Exercise calorimetry in sedentary patients: procedures based on short 3 min steps underestimate carbohydrate oxidation and overestimate lipid oxidation

Toward Exercise Guidelines for Optimizing Fat Oxidation During Exercise in Obesity: A Systematic Review and Meta-Regression

BACKGROUND

Exercise training performed at maximal fat oxidation (FATmax) is an efficient non-pharmacological approach for the management of obesity and its related cardio-metabolic disorders.

OBJECTIVES

Therefore, this work aimed to provide exercise intensity guidelines and training volume recommendations for maximizing fat oxidation in patients with obesity.

METHODS

A systematic review of original articles published in English, Spanish or French languages was carried out in EBSCOhost, PubMed and Scopus by strictly following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Those studies that analyzed maximal fat oxidation (MFO) and FATmax in patients with obesity (body fat > 25% for men; > 35% for women) by calculating substrate oxidation rates through indirect calorimetry during a graded exercise test with short-duration stages (< 10 min) were selected for quantitative analysis. The accuracy of relative oxygen uptake (% peak oxygen uptake [%[Formula: see text]O2peak]) and relative heart rate (% peak heart rate [%HRpeak]) for establishing FATmax reference values was investigated by analyzing their intra-individual and inter-study variation. Moreover, cluster analysis and meta-regression were used for determining the influence of biological factors and methodological procedures on MFO and FATmax.

RESULTS

Sixty-four manuscripts were selected from 146 records; 23 studies only recruited men (n = 465), 14 studies only evaluated women (n = 575), and 27 studies included individuals from both sexes (n = 6434). The majority of the evaluated subjects were middle-aged adults (aged 40-60 y; 84%) with a poor cardiorespiratory fitness (≤ 43 mL·kg-1·min-1; 81%), and the reported MFO ranged from 0.27 to 0.33 g·min-1. The relative heart rate at FATmax (coefficient of variation [CV]: 8.8%) showed a lower intra-individual variation compared with relative oxygen uptake (CV: 17.2%). Furthermore, blood lactate levels at FATmax ranged from 1.3 to 2.7 mmol·L-1 while the speed and power output at FATmax fluctuated from 4 to 5.1 km·h-1 and 42.8-60.2 watts, respectively. Age, body mass index, cardiorespiratory fitness, FATmax, the type of ergometer and the stoichiometric equation used to calculate the MFO independently explained MFO values (R2 = 0.85; p < 0.01). The MFO in adolescents was superior in comparison with MFO observed in young and middle-aged adults. On the other hand, the MFO was higher during treadmill walking in comparison with stationary cycling. Body fat and MFO alone determined 29% of the variation in FATmax (p < 0.01), noting that individuals with body fat > 35% showed a heart rate of 61-66% HRpeak while individuals with < 35% body fat showed a heart rate between 57 and 64% HRpeak. Neither biological sex nor the analytical procedure for computing the fat oxidation kinetics were associated with MFO and FATmax.

CONCLUSION

Relative heart rate rather than relative oxygen uptake should be used for establishing FATmax reference values in patients with obesity. A heart rate of 61-66% HRpeak should be recommended to patients with > 35% body fat while a heart rate of 57-64% HRpeak should be recommended to patients with body fat < 35%. Moreover, training volume must be higher in adults to achieve a similar fat oxidation compared with adolescents whereas exercising on a treadmill requires a lower training volume to achieve significant fat oxidation in comparison with stationary cycling.

Discrepancy between predicted and measured exercise intensity for eliciting the maximal rate of lipid oxidation

BACKGROUND AND AIMS

Ectopic lipid storage is implicated in type 2 diabetes pathogenesis; hence, exercise to deplete stores (i.e., at the intensity that allows for maximal rate of lipid oxidation; MLO) might be optimal for restoring metabolic health. This intensity ("Fatmax") is estimated during incremental exercise ("Fatmax test"). However, in "the field" general recommendations exist regarding a range of percentages of maximal heart rate (HR) to elicit MLO. The degree to which this range is aligned with measured Fatmax has not been investigated. We compared measured HR at Fatmax, with maximal HR percentages within the typically recommended range in a sample of 26 individuals (Female: n = 11, European ancestry: n = 17).

METHODS AND RESULTS

Subjects completed a modified Fatmax test with a 5-min warmup, followed by incremental stages starting at 15 W with work rate increased by 15 W every 5 min until termination criteria were reached. Pulmonary gas exchange was recorded and average values for V˙ o2 and V˙ co2 for the final minute of each stage were used to estimate substrate-oxidation rates. We modeled lipid-oxidation kinetics using a sinusoidal model and expressed MLO relative to peak V˙ o2 and HR. Bland-Altman analysis demonstrated lack of concordance between HR at Fatmax and at 50%, 70%, and 80% of age-predicted maximum with a mean difference of 23 b·min-1.

CONCLUSION

Our results indicate that estimated "fat-burning" heart rate zones are inappropriate for prescribing exercise to elicit MLO and we recommend direct individual exercise lipid oxidation measurements to elicit these values.

Low carbohydrate high fat ketogenic diets on the exercise crossover point and glucose homeostasis

In exercise science, the crossover effect denotes that fat oxidation is the primary fuel at rest and during low-intensity exercise with a shift towards an increased reliance on carbohydrate oxidation at moderate to high exercise intensities. This model makes four predictions: First, &gt;50% of energy comes from carbohydrate oxidation at ≥60% of maximum oxygen consumption (VO2max), termed the crossover point. Second, each individual has a maximum fat oxidation capacity (FATMAX) at an exercise intensity lower than the crossover point. FATMAX values are typically 0.3–0.6 g/min. Third, fat oxidation is minimized during exercise ≥85%VO2max, making carbohydrates the predominant energetic substrate during high-intensity exercise, especially at &gt;85%VO2max. Fourth, high-carbohydrate low-fat (HCLF) diets will produce superior exercise performances via maximizing pre-exercise storage of this predominant exercise substrate. In a series of recent publications evaluating the metabolic and performance effects of low-carbohydrate high-fat (LCHF/ketogenic) diet adaptations during exercise of different intensities, we provide findings that challenge this model and these four predictions. First, we show that adaptation to the LCHF diet shifts the crossover point to a higher %VO2max (&gt;80%VO2max) than previously reported. Second, substantially higher FATMAX values (&gt;1.5 g/min) can be measured in athletes adapted to the LCHF diet. Third, endurance athletes exercising at &gt;85%VO2max, whilst performing 6 × 800 m running intervals, measured the highest rates of fat oxidation yet reported in humans. Peak fat oxidation rates measured at 86.4 ± 6.2%VO2max were 1.58 ± 0.33 g/min with 30% of subjects achieving &gt;1.85 g/min. These studies challenge the prevailing doctrine that carbohydrates are the predominant oxidized fuel during high-intensity exercise. We recently found that 30% of middle-aged competitive athletes presented with pre-diabetic glycemic values while on an HCLF diet, which was reversed on LCHF. We speculate that these rapid changes between diet, insulin, glucose homeostasis, and fat oxidation might be linked by diet-induced changes in mitochondrial function and insulin action. Together, we demonstrate evidence that challenges the current crossover concept and demonstrate evidence that a LCHF diet may also reverse features of pre-diabetes and future metabolic disease risk, demonstrating the impact of dietary choice has extended beyond physical performance even in athletic populations.

