An Examination and Critique of Subjective Methods to Determine Exercise Intensity: The Talk Test, Feeling Scale, and Rating of Perceived Exertion

Update on Exercise in Persons With Muscle Disease

Myopathies are heterogeneous in their etiology, muscle group involvement, clinical manifestation, and progression. Deficits in myopathy may include muscle weakness, atrophy, stiffness, myalgia, and extra-muscular manifestations. Consequently, these deficits could lead to impaired musculoskeletal function, inadequate engagement in daily activities and reduced participation in social activities. Exercise has been viewed as a potentially efficacious intervention to halt the loss of muscle function and to improve secondary symptoms that result from muscle loss, such as pain and fatigue. The purpose of this review is to discuss research findings within the last 10 years that examine effects of exercise interventions in many types of myopathies in humans. In general, most studies were small scale, and they varied with respect to exercise type, intensity, and outcome measures. Despite the different pathologies, various exercise subtypes of aerobic/endurance or strength/resistance training are generally beneficial and may improve muscle strength and functional outcomes. Exercise therapies are generally safe and well tolerated. Exercise prescription should be part of routine neuromuscular care for patients with myopathy, and ideally with input from a multidisciplinary team, with a focus on providing individualized exercise regimens. Further work is needed to define the optimal intensity and type of exercise to result in the best functional outcomes for persons with myopathy, as well as the effects of combining exercise and novel disease modifying therapies.

The effects of online pilates training on cognitive functions and dual task performance in people with multiple sclerosis: A randomized controlled study

BACKGROUND

Cognitive impairments in people with multiple sclerosis (PwMS) are common and aggravate dual-task (DT) performance. This study aimed to investigate the effectiveness of online Pilates training on cognitive functions and the DT performance of balance, walking, and functional mobility in PwMS.

METHOD

In this randomized controlled trial, forty-six PwMS were recruited and randomly allocated into two groups. The Online Pilates group (OPG) received Pilates training via videoconferences three days per week during six weeks at home. The control group (CG) was a waitlist with no Pilates treatment. Cognitive Functions were assessed with Montreal Cognitive Asssessment (MoCA), The Trail Making Test (TMT), and The Stroop Test (ST). DT performance was assessed with mental tracking and verbal fluency during postural stability (PS), walking, and functional mobility.

RESULTS

At the end of six weeks, the interaction effects (time × group) revealed significant differences for MoCA (p = 0.024), TMT-B (p = 0.012), ST (p ≤ 0.012), PS-with mental tracking (p = 0.004), PS-with verbal fluency (p = 0.003), cadence-with mental tracking (p = 0.048), and functional mobility-with mental tracking (p = 0.043) in favor of the OPG. Additionally, MoCA, TMT, ST, and DT performance during balance and functional mobility significantly improved in after six-week online Pilates training, but did not in CG.

CONCLUSION

Pilates training via videoconference was effective in the improvement of cognitive functions and DT performance in PwMS. Online Pilates may be considered for improving cognitive impairments and DT performances in PwMS with barriers to accessing clinics.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT06462339.

Serendipity in Science: 50+ Years of Designed, and Sometimes Lucky, Science

Normal science is about assessing what is already known about a topic, about what needs to be known, and careful methods to collect the data required to answer the scientific question. It is the mainstay of scientific progress. But sometimes, luck or chance (eg, serendipity) plays a significant role in scientific process. We trace career experiences in our lives to show how serendipity, the gift that Mother Nature gives to science, has a nontrivial role in scientific progress and professional careers. This gift often encourages us to change the focus of experiments or to look for the answers to our questions in ways that were not immediately obvious.

The accuracy of fixed intensity anchors to estimate lactate thresholds in recreational runners

BACKGROUND

Endurance exercise intensities can be categorized into moderate, heavy, and severe domains based on physiological responses during incremental exercise testing. Since the evaluation of metabolic thresholds is not always possible, this study assessed the accuracy of fixed intensity anchors to estimate lactate thresholds.

METHODS

165 (64 females, 101 males) recreational runners performed a maximal incremental treadmill test. The first (LT1) and second (LT2) lactate thresholds were determined as percentages of maximum heart rate (HR), oxygen consumption (VO2), and running speed, alongside the rating of perceived exertion (RPE). Sex-specific mean values were used to determine the threshold intensities and to analyze the error magnitude for each method.

RESULTS

Females had a higher relative HR, VO2, and speed at LT1 compared to males (p < 0.001). In the pooled data, the mean absolute error for estimating LT1 varied from 0.6 to 0.8 km/h for speed and 4.9-7.4 bpm for HR, while LT2 errors ranged from 0.4 to 0.8 km/h and 2.8-5.2 bpm, respectively. The speed-derived estimations yielded the smallest error magnitudes, while the RPE-derived estimations were the least accurate. Estimating the maximum speed increased the respective errors to 1.0 km/h and 8.4 bpm for LT1, and to 1.1 km/h and 6.7 bpm for LT2.

CONCLUSION

LT1 occurred at higher relative intensity in females, suggesting a need for sex-specific intensity anchors. The speed-derived estimates were the most accurate, but the estimation of maximum values impaired the prediction accuracy. Thus, the optimal method also depends on the availability of the maximum values.

High-Intensity Interval Training for Cancer Patients: A Review of Key Considerations for Exercise Prescription

BACKGROUND

High-intensity interval training (HIIT) performed before, during, and after cancer treatment can attenuate the adverse effects induced by anti-cancer drugs. A clear presentation and rationale of characteristics of HIIT variables is vital to produce the expected HIIT adaptations in cancer patients. However, there are concerns regarding the HIIT protocols used in the cancer literature.

OBJECTIVES

The aims were to (1) identify the characteristics of HIIT and the formats that have been prescribed, (2) analyze which anchors have been utilized to prescribe effort and pause intensity, (3) examine characteristics of the physical tests used for HIIT prescription, and (4) identify potential adverse events related to HIIT intervention.

METHODS

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, including PubMed, Scopus, and Web of Science databases.

RESULTS

A total of 51 studies were retrieved, and the following results were found: (1) Only 25 studies reported all four essential variables for HIIT prescription [effort intensity (effort duration): pause intensity (pause duration)]. Of these studies, 23 used active pause and employed the following prescription (on average): [84% (116 s): 39% (118 s)] when percentage of maximal aerobic power (MAP) [maximal/peak oxygen uptake ( V O2max/peak)/MAP] was used; [124% (161 s): 55% (142 s)] when percentage of anaerobic threshold (AT) was used; [83% (230 s): 62% (165 s)] when maximal heart rate percentage (%HRmax) was used. From these 23 studies, 12 used V O2max/peak/MAP (one of the most recommended variables for HIIT prescription). Seven studies adopted the HIIT-long format, and in the remaining five studies, the format was unclear. (2) Twenty-four studies used fractions of V O2max/peak or mechanical variables like MAP as anchors for prescribing effort intensity, two studies used AT, 20 studies used fractions of HRmax/heart rate reserve, two studies used rate of perceived exertion (RPE), while one used RPE and % V O2peak concomitantly, and two studies utilized RPE/%HRmax concomitantly. Two studies utilized passive resting, 12 studies used % V O2peak/%MAP for prescribing pause intensity, four studies used AT, seven studies used %HRmax, one study used %HRmax/% V O2peak, and two studies used absolute loads. (3) Ten studies did not report the characteristics of the physical tests employed, two studies used submaximal tests, and 39 studies utilized graded exercise tests. (4) Ten studies did not report if there were adverse events associated with the exercise program, while 34 studies did not report any adverse events.

