Reliability of threshold determination using portable muscle oxygenation monitors during exercise testing: a systematic review and meta-analysis

Muscle Oximetry in Sports Science: An Updated Systematic Review

BACKGROUND

In the last 5 years since our last systematic review, a significant number of articles have been published on the technical aspects of muscle near-infrared spectroscopy (NIRS), the interpretation of the signals and the benefits of using the NIRS technique to measure the physiological status of muscles and to determine the workload of working muscles.

OBJECTIVES

Considering the consistent number of studies on the application of muscle oximetry in sports science published over the last 5 years, the objectives of this updated systematic review were to highlight the applications of muscle oximetry in the assessment of skeletal muscle oxidative performance in sports activities and to emphasize how this technology has been applied to exercise and training over the last 5 years. In addition, some recent instrumental developments will be briefly summarized.

METHODS

Preferred Reporting Items for Systematic Reviews guidelines were followed in a systematic fashion to search, appraise and synthesize existing literature on this topic. Electronic databases such as Scopus, MEDLINE/PubMed and SPORTDiscus were searched from March 2017 up to March 2023. Potential inclusions were screened against eligibility criteria relating to recreationally trained to elite athletes, with or without training programmes, who must have assessed physiological variables monitored by commercial oximeters or NIRS instrumentation.

RESULTS

Of the identified records, 191 studies regrouping 3435 participants, met the eligibility criteria. This systematic review highlighted a number of key findings in 37 domains of sport activities. Overall, NIRS information can be used as a meaningful marker of skeletal muscle oxidative capacity and can become one of the primary monitoring tools in practice in conjunction with, or in comparison with, heart rate or mechanical power indices in diverse exercise contexts and across different types of training and interventions.

CONCLUSIONS

Although the feasibility and success of the use of muscle oximetry in sports science is well documented, there is still a need for further instrumental development to overcome current instrumental limitations. Longitudinal studies are urgently needed to strengthen the benefits of using muscle oximetry in sports science.

Agreement between Ventilatory Thresholds and Bilaterally Measured Vastus Lateralis Muscle Oxygen Saturation Breakpoints in Trained Cyclists: Effects of Age and Performance

This study focused on comparing metabolic thresholds derived from local muscle oxygen saturation (SmO2) signals, obtained using near-infrared spectroscopy (NIRS), with global pulmonary ventilation rates measured at the mouth. It was conducted among various Age Groups within a well-trained cyclist population. Additionally, the study examined how cycling performance characteristics impact the discrepancies between ventilatory thresholds (VTs) and SmO2 breakpoints (BPs).

METHODS

Junior (n = 18) and Senior (n = 15) cyclists underwent incremental cycling tests to assess their aerobic performance and to determine aerobic (AeT) and anaerobic (AnT) threshold characteristics through pulmonary gas exchange and changes in linearity of the vastus lateralis (VL) muscle SmO2 signals. We compared the relative power (Pkg) at ventilatory thresholds (VTs) and breakpoints (BPs) for the nondominant (ND), dominant (DO), and bilaterally averaged (Avr) SmO2 during the agreement analysis. Additionally, a 30 s sprint test was performed to estimate anaerobic performance capabilities and to assess the cyclists' phenotype, defined as the ratio of P@VT2 to the highest 5 s sprint power.

RESULTS

The Pkg@BP for Avr SmO2 had higher agreement with VT values than ND and DO. Avr SmO2 Pkg@BP1 was lower (p < 0.05) than Pkg@VT1 (mean bias: 0.12 ± 0.29 W/kg; Limits of Agreement (LOA): -0.45 to 0.68 W/kg; R2 = 0.72) and mainly among Seniors (0.21 ± 0.22 W/kg; LOA: -0.22 to 0.63 W/kg); there was no difference (p > 0.05) between Avr Pkg@BP2 and Pkg@VT2 (0.03 ± 0.22 W/kg; LOA: -0.40 to 0.45 W/kg; R2 = 0.86). The bias between two methods correlated significantly with the phenotype (r = -0.385 and r = -0.515 for AeT and AnT, respectively).

CONCLUSIONS

Two breakpoints can be defined in the NIRS-captured SmO2 signal of VL, but the agreement between the two methods at the individual level was too low for interchangeable usage of those methods in the practical training process. Older cyclists generally exhibited earlier thresholds in muscle oxygenation signals compared to systemic responses, unlike younger cyclists who showed greater variability and no significant differences in this regard in bias values between the two threshold evaluation methods with no significant difference between methods. More sprinter-type cyclists tended to have systemic VT thresholds earlier than local NIRS-derived thresholds than athletes with relatively higher aerobic abilities.