Chronic Statin Treatment Does Not Impair Exercise Lipolysis or Fat Oxidation in Exercise-Trained Individuals With Obesity and Dyslipidemia

OBJECTIVE

To determine whether statin medication in individuals with obesity, dyslipidemia, and metabolic syndrome affects their capacity to mobilize and oxidize fat during exercise.

METHODS

Twelve individuals with metabolic syndrome pedaled during 75 min at 54 ± 13% V˙O2max (5.7 ± 0.5 metabolic equivalents) while taking statins (STATs) or after 96-hr statin withdrawal (PLAC) in a randomized double-blind fashion.

RESULTS

At rest, PLAC increased low-density lipoprotein cholesterol (i.e., STAT 2.55 ± 0.96 vs. PLAC 3.16 ± 0.76 mmol/L; p = .004) and total cholesterol blood levels (i.e., STAT 4.39 ± 1.16 vs. PLAC 4.98 ± 0.97 mmol/L; p = .008). At rest, fat oxidation (0.99 ± 0.34 vs. 0.76 ± 0.37 μmol·kg-1·min-1 for STAT vs. PLAC; p = .068) and the rates of plasma appearance of glucose and glycerol (i.e., Ra glucose-glycerol) were not affected by PLAC. After 70 min of exercise, fat oxidation was similar between trials (2.94 ± 1.56 vs. 3.06 ± 1.94 μmol·kg-1·min-1, STA vs. PLAC; p = .875). PLAC did not alter the rates of disappearance of glucose in plasma during exercise (i.e., 23.9 ± 6.9 vs. 24.5 ± 8.2 μmol·kg-1·min-1 for STAT vs. PLAC; p = .611) or the rate of plasma appearance of glycerol (i.e., 8.5 ± 1.9 vs. 7.9 ± 1.8 μmol·kg-1·min-1 for STAT vs. PLAC; p = .262).

CONCLUSIONS

In patients with obesity, dyslipidemia, and metabolic syndrome, statins do not compromise their ability to mobilize and oxidize fat at rest or during prolonged, moderately intense exercise (i.e., equivalent to brisk walking). In these patients, the combination of statins and exercise could help to better manage their dyslipidemia.

Resting and exercise metabolic characteristics in obese children with insulin resistance

Purpose: This study aimed to explore the characteristics of resting energy expenditure (REE) and lipid metabolism during incremental load exercise in obese children and adolescents with insulin resistance (IR) to provide evidence for exercise intervention in obese children and adolescents with IR.

Method: From July 2019 to August 2021, 195 obese children and adolescents aged 13–17 were recruited through a summer camp. The participants were divided into IR (n = 67) and no-IR (without insulin resistance, n = 128) groups and underwent morphology, blood indicators, body composition, and resting energy consumption gas metabolism tests. Thirty participants each were randomly selected from the IR and no-IR groups to carry out the incremental treadmill test.

Results: Significant metabolic differences in resting and exercise duration were found between the IR and no-IR groups. In the resting state, the resting metabolic equivalents (4.33 ± 0.94 ml/min/kg vs. 3.91 ± 0.73 ml/min/kg, p = 0.001) and REE (2464.03 ± 462.29 kcal/d vs. 2143.88 ± 380.07 kcal/d, p &lt; 0.001) in the IR group were significantly higher than in the no-IR group. During exercise, the absolute maximal fat oxidation (0.33 ± 0.07 g/min vs. 0.36 ± 0.09 g/min, p = 0.002) in the IR group was significantly lower than in the no-IR group; maximal fat oxidation intensity (130.9 ± 8.9 bpm vs. 139.9 ± 7.4 bpm, p = 0.040) was significantly lower in the IR group.

Conclusion: Significant resting and exercise metabolic differences were found between obese IR and no-IR children and adolescents. Obese IR children and adolescents have higher REE and lower maximal fat oxidation intensity than obese no-IR children and adolescents.

Does the Time of Day Play a Role in the Acute Effect of p-Synephrine on Fat Oxidation Rate during Exercise in Women? A Randomized, Crossover and Double-Blind Study

p-Synephrine is deemed a safe and effective substance to increase fat utilization during exercise of low-to-moderate intensity in men but not in women. Additionally, the existence of a diurnal variation in substrate utilization has been documented during exercise with enhanced fat oxidation in the evening compared with early morning. However, it remains unknown whether there is an interaction between the effect of p-synephrine and the time of the day on fat oxidation during exercise. This study aimed to evaluate the effect of the acute ingestion of 3 milligram of p-synephrine per kilogram of body mass (mg/kg) on fat oxidation during exercise of increasing intensity when the exercise is performed in the morning vs. the evening. Using a randomized, double-blind, placebo-controlled experimental design, 16 healthy and active women performed four identical exercise trials after the ingestion of 3 mg/kg of p-synephrine and 3 mg/kg of a placebo (cellulose) both in the morning (8-10 am) and in the evening (5-7 pm). In the exercise trials, the substances were ingested 60 min before an incremental test on a cycle ergometer with 3 min stages at workloads from 30 to 80% of maximal oxygen uptake (VO₂max). Substrate oxidation rates were measured by indirect calorimetry. In each trial, the maximum rate of fat oxidation (MFO) and the intensity that elicited MFO (Fatmax) were measured. A two-way analysis of variance (time-of-the day × substance) was used to detect differences among the trials. With the placebo, MFO was 0.25 ± 0.11 g/min in the morning and 0.24 ± 0.07 g/min in the evening. With p-synephrine, MFO was 0.26 ± 0.09 g/min in the morning and 0.21 ± 0.07 g/min in the evening. There was no main effect of substance (p = 0.349), time of day (p = 0.186) and the substance × time of day (p = 0.365) on MFO. Additionally, Fatmax was reached at a similar exercise intensity with the placebo (41.33 ± 8.34% VO₂max in the morning and 44.38 ± 7.37% VO₂max in the evening) and with p-synephrine (43.33 ± 7.24% VO₂max in the morning and 45.00 ± 7.43% VO₂max in the evening), irrespective of the time of day with no main effect of substance (p = 0.633), time of day (p = 0.191), or interaction (p = 0.580). In summary, the acute intake of 3 mg/kg of p-synephrine before exercise did not increase MFO and Fatmax, independently of the time of day, in female athletes. This indicates that the time of day is not a factor explaining the lack of effectiveness of this substance to enhance fat oxidation during aerobic exercise in women.

Associations between heart rate variability and maximal fat oxidation in two different cohorts of healthy sedentary adults

BACKGROUND AND AIMS

Resting heart rate variability (HRV) and maximal fat oxidation (MFO) during exercise are both considered as a noninvasive biomarkers for early detection of cardiovascular risk factors. Thus, this study aimed to analyze the relationship between resting HRV parameters and MFO during exercise, and the intensity of exercise that elicit MFO (Fat_max) in healthy sedentary adults.