CONCLUSIONS

Only 50% of the studies provided all the necessary variables for accurate HIIT prescription, raising concerns about the replicability, comprehension, and effective application of HIIT in cancer patients. Most of the studies that reported all variables appeared to have employed the HIIT-long format. Only a few studies used more individualized anchors (e.g., AT) to prescribe HIIT-long format for cancer patients, which is considered a very heterogeneous population.

Changes in Cardiorespiratory Fitness Following Exercise Training Prescribed Relative to Traditional Intensity Anchors and Physiological Thresholds: A Systematic Review with Meta-analysis of Individual Participant Data

BACKGROUND

It is unknown whether there are differences in maximal oxygen uptake ( V O2max) response when prescribing intensity relative to traditional (TRAD) anchors or to physiological thresholds (THR).

OBJECTIVES

The present meta-analysis sought to compare: (a) mean change in V O2max, (b) proportion of individuals increasing V O2max beyond a minimum important difference (MID) and (c) response variability in V O2max between TRAD and THR.

METHODS

Electronic databases were searched, yielding data for 1544 individuals from 42 studies. Two datasets were created, comprising studies with a control group ('controlled' studies), and without a control group ('non-controlled' studies). A Bayesian approach with multi-level distributional models was used to separately analyse V O2max change scores from the two datasets and inferences were made using Bayes factors (BF). The MID was predefined as one metabolic equivalent (MET; 3.5 mL kg-1 min-1).

RESULTS

In controlled studies, mean V O2max change was greater in the THR group compared with TRAD (4.1 versus 1.8 mL kg-1 min-1, BF > 100), with 64% of individuals in the THR group experiencing an increase in V O2max > MID, compared with 16% of individuals taking part in TRAD. Evidence indicated no difference in standard deviation of change between THR and TRAD (1.5 versus 1.7 mL kg-1 min-1, BF = 0.55), and greater variation in exercise groups relative to non-exercising controls (1.9 versus 1.3 mL kg-1 min-1, BF = 12.4). In non-controlled studies, mean V O2max change was greater in the THR group versus the TRAD group (4.4 versus 3.4 mL kg-1 min-1, BF = 35.1), with no difference in standard deviation of change (3.0 versus 3.2 mL kg-1 min-1, BF = 0.41).

CONCLUSION

Prescribing exercise intensity using THR approaches elicited superior mean changes in V O2max and increased the likelihood of increasing V O2max beyond the MID compared with TRAD. Researchers designing future exercise training studies should thus consider the use of THR approaches to prescribe exercise intensity where possible. Analysis comparing interventions with controls suggested the existence of intervention response heterogeneity; however, evidence was not obtained for a difference in response variability between THR and TRAD. Future primary research should be conducted with adequate power to investigate the scope of inter-individual differences in V O2max trainability, and if meaningful, the causative factors.

Exercise intensity of virtual reality exergaming modulates the responses to executive function and affective response in sedentary young adults: A randomized, controlled crossover feasibility study

Virtual reality (VR) exergaming is a novel strategy to encourage physical activity and boost emotional well-being. However, its effects on executive function (EF) are not fully understood. This study assessed the immediate and retention effects of immersive VR exergaming, at varying exercise intensities, on EF and affect among sedentary college students. Thirty participants (mean age = 22.2 ± 2.5 years; 18 females) underwent 15-minute sessions of moderate-intensity (MI), high-intensity (HI), and active-control intensity (AC) VR exergaming in a counterbalanced order. EF was evaluated using the Flanker, Task-switching, and N-back tasks before, immediately after, and 30 min post-intervention. Emotional valence and arousal were measured by the Feeling Scale and Felt Arousal Scale, respectively. The inverse efficiency score (IES) results indicated that inhibitory control was higher following both MI and HI exergaming compared to AC (p < 0.05), with improvements sustained for 30 minutes HI VR exergaming showed the greatest improvement (p = 0.048). Both HI and MI also exhibited higher working memory capacity than AC (p < 0.05), with HI performing better (p = 0.039). No significant differences in task-switching performance were observed among the groups (p > 0.05). Emotional valence and arousal were significantly elevated immediately after and sustained for 30 minutes following MI and HI exergaming (p < 0.05). This study demonstrates the cognitive and affective benefits of MI and HI VR exergaming in young adults, with HI VR exergaming showing longer-lasting improvements. These findings suggest that immersive VR exergaming can enhance both physical and cognitive health, potentially improving academic performance and daily functionality in collegiate populations.

History and perspectives on interval training in sport, health, and disease

Exercise can be conducted as low-intensity continuous training (LICT) or a variety of higher intensity work/rest formats, collectively called interval training. Interval training was developed for athletes in the early 20th century. It was systemized in Sweden as Fartlek, and in Germany as die interval Method, in the 1930s. Most contemporary forms of interval training evolved from these progenitors. In essence, interval training allows a large volume of high-intensity or race specific training to be performed while controlling the development of fatigue. Adding interval training to LICT done by athletes adds about 2%-4% to performance achievable with LICT, which represents a competitively meaningful difference in performance (e.g., 4:25 vs. 4:00 over 1 mile). More recently, interval training has been applied to health- fitness participants and even to patients with health conditions. Studies indicate that a comparatively low volume of interval training can produce substantial improvement in physiologic capacity, in as little as 20% of training time versus LICT. There are data indicating that interval training can be reasonably pleasant, have good adherence, and is safe, even in patients. Although interval training was originally designed for athletics, the fundamental patterns of work versus recovery are remarkably similar in healthy adults and patients. Although the total volume of training and both absolute and relative intensity and magnitude of homeostatic disturbance are larger in athletes, the overall pattern of effort is the same in fitness participants and patients. Interval training can thus be characterized as an important step in the evolution of exercise training.

Warm-Up in Triathlon: Do Triathletes Follow the Scientific Guidelines?

PURPOSE

Warming up before competition is universally recognized as an effective way to enhance performance. However, only a few articles have directly investigated different warm-up strategies adopted by triathletes and suggested by coaches. The Olympic-distance triathlon is an endurance competition characterized, at least for the elite, by a fast start with a strong correlation to the final position in the race. Thus, executing a proper warm-up protocol would be beneficial in optimizing performance. The present study aimed to provide an overview of the warm-up protocol adopted/suggested by national-caliber triathletes/coaches before an Olympic-distance triathlon race.

METHODS

Online surveys were created and shared between national- and international-caliber Italian, French, and Spanish triathletes and coaches. Information about the rationale, structure, and specific exercises adopted/suggested during personal warm-up protocols was collected. Thereafter, triathletes were grouped according to the discipline sequence reported.

RESULTS

Seventy-nine triathletes and nineteen coaches completed the survey. The cycle-run-swim was the most reported discipline sequence adopted, with a total time of 90.0 (25.0) minutes, against the 62.5 (25.0) minutes suggested by coaches. Conditioning exercises were performed by only 31.6% of triathletes 20 to 10 minutes before the race start.

CONCLUSIONS

Triathletes who took part in this survey adopted very long protocols with the specific intention of including all disciplines. These results highlight the need to raise awareness in triathletes and coaches on the correct warm-up procedures and to stimulate researchers to design studies that directly investigate the effects of different warm-up protocols before competitions.