A comparative analysis of mathematical methods for detecting lactate thresholds using muscle oxygenation data during a graded cycling test

Objective. Threshold determination for improving training and sports performance is important for researchers and trainers, who currently use different methods for determining lactate, ventilatory or muscle oxygenation (SmO2) thresholds. Our study aimed to compare the identification of the intensity at the first and second thresholds using lactate and SmO2data by different mathematical methods in different muscles during a graded cycling test.Approach. Twenty-six cyclists (15 males and 11 females; 23 ±6 years, 1.71 ± 0.09 m, 64.3 ± 8.8 Kg and 12 ± 3 training hours per week) performed a graded test on the cycle ergometer. Power output and saturation of muscle oxygen in four muscles (vastus lateralis, biceps femoris, gastrocnemius and tibialis anterior) were measured, along with systemic lactate concentration.Main Results. Our results showed that any method was reliable for determining the first muscle oxygenation threshold (MOT1) when comparing the lactate threshold in any muscle. However, the best method for determining the second muscle oxygenation threshold (MOT2) was the Exp-Dmax (p< 0.01; ICC = 0.79-0.91) in all muscles. In particular, the vastus lateralis muscle showed the highest intraclass correlation coefficient (ICC = 0.91, CI95% [0.81, 0.96]). However, results varied per sex across all muscles analyzed.Significance. Although the first muscle oxygenation threshold could not be determined using mathematical methods in all the muscles analyzed, the Exp-Dmax method presented excellent results in detecting the second systemic threshold in the vastus lateralis.

Monitoring Changes in Oxygen Muscle during Exercise with High-Flow Nasal Cannula Using Wearable NIRS Biosensors

Exercise increases the cost of breathing (COB) due to increased lung ventilation (V˙E), inducing respiratory muscles deoxygenation (∇SmO2), while the increase in workload implies ∇SmO2 in locomotor muscles. This phenomenon has been proposed as a leading cause of exercise intolerance, especially in clinical contexts. The use of high-flow nasal cannula (HFNC) during exercise routines in rehabilitation programs has gained significant interest because it is proposed as a therapeutic intervention for reducing symptoms associated with exercise intolerance, such as fatigue and dyspnea, assuming that HFNC could reduce exercise-induced ∇SmO2. SmO2 can be detected using optical wearable devices provided by near-infrared spectroscopy (NIRS) technology, which measures the changes in the amount of oxygen bound to chromophores (e.g., hemoglobin, myoglobin, cytochrome oxidase) at the target tissue level. We tested in a study with a cross-over design whether the muscular desaturation of m.vastus lateralis and m.intercostales during a high-intensity constant-load exercise can be reduced when it was supported with HFNC in non-physically active adults. Eighteen participants (nine women; age: 22 ± 2 years, weight: 65.1 ± 11.2 kg, height: 173.0 ± 5.8 cm, BMI: 21.6 ± 2.8 kg·m-2) were evaluated in a cycle ergometer (15 min, 70% maximum watts achieved in ergospirometry (V˙O2-peak)) breathing spontaneously (control, CTRL) or with HFNC support (HFNC; 50 L·min-1, fiO2: 21%, 30 °C), separated by seven days in randomized order. Two-way ANOVA tests analyzed the ∇SmO2 (m.intercostales and m.vastus lateralis), and changes in V˙E and ∇SmO2·V˙E-1. Dyspnea, leg fatigue, and effort level (RPE) were compared between trials by the Wilcoxon matched-paired signed rank test. We found that the interaction of factors (trial × exercise-time) was significant in ∇SmO2-m.intercostales, V˙E, and (∇SmO2-m.intercostales)/V˙E (p < 0.05, all) but not in ∇SmO2-m.vastus lateralis. ∇SmO2-m.intercostales was more pronounced in CTRL during exercise since 5' (p < 0.05). Hyperventilation was higher in CTRL since 10' (p < 0.05). The ∇SmO2·V˙E-1 decreased during exercise, being lowest in CTRL since 5'. Lower dyspnea was reported in HFNC, with no differences in leg fatigue and RPE. We concluded that wearable optical biosensors documented the beneficial effect of HFNC in COB due to lower respiratory ∇SmO2 induced by exercise. We suggest incorporating NIRS devices in rehabilitation programs to monitor physiological changes that can support the clinical impact of the therapeutic intervention implemented.