METHODS AND RESULTS

A total of 103 healthy young adults (22.2 ± 2.3 years old, 67% female; from the ACTIBATE cohort) and 67 healthy middle-aged adults (53.1 ± 5.0 years old, 52% female; from the FIT-AGEING cohort) were included in this cross-sectional study. HRV was assessed using a Polar RS800CX heart rate monitor, while MFO and Fat_max were determined during a graded exercise treadmill test using indirect calorimetry. No significant associations were observed for healthy young adults (standardized β coefficients ranged from -0.063 to 0.094, and all P ≥ 0.347) and for middle-aged adults (standardized β coefficients ranged from -0.234 to 0.090, and all P ≥ 0.056). Nevertheless, only a weak association was observed between one HRV parameter in time-domain (the percentage of R-R intervals that shows a difference higher than 50 ms [pNN50]) and MFO in the cohort of middle-aged adults (β coefficient = -0.279, and P = 0.033).

CONCLUSION

The results of this study suggest that resting HRV parameters are not associated with MFO and Fat_max during exercise in two independent cohorts of healthy sedentary young and middle-aged adults, respectively.

Effects of Different Low-Intensity Exercise Types on Duration, Energy Expenditure and Perceived Exertion in Obese Individuals

Physical exercise is a common strategy in overweight and obesity management. Exercise type, intensity, duration, energy expenditure and the rate of perceived exertion (RPE) are the essential determinants of exercise efficiency. The purpose of the present study was to compare continuous and intermittent exercises targeted at the maximal fat oxidation intensity (FAT max) in obese individuals. Ten obese males (BMI > 30 kg/m2; age: 19 to 35 years) who maintained a sedentary lifestyle were recruited for this study to perform three separate exhaustive exercises: a continuous exercise at FAT max (CON), an intermittent exercise that alternates two minutes at FAT max −10% with one minute at FAT max +20% (INT½), and a second intermittent exercise that alternates four minutes at FAT max −10% with one minute at FAT max +40% (INT¼). The duration of the INT¼ exercise (65.1 min ± 13.4) was significantly longer than that of the CON exercise (55.4 min ± 6.0). No significant difference in the total amount of energy expenditure was observed across the three types of exercise (CON: 372 Kcal ± 98.2, INT¼: 398 Kcal ± 145.5, INT½: 374.4 Kcal ± 116.1). The fat oxidation rate after 45 min during the INT exercises (INT¼: 93.0 ± 19.1 mg/min, INT½: 71.1 ± 15.6 mg/min) was significantly higher than that of the CON exercise (36.1 ± 12.2 mg/min). The CON exercise was less well tolerated. The rate of perceived exertion (RPE) at the end of the CON (15.8 ± 2) was significantly higher than that of the INT exercises (13.5 ± 2 for the INT¼ and 13.1 ± 1.8 for the INT½). The INT exercises were more efficient in terms of duration, fat oxidation and RPE.

Beyond the Calorie Paradigm: Taking into Account in Practice the Balance of Fat and Carbohydrate Oxidation during Exercise?

Recent literature shows that exercise is not simply a way to generate a calorie deficit as an add-on to restrictive diets but exerts powerful additional biological effects via its impact on mitochondrial function, the release of chemical messengers induced by muscular activity, and its ability to reverse epigenetic alterations. This review aims to summarize the current literature dealing with the hypothesis that some of these effects of exercise unexplained by an energy deficit are related to the balance of substrates used as fuel by the exercising muscle. This balance of substrates can be measured with reliable techniques, which provide information about metabolic disturbances associated with sedentarity and obesity, as well as adaptations of fuel metabolism in trained individuals. The exercise intensity that elicits maximal oxidation of lipids, termed LIPOXmax, FATOXmax, or FATmax, provides a marker of the mitochondrial ability to oxidize fatty acids and predicts how much fat will be oxidized over 45–60 min of low- to moderate-intensity training performed at the corresponding intensity. LIPOXmax is a reproducible parameter that can be modified by many physiological and lifestyle influences (exercise, diet, gender, age, hormones such as catecholamines, and the growth hormone-Insulin-like growth factor I axis). Individuals told to select an exercise intensity to maintain for 45 min or more spontaneously select a level close to this intensity. There is increasing evidence that training targeted at this level is efficient for reducing fat mass, sparing muscle mass, increasing the ability to oxidize lipids during exercise, lowering blood pressure and low-grade inflammation, improving insulin secretion and insulin sensitivity, reducing blood glucose and HbA_1c in type 2 diabetes, and decreasing the circulating cholesterol level. Training protocols based on this concept are easy to implement and accept in very sedentary patients and have shown an unexpected efficacy over the long term. They also represent a useful add-on to bariatric surgery in order to maintain and improve its weight-lowering effect. Additional studies are required to confirm and more precisely analyze the determinants of LIPOXmax and the long-term effects of training at this level on body composition, metabolism, and health.

Uncertain association between maximal fat oxidation during exercise and cardiometabolic risk factors in healthy sedentary adults

The present work examines the relationships between maximal fat oxidation during a graded exercise test (MFO), the intensity of exercise that elicits MFO (Fat_max), and traditional cardiometabolic risk factors in healthy, sedentary adults. A total of 119 (81 women) young, sedentary adults (22.1 ± 2.2 years old), and 71 (37 women) middle-aged, sedentary adults (53.4 ± 4.9 years old) participated in the current study. Systolic and diastolic blood pressures were determined following standard procedures. Plasma glucose, insulin, total cholesterol, high-density lipoprotein cholesterol and triglycerides were determined in a fasted state and the homeostatic model assessment of insulin resistance index and low-density lipoprotein cholesterol levels subsequently calculated. A sex and age group-specific cardiometabolic risk Z-score was also calculated for each subject based on waist circumference, systolic and diastolic blood pressure, plasma glucose, high-density lipoprotein cholesterol and triglycerides. MFO and Fat_max were determined using a walking graded exercise test using indirect calorimetry. No clear association was seen of MFO and Fat_max with any cardiometabolic risk factor (all P≥0.05), except for a weak, inverse association between Fat_max and the fatty liver index (P=0.027). Similarly, neither MFO nor Fat_max was apparently associated with the cardiometabolic risk Z-score (all P≥0.05). The current findings suggest an uncertain association of MFO and Fat_max during a graded exercise test with the cardiometabolic profile of healthy, sedentary adults.HighlightsThe study of the physiological mechanisms that trigger the onset of metabolic disorders has received considerable attention in recent years, with changes in MFO and Fat_max being highlighted as a potential key factor.This work shows that MFO and Fat_max during a graded exercise test are not associated with the cardiometabolic profile in sedentary, healthy adults.Further studies are needed to elucidate which other physiological disorders are related to cardiometabolic risk.