Immersive Virtual Reality Decreases Work Rate and Manipulates Attentional Focus During Self-Regulated Vigorous Exercise

To determine the effect of immersive virtual reality use on finishing time of a vigorous-intensity self-regulated exercise task, and on relevant psychological variables. Healthy untrained adults (N = 21; 10 men/11 women; age = 22.9 ± 7.2 years; BMI = 24.0 ± 4.5 kg/m2) completed 1500-m exercise bouts on a rowing ergometer in a counterbalanced and randomized order, with and without use of a headset-delivered virtual reality fitness program. Heart rate, rating of perceived exertion, affective valence, and attentional focus were collected every 300 m, in addition to finishing time. Data were analyzed with repeated measures as appropriate. Intensity of both exercise bouts was considered vigorous according to heart rate results (>77% maximal heart rate). Finishing time was faster in the control condition (449.57 ± 82.39 s) than in the virtual reality condition (463.00 ± 91.78 s), p = .007. Compared to the control condition, the virtual reality condition was characterized by a more external attentional focus (52.38 ± 18.22 vs. 38.76 ± 17.81, p < .001). No differences were observed for remaining variables as a result of condition (p > .05 for all). When a headset-delivered VR program was used during a self-regulated vigorous-intensity exercise task, participants were 13.6 seconds (~3%) slower than in a control condition. Attentional focus was manipulated to be more external with VR use, which may have ultimately distracted from the exercise objective. Recommendations for selecting an appropriate virtual reality experience for a given exercise task are discussed.

Virtual Reality Exercise with Autonomy Support Increases Positive Affect During Time Trial Exercise

Background: Being able to choose elements of an exercise session, known as autonomy support, improves motor performance and psychological responses. Virtual reality (VR) programs provide many options for embedding autonomy support in exercise sessions. The purpose of this study was to investigate the effects of autonomy support in a VR setting on physiological and psychological responses to self-regulated rowing exercise. Methods: Using a repeated-measures crossover design, healthy untrained men and women (N = 20, age = 23.0 ± 7.4) completed exercise sessions on a rowing ergometer coupled with a head-mounted immersive VR application. In the Choice condition, participants chose the virtual environment, and in the Control condition, the environment was assigned to the participant. Participants were instructed to complete 1500 m as quickly as possible in both conditions, while ratings of perceived exertion, affective valence, and heart rate were recorded throughout the trials. Finishing time and remembered pleasure were assessed at the end of each session. Repeated-measures analyses with an alpha level of 0.05 were used for all variables as appropriate, with Bonferroni adjustments applied for any post hoc tests. Results: There was a main effect of condition on affective valence which was higher in Choice (2.07 ± 1.67) than Control (1.64 ± 2.12, P = 0.03, η2 = 0.22). No other differences were detected between conditions for finishing time or the remaining variables. Conclusion: During self-regulated exercise accompanied by an immersive VR application, being able to choose the virtual environment oneself leads to a more positive affective state without compromising exercise effort, physiological strain, or performance.

Rating of perceived exertion as a tool for managing exercise intensity during pregnancy: a scoping review

OBJECTIVE

During pregnancy, international guidelines recommend ≥150 min of moderate-intensity aerobic physical activity per week, with an intensity perceived as fairly light to somewhat hard on the Borg Rating of Perceived Exertion (RPE) scale (ranging from 6 'no exertion' to 20 'maximal exertion', corresponding to 60% to 80% of maximum heart rate). However, the determination and monitoring of exercise intensity seem to be a particular source of confusion, and the most effective method to monitor exercise intensity remains uncertain. This study aimed to examine existing research on the correlation between the Borg RPE scale and maternal heart rate (MHR) for monitoring exercise intensity during pregnancy.

DESIGN

Scoping review using the mixed methods appraisal tool (MMAT) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

DATA SOURCES

PubMed, Web of Science and SPORTDiscus were searched from 16-17 April 2023, with a subsequent search on 1 November 2023.

ELIGIBILITY CRITERIA

We included studies investigating the correlation between perceived intensity on the Borg RPE scale (6-20) and MHR during exercise in pregnant individuals and written in English/Scandinavian language. There were no restrictions on publication year or study design.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers screened the articles based on title and abstract. Selected articles were read in full text and reference lists of screened articles were also checked. Out of 120 studies screened, six articles met the inclusion criteria after removing one duplicate. The results were qualitatively summarised to provide an overview of common themes and variations between studies. MMAT and GRADE assessed the risk of bias and the certainty of the evidence.

RESULTS

The six studies involved a total of 260 healthy pregnant individuals (gestational week: from 16 to 38), with various exercise protocols (cycling, walking, running and resistance exercise) and intensities (from light to moderate). Three studies supported the Borg RPE scale to estimate exercise intensity during pregnancy, while three found no correlation between this scale and MHR. The certainty of the evidence was graded as low to moderate, with a potential risk of bias due to small sample sizes, incomplete outcome data and inconsistencies across studies.

CONCLUSION

The mixed results highlight the complexity of monitoring exercise intensity during pregnancy. Using both the Borg RPE scale and MHR might be better than using them separately for monitoring exercise intensity during pregnancy. Due to limited and inconsistent research, more extensive studies are needed.

Identifying fatigue of climbing workers using physiological data based on the XGBoost algorithm

Background

High-voltage workers often experience fatigue due to the physically demanding nature of climbing in dynamic and complex environments, which negatively impacts their motor and mental abilities. Effective monitoring is necessary to ensure safety.

Methods

This study proposed an experimental method to quantify fatigue in climbing operations. We collected subjective fatigue (using the RPE scale) and objective fatigue data, including systolic blood pressure (SBP), diastolic blood pressure (DBP), blood oxygen saturation (SpO2), vital capacity (VC), grip strength (GS), response time (RT), critical fusion frequency (CFF), and heart rate (HR) from 33 high-voltage workers before and after climbing tasks. The XGBoost algorithm was applied to establish a fatigue identification model.

Results

The analysis showed that the physiological indicators of SpO2, VC, GS, RT, and CFF can effectively evaluate fatigue in climbing operations. The XGBoost fatigue identification model, based on subjective fatigue and the five physiological indicators, achieved an average accuracy of 89.75%.

Conclusion

This study provides a basis for personalized management of fatigue in climbing operations, enabling timely detection of their fatigue states and implementation of corresponding measures to minimize the likelihood of accidents.

Exercise and weight loss with a left ventricular assist device: A case report and review of the literature

With changes in the heart transplant allocation system in the United States, the use of left ventricular device therapy (LVAD) as a bridge to transplant has decreased. Currently, one of the primary reasons to implant a device is for patient support until they can lose weight to qualify for transplant. This paper reviews the outcomes of various weight loss strategies for patients with LVADs including weight reduction surgery and cardiac rehab. Additionally, results of the use of GLP1 agonists on weight loss in general and in heart failure patients is reviewed. Finally, because of the unique issues involving exercise for patients with LVADs, we review safe exercise techniques with instructions for patients.

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

Cognitive reappraisal and affective response to physical activity: associations with physical activity behavior

OBJECTIVE

Cognitive reappraisal (CR), as an adaptive emotion regulation strategy, may play a role in transforming affect in a positive direction during or after exercise, thereby supporting physical activity (PA) adherence. The present study aimed to test the associations among PA, CR frequency, and affective response to PA, and further to examine the role of CR on PA behavior through affective response.

METHODS

A cross-sectional study was conducted with a sample of 105 adults, 74 of whom were women, with a mean age of 25.91. Self-report scales were used to measure PA, CR, and affective response to PA. Along with scales, demographic questions on age, sex, and education level were included. Data was collected via an online questionnaire.

RESULTS

The frequency of CR use was positively associated with affective response, and affective response with PA behavior. Mediation analysis revealed that affective response mediated the relationship between CR and PA.

DISCUSSION

Results were in the expected direction demonstrating the mediating role of affective response between CR and PA which implies that PA adherence might be facilitated by CR engagement. PA intervention programs should consider implementing CR ability and use frequency improving techniques.

