerobic threshold is dependent on the occurrence of a deflection of the heart rate performance curve (HRPC). The aim of our study was to evaluate the degree and direction of the deflection of the HRPC and the relationship of the heart rate threshold (HRT) to the lactate turn point in a group of 227 healthy young subjects (age: 23 +/- 4 yr). The subjects were divided into three groups by means of second degree polynomial fitting (GI: regular deflection, kHR > 0.1; G II: no deflection, 0 < kHR < 0.1; G II: inverse deflection, k < -0.1). No significant differences between the groups were found in the anthropometric data or in the power output and the blood lactate concentration at both the first (LTP1) and second (LTP2) lactate turn points and at maximum performance (Pmax). Using the method of Conconi et al. (20), 85.9% of the subjects showed a "regular" deflection, 6.2% showed no deflection at all, and 7.9% showed even an inverted deflection of the HRPC. An HRT could be obtained in both G I and G III, and power output at HRT was not significantly different in comparison to that at the LTP2. No HRT could be assessed in G II. The heart rate at HRT and the LTP2 were significantly lower in G III compared with G I. The phenomenon of heart rate break point may be attractive in training regulation, but its application is limited because a heart rate deflection cannot be found even in young subjects in some cases.

Verification of the heart rate threshold

Among the methods for determining anaerobic threshold (AT), the heart rate (HR) method seems to be the simplest. On the other hand, many conflicting results from comparing this method with others have been presented over the last 10 years. Therefore, the aim of this study was to compare the heart rate threshold (HRT) with the lactate turn point (LTP)-"second" break point of dependence of lactate (LA) to power output, ventilatory threshold (VT) and threshold determined by electromyography (EMGAT), all determined by the same exercise test and evaluated by the same computer algorithm. A group of 24 female students [mean age 20.5 (SD 1.6) years, maximal oxygen consumption 48.8 (SD 4.7) ml.kg-1.min-1] performed an incremental exercise test on a cycle ergometer (modified Conconi test) starting with an initial power output (PO) of 40 W with intensity increments of 10 W.min-1 until the subjects were exhausted. The HRT, LTP and EMGAT determination was done by computer-aided break-point regression analysis from dependence of functional measures on PO. The same computer algorithm was used for VT determination from the relationship between ventilation (V) and oxygen uptake (VO2) or carbon dioxide output (VCO2).(ABSTRACT TRUNCATED AT 250 WORDS)

Heart rate deflection related to lactate performance curve and plasma catecholamine response during incremental cycle ergometer exercise

The correlation between the behaviour of the heart rate/work performance (fc/W) curve and blood lactate ([la]b) and plasma adrenaline/noradrenaline concentrations ([A]/[NA]) during incremental cycle ergometer exercise was investigated. A group of 21 male sports students was divided into two groups: group I, with a clear deflection of the fc/W curve; group II, without or with an inverse deflection of the fc/W curve. The aerobic threshold (Thaer) and the lactate turn point (LTP) were defined. Between Thaer and maximal work performance (Wmax) the behaviour of the fc/W curve as well as the behaviour of [la-]b and [A]. [NA] were described mathematically. The fc, systolic blood pressure (BPs), W, [la-]b, [A] and [NA] at rest, Thaer, LTP, Wmax, after 3 and 6 min of recovery (Re3/Re6) were calculated. A significant difference between the two groups could only be detected for fc at LTP, Re3 and Re6 (P < 0.05). No significant correlation could be found between individual fc/W-behaviour and individual time course of [la-]b, [A] and [NA]. However, a significant correlation was visible between [la-]b/W-behaviour and individual catecholamine response. These results and the fact that the different flattening at the top of the fc/W curve was related to diminished stress-dependent myocardial function led us to the conclusion that it is possible that sympathetic drive is not directly involved in mechanisms of regulation between load dependent fc and myocardial function. In addition, individual fc/W behaviour was independent of BPs and Wmax, or individual conditions of energy supply.

Heart rate threshold related to lactate turn point and steady-state exercise on a cycle ergometer

The aim of this study was to investigate heart rate threshold (HRT) related exercise intensities by means of two endurance cycle ergometer tests using blood lactate concentration [La], pulmonary ventilation (VE), oxygen uptake (VO2), heart rate (HR) and electromyogram (EMG) activity of working muscle. Firstly, 16 healthy female students [age, 21.4 (SD 2.8) years; height, 167.1 (SD 5.1) cm; body mass 62.7 (SD 7.1) kg] performed an incremental exercise test (10 W each minute) on an electrically braked cycle ergometer until they felt exhausted. The HRT and lactate turn point (LTP) were assessed by means of computer-aided linear regression break point analysis from the relationship of HR or [La] to power output. No significant difference was found between HRT and LTP for all the variables measured. Secondly, two endurance tests (ET) of 20 min duration were performed by 7 subjects. The first (ET I) was performed at an exercise intensity which was about 10% lower than the power output at HRT [61.2 (SD 3.1)% maximal oxygen uptake (VO2max)], the second (ET II) at an exercise intensity about 10% higher than the power output at HRT [79.2 (SD 3.4) % VO2max]. The parameters measured showed a clear steady state in ET I. All mean values were lower than values at HRT [power, 138.7 (SD 18.9) W; HR, 172.1 (SD 4.7) beats.min-1; VO2, 2.2 (SD 0.3) l.min-1; VE, 54.0 (SD 9.1) l.min-1; [La], 3.7 (SD 1.1) mmol.l-1; EMG, 81.1 (SD 24.0) microV] except HR which was the same.(ABSTRACT TRUNCATED AT 250 WORDS)