Higher Peak Fat Oxidation During Rowing vs. Cycling in Active Men and Women

ABSTRACT

Astorino, TA, Oriente, C, Peterson, J, Alberto, G, Castillo, EE, Vasquez-Soto, U, Ibarra, E, Guise, V, Castaneda, I, Marroquin, JR, Dargis, R, and Thum, JS. Higher peak fat oxidation during rowing vs. cycling in active men and women. J Strength Cond Res 35(1): 9-15, 2021-This study compared fat and carbohydrate oxidation (CHOOx) between progressive rowing and cycling. Initially, 22 active healthy adults (age = 27 ± 8 years) performed incremental cycling and rowing to volitional fatigue to assess maximal oxygen uptake (V̇o2max) and maximal heart rate (HRmax). The order of 2 subsequent sessions was randomized, performed 2 hours postmeal, and included a warm-up followed by three 8-minute stages of rowing or cycling at 60-65, 70-75, and 80-85 %HRmax. During exercise, power output was modified to maintain work rate in the desired range. Gas exchange data and blood samples were obtained to measure fat and CHOOx and blood lactate concentration. Fat oxidation (FOx) increased during exercise (p < 0.001) and there was a main effect of mode (p = 0.03) but no modeXintensity interaction (p = 0.33). Peak FOx was higher in response to rowing vs. cycling (0.23 ± 0.09 g·min-1 vs. 0.18 ± 0.07 g·min-1, p = 0.01). Carbohydrate oxidation increased during exercise (p < 0.001) but there was no effect of mode (p = 0.25) or modeXintensity interaction (p = 0.08). Blood lactate concentration was lower (p = 0.007) at the end of rowing vs. cycling (3.1 ± 1.0 mM vs. 3.9 ± 1.6 mM, d = 1.1). Prolonged rowing having equivalent calorie expenditure and intensity vs. cycling elicits higher peak FOx, which is likely attributed to greater muscle mass used during rowing.

Similar rates of fat oxidation during graded submaximal exercise in women of different body composition

BACKGROUND

Moderate intensity exercise ranging 40-60% of maximum oxygen uptake is advised to promote energy expenditure and fat oxidation in overweight and obese people. Although fat oxidation has been shown to be highly variable among individual, there is still a relative uncertainty regarding exercise prescription for women specifically. This article aimed to determine whether indicators of body composition can be used to narrow the exercise intensity range for exercise prescription in women.

METHODS

A total of 35 healthy women (age 30.8±9.5 yr) classified according to their BMI in normal weight (NOR; ≤24.9 kg·m2), overweight (OVW; 25-29.9 kg·m2) and obese groups (OBE; ≥30 kg·m2) completed a submaximal graded test (intensities eliciting ~30%, 40%, 50% and 60% of maximum oxygen uptake). Blood lactate, perceived exertion and absolute and relative substrate oxidation for fat (OXFAT) and carbohydrates (OXCHO) were measured at each stage.

RESULTS

Perceived exertion and blood lactate increased as a function of exercise but did not differ across groups. There were no significant changes in absolute and relative OXFAT across groups, or as a function of exercise intensity. Peak OXFAT occurred at the 40%, 50% and 40% stages for NOR, OVW and OBE groups, respectively, with no significant differences across groups.

CONCLUSION

We measured no differences, but considerable inter-individual variation, in fat oxidation in women of different body composition. This result is in agreement with previous research based on exercise performed at constant rate and in independent participant groups. Our findings do not support the fat oxidation hypothesis, and further emphasise the perspective that exercise prescription should be individualised and likely be based on considerations other than substrate oxidation.

Evaluating the influence of differences in methodological approach on metabolic thresholds and fat oxidation points relationship

In this study, we aimed to determine the exercise intensities eliciting the highest (FAT_max) and the lowest (FAT_min) fat oxidation rate in male cyclists and to compare these intensities with their individual aerobic (AeT) and anaerobic (AnT) thresholds, respectively. Twenty-two moderately trained male cyclists performed a 2-min stage graded exercise test until exhaustion using breath-by-breath gas analysis to determine maximal oxygen consumption (VO_2max). The fat oxidation rate was calculated using a stoichiometric equation, with metabolic thresholds being determined by ventilatory gas analysis. In the present group of subjects, FAT_max was found at a 21.34 ± 3.64 ml·kg^-1·min^-1 corresponding to 45.05 ± 7.68% VO_2max. AeT occurred at an exercise intensity of 22.15 ± 4.84 ml·kg^-1·min^-1, matching 46.76 ± 10.24% VO_2max. AnT and FAT_min were located at intensities equivalent to 32.56 ± 5.52 ml·kg^-1·min^-1 and 32.30 ± 5.35 ml·kg^-1·min^-1 which corresponded to 68.74 ± 11.65 and 68.19 ± 11.29% VO_2max, respectively. The correlation between FAT_max and AeT was strong (r = 0.80, p < 0.05). No statistical difference was observed between FAT_min and AnT (r = 0.99, p < 0.05). The strong relationship between observed indices can be used to provide a more tailored exercise approach.

Determination and validation of peak fat oxidation in endurance-trained men using an upper body graded exercise test

Peak fat oxidation rate (PFO) and the intensity that elicits PFO (Fat_max ) are commonly determined by a validated graded exercise test (GE) on a cycling ergometer with indirect calorimetry. However, for upper body exercise fat oxidation rates are not well elucidated and no protocol has been validated. Thus, our aim was to test validity and inter-method reliability for determination of PFO and Fat_max in trained men using a GE protocol applying double poling on a ski-ergometer. PFO and Fat_max were assessed during two identical GE tests (GE1 and GE2) and validated against separated short continuous exercise bouts (SCE) at 35%, 50%, and 65% of V̇O_2peak on the ski-ergometer in 10 endurance-trained men (V̇O_2peak : 65.1 ± 1.0 mL·min^-1 ·kg^-1 , mean ± SEM). Between GE tests no differences were found in PFO (GE1: 0.42 ± 0.03; GE2: 0.45 ± 0.03 g·min^-1 , P = .256) or Fat_max (GE1: 41 ± 2%; GE2: 43 ± 3% of V̇O_2peak , P = .457) and the intra-individual coefficient of variation (CV) was 8 ± 2% and 11 ± 2% for PFO and Fat_max , respectively. Between GE and SCE tests, PFO (GE_avg : 0.44 ± 0.03; SCE; 0.47 ± 0.06 g·min^-1 , P = .510) was not different, whereas a difference in Fat_max (GE_avg : 42 ± 2%; SCE: 52 ± 4% of V̇O_2peak , P = .030) was observed with a CV of 17 ± 4% and 15 ± 4% for PFO and Fat_max , respectively. In conclusion, GE has a high day-to-day reliability in determination of PFO and Fat_max in trained men, whereas it is unclear if PFO and Fat_max determined by GE reflect continuous exercise in general.

Optimizing Maximal Fat Oxidation Assessment by a Treadmill-Based Graded Exercise Protocol: When Should the Test End?

Maximal fat oxidation during exercise (MFO) and the exercise intensity eliciting MFO (Fatmax) are considered important factors related to metabolic health and performance. Numerous MFO and Fatmax data collection and analysis approaches have been applied, which may have influenced their estimation during an incremental graded exercise protocol. Despite the heterogeneity of protocols used, all studies consistently stopped the MFO and Fatmax test when the respiratory exchange ratio (RER) was 1.0. It remains unknown however whether reaching a RER of 1.0 is required to have an accurate, reliable, and valid measure of MFO and Fatmax. We aimed to investigate the RER at which MFO and Fatmax occurred in sedentary and trained healthy adults. A total of 166 sedentary adults aged between 18 and 65 years participated in the study. MFO and Fatmax were calculated by an incremental graded exercise protocol before and after two exercise-based interventions. Our findings suggest that a graded exercise protocol aiming to determine MFO and Fatmax could end when a RER = 0.93 is reached in sedentary healthy adults, and when a RER = 0.90 is reached in trained adults independently of sex, age, body weight status, or the Fatmax data analysis approach. In conclusion, we suggest reducing the RER from 1.0 to 0.95 to be sure that MFO is reached in outliers. This methodological consideration has important clinical implications, since it would allow to apply smaller workload increments and/or to extend the stage duration to attain the steady state, without increasing the test duration.