Maintain your mind, maintain your focus: Effects of focused attention and intensity in experienced runners

The intensity that people choose for their endurance activities has a major influence on their affective experience. Furthermore, the direction of attention (e.g., internal or external) during endurance activities may significantly influence performance and personal perceptions. Therefore, in the current study, we focus on the interaction between intensity and attentional focus. We aim to address the question of whether adopting an internal (IAF; breathing) or an external attentional focus (EAF; environment), compared to a control condition, leads in differences in speed, heart rate, and affect during running at different intensities in experienced runners. Data from 59 participants were analyzed (Mage: 26.95 (SD = 4.78) years; 34 male; 25 female). Participants ran 9 × 3 min in an outdoor park with three intensity conditions (light, somewhat hard, hard) and three attention conditions (internal, external, control). Intensity, but not attentional focus, impacted affective responses. Results revealed a significant interaction between attentional focus and intensity on heart rate (p < 0.001, ω2p = 0.199): during the somewhat hard intensity, the control focus condition was significantly lower compared the internal and external attentional focus conditions. Additionally, we used exploratory multilevel models (MLM). In the best-fitting MLM of heart rate, 45% of the variance is attributed to differences between athletes, and thus 55% of the variance within athletes. Furthermore, the model indicated that athletes running at a somewhat hard intensity and maintaining an EAF (b = 7.69) or IAF (b = 6.36) had an increase in heart rate compared to the control condition. We speculate that simultaneously monitoring effort and following an attentional instruction was such a difficult task that led to a favorable effect for the control condition. In practice, this could mean that the implementation of an unfamiliar focus of attention, for example, initially requires additional energy expenditure.

Heart Rate Variability Thresholds: Agreement with Established Approaches and Reproducibility in Trained Females and Males

PURPOSE

To determine in trained females and males i) the agreement between the gas exchange threshold (GET), lactate threshold 1 (LT1), and heart rate variability threshold 1 (HRVT1), as well as between the respiratory compensation point (RCP), lactate threshold 2 (LT2), and heart rate variability threshold 2 (HRVT2), and ii) the reproducibility of HRVT1 and HRVT2 during 2-min incremental step protocols.

METHODS

Fifty-seven trained participants (24 females) completed a 2-min step incremental test to task failure. Nineteen participants (eight females) completed a second test to evaluate reproducibility. Gas exchange and ventilatory responses, blood lactate concentration, and RR time series were recorded to assess the oxygen consumption (V̇O 2 ) and heart rate (HR) associated with the GET, RCP, LT1, LT2, HRVT1, and HRVT2.

RESULTS

V̇O 2 -GET versus V̇O 2 -HRVT1 and HR-GET versus HR-HRVT1 were statistically different for females (29.5 ± 4.0 vs 34.6 ± 6.1 mL·kg -1 ·min -1 ; 154 ± 11 vs 166 ± 12 bpm) and for males (33.9 ± 4.2 vs 42.7 ± 4.6 mL·kg -1 ·min -1 ; 145 ± 11 vs 165 ± 9 bpm; P < 0.001). V̇O 2 and HR at HRVT1 were greater than at LT1 ( P < 0.05). V̇O 2 -RCP versus V̇O 2 -HRVT2 and HR-RCP versus HR-HRVT2 were not statistically different for females (40.1 ± 4.7 vs 39.5 ± 6.7 mL·kg -1 ·min -1 ; 177 ± 9 vs 176 ± 9 bpm) and males (48.4 ± 5.4 vs 47.8 ± 4.8 mL·kg -1 ·min -1 ; 176 ± 8 vs 175 ± 9 bpm; P > 0.05). V̇O 2 and HR responses at LT2 were similar to HRVT2 ( P > 0.05). Intraclass correlation coefficient for V̇O 2 -HRVT1, HR-HRVT1, V̇O 2 -HRVT2, and HR-HRVT2 indicated good reproducibility when comparing the two different time points to standard methods.

CONCLUSIONS

Whereas HRVT2 is a valid and reproducible estimate of the RCP/LT2, current approaches for HRVT1 estimation did not show good agreement with outcomes at GET and LT1.

Rating of Perceived Exertion: A Large Cross-Sectional Study Defining Intensity Levels for Individual Physical Activity Recommendations

BACKGROUND

Physical inactivity is a growing risk factor worldwide, therefore getting people into sports is necessary. When prescribing physical activity, it is essential to recommend the correct training intensities. Cardiopulmonary exercise testing (CPX) enables precise determination of individuals' training intensities but is unavailable for a broad population. Therefore, the Borg scale allows individuals to assess perceived exertion and set their intensity easily and cost-efficiently. In order to transfer CPX to rating of perceived exertion (RPE), previous studies investigated RPE on specific physiological anchors, e.g. blood lactate (bLa) concentrations, but representativeness for a broad population is questionable. Some contradictory findings regarding individual factors influencing RPE occur, whereas univariable analysis has been performed so far. Moreover, a multivariable understanding of individual factors influencing RPE is missing. This study aims to determine RPE values at the individual anaerobic threshold (LT2) and defined bLa concentrations in a large cohort and to evaluate individual factors influencing RPE with multivariable analysis.

METHODS

CPX with bicycle or treadmill ergometer of 6311 participants were analyzed in this cross-sectional study. RPE values at bLa concentrations 2 mmol/l, 3 mmol/l, 4 mmol/l, and LT2 (first rise in bLa over baseline + 1.5 mmol/l) were estimated by spline interpolation. Multivariable cumulative ordinal regression models were performed to assess the influence of sex, age, type of ergometry, VO2max, and duration of exercise testing on RPE.

RESULTS

Median values [interquartile range (IQR)] of the total population were RPE 13 [11; 14] at 2 mmol/l, RPE 15 [13; 16] at 3 mmol/l, RPE 16 [15; 17] at 4 mmol/l, and RPE 15 [14; 16] at LT2. Main influence of individual factors on RPE were seen especially at 2 mmol/l: male sex (odds ratio (OR) [95%-CI]: 0.65 [0.587; 0.719]), treadmill ergometry (OR 0.754 [0.641; 0.886]), number of stages (OR 1.345 [1.300; 1.394]), age (OR 1.015 [1.012; 1.018]), and VO2max (OR 1.023 [1.015; 1.030]). Number of stages was the only identified influencing factor on RPE at all lactate concentrations/LT2 (3 mmol/l: OR 1.290 [1.244; 1.336]; 4 mmol/l: OR 1.229 [1.187; 1.274]; LT2: OR 1.155 [1.115; 1.197]).

CONCLUSION

Our results suggest RPE ≤ 11 for light intensity, RPE 12-14 for moderate intensity, and RPE 15-17 for vigorous intensity, which slightly differs from the current American College of Sports Medicine (ACSM) recommendations. Additionally, we propose an RPE of 15 delineating heavy and severe intensity domain. Age, sex, type of ergometry, duration of exercise, and cardiopulmonary fitness should be considered when recommending individualized intensities with RPE, primarily at lower intensities. Therefore, this study can be used as a new guideline for prescribing individual RPE values in the clinical practice, predominantly for endurance type exercise.

Are incremental exercise relationships between rating of perceived exertion and oxygen uptake or heart rate reserve valid during steady-state exercises?

Background

Rating of perceived exertion (RPE) is considered a valid method for prescribing prolonged aerobic steady-state exercise (SSE) intensity due to its association with physiological indicators of exercise intensity, such as oxygen uptake (V̇O2) or heart rate (HR). However, these associations between psychological and physiological indicators of exercise intensity were found during graded exercise tests (GXT) but are currently used to prescribe SSE intensity even though the transferability and validity of the relationships found during GXT to SSE were not investigated. The present study aims to verify whether (a) RPE-HR or RPE-V̇O2 relations found during GXTs are valid during SSEs, and (b) the duration and intensity of SSE affect these relations.