Assessment of maximal fat oxidation during exercise: A systematic review

Maximal fat oxidation during exercise (MFO) and the exercise intensity eliciting MFO (Fat_max ) are considered biological markers of metabolic health and performance. A wide range of studies have been performed to increase our knowledge about their regulation by exercise and/or nutritional intervention. However, numerous data collection and analysis approaches have been applied, which may have affected the MFO and Fat_max estimation. We aimed to systematically review the available studies describing and/or comparing different data collection and analysis approach factors that could affect MFO and Fat_max estimation in healthy individuals and patients. Two independent researchers performed the search. We included all original studies in which MFO and/or Fat_max were estimated by indirect calorimetry through an incremental graded exercise protocol published from 2002 to 2019. This systematic review provides key information about the factors that could affect MFO and Fat_max estimation: ergometer type, metabolic cart used, warm-up duration and intensity, stage duration and intensities imposed in the graded exercise protocol, time interval selected for data analysis, stoichiometric equation selected to estimate fat oxidation, data analysis approach, time of the day when the test was performed, fasting time/previous meal before the test, and testing days for MFO/Fat_max and maximal oxygen uptake assessment. We suggest that researchers measuring MFO and Fat_max should take into account these key methodological issues that can considerably affect the accuracy, validity, and reliability of the measurement. Likewise, when comparing different studies, it is important to check whether the above-mentioned key methodological issues are similar in such studies to avoid ambiguous and unacceptable comparisons.

Relationship between individual ventilatory threshold and maximal fat oxidation (MFO) over different obesity classes in women

Objective

The use of the Individual Ventilatory Threshold (IVT), as parameter to prescribe exercise intensity in individuals with obesity, has become more frequent during the last years. This study aimed to evaluate the relationship between IVT and Maximal Fat Oxidation (MFO) in women with obesity.

Methods

Fifty-two obese female adults (age = 43.6±10.9 years; BMI = 38.5±5.2 kg/m²) were included in this study. According to the BMI classification, subjects were divided into three groups: Obese Class I (OBI, n = 16); Obese Class II (OBII, n = 20) and Obese Class III (OBIII, n = 16). All subjects performed an incremental graded exercise test to evaluate peak oxygen uptake (VO_2peak), IVT and MFO. MFO was evaluated using a stoichiometric equation. Fat max zone was determined for each subject within 10% of fat oxidation rates at MFO. For each HR, %HR_max, VO₂ and %VO_2peak variable, Pearson’s correlation test was done between IVT and MFO exercise intensity. When statistical correlation was found we used a comparative statistical analysis to assess differences between IVT and MFO. Statistical significance was set at P ≤ 0.05.

Results

For each HR, %HR_max, VO₂ and %VO_2peak variable there was a positive significant correlation (P<0.01) between IVT and MFO. No significant differences were found for HR, %HR_max, and VO₂ between IVT and MFO. %VO_2peak was significantly higher at IVT than at MFO (P = 0.03).

MFO rates were significantly higher in OBIII women than in women of the other two classes. In all subjects, IVT was within the fat max zone.

Conclusion

The use of HR and VO₂ corresponding to IVT could be a useful parameter not only to improve cardiorespiratory fitness but also to prescribe physical activity that maximize fat oxidation in obese subjects.

Evaluation of a graded exercise test to determine peak fat oxidation in individuals with low cardiorespiratory fitness

The maximal capacity to utilise fat (peak fat oxidation, PFO) may have implications for health and ultra-endurance performance and is commonly determined by incremental exercise tests employing 3-min stages. However, 3-min stages may be insufficient to attain steady-state gas kinetics, compromising test validity. We assessed whether 4-min stages produce steady-state gas exchange and reliable PFO estimates in adults with peak oxygen consumption < 40 mL·kg−1·min−1. Fifteen participants (9 females) completed a graded test to determine PFO and the intensity at which this occurred (FATMAX). Three short continuous exercise sessions (SCE) were then completed in a randomised order, involving completion of the graded test to the stage (i) preceding, (ii) equal to (SCEequal), or (iii) after the stage at which PFO was previously attained, whereupon participants then continued to cycle for 10 min at that respective intensity. Expired gases were sampled at minutes 3–4, 5–6, 7–8, and 9–10. Individual data showed steady-state gas exchange was achieved within 4 min during SCEequal. Mean fat oxidation rates were not different across time within SCEequal nor compared with the graded test at FATMAX (both p > 0.05). However, the graded test displayed poor surrogate validity (SCEequal, minutes 3–4 vs. 5–6, 7–8, and 9–10) and day-to-day reliability (minutes 3–4, SCEequal vs. graded test) to determine PFO, as evident by correlations (range: 0.47–0.83) and typical errors and 95% limits of agreement (ranges: 0.03–0.05 and ±0.09–0.15 g·min−1, respectively). In conclusion, intraindividual variation in PFO is substantial despite 4-min stages establishing steady-state gas exchange in individuals with low fitness. Individual assessment of PFO may require multiple assessments.

Contextualising Maximal Fat Oxidation During Exercise: Determinants and Normative Values

Using a short-duration step protocol and continuous indirect calorimetry, whole-body rates of fat and carbohydrate oxidation can be estimated across a range of exercise workloads, along with the individual maximal rate of fat oxidation (MFO) and the exercise intensity at which MFO occurs (Fatmax). These variables appear to have implications both in sport and health contexts. After discussion of the key determinants of MFO and Fatmax that must be considered during laboratory measurement, the present review sought to synthesize existing data in order to contextualize individually measured fat oxidation values. Data collected in homogenous cohorts on cycle ergometers after an overnight fast was synthesized to produce normative values in given subject populations. These normative values might be used to contextualize individual measurements and define research cohorts according their capacity for fat oxidation during exercise. Pertinent directions for future research were identified.

Changes in fat oxidation in response to various regimes of high intensity interval training (HIIT)

Increased whole-body fat oxidation (FOx) has been consistently demonstrated in response to moderate intensity continuous exercise training. Completion of high intensity interval training (HIIT) and its more intense form, sprint interval training (SIT), has also been reported to increase FOx in different populations. An explanation for this increase in FOx is primarily peripheral adaptations via improvements in mitochondrial content and function. However, studies examining changes in FOx are less common in response to HIIT or SIT than those determining increases in maximal oxygen uptake which is concerning, considering that FOx has been identified as a predictor of weight gain and glycemic control. In this review, we explored physiological and methodological issues underpinning existing literature concerning changes in FOx in response to HIIT and SIT. Our results show that completion of interval training increases FOx in approximately 50% of studies, with the frequency of increased FOx higher in response to studies using HIIT compared to SIT. Significant increases in β-HAD, citrate synthase, fatty acid binding protein, or FAT/CD36 are likely responsible for the greater FOx seen in these studies. We encourage scientists to adopt strict methodological procedures to attenuate day-to-day variability in FOx, which is dramatic, and develop standardized procedures for assessing FOx, which may improve detection of changes in FOx in response to HIIT.

Determination of the exercise intensity that elicits maximal fat oxidation in individuals with obesity

Maximal fat oxidation (MFO) and the exercise intensity that elicits MFO (FatMax) are commonly determined by indirect calorimetry during graded exercise tests in both obese and normal-weight individuals. However, no protocol has been validated in individuals with obesity. Thus, the aims were to develop a graded exercise protocol for determination of FatMax in individuals with obesity, and to test validity and inter-method reliability. Fat oxidation was assessed over a range of exercise intensities in 16 individuals (age: 28 (26-29) years; body mass index: 36 (35-38) kg·m-2; 95% confidence interval) on a cycle ergometer. The graded exercise protocol was validated against a short continuous exercise (SCE) protocol, in which FatMax was determined from fat oxidation at rest and during 10 min of continuous exercise at 35%, 50%, and 65% of maximal oxygen uptake. Intraclass and Pearson correlation coefficients between the protocols were 0.75 and 0.72 and within-subject coefficient of variation (CV) was 5 (3-7)%. A Bland-Altman plot revealed a bias of -3% points of maximal oxygen uptake (limits of agreement: -12 to 7). A tendency towards a systematic difference (p = 0.06) was observed, where FatMax occurred at 42 (40-44)% and 45 (43-47)% of maximal oxygen uptake with the graded and the SCE protocol, respectively. In conclusion, there was a high-excellent correlation and a low CV between the 2 protocols, suggesting that the graded exercise protocol has a high inter-method reliability. However, considerable intra-individual variation and a trend towards systematic difference between the protocols reveal that further optimization of the graded exercise protocol is needed to improve validity.

High-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes

PURPOSE

It remains to be established how high-intensity aerobic interval training (HAIT) affects risk factors associated with type 2 diabetes (TD2). This study investigated effects of HAIT on maximal oxygen uptake (VO_2max), glycated Hemoglobin type A1C (HbA1c), insulin resistance (IR), fat oxidation (FatOx), body weight (BW), percent body fat (%BF), lactate threshold (LT), blood pressure (BP), and blood lipid profile (BLP) among persons with T2D. Results were compared to the effects after a moderate-intensity training (MIT) program.

METHODS

Thirty-eight individuals with T2D completed 12 weeks of supervised training. HAIT consisted of 4 × 4 min of walking or running uphill at 85-95% of maximal heart rate, and MIT consisted of continuous walking at 70-75% of maximal heart rate.

RESULTS

A 21% increase in VO_2max (from 25.6 to 30.9 ml kg^-1 min^-1, p < 0.001), and a reduction in HbA1c by -0.58% points (from 7.78 to 7.20%, p < 0.001) was found in HAIT. BW and body mass index (BMI) was reduced by 1.9% (p < 0.01). There was a tendency towards an improved FatOx at 60% VO_2max (14%, p = 0.065). These improvements were significant different from MIT. Both HAIT and MIT increased velocity at LT, and reduced %BF, waist circumference, hip circumference, and BP, with no significant differences between the two groups. Correlations were found between change in VO_2max and change in HbA1c when the two intervention groups were combined (R = -0.52, p < 0.01).

CONCLUSION

HAIT is an effective exercise strategy to improve aerobic fitness and reduce risk factors associated with T2D.

Day to day variability in fat oxidation and the effect after only 1 day of change in diet composition

Indirect calorimetry is a common and noninvasive method to estimate rate of fat oxidation (FatOx) during exercise, and test-retest reliability should be considered when interpreting results. Diet also has an impact on FatOx. The aim of the present study was to investigate day to day variations in FatOx during moderate exercise given the same diet and 2 different isoenergetic diets. Nine healthy, moderately-trained females participated in the study. They performed 1 maximal oxygen uptake test and 4 FatOx tests. Habitual diets were recorded and repeated to assess day to day variability in FatOx. FatOx was also measured after 1 day of fat-rich (26.8% carbohydrates (CHO), 23.2% protein, 47.1% fat) and 1 day of CHO-rich diet (62.6% CHO, 20.1% protein, 12.4% fat). The reliability test revealed no differences in FatOx, respiratory exchange ratio (RER), oxygen uptake, carbon dioxide production, heart rate, blood lactate concentration, or blood glucose between the 2 habitual diet days. FatOx decreased after the CHO-rich diet compared with the habitual day 2 (from 0.42 ± 0.15 to 0.29 ± 0.13 g·min(-1), p < 0.05). No difference was found in FatOx between fat-rich diet and the 2 habitual diet days. FatOx was 31% lower (from 0.42 ± 0.14 to 0.29 ± 0.13 g·min(-1), p < 0.01) after the CHO-rich diet compared with the fat-rich diet. Using RER data to measure FatOx is a reliable method as long as the diet is strictly controlled. However, even a 1-day change in macronutrient composition will likely affect the FatOx results.

Short-term HIIT and Fat max training increase aerobic and metabolic fitness in men with class II and III obesity

OBJECTIVE

To compare the effects of two different 2-week-long training modalities [continuous at the intensity eliciting the maximal fat oxidation (Fatmax) versus high-intensity interval training (HIIT)] in men with class II and III obesity.

METHODS

Nineteen men with obesity (BMI ≥ 35 kg · m(-2)) were assigned to Fatmax group (GFatmax) or to HIIT group (GHIIT). Both groups performed eight cycling sessions matched for mechanical work. Aerobic fitness and fat oxidation rates (FORs) during exercise were assessed prior and following the training. Blood samples were drawn to determine hormones and plasma metabolites levels. Insulin resistance was assessed by the homeostasis model assessment of insulin resistance (HOMA2-IR).

RESULTS

Aerobic fitness and FORs during exercise were significantly increased in both groups after training (P ≤ 0.001). HOMA2-IR was significantly reduced only for GFatmax (P ≤ 0.001). Resting non-esterified fatty acids (NEFA) and insulin decreased significantly only in GFatmax (P ≤ 0.002).

CONCLUSIONS

Two weeks of HIIT and Fatmax training are effective for the improvement of aerobic fitness and FORs during exercise in these classes of obesity. The decreased levels of resting NEFA only in GFatmax may be involved in the decreased insulin resistance only in this group.

Higher rate of fat oxidation during rowing compared with cycling ergometer exercise across a range of exercise intensities

The relative contribution of carbohydrate and fat oxidation to energy expenditure during exercise is dependent on variables including exercise intensity, mode, and recruited muscle mass. This study investigated patterns of substrate utilization during two non-weightbearing exercise modalities, namely cycling and rowing. Thirteen young, moderately trained males performed a continuous incremental (3-min stages) exercise test to exhaustion on separate occasions on an electronically braked cycle (CYC) ergometer and an air-braked rowing (ROW) ergometer, respectively. On two further occasions, participants performed a 20-min steady-state exercise bout at ∼50%VO2peak on the respective modalities. Despite similar oxygen consumption, rates of fat oxidation (FATox ) were ∼45% higher during ROW compared with CYC (P < 0.05) across a range of power output increments. The crossover point for substrate utilization occurred at a higher relative exercise intensity for ROW than CYC (57.8 ± 2.1 vs 42.1 ± 3.6%VO2peak , P < 0.05). During steady-state submaximal exercise, the higher FATox during ROW compared with CYC was maintained (P < 0.05), but absolute FATox were 42% (CYC) and 28% (ROW) lower than during incremental exercise. FATox is higher during ROW compared with CYC exercise across a range of exercise intensities matched for energy expenditure, and is likely as a consequence of larger muscle mass recruited during ROW.