Methods

Eight healthy and physically active males (age 22.6 ± 1.2 years) were enrolled. On the first visit, pre-exercise (during 20 min standing) and maximal (during a GXT) HR and V̇O2 values were measured. Then, on separate days, participants performed 4 SSEs on the treadmill by running at 60% and 80% of the HR reserve (HRR) for 15 and 45 min (random order). Individual linear regressions between GXTs' RPE (dependent variable) and HRR and V̇O2 reserve (V̇O2R) values (computed as the difference between maximal and pre-exercise values) were used to predict the RPE associated with %HRR (RPEHRR) and %V̇O2R (RPEV̇O2R) during the SSEs. For each relation (RPE-%HRR and RPE-%V̇O2R), a three-way factorial repeated measures ANOVA (α = 0.05) was used to assess if RPE (dependent variable) was affected by exercise modality (i.e., RPE recorded during SSE [RPESSE] or GXT-predicted), duration (i.e., 15 or 45 min), and intensity (i.e., 60% or 80% of HRR).

Results

The differences between RPESSE and GXT-predicted RPE, which were assessed by evaluating the effect of modality and its interactions with SSE intensity and duration, showed no significant differences between RPESSE and RPEHRR. However, when RPESSE was compared with RPEV̇O2R, although modality or its interactions with intensity were not significant, there was a significant (p = 0.020) interaction effect of modality and duration yielding a dissociation between changes of RPESSE and RPEV̇O2R over time. Indeed, RPESSE did not change significantly (p = 0.054) from SSE of 15 min (12.1 ± 2.0) to SSE of 45 min (13.5 ± 2.1), with a mean change of 1.4 ± 1.8, whereas RPEV̇O2R decreased significantly (p = 0.022) from SSE of 15 min (13.7 ± 3.2) to SSE of 45 min (12.4 ± 2.8), with a mean change of -1.3 ± 1.5.

Conclusion

The transferability of the individual relationships between RPE and physiological parameters found during GXT to SSE should not be assumed as shown by the results of this study. Therefore, future studies modelling how the exercise prescription method used (e.g., RPE, HR, or V̇O2) and SSE characteristics (e.g., exercise intensity, duration, or modality) affect the relationships between RPE and physiological parameters are warranted.

The Affective Responses to Moderate Physical Activity: A Further Study to Prove the Convergent and the Discriminant Validity for the German Versions of the Feeling Scale and the Felt Arousal Scale

The present study proves the construct validity of the German versions of the Feeling Scale (FS) and the Felt Arousal Scale (FAS) for measuring the affective responses (affective valence and arousal) for a moderate-intensity jogging (JG) exercise. In previous studies, both scales were validated for a high-intensity bicycle ergometer exercise and for relaxation techniques. In the present study, 194 participants performed the JG exercise for 45 min and completed the FS and the FAS, as well as the Self-Assessment Manikin (SAM), for a self-other comparison in a pre-test-intervention-post-test design. The results of the correlation analyses replicated the previous findings for the high-intensity bicycle ergometer exercise and the relaxation techniques, revealing significant positive correlations for the valence dimension between the FS and the SAM-Pleasure subscale (r = 0.50) and for the arousal dimension between the FAS and the SAM-Arousal subscale (r = 0.16). These findings suggest that the German versions of the FS and the FAS are also suitable for exercises of moderate intensity.

Reliability of Ultrasound Shear Wave Elastography for Evaluating Psoas Major and Quadratus Lumborum Stiffness: Gender and Physical Activity Effects

OBJECTIVE

We aimed to assess the reliability of quantifying psoas major (PM) and quadratus lumborum (QL) stiffness with ultrasound shear wave elastography (SWE), and to explore the effects of gender and physical activity on muscle stiffness.

METHODS

Fifty-two healthy participants (18-32 y) were recruited. To determine reliability, 29 of them underwent repeated SWE measurements of PM and QL stiffness by an operator on the same day. The intra-class correlation coefficients (ICC3,1), standard error of measurement (SEM) and minimal detectable change with 95% confidence interval (MDC95) were calculated. The rest participants underwent a single measurement. Two-way MANCOVA was conducted for the effects of gender and physical activity on muscle stiffness.

RESULTS

The observed reliability for PM (ICC3,1 = 0.89-0.92) and QL (ICC3,1 = 0.79-0.82) were good-to-excellent and good, respectively. The SEM (kPa) was 0.79-1.03 and 1.23-1.28, and the MDC95 (kPa) was 2.20-2.85 and 3.41-3.56 for PM and QL, respectively. After BMI adjustment, both gender (PM: F = 10.15, p = 0.003; QL: F = 18.07, p < 0.001) and activity level (PM: F = 5.90, p = 0.005; QL: F = 6.33, p = 0.004) influenced muscle stiffness. The female and inactive groups exhibited higher stiffness in both muscles.

CONCLUSION

SWE is reliable for quantifying the stiffness of PM and QL. Female and physical inactivity may elevate PM and QL stiffness, underscoring the importance of accounting for these factors in muscle stiffness investigations. Larger prospective studies are needed to further elucidate their effects.

Validity of information integration based on subjective and physiological data from a real sports condition: application to the judgment of fatigue in sport

The objective of the present study was to confirm the convergent validity of information integration theory in the judgment of fatigue in sport, using information integration, subjective, and physiological data. Twenty healthy athletes were confronted with six cycling scenarios in two experimental conditions. In the laboratory condition, the athletes imagined the scenarios and had to cognitively combine the exercise intensity (30%, 50%, and 70% of the maximal intensity) and the exercise duration (15 and 30 min) when judging their expected level of fatigue. In the real sports condition, the athletes enacted each scenario and then rated their subjective fatigue. The heart rate was recorded continuously, so that the physiological training impulse could be calculated. We applied analyses of variance to the data and analyzed correlations between variables. The information integration data from the laboratory condition, the subjective data from the real sports condition, and the objective (physiological) data from the real sports condition were strongly correlated. The information integration patterns concerning fatigue as a function of the exercise duration and intensity obtained respectively from the three data sets were extremely similar.

Determination of moderate walking intensity using step rate and VO2 reserve in healthy men

OBJECTIVE

This study investigated step rates (SR) during overground walking to estimate the relative aerobic capacity that corresponds to a moderate intensity.

METHODS

The present study utilized a repeated measure, within-subjects design incorporating a counterbalanced order. A total of twenty-three healthy men walked on a 119-meter oval track with artificial turf at self-selected pace (FP), 100, 120, and 140 steps/min for 6 min each while oxygen uptake (VO2), speed (in km/h), distance (in m), and steps (in steps/min) were measured.

RESULTS

During FP, participants walked an average cadence of 117 ± 9.3 steps/minclose to 120 steps/min, which corresponds to 4.7 metabolic equivalents (METs). The estimated VO2 reserve was 30.5% of VO2 reserve at the FP and was close to the 120 steps/min of 33.3%. At the 100 and 140 steps/min, the VO2 reserve were 24.1% and 45.2%, respectively. The regression analysis revealed that an SR of 88.2 elicited 3METs and 17.1% of VO2reserve. Additionally, an SR of 129 elicited 5.9METs and 40% of VO2 reserve.

CONCLUSIONS

This study demonstrated that a moderate walking intensity for young, healthy men corresponded to 128.9 steps per minute. A range of 120 ~ 140 steps/min for walking could be recommended as a general guideline for moderate-intensity exercise. However, concerning providing public guidelines, caution should be taken regarding determining the moderate walking intensity due to the individual's fitness level.

The Fine-Tuning Approach for Training Monitoring

PURPOSE

Monitoring is a fundamental part of the training process to guarantee that the programmed training loads are executed by athletes and result in the intended adaptations and enhanced performance. A number of monitoring tools have emerged during the last century in sport. These tools capture different facets (eg, psychophysiological, physical, biomechanical) of acute training bouts and chronic adaptations while presenting specific advantages and limitations. Therefore, there is a need to identify what tools are more efficient in each sport context for better monitoring of training process.

METHODS AND RESULTS

We present and discuss the fine-tuning approach for training monitoring, which consists of identifying and combining the best monitoring tools with experts' knowledge in different sport settings, designed to improve (1) the control of actual training loads and (2) understanding of athletes' training adaptations. Instead of using single-tool approaches or merely subjective decision making, the identification of the best combination of monitoring tools to assist experts' decisions in each specific context (ie, triangulation) is necessary to better understand the link between acute and chronic adaptations and their impact on health and performance. Future studies should elaborate on the identification of the best combination of monitoring tools for each specific sport setting.

CONCLUSION

The fine-tuning monitoring approach requires the simultaneous use of several valid and practical tools, instead of a single tool, to improve the effectiveness of monitoring practices when added to experts' knowledge.

Promoting physical activity and a healthy active lifestyle in community-dwelling older adults: a design thinking approach for the development of a mobile health application

Background

Physical activity (PA) has wide-ranging, and well documented benefits for older adults, encompassing physical, cognitive, and mental well-being. The World Health Organization advocates for a minimum of 150-300 min of moderate intensity PA per week, supplemented by muscle-strengthening exercises. However, the rates of PA among older adults remain a concern. While portable technologies hold promises in promoting PA, sustaining long-term engagement continues to be a challenge.

Objective

The aims of this study are to identify barriers and facilitators to PA in older adults, to develop an mHealth app promoting PA and an active healthy lifestyle in collaboration with community-dwelling older adults guided by the design thinking process, and to test it.

Methods

A co-creative process was used, employing design thinking. Interviews were conducted to understand the needs of the target population and identify the problem of insufficient PA. Two cocreation sessions involving older adults and experts were conducted to generate innovative ideas. Participants were selected based on age (≥65 years), no severe illness, Dutch language proficiency, and active participation ability. Results were qualitatively analyzed and coded. Finally a prototype was developed and tested.

Results

Interviews with older adults highlighted diverse perceptions of PA but unanimous agreement on its importance. They recognized health benefits such as improved mobility, balance, and reduced fall risk, while emphasizing the social and mental aspects. Barriers included poor health, time constraints, weather conditions and fear of falling. Cocreation sessions identified key topics: perception of a healthy lifestyle, coping strategies, mHealth App features, screen visualization, and tailored notifications, which led to the development of a mobile app promoting PA and an active lifestyle. The app was stepwise prototyped.

Conclusion

This study emphasizes the importance of promoting PA among older adults through a collaborative design thinking approach. However, the implementation of mHealth apps faces obstacles due to the digital divide, necessitating personalized solutions to bridge the gap. Moreover, it calls for further research to investigate the long-term impact of such interventions and explore behavior change patterns in this population.

Next steps to advance general physical activity recommendations towards physical exercise prescription: a narrative review

Physical inactivity is a major health concern, associated with the development of several non-communicable diseases and with an increased mortality rate. Therefore, promoting active lifestyles has become a crucial public health necessity for enhancing overall health and quality of life. The WHO guidelines for physical activity (PA) present valuable contributions in this respect; however, we believe that greater specificity should be added or complemented towards physical exercise (PE) testing, prescription and programming in future recommendations. In this review article, we suggest simple and practical tools accessible to the entire population to improve the specificity of this approach, highlighting aspects of PE programming used by trained subjects. By adopting these suggestions, exercise professionals, clinicians and physical trainers can optimise the current general PA recommendations towards PE prescription to improve fitness status and encourage PE adherence in the general population.

Exercise testing and training in frail older adults with an orthopedic impairment participating in a geriatric rehabilitation program: an international Delphi study

BACKGROUND

Little is known about exercise testing and training in orthopedic geriatric rehabilitation. This study aims to obtain expert-consensus-based recommendations on this matter.

METHODS

Using an online Delphi study we aimed to reach international expert consensus on statements related to testing and training of endurance capacity and muscle strength. Participants needed to have relevant research or clinical expertise. Statements were evaluated and explanatory comments could be provided. After each round anonymous results were presented to participants. Statements could be adjusted or new ones could be formulated if necessary. Consensus was defined as > 75% of participants agreeing.

RESULTS

Thirty experts completed the first round. Twenty-eight (93%) the second and 25 (83%) completed the third round. The majority of experts were physical therapists. Consensus was reached on a total of 34 statements. The statements and comments reflected the need for a pragmatic and tailored approach in this population both for testing and training. For example, for testing endurance capacity, a 6 Minute walk test was promoted and for testing muscle strength, performance in a functional activity was suggested. Ratings of perceived exertion were promoted for monitoring intensity of endurance and muscle strength training in patients without cognitive impairment.

CONCLUSION

In orthopedic GR, endurance and muscle strength testing should be pragmatic and is preferably performed in functional activities. For endurance training existing guidelines of the American College of Sports Medicine can be strived for but adapted as needed and for muscle strength training only lower intensities are agreed upon.

Toward a New Conceptual Approach to "Intensity" in Soccer Player's Monitoring: A Narrative Review

ABSTRACT

Pillitteri, G, Clemente, FM, Petrucci, M, Rossi, A, Bellafiore, M, Bianco, A, Palma, A, and Battaglia, G. Toward a new conceptual approach to "intensity" in soccer player's monitoring: A narrative review. J Strength Cond Res 37(9): 1896-1911, 2023-In the last decade, monitoring physiological and match-related demands in soccer has become an increasingly common practice in sports sciences. One of the great challenges during monitoring process is the identification of key indicators that permit to generalize evidence and sustain decision-making process during training prescription. Actually, one of the major debates in the scientific community and among practitioners is the identification of the "intensity" concept. Defining a given training session or exercise based on "intensity" is difficult due to the fact that a huge amount of indicators are available (related both to the performed activities and to the athletes' psychophysiological responses). These indicators can lead to specific outcomes with different interpretations. The current narrative review aims to discuss the different measures approaches used in soccer to describe the intensity for both internal and external demands. In addition, a second purpose of this review is to propose general recommendations for combining intensity indicators with the aim of defining an overall intensity score of a training session or drill.

Oxygen uptake and heart rate responses to 4 weeks of RPE-guided handcycle training

PURPOSE

To investigate the efficacy of using Ratings of Perceived Exertion (RPE) to prescribe and regulate a 4-week handcycle training intervention.

METHODS

Thirty active adults, untrained in upper body endurance exercise, were divided into three groups to complete a 4-week intervention: (i) RPE-guided training (n = 10; 2 female), (ii) power output (PO)-guided (n = 10; 2 female) training, or (iii) non-training control (n = 10; 4 female). Training groups performed three sessions of handcycling each week. Oxygen uptake ([Formula: see text]), heart rate (HR), and Feeling Scale (FS) rating were collected during training sessions. RPE-guided training was performed at RPE 13. PO-guided training was matched for percentage of peak PO per session, based upon that achieved by the RPE-guided training group.

RESULTS

There were no differences in percentage of peak [Formula: see text] (66 ± 13% vs 61 ± 9%, p = 0.22), peak HR (75 ± 8% vs 71 ± 6%, p = 0.11) or FS rating (1.2 ± 1.9 vs 0.8 ± 1.6, p = 0.48) between RPE- and PO-guided training, respectively. The average coefficient of variation in percentage of peak HR between consecutive training sessions was 2.8% during RPE-guided training, and 3.4% during PO-guided training.

CONCLUSION

Moderate-vigorous intensity handcycling exercise can be prescribed effectively using RPE across a chronic training intervention, suggesting utility for practitioners in a variety of rehabilitation settings.

Comparison of anaerobic speed reserve and maximal aerobic speed methods to prescribe short format high-intensity interval training

The purpose of the study was to compare the degree of intersubject variability in the cardiorespiratory, metabolic, and perceptual responses to high-intensity interval training (HIIT) prescribed based on the relative anaerobic speed reserve (ASR) or maximal aerobic speed (MAS) and to identify the optimal % ASR for execution of such HIIT. Seventeen male physical education students (age: 23.6 ± 1.1 years, height: 180.2 ± 5.9, body mass: 78.3 ± 8.1 kg; % body fat: 14.3 ± 2.7%) volunteered to execute three randomly scheduled 10-min HIIT exercises at 110% vVO2max , Δ15% ASR, or Δ25% ASR. Analysis of variance for repeated measures and the least significant difference post-hoc test were used to compare the physiological responses and the mean of individual residuals between the training sessions. The coefficients of variation (CV) of time spent ≥90% of maximal oxygen uptake (VO2max ) and maximal heart rate (HRmax ), peak VO2 , mean VO2 , peak HR, mean HR, blood lactate [La], and rating of perceived exertion (RPE) were 48.7%, 35.9%, 9.3%, 7%, 3.5%, 4.8%, 32%, and 16.9% during 110% vVO2max , 47.2%, 31%, 7.5%, 6.7%, 3.9%, 4.6%, 24.2%, and 14.6% during Δ15% ASR, and 48.1%, 31.5%, 7.6%, 8.4%, 3.6%, 4.1%, 20.2%, and 3.4% during Δ25% ASR session, respectively. Only the residuals in RPE were significantly (p < 0.001) higher in 110% vVO2max and Δ15% ASR in comparison to Δ25% ASR. Time spent ≥90% HRmax /VO2max was maximized during Δ15% ASR session, albeit this was not significantly different from other sessions. The ASR-based method leads to reduced CVs of physiological and perceptual responses during 10-min HIIT; however, only reductions in [La] and RPE may be considered practically meaningful. Practitioners can use vVO2max for prescription of 10-min HIIT session comprised of 15-s work and passive recovery intervals.

Unraveling the pathophysiology of lower-limb postthrombotic syndrome in adolescents: a proof-of-concept study

A better understanding of the pathophysiology of pediatric postthrombotic syndrome (PTS) is needed to develop strategies to treat this condition. We investigated calf pump function, exercise capacity, balance in power output, and changes in limb muscle oxygen saturation (SmO2) and fluid content during exercise in 10 pediatric patients with unilateral lower-limb PTS, and in age- and sex-matched controls (1:1-1:2 ratio). Outcomes were investigated using bioimpedance spectroscopy, torque-sensing pedals, and near-infrared spectroscopy during incremental- and constant-load cycling tests. The median age at participation was 17 years (25th-75th percentile, 15-18 years); 68% of participants were females. The median CAPTSure score in the affected leg of affected participants was 35 points (25th-75th percentile, 24-46 points), indicating moderate/severe PTS; 20% of patients had a history of central venous catheter-related thrombosis. Increasing PTS severity was associated with higher calf pump venous volume and higher ejection volume, leading to compensated calf pump performance. We found no evidence of PTS impact on exercise capacity. Leg contribution to power output was similar in affected and unaffected legs. However, the PTS-affected legs showed lower SmO2 during active cycling and recovery with increasing PTS severity, indicating impaired microvascular function in the muscle. These findings suggest that PTS severity is associated with impaired blood flow, presumably from elevated venous pressure during and after exercise. The fact that microvascular function is impaired in young patients with PTS underscores the relevance of developing strategies to mitigate the effects of this chronic vascular disease to minimize its deleterious effects as children grow older.

A Validation Study for the German Versions of the Feeling Scale and the Felt Arousal Scale for a Progressive Muscle Relaxation Exercise

The aim of the present study is to prove the construct validity of the German versions of the Feeling Scale (FS) and the Felt Arousal Scale (FAS) for a progressive muscle relaxation (PMR) exercise. A total of 228 sport science students conducted the PMR exercise for 45 min and completed the FS, the FAS, and the Self-Assessment Manikin (SAM) in a pre-test-post-test design. A significant decrease in arousal (t(227) = 8.296, p < 0.001) and a significant increase in pleasure (t(227) = 4.748, p < 0.001) were observed. For convergent validity, the correlations between the FS and the subscale SAM-P for the valence dimension (r = 0.67, p < 0.001) and between the FAS and the subscale SAM-A for the arousal dimension (r = 0.31, p < 0.001) were significant. For discriminant validity, the correlations between different constructs (FS and SAM-A, FAS and SAM-P) were not significant, whereas the discriminant analysis between the FS and the FAS revealed a negative significant correlation (r = -0.15, p < 0.001). Together, the pattern of results confirms the use of the German versions of the FS and the FAS to measure the affective response for a PMR exercise.

Comparison of Effects of Liuzijue Exercise and Conventional Respiratory Training on Patients after Cardiac Surgery: A Randomized Controlled Trial

OBJECTIVE

To evaluate the feasibility and safety of Liuzijue exercise (LE) for the clinical effect in patients after cardiac surgery.

METHODS

Totally 120 patients who underwent cardiac surgery and were admitted to the Cardiothoracic Intensive Care Unit of Nanjing Drum Tower Hospital between July and Oclober, 2022 were allocated to the LE group, the conventional respiratory training (CRT) group, and the control group by a random number table at a ratio of 1:1:1; 40 patients in each group. All patients received routine treatment and cardiac rehabilitation. LE group and CRT group respectively performed LE and CRT once a day for 30 min for 7 days. Control group did not receive specialized respiratory training. The forced vital capacity, forced expiratory volume in 1 s, peak inspiratory flow rate, peak expiratory flow rate, maximum inspiratory pressure, maximum expiratory pressure, modified Barthel index (MBI), and Hamilton Rating Scale for Anxiety (HAM-A) were evaluated before, after 3 and 7 days of intervention. In addition, the postoperative length of hospital stay (LOS) and the adverse events that occurred during the intervention period were compared.

RESULTS

A total of 107 patients completed the study, 120 patients were included in the analysis. After 3 days of intervention, the pulmonary function, respiratory muscle strength, MBI and HAM-A of all 3 groups improved compared with that before the intervention (P<0.05 or P<0.01). Compared with the control group, pulmonary function and respiratory muscle strength were significantly improved in the CRT and LE groups (P<0.05 or P<0.01). MBI and HAM-A were significantly improved in the LE group compared with the control and CRT groups (P<0.05 or P<0.01). On the 7th day after intervention, the difference was still statistically significant (P<0.01), and was significantly different from that on the 3rd day (P<0.05 or P<0.01). In addition, on the 7th day of intervention, the pulmonary function and respiratory muscle strength in the LE group were significantly improved compared with those in the CRT group (P<0.01). MBI and HAM-A were significantly improved in the CRT group compared with the control group (P<0.01). There were no significant differences in postoperative LOS among the 3 groups (P>0.05). No training-related adverse events occurred during the intervention period.

CONCLUSIONS

LE is safe and feasible for improving pulmonary function, respiratory muscle strength, the ability to complete activities of daily living and for relieving anxiety of patients after cardiac surgery (Registration No. ChiCTR2200062964).

Exercise effects on functional capacity and quality of life in older patients with colorectal cancer: study protocol for the ECOOL randomized controlled trial

BACKGROUND

Surgery and treatment for colorectal cancer (CRC) in the elderly patient increase the risk of developing post-operative complications, losing functional independence, and worsening health-related quality of life (HRQoL). There is a lack of high-quality randomized controlled trials evaluating the potential benefit of exercise as a countermeasure. The primary aim of this study is to evaluate the effectiveness of a home-based multicomponent exercise program for improving HRQoL and functional capacity in older adults undergoing CRC surgery and treatment.

METHODS

This randomized, controlled, observer-blinded, single-center trial aims to randomize 250 patients (>74 years) to either an intervention or a control group (i.e., usual care). The intervention group will perform an individualized home-based multicomponent exercise program with weekly telephone supervision from diagnosis until three months post-surgery. The primary outcomes will be HRQoL (EORTC QLQ-C30; CR29; and ELD14) and functional capacity (Barthel Index and Short Physical Performance Battery), which will be assessed at diagnosis, at discharge, and one, three, and six months after surgery. Secondary outcomes will be frailty, physical fitness, physical activity, inspiratory muscle function, sarcopenia and cachexia, anxiety and depression, ambulation ability, surgical complications, and hospital length of stay, readmission and mortality.

DISCUSSION

This study will examine the effects of an exercise program in older patients with CRC across a range of health-related outcomes. Expected findings are improvement in HRQoL and physical functioning. If proven effective, this simple exercise program may be applied in clinical practice to improve CRC care in older patients.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05448846.

The promotion of homebased physical activity for people with lung cancer and cachexia, a qualitative study of healthcare professionals, patients and carers

PURPOSE

There is some evidence of the benefits of physical activity (PA) in patients with lung cancer; however, there is a lack of understanding of acceptable PA for patients with established cachexia and how to facilitate sustainable behaviour change to promote PA. Therefore, this study explored the views of healthcare professionals (HP), patients with lung cancer and cachexia, and their carers on preferences for, barriers and facilitators of homebased PA.

METHODS

This qualitative study involved ten telephone interviews with HPs and face-to-face interviews with seven patients with lung cancer and cachexia and their carers. Interviews were transcribed and analysed thematically. The Capability, Opportunity, Motivation and Behaviour (COM-B) model was used as a framework for the thematic cross-group analysis.

RESULTS

The types of homebased PA suggested by patients with lung cancer and cachexia (n = 7), their carers (n = 7) and HPs (n = 10) were functional, flexible, individualised and initially of short duration and low intensity. PA was influenced by themes within physical and psychological Capability, physical and social Opportunities as well as automatic and reflective Motivation.

CONCLUSION

Based on a behaviour change theory, principles to promote homebased PA were developed. These principles need to be integrated into tools to promote PA in people with lung cancer and weight loss.

IMPLICATIONS FOR CANCER SURVIVORS

The application of the proposed principles by clinicians will promote physical activity, enhancing the function and wellbeing of patients with lung cancer and reducing burden on carers.

Improved Estimation of Exercise Intensity Thresholds by Combining Dual Non-Invasive Biomarker Concepts: Correlation Properties of Heart Rate Variability and Respiratory Frequency

Identifying exercise intensity boundaries has been shown to be important during endurance training for performance enhancement and rehabilitation. Unfortunately, even though surrogate markers show promise when assessed on a group level, substantial deviation from gold standards can be present in each individual. The aim of this study was to evaluate whether combining two surrogate intensity markers improved this agreement. Electrocardiogram (ECG) and gas exchange data were obtained from 21 participants who performed an incremental cycling ramp to exhaustion and evaluated for first (VT1) and second (VT2) ventilatory thresholds, heart rate (HR) variability (HRV), and ECG derived respiratory frequency (EDR). HRV thresholds (HRVT) were based on the non-linear index a1 of a Detrended Fluctuation Analysis (DFA a1) and EDR thresholds (EDRT) upon the second derivative of the sixth-order polynomial of EDR over time. The average of HRVT and EDRT HR was set as the combined threshold (Combo). Mean VT1 was reached at a HR of 141 ± 15, HRVT1 at 152 ± 14 (p < 0.001), EDRT1 at 133 ± 12 (p < 0.001), and Combo1 at 140 ± 13 (p = 0.36) bpm with Pearson's r of 0.83, 0.78, and 0.84, respectively, for comparisons to VT1. A Bland-Altman analysis showed mean biases of 8.3 ± 7.9, -8.3 ± 9.5, and -1.7 ± 8.3 bpm, respectively. A mean VT2 was reached at a HR of 165 ± 13, HRVT2 at 167 ± 10 (p = 0.89), EDRT2 at 164 ± 14 (p = 0.36), and Combo2 at 164 ± 13 (p = 0.59) bpm with Pearson's r of 0.58, 0.95, and 0.94, respectively, for comparisons to VT2. A Bland-Altman analysis showed mean biases of -0.3 ± 8.9, -1.0 ± 4.6, and -0.6 ± 4.6 bpm, respectively. Both the DFA a1 and EDR intensity thresholds based on HR taken individually had moderate agreement to targets derived through gas exchange measurements. By combining both non-invasive approaches, there was improved correlation, reduced bias, and limits of agreement to the respective corresponding HRs at VT1 and VT2.

Perceived Exertion: Revisiting the History and Updating the Neurophysiology and the Practical Applications

The perceived exertion construct creation is a landmark in exercise physiology and sport science. Obtaining perceived exertion is relatively easy, but practitioners often neglect some critical methodological issues in its assessment. Furthermore, the perceived exertion definition, neurophysiological basis, and practical applications have evolved since the perceived exertion construct's inception. Therefore, we revisit the careful work devoted by Gunnar Borg with psychophysical methods to develop the perceived exertion construct, which resulted in the creation of two scales: the rating of perceived exertion (RPE) and the category-ratio 10 (CR10). We discuss a contemporary definition that considers perceived exertion as a conscious perception of how hard, heavy, and strenuous the exercise is, according to the sense of effort to command the limbs and the feeling of heavy breathing (respiratory effort). Thus, other exercise-evoked sensations would not hinder the reported perceived exertion. We then describe the neurophysiological mechanisms involved in the perceived exertion genesis during exercise, including the influence of the peripheral feedback from the skeletal muscles and the cardiorespiratory system (i.e., afferent feedback) and the influence of efferent copies from the motor command and respiratory drive (i.e., corollary discharges), as well as the interaction between them. We highlight essential details practitioners should consider when using the RPE and CR10 scales, such as the perceived exertion definition, the original scales utilization, and the descriptors anchoring process. Finally, we present how practitioners can use perceived exertion to assess cardiorespiratory fitness, individualize exercise intensity prescription, predict endurance exercise performance, and monitor athletes' responses to physical training.

Effect of Face Masks on Physiological and Perceptual Responses during 30 Minutes of Self-Paced Exercise in Older Community Dwelling Adults

This study examined the effects of different types of masks (no mask, surgical mask (SM), and N95-mask) on physiological and perceptual responses during 30-min of self-paced cycle ergometer exercise. This study was a prospective randomly assigned experimental design. Outcomes included workload (Watts), oxygen saturation (SpO₂), end-tidal carbon dioxide (PetCO₂), heart rate (HR), respiratory rate (RR), rating of perceived exertion (RPE), and rating of perceived dyspnea (RPD). Volunteers (54-83 years (n = 19)) completed two familiarization sessions and three testing sessions on an air braked cycle ergometer. No significant difference was found for condition x time for any of the dependent variables. RPE, RPD, and PetCO₂ were significantly higher with an N95-mask vs. no mask (NM) ((p = 0.012), (p = 0.002), (p < 0.001)). HR was significantly higher with the SM compared to the NM condition (p = 0.027) (NM 107.18 ± 9.96) (SM 112.34 ± 10.28), but no significant difference was found when comparing the SM to the N95 condition or when comparing the N95condition to the NM condition. Watts increased across time in each condition (p = 0.003). Initially RR increased during the first 3 min of exercise (p < 0.001) with an overall gradual increase noted across time regardless of mask condition (p < 0.001). SpO₂ significantly decreased across time but remained within normal limits (>95%). No significant difference was found in Watts, RR, or SpO₂ regardless of mask condition. Overall, the N95mask was associated with increased RPE, RPD, and PetCO₂ levels. This suggests trapping of CO₂ inside the mask leading to increased RPE and RPD.