Effects of Endurance Training at the Crossover Point in Women with Metabolic Syndrome

INTRODUCTION

On the basis of theoretical evidence, intensity at the crossover point (COP) of substrate utilization could be considered as potential exercise intensity for metabolic syndrome (MetS). This study aimed to examine the effects of a training program at COP on exercise capacity parameters in women with MetS and to compare two metabolic indices (COP and the maximal fat oxidation rate point LIPOXmax®) with ventilatory threshold (VT).

METHODS

Nineteen women with MetS volunteered to perform a 12-wk training program on a cycle ergometer, with intensity corresponding to COP. Pre- and posttraining values of anthropometric and exercise capacity parameters were compared to determine the effects of exercise training. The pre-post training change of COP, LIPOXmax®, and VT were also investigated.

RESULTS

After training, anthropometric parameters were significantly modified, with reduction of body mass (3.0% ± 3.0%, P < 0.001), fat mass (3.3% ± 3.4%, P < 0.001), and body mass index (3.2% ± 3.4%, P < 0.001). Exercise capacity was improved after the training program, with significant increase of maximal power output (25.0% ± 18.4%, P < 0.001) and maximal oxygen uptake (V˙O2max, 9.0% ± 11.2%; P < 0.01). Lastly, when expressed in terms of power output, COP, LIPOXmax®, and VT occurred at a similar exercise intensity, but the occurrence of these three indices is different when expressed in terms of oxygen uptake, HR, or RPE.

CONCLUSIONS

This study highlights the effectiveness of a 12-wk training program at COP to improve physical fitness in women with MetS. The relations between metabolic indices and VT in terms of power output highlight the determination of VT from a shorter maximal exercise as a useful method for determining metabolic indices in MetS.

A RAPID AND AUTOMATED METHOD TO DETERMINE APPROPRIATE EXERCISE PARAMETERS FOR TAILORED SUBSTRATE CONSUMPTION DURING AEROBIC EXERCISE

The growing prevalence of obesity and metabolic disorders such as type II diabetes, is associated with reduced exercise and maximal fat oxidation rate (Fatmax). The aim of this study was to verify the reliability of a new test protocol (Fatmaxwork) using the INCA software package. Twenty four sedentary subjects was enrolled and performed the following tests using a VO2000 metabolimeter: (1) An incremental test of 20 min to determine the individual Fatmax and maximum rate of fat oxidation (MFO) with new Fatmaxwork test; (2) a constant load test of 60 min. For our subjects, the average fat zone was estimated by INCA at 54.2 ± 4.9% max HR, RER 0.86 ± 0.09, 130 ± 64 W. The results from the constant load test differed by 0.01 ± 1.92 for respiratory gas exchange rate (RER) and -0.22 ± 1.92% for heart rate (HR). This study showed that the Fatmaxwork test can be used to predict Fatmax in untrained overweight subjects and INCA is a reliable and accurate software package.

Determination of the exercise intensity that elicits maximal fat oxidation in short-time testing

Maximal fat oxidation (MFO) rate and the exercise intensity that elicits MFO (FATmax-intensity) were designed to evaluate fat metabolism capacity and to provide individuals with a target exercise intensity during prolonged exercise. However, the previous methods of determining FATmax-intensity were time-consuming. The purpose of this study was to examine the validity of FATmax-intensity determined by short-time testing. Nine healthy young men performed ramp exercise, in a short-time test, until exhaustion and 5 constant-load exercises of 60 min each at individual FATmax-intensity determined by ramp protocol (FATmax-intensity(R)), FATmax-intensity(R) ± 5% of peak oxygen uptake (VO₂peak) and FATmax-intensity(R) ± 10%VO₂peak. FATmax-intensity was determined among 5 trials at points of early exercise (10 min) and prolonged exercise (60 min) to evaluate the validity of FATmax-intensity(R). Ten minutes after starting constant-load exercise, FATmax-intensity(R) showed the highest fat oxidation among 5 trials, even though MFO by ramp protocol was overestimated. Therefore, it may be useful for evaluation of fat metabolism to include the measurement of the FATmax-intensity in a routine ramp test. However, because FATmax-intensity(R) did not elicit the highest fat oxidation among 5 trials of 60 min each after starting constant-load exercise, FATmax-intensity(R) may not be effective for prolonged exercise training.

The anaerobic threshold: over-valued or under-utilized? A novel concept to enhance lipid optimization!

PURPOSE OF REVIEW

The purpose of this article is to assess the value of the anaerobic threshold for use in clinical populations with the intent to improve exercise adaptations and outcomes. The anaerobic threshold is generally poorly understood, improperly used, and poorly measured. It is rarely used in clinical settings and often reserved for athletic performance testing.

RECENT FINDINGS

Increased exercise participation within both clinical and other less healthy populations has increased our attention to optimizing exercise outcomes. Of particular interest is the optimization of lipid metabolism during exercise in order to improve numerous conditions such as blood lipid profile, insulin sensitivity and secretion, and weight loss. Numerous authors report on the benefits of appropriate exercise intensity in optimizing outcomes even though regulation of intensity has proved difficult for many. Despite limited use, selected exercise physiology markers have considerable merit in exercise-intensity regulation. The anaerobic threshold, and other markers such as heart rate, may well provide a simple and valuable mechanism for regulating exercising intensity.

SUMMARY

The use of the anaerobic threshold and accurate target heart rate to regulate exercise intensity is a valuable approach that is under-utilized across populations. The measurement of the anaerobic threshold can be simplified to allow clients to use nonlaboratory measures, for example heart rate, in order to self-regulate exercise intensity and improve outcomes.

Maximal lipid oxidation during exercise: a target for individualizing endurance training in obesity and diabetes?

This review summarizes the rationale for personalized exercise training in obesity and diabetes, targeted at the level of maximal lipid oxidation as can be determined by exercise calorimetry. This measurement is reproducible and reflects muscles' ability to oxidize lipids. Targeted training at this level is well tolerated, increases the ability to oxidize lipids during exercise and improves body composition, lipid and inflammatory status, and glycated hemoglobin, thus representing a possible future strategy for exercise prescription in patients suffering from obesity and diabetes.

Does exercise duration affect Fatmax in overweight boys?

To compare the assessment of Fat(max) using a single graded exercise test with 3 min stages against 30 min prolonged exercise bouts in overweight boys. Ten overweight boys (8-12 years) attended the laboratory on seven separate occasions. On the first visit, body anthropometrics and peak aerobic capacity ([Formula: see text]O(2peak)) were assessed. Following this, each participant attended the laboratory after an overnight fast for six morning cycling sessions. During the first session, participants completed a continuous, submaximal graded exercise protocol with seven 3 min stages (GRAD) at 35, 40, 45, 50, 55, 60 and 65% [Formula: see text]O(2peak). The final five visits consisted of a 30 min bout of prolonged exercise (PROL) performed in a counterbalanced order at 40, 45, 50, 55 and 60% [Formula: see text]O(2peak). There was no effect of exercise duration on Fat(max) or the absolute rate of fat oxidation during PROL (p > 0.05). At the group level, GRAD and PROL provided similar estimates of Fat(max) (GRAD: 53 ± 10% [Formula: see text]O(2peak); PROL: 53 ± 10% [Formula: see text]O(2peak); p = 0.995); however, individual variation between the two protocols is shown by a systematic bias and residual error of 0 ± 11% [Formula: see text]O(2peak). Fat oxidation rates remained stable across 30 min of steady-state exercise in overweight boys. Furthermore, Fat(max) was similar at 3, 10, 20 and 30 min of exercise, suggesting that for exercise lasting ≤ 30 min, exercise duration does not affect Fat(max). However, Fat(max) determined with GRAD may need to be interpreted with caution at the individual level given the variation in Fat(max) between protocols.

Crossover and maximal fat-oxidation points in sedentary healthy subjects: methodological issues

AIM

Our study aimed to assess the influence of protocol on the crossover point and maximal fat-oxidation (LIPOX(max)) values in sedentary, but otherwise healthy, young men.

METHODS

Maximal oxygen intake was assessed in 23 subjects, using a progressive maximal cycle ergometer test. Twelve sedentary males (aged 20.5±1.0 years) whose directly measured maximal aerobic power (MAP) values were lower than their theoretical maximal values (tMAP) were selected from this group. These individuals performed, in random sequence, three submaximal graded exercise tests, separated by three-day intervals; work rates were based on the tMAP in one test and on MAP in the remaining two. The third test was used to assess the reliability of data. Heart rate, respiratory parameters, blood lactate, the crossover point and LIPOX(max) values were measured during each of these tests.

RESULTS

The crossover point and LIPOX(max) values were significantly lower when the testing protocol was based on tMAP rather than on MAP (P<0.001). Respiratory exchange ratios were significantly lower with MAP than with tMAP at 30, 40, 50 and 60% of maximal aerobic power (P<0.01). At the crossover point, lactate and 5-min postexercise oxygen consumption (EPOC(5 min)) values were significantly higher using tMAP rather than MAP (P<0.001). During the first 5 min of recovery, EPOC(5 min) and blood lactate were significantly correlated (r=0.89; P<0.001).

CONCLUSION

Our data show that, to assess the crossover point and LIPOX(max) values for research purposes, the protocol must be based on the measured MAP rather than on a theoretical value. Such a determination should improve individualization of training for initially sedentary subjects.

Effect of a 1-hour single bout of moderate-intensity exercise on fat oxidation kinetics

The present study aimed to examine the effects of a prior 1-hour continuous exercise bout (CONT) at an intensity (Fat(max)) that elicits the maximal fat oxidation (MFO) on the fat oxidation kinetics during a subsequent submaximal incremental test (IncrC). Twenty moderately trained subjects (9 men and 11 women) performed a graded test on a treadmill (Incr), with 3-minute stages and 1-km.h(-1) increments. Fat oxidation was measured using indirect calorimetry and plotted as a function of exercise intensity. A mathematical model (SIN) including 3 independent variables (dilatation, symmetry, and translation) was used to characterize the shape of fat oxidation kinetics and to determine Fat(max) and MFO. On a second visit, the subjects performed CONT at Fat(max) followed by IncrC. After CONT performed at 57% +/- 3% (means +/- SE) maximal oxygen uptake (Vo(2max)), the respiratory exchange ratio during IncrC was lower at every stage compared with Incr (P < .05). Fat(max) (56.4% +/- 2.3% vs 51.5% +/- 2.4% Vo(2max), P = .013), MFO (0.50 +/- 0.03 vs 0.40 +/- 0.03 g.min(-1), P < .001), and fat oxidation rates from 35% to 70% Vo(2max) (P < .05) were significantly greater during IncrC compared with Incr. However, dilatation and translation were not significantly different (P > .05), whereas symmetry tended to be greater in IncrC (P = .096). This study showed that the prior 1-hour continuous moderate-intensity exercise bout increased Fat(max), MFO, and fat oxidation rates over a wide range of intensities during the postexercise incremental test. Moreover, the shape of the postexercise fat oxidation kinetics tended to have a rightward asymmetry.

Determination of the maximal fat oxidation point in obese children and adolescents: validity of methods to assess maximal aerobic power

We aimed to examine the interchangeability of techniques used to assess maximal oxygen consumption (VO2max) and maximal aerobic power (MAP) employed to express the maximal fat oxidation point in obese children and adolescents. Rate of fat oxidation were measured in 24 obese subjects (13.0 +/- 2.4 years; Body Mass Index 30.2 +/- 6.3 kg m(-2)) who performed a five 4-min stages submaximal incremental cycling exercise. A second cycling exercise was performed to measure VO2max. Results are those of the 20 children who achieved the criterion of RER (>1.02) to assess the attainment of VO2max. Although correlations between results obtained by different methods were strong, Bland-Altman plots showed little agreement between the maximal fat oxidation point expressed as a percentage of measured VO2max and as % VO2max estimated according to ACSM guidelines (underestimation : -5.9%) or using the predictive equations of Wasserman (-13.9%). Despite a mean underestimation of 1.4% several values were out of the limits of agreement when comparing measured MAP and Theoretical MAP. Estimations of VO2max lead to underestimations of the maximal fat oxidation point.

Methodological aspects of crossover and maximum fat-oxidation rate point determination

AIM

Indirect calorimetry during exercise provides two metabolic indices of substrate oxidation balance: the crossover point (COP) and maximum fat oxidation rate (LIPOXmax). We aimed to study the effects of the analytical device, protocol type and ventilatory response on variability of these indices, and the relationship with lactate and ventilation thresholds.

METHODS

After maximum exercise testing, 14 relatively fit subjects (aged 32+/-10 years; nine men, five women) performed three submaximum graded tests: one was based on a theoretical maximum power (tMAP) reference; and two were based on the true maximum aerobic power (MAP). Gas exchange was measured concomitantly using a Douglas bag (D) and an ergospirometer (E).

RESULTS

All metabolic indices were interpretable only when obtained by the D reference method and MAP protocol. Bland and Altman analysis showed overestimation of both indices with E versus D. Despite no mean differences between COP and LIPOXmax whether tMAP or MAP was used, the individual data clearly showed disagreement between the two protocols. Ventilation explained 10-16% of the metabolic index variations. COP was correlated with ventilation (r=0.96, P<0.01) and the rate of increase in blood lactate (r=0.79, P<0.01), and LIPOXmax correlated with the ventilation threshold (r=0.95, P<0.01).

CONCLUSION

This study shows that, in fit healthy subjects, the analytical device, reference used to build the protocol and ventilation responses affect metabolic indices. In this population, and particularly to obtain interpretable metabolic indices, we recommend a protocol based on the true MAP or one adapted to include the transition from fat to carbohydrate. The correlation between metabolic indices and lactate/ventilation thresholds suggests that shorter, classical maximum progressive exercise testing may be an alternative means of estimating these indices in relatively fit subjects. However, this needs to be confirmed in patients who have metabolic